Mulugeta Taeme Gebretsion, Tilahun Sisay Alemu, Yimam Ali Mergiyaw
{"title":"Gossypiboma – A Rare Cause of Palpable Intra-Abdominal Mass: A Case Report","authors":"Mulugeta Taeme Gebretsion, Tilahun Sisay Alemu, Yimam Ali Mergiyaw","doi":"10.2147/oas.s407868","DOIUrl":"https://doi.org/10.2147/oas.s407868","url":null,"abstract":"","PeriodicalId":56363,"journal":{"name":"Open Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46992657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Colostomy Patient Lived Experience at Public Hospitals of Addis Ababa, Ethiopia: Phenomenology","authors":"Daniel Aboma, M. Kaba","doi":"10.2147/oas.s406211","DOIUrl":"https://doi.org/10.2147/oas.s406211","url":null,"abstract":"","PeriodicalId":56363,"journal":{"name":"Open Access Surgery","volume":"1 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43192826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Case Report and Literature Review: Intraoperative Injury to Cisterna Chyli During an Elective Pancreatic Resection Leads to Chylous Ascites and a Poor Outcome","authors":"W. Al-Kubati, H. Rihani, Abdelaziz Zeadat","doi":"10.2147/oas.s394350","DOIUrl":"https://doi.org/10.2147/oas.s394350","url":null,"abstract":"","PeriodicalId":56363,"journal":{"name":"Open Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49491650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aim: To establish if the NELA risk calculator underestimates mortality risk in older adults undergoing laparotomy for mesenteric or colonic ischaemia. Methods: A retrospective search of the operative database was performed for all patients over age 65 years who underwent laparotomy across two tertiary centres over a 3-year period. Cases of mesenteric or colonic ischaemia were identified from the operative records. Cases where ischaemia occurred secondarily to a primary obstructive or other pathology were excluded. Cases where a NELA score was not documented preoperatively were excluded. We then compared the NELA scores to the observed 30-day mortality rate. Secondary outcomes were hospital length of stay and intensive care unit length of stay. Results: Sixty cases were included in our analysis. There were 27 cases of colonic ischaemia and 33 cases of mesenteric ischaemia (mesenteric ischaemia group included five cases of distal small-bowel and colonic ischaemia). The overall mean NELA score was 21.9%, while the actual 30-day mortality was 43.3% ( p =0.0094). Mean NELA score for mesenteric ischaemia cases only was 20.6% with an actual mortality rate of 45.5%. Mean NELA score for the colonic ischaemia cases was 23.5% with an actual mortality rate of 40.7%. The median time from operation to mortality was 8 days. Mean age was 77 years. Length of stay for survivors was a mean 27 days with intensive care unit length of stay of 9.3 days. Conclusion: The NELA risk score for mortality post–emergency laparotomy underestimates mortality risk by a factor of two in older adults where the primary pathology is mesenteric or colonic ischaemia.
{"title":"NELA Risk Calculator Significantly Underestimates Mortality Risk of Laparotomy for Mesenteric and Colonic Ischaemia in Older Adult Surgical Patients","authors":"Louis Connell","doi":"10.2147/oas.s401635","DOIUrl":"https://doi.org/10.2147/oas.s401635","url":null,"abstract":"Aim: To establish if the NELA risk calculator underestimates mortality risk in older adults undergoing laparotomy for mesenteric or colonic ischaemia. Methods: A retrospective search of the operative database was performed for all patients over age 65 years who underwent laparotomy across two tertiary centres over a 3-year period. Cases of mesenteric or colonic ischaemia were identified from the operative records. Cases where ischaemia occurred secondarily to a primary obstructive or other pathology were excluded. Cases where a NELA score was not documented preoperatively were excluded. We then compared the NELA scores to the observed 30-day mortality rate. Secondary outcomes were hospital length of stay and intensive care unit length of stay. Results: Sixty cases were included in our analysis. There were 27 cases of colonic ischaemia and 33 cases of mesenteric ischaemia (mesenteric ischaemia group included five cases of distal small-bowel and colonic ischaemia). The overall mean NELA score was 21.9%, while the actual 30-day mortality was 43.3% ( p =0.0094). Mean NELA score for mesenteric ischaemia cases only was 20.6% with an actual mortality rate of 45.5%. Mean NELA score for the colonic ischaemia cases was 23.5% with an actual mortality rate of 40.7%. The median time from operation to mortality was 8 days. Mean age was 77 years. Length of stay for survivors was a mean 27 days with intensive care unit length of stay of 9.3 days. Conclusion: The NELA risk score for mortality post–emergency laparotomy underestimates mortality risk by a factor of two in older adults where the primary pathology is mesenteric or colonic ischaemia.","PeriodicalId":56363,"journal":{"name":"Open Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48132778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abdullahi Yusuf Ali, Ahmet Sarac, Abdishakur Mohamed Abdi
