We report a case of 14 year old male who presented with abdominal pain for 1 day. Our initial cli... more We report a case of 14 year old male who presented with abdominal pain for 1 day. Our initial clinical suspicion was complicated acute appendicitis, which was later supported by ultrasonogram. His CT abdomen revealed acute intestinal obstruction. Subsequently he was taken up for emergency laparotomy which revealed a fibrous cord like remnant of vitellointestinal duct with a Vitelline cyst causing volvulus of small bowel. The cord along with cyst was excised. The gangrenous bowel was resected and an ostomy was fashioned. Post operative period uneventful and evaluation for any associated congenital malformations revealed none.
Fournier’s gangrene (FG) is a fulminant and lethal condition usually occurring in the immunocompr... more Fournier’s gangrene (FG) is a fulminant and lethal condition usually occurring in the immunocompromised, first described in 1883 by the French dermatologist Jean Alfred Fournier. It is a form of necrotizing fasciitis of the perineal, genitourinary and perianal regions mostly in males with a mortality of nearly 20-50%. It is a surgical emergency and requires early diagnosis aided by scores such as laboratory risk indicator for necrotising fasciitis (LRINEC) and FG severity index (FGSI), extensive debridement combined with supportive procedures to manage associated complications and broad-spectrum antibiotics. Management of FG thus required a multimodal approach and emphasis on reconstruction after recovery in patients who survive was crucial to improving the quality of life in these patients. Here we were presenting 7 cases of FG successfully managed at our institution, grouped under the four methods by which wound closure was achieved: fecal diversion and split skin grafting of scro...
Abdominal cocoon is a rare condition leading to acute or chronic bowel obstruction. Though multip... more Abdominal cocoon is a rare condition leading to acute or chronic bowel obstruction. Though multiple etiologies have been defined, many are idiopathic. We had three different cases of intestinal obstruction. First one was a case of intestinal obstruction in a young female and was diagnosed to have tuberculosis. She had abdominal cocoon along with perforation where even adhesiolysis was unsuccessful. Second one was a cause of right inguinal hernia in a 62-year-old male. Bowel was enclosed in a membrane and diagnosed as localised variant of abdominal cocoon. Membrane was removed and right herniorrhaphy was done. Third one was a 35-year-old male with abdominal cocoon. No previous tuberculosis history was noted and adhesiolysis was done. Thus, abdominal cocoon can present with enigmatic etiology and presentation. Only an occasional case can be due to tuberculosis as described in literature. It must always be a differential diagnosis for a case of acute or chronic intestinal obstruction.
Fournier’s gangrene is a rare, rapidly progressive, fulminant form of necrotizing fasciitis of th... more Fournier’s gangrene is a rare, rapidly progressive, fulminant form of necrotizing fasciitis of the genital, perianal and perineal regions extending to the abdominal wall between the fascial planes. It is secondary to polymicrobial infection by aerobic and anaerobic bacteria with a synergistic action. A 42 year old male who is an alcoholic and diabetic on irregular treatment presented with scrotal swelling and pain for 5 days following a trauma. On examination, patient was febrile, tachypneic and had tachycardia. His scrotum was edematous and erythematous on right side with crepitus. Abdomen was warm on right side till umbilicus and had crepitus. He was in sepsis and had diabetic ketoacidosis, prerenal azotemia and mild impairment of liver function. A diagnosis of extensive Fournier gangrene with retroperitoneal involvement was made. Patient underwent scrotal exploration and aggressive debridement serially. Testis was spared. As patient improved with good wound care and glycemic cont...
Varicella gangrenosum is a gangrenous ulceration of varicella lesions involving the skin and soft... more Varicella gangrenosum is a gangrenous ulceration of varicella lesions involving the skin and soft tissues of the body. It most commonly occurs in children less than 5 years of age and life threatening. This is a very rare complication of chicken pox in adults which deserves early diagnosis and management. 21-year-old male presented with blackish discoloration in the lateral aspect of right thigh for 5 days. He has positive history of chicken pox for his brother and sister following which he acquired it 15 days back. During that episode he had fever, headache and blisters which ruptured to heal by scab. But scab in right thigh coalesced to form the gangrenous area with serous discharge. On presentation he had no fever with local lesion and surrounding erythema. Patient underwent radical surgical debridement and regular dressing. Pus culture was sent which showed no growth. He gradually improved and the ulcer granulated well and split skin graft is done. Varicella gangrenosum is a lif...
Managing a giant inguinal hernia/ incisional/ ventral hernia had its own complications. The overt... more Managing a giant inguinal hernia/ incisional/ ventral hernia had its own complications. The overtime adaptation of peritoneal cavity to a lower abdominal pressure was one of the most important factors responsible for these complications. Surgical repair is also quite a challenge because of the massive contents in sac, adhesions and concomitant fibrosis. In order to reduce the complications like intra-abdominal hypertension, cardiorespiratory problems and to increase the abdominal wall compliance, many techniques were described. Progressive preoperative pneumoperitoneum is a well described technique for the repair of giant inguinal hernia/ incisional/ ventral hernia with loss of domain which helps in conditioning the abdominal wall in the preoperative period, increasing the likelihood of primary closure and decreasing the incidence of compartment syndrome.
