A study of 50 cases of gangrenous bowel diseases

Uma Maheswari, T (2013) A study of 50 cases of gangrenous bowel diseases. Masters thesis, Thanjavur Medical College, Thanjavur.

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Abstract

INTRODUCTION: Bowel gangrene is one of the most challenging surgical emergency with high morbidity and mortality all over the world. The causes are diverse and clinical and radiological manifestations vary according to etiology. Early diagnosis, prompt treatment and good postoperative care are the three important basic key stones for a successful outcome in a patient with bowel gangrene. These include rapid correction of fluid and electrolyte imbalance, control of sepsis and urgent & prompt resection of the diseased bowel. All will be lost once the lethal toxins enter the systemic circulation. The technical and judgment errors during surgery are the two important preventable factors that can have high impact on morbidity and mortality of the patient and therefore it should be limited. These errors can be minimized by meticulous surgery, clear goal and alternative surgical strategy- i.e. safest surgery that gives best outcome for each individual patient. However certain uncontrollable factors like advanced age, poor functional status and associated co-morbid systemic illness can cause potential life threatening consequences in a patient with bowel gangrene undergoing surgery. AIM OF THE STUDY: 1. To analyze various etiological factors causing Bowel Gangrene. 2. To evaluate the final outcome of the treatment offered. 3. To study various factors influencing the morbidity and mortality associated with Bowel Gangrene. Materials & Methods: MATERIALS: Study group: 50 cases with Bowel gangrene admitted under all surgical units at Government Thanjavur Medical College Hospital. Inclusion Criteria: • Patients age group : 12 years & above. • Both sexes. Exclusion criteria: • Patient < 12 yrs. Total Number of cases studied: 50 Cases. Study Period: May 2010 to November 2012. Data Collection regarding the study: • Demographic details. • Time interval between onset of symptoms and surgery. • Clinical Presentation. • Imaging studies and Laboratory investigation. • Operative Findings & Cause for Gangrene. • Type of the treatment offered. • Eventual outcome of the patient. Methodology: Study was a prospective observational study Study group was 50 cases with Gangrenous Bowel disease admitted at Thanjavur Medical college Hospital, satisfying the inclusion & Exclusion criteria, during the period of 2 years from May 2010 to November 2012. Detailed History, clinical Findings and Pre operative complications if any were noted. All the patients were subjected to relevant radiological and Blood investigations with simultaneous resuscitation. After adequate pre operative resuscitative measures that includes fluid & Electrolyte correction by intravenous route, naso gastric decompression and broad spectrum antibiotics, all the patients were subjected to Emergency surgical procedure appropriate to the condition. Preoperative findings, intra operative complications if any and type of surgical procedure offered was documented. Post operatively, all the patients were managed effectively under surgical intensive care unit with intravenous fluids, Antibiotics, etc. CONCLUSION: Intestinal strangulation from hernia, adhesions and Volvulus was the major cause for Bowel Gangrene. Mesenteric Vascular diseases contribute only about 4% in our study. (1) (a) Among the Bowel strangulation, Hernia is leading cause for bowel gangrene in our study (34%) of which Inguinal Hernia along accounts for 88% in total (b) Strangulation following adhesive obstruction comes as the 2nd leading cause for Bowel Gangrene (28%) of which post inflammatory adhesions is the major cause (65%). (c) Sigmoid Volvulus ranks 3rd in etiology of Bowel Gangrene contributing 14%. Large Bowel Neoplasm contributes 8%. (2) The final outcome of the treatment offered is as follows: (a) Complete recovery is attained in 50% of patients. (b) Overall mortality rate is 30%. This figure is 18% for hernia, 21% for Adhesions 71% for sigmoid volvulus and 50% for malignancy and 50% for MVD. (c) Septicemic shock is the prime cause of death in vast majority of patients with Bowel Gangrene (47%). Failures to wean from ventilator, ARDS, Progressive renal insufficiency and cardiogenic shock together contribute the rest. (d) Overall morbidity rate is 20%. Among these local complications like Anastomotic leak and local sepsis together constitute about 14%. (3) Old age, premorbid illness, treatment delay, and Fecal contamination are significantly associated with increased morbidity and mortality rate. (4) Mortality and Morbidity associated with Bowel Gangrene can be limited by following measures: (a) Pre operative optimization of hemodynamic and respiratory parameters. (b) Control the sepsis with liberal use of antibiotics. (c) Early surgical intervention and removal of devitalized Bowel, before lethal toxins enters into the circulation. (d) Careful planning and Technique during definitive surgical therapy. (e) Recognition of Barriers to healing and control over them.

Item Type: Thesis (Masters)
Uncontrolled Keywords: gangrenous bowel diseases ; 50 cases.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 07 Jun 2018 03:13
Last Modified: 07 Jun 2018 03:21
URI: http://repository-tnmgrmu.ac.in/id/eprint/8278

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