Background: Inguinal hernia is one of the most prevalent reasons for transfer to the pediatric surgery department. The incidence varies from 0.8–4.4% of term babies and up to 30% of preterm babies. Surgery for inguinal hernia has become one of the most frequently carried out operations, with better outcomes and very few complications. Methods: This is a retrospective cross-sectional study of all children diagnosed with inguinal hernia (under 15 years of age) was conducted from April 1 th , 2018 to July 31 th , 2022, in a tertiary hospital in Mogadishu, Somalia. All cases of inguinal hernia are operated on using a modified Ferguson surgical technique. Results: During the 51 mounts, 119 cases with inguinal hernia were operated. 94.1% of cases (n=112) were male and 5.9% (n=7) of were female; the ratio of inguinal hernia from male to female was 16:1. The right side was slightly more common and the proportion of bilaterally affected cases was about 6.7%. The median age at presentation was 52 months, and the mean waiting period for patients to be operated on was 2 months. The rate of incarcerated cases was 4.2%. Infants had a greater risk of incarceration than other children.The total wound infection and recurrence rates following surgery were 1.6% and 0.8%, respectively. Conclusion: Babies with inguinal hernias are at an increased risk of incarceration and it would be wise to consider surgery soon, depending on current waiting lists. Surgical therapy should be performed as soon as possible to minimize associated morbidities and mortality.
{"title":"A Retrospective Study of Pediatric Patients with Inguinal Hernia in a Tertiary Hospital in Somalia","authors":"Abdullahi Yusuf Ali, Ahmet Sarac, Abdishakur Mohamed Abdi","doi":"10.2147/oas.s392042","DOIUrl":"https://doi.org/10.2147/oas.s392042","url":null,"abstract":"Background: Inguinal hernia is one of the most prevalent reasons for transfer to the pediatric surgery department. The incidence varies from 0.8–4.4% of term babies and up to 30% of preterm babies. Surgery for inguinal hernia has become one of the most frequently carried out operations, with better outcomes and very few complications. Methods: This is a retrospective cross-sectional study of all children diagnosed with inguinal hernia (under 15 years of age) was conducted from April 1 th , 2018 to July 31 th , 2022, in a tertiary hospital in Mogadishu, Somalia. All cases of inguinal hernia are operated on using a modified Ferguson surgical technique. Results: During the 51 mounts, 119 cases with inguinal hernia were operated. 94.1% of cases (n=112) were male and 5.9% (n=7) of were female; the ratio of inguinal hernia from male to female was 16:1. The right side was slightly more common and the proportion of bilaterally affected cases was about 6.7%. The median age at presentation was 52 months, and the mean waiting period for patients to be operated on was 2 months. The rate of incarcerated cases was 4.2%. Infants had a greater risk of incarceration than other children.The total wound infection and recurrence rates following surgery were 1.6% and 0.8%, respectively. Conclusion: Babies with inguinal hernias are at an increased risk of incarceration and it would be wise to consider surgery soon, depending on current waiting lists. Surgical therapy should be performed as soon as possible to minimize associated morbidities and mortality.","PeriodicalId":56363,"journal":{"name":"Open Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45422501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Toxic multinodular goiter (TMNG) usually occurs in older individuals, who often have a lengthy history of nontoxic multinodular goiter. The cases of giant multinodular goiter are rare clinical conditions nowadays. Thyroidectomy is generally the preferred treatment option because it resolves both toxic and compressive symptoms. Case Report: We present here a case of giant toxic multinodular goiter successfully treated at Dessie comprehensive specialized hospital. A 60-year-old female presented with anterior neck swelling of 30 years and toxic symptoms of 3 years duration. She had breathing difficulty in a supine position. On physical examination, there was a huge anterior neck mass measuring 27×24 cm in the largest dimensions. Based on TFT, FNAC, and ultrasound, she was diagnosed with a giant toxic multinodular goiter. After medical treatment with antithyroid drugs, a total thyroidectomy was performed and the gland was dissected successfully. Discussion: The most effective treatment of giant toxic multinodular goiter is total thyroidectomy which avoids recurrence and subsequent complication rates with repeat surgery. Conclusion: Due to difficulty during intubation, the presence of altered anatomy, and adhesions to the surrounding structures associated with giant toxic MNG, it will be a challenge to do a thyroidectomy.