We report a case of 14 year old male who presented with abdominal pain for 1 day. Our initial cli... more We report a case of 14 year old male who presented with abdominal pain for 1 day. Our initial clinical suspicion was complicated acute appendicitis, which was later supported by ultrasonogram. His CT abdomen revealed acute intestinal obstruction. Subsequently he was taken up for emergency laparotomy which revealed a fibrous cord like remnant of vitellointestinal duct with a Vitelline cyst causing volvulus of small bowel. The cord along with cyst was excised. The gangrenous bowel was resected and an ostomy was fashioned. Post operative period uneventful and evaluation for any associated congenital malformations revealed none.
Fournier’s gangrene (FG) is a fulminant and lethal condition usually occurring in the immunocompr... more Fournier’s gangrene (FG) is a fulminant and lethal condition usually occurring in the immunocompromised, first described in 1883 by the French dermatologist Jean Alfred Fournier. It is a form of necrotizing fasciitis of the perineal, genitourinary and perianal regions mostly in males with a mortality of nearly 20-50%. It is a surgical emergency and requires early diagnosis aided by scores such as laboratory risk indicator for necrotising fasciitis (LRINEC) and FG severity index (FGSI), extensive debridement combined with supportive procedures to manage associated complications and broad-spectrum antibiotics. Management of FG thus required a multimodal approach and emphasis on reconstruction after recovery in patients who survive was crucial to improving the quality of life in these patients. Here we were presenting 7 cases of FG successfully managed at our institution, grouped under the four methods by which wound closure was achieved: fecal diversion and split skin grafting of scro...
Abdominal cocoon is a rare condition leading to acute or chronic bowel obstruction. Though multip... more Abdominal cocoon is a rare condition leading to acute or chronic bowel obstruction. Though multiple etiologies have been defined, many are idiopathic. We had three different cases of intestinal obstruction. First one was a case of intestinal obstruction in a young female and was diagnosed to have tuberculosis. She had abdominal cocoon along with perforation where even adhesiolysis was unsuccessful. Second one was a cause of right inguinal hernia in a 62-year-old male. Bowel was enclosed in a membrane and diagnosed as localised variant of abdominal cocoon. Membrane was removed and right herniorrhaphy was done. Third one was a 35-year-old male with abdominal cocoon. No previous tuberculosis history was noted and adhesiolysis was done. Thus, abdominal cocoon can present with enigmatic etiology and presentation. Only an occasional case can be due to tuberculosis as described in literature. It must always be a differential diagnosis for a case of acute or chronic intestinal obstruction.
Fournier’s gangrene is a rare, rapidly progressive, fulminant form of necrotizing fasciitis of th... more Fournier’s gangrene is a rare, rapidly progressive, fulminant form of necrotizing fasciitis of the genital, perianal and perineal regions extending to the abdominal wall between the fascial planes. It is secondary to polymicrobial infection by aerobic and anaerobic bacteria with a synergistic action. A 42 year old male who is an alcoholic and diabetic on irregular treatment presented with scrotal swelling and pain for 5 days following a trauma. On examination, patient was febrile, tachypneic and had tachycardia. His scrotum was edematous and erythematous on right side with crepitus. Abdomen was warm on right side till umbilicus and had crepitus. He was in sepsis and had diabetic ketoacidosis, prerenal azotemia and mild impairment of liver function. A diagnosis of extensive Fournier gangrene with retroperitoneal involvement was made. Patient underwent scrotal exploration and aggressive debridement serially. Testis was spared. As patient improved with good wound care and glycemic cont...
Varicella gangrenosum is a gangrenous ulceration of varicella lesions involving the skin and soft... more Varicella gangrenosum is a gangrenous ulceration of varicella lesions involving the skin and soft tissues of the body. It most commonly occurs in children less than 5 years of age and life threatening. This is a very rare complication of chicken pox in adults which deserves early diagnosis and management. 21-year-old male presented with blackish discoloration in the lateral aspect of right thigh for 5 days. He has positive history of chicken pox for his brother and sister following which he acquired it 15 days back. During that episode he had fever, headache and blisters which ruptured to heal by scab. But scab in right thigh coalesced to form the gangrenous area with serous discharge. On presentation he had no fever with local lesion and surrounding erythema. Patient underwent radical surgical debridement and regular dressing. Pus culture was sent which showed no growth. He gradually improved and the ulcer granulated well and split skin graft is done. Varicella gangrenosum is a lif...
Managing a giant inguinal hernia/ incisional/ ventral hernia had its own complications. The overt... more Managing a giant inguinal hernia/ incisional/ ventral hernia had its own complications. The overtime adaptation of peritoneal cavity to a lower abdominal pressure was one of the most important factors responsible for these complications. Surgical repair is also quite a challenge because of the massive contents in sac, adhesions and concomitant fibrosis. In order to reduce the complications like intra-abdominal hypertension, cardiorespiratory problems and to increase the abdominal wall compliance, many techniques were described. Progressive preoperative pneumoperitoneum is a well described technique for the repair of giant inguinal hernia/ incisional/ ventral hernia with loss of domain which helps in conditioning the abdominal wall in the preoperative period, increasing the likelihood of primary closure and decreasing the incidence of compartment syndrome.
Uploads
Papers by Dr.sabari girieasen