{"title":"Surgical Management of Giant Toxic Multinodular Goiter with Compressive Symptoms in Setup with Scarce Resources: A Case Report","authors":"Mulugeta Taeme G/tsion, Aschalew Tibebu Shumargaw","doi":"10.2147/oas.s389685","DOIUrl":"https://doi.org/10.2147/oas.s389685","url":null,"abstract":"Introduction: Toxic multinodular goiter (TMNG) usually occurs in older individuals, who often have a lengthy history of nontoxic multinodular goiter. The cases of giant multinodular goiter are rare clinical conditions nowadays. Thyroidectomy is generally the preferred treatment option because it resolves both toxic and compressive symptoms. Case Report: We present here a case of giant toxic multinodular goiter successfully treated at Dessie comprehensive specialized hospital. A 60-year-old female presented with anterior neck swelling of 30 years and toxic symptoms of 3 years duration. She had breathing difficulty in a supine position. On physical examination, there was a huge anterior neck mass measuring 27×24 cm in the largest dimensions. Based on TFT, FNAC, and ultrasound, she was diagnosed with a giant toxic multinodular goiter. After medical treatment with antithyroid drugs, a total thyroidectomy was performed and the gland was dissected successfully. Discussion: The most effective treatment of giant toxic multinodular goiter is total thyroidectomy which avoids recurrence and subsequent complication rates with repeat surgery. Conclusion: Due to difficulty during intubation, the presence of altered anatomy, and adhesions to the surrounding structures associated with giant toxic MNG, it will be a challenge to do a thyroidectomy.","PeriodicalId":56363,"journal":{"name":"Open Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46702372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Megersa Kelbesa Olika, Gudeta Teku Ayano, T. Ilala
Background: A retropharyngeal abscess is a bacterial infection of the back of the throat. It rarely results in deadly complications such as mediastinitis and thoracic empyema from deep neck infections involving soft tissues of the face, arising from oropharyngeal infections, particularly dental caries. Thus, complicating retropharyngeal abscess extending to mediastinitis poses an increased risk of high mortality rate as a result of its significant invasive potential and the fact that the recognition and diagnosis must be made early, as this is usually delayed. Complicating retropharyngeal abscess increases airway compromise and difficult airway management during anesthesia. We present a 40-year-old, male patient who transferred from another primary hospital to our institution’s surgical emergency outpatient department with a complaint of neck swelling of 10 days secondary to tooth extraction. He had a complaint of dull-itching pain, localized initially to the submandibular area and subsequently involving the oropharyngeal, neck, and descending to the chest and mediastinum. He was diagnosed with a complicated retropharyngeal abscess extending to the mediastinum (mediastinitis) and thoracic empyema as a complication of odontogenic infection in origin. Besides intravenous antimicrobial therapy, deep neck incision and drainage, and thoracotomy was done under general anesthesia. After adequate venous access and the patient positioned in head-up position, premedication was given. General anesthesia with an endotracheal tube was provided with a ready tracheostomy set. Inhalational induction was conducted and laryngoscopy was performed after the adequate depth of anesthesia was achieved. We experienced anticipated difficult intubation after induction. After multiple attempts, the tracheal tube was placed correctly by using a bougie. Halothane was used for maintenance anesthesia with intermediate-acting muscle relaxant under controlled ventilation. Conclusion: On top of a detailed review of the patient’s history, physical examination, laboratory investigations, and imaging profiles; early recognition of the airway compromise from the complicated retropharyngeal abscess, and proper readiness to manage potentially challenging airway compromise, and difficult airway management during the perioperative period.
{"title":"Perioperative Anesthesia Management for a Patient Presented with Acute Cardiopulmonary Compromise Secondary to a Complicating Retropharyngeal Abscess Extending to the Mediastinum. A Rare Case Report","authors":"Megersa Kelbesa Olika, Gudeta Teku Ayano, T. Ilala","doi":"10.2147/oas.s383062","DOIUrl":"https://doi.org/10.2147/oas.s383062","url":null,"abstract":"Background: A retropharyngeal abscess is a bacterial infection of the back of the throat. It rarely results in deadly complications such as mediastinitis and thoracic empyema from deep neck infections involving soft tissues of the face, arising from oropharyngeal infections, particularly dental caries. Thus, complicating retropharyngeal abscess extending to mediastinitis poses an increased risk of high mortality rate as a result of its significant invasive potential and the fact that the recognition and diagnosis must be made early, as this is usually delayed. Complicating retropharyngeal abscess increases airway compromise and difficult airway management during anesthesia. We present a 40-year-old, male patient who transferred from another primary hospital to our institution’s surgical emergency outpatient department with a complaint of neck swelling of 10 days secondary to tooth extraction. He had a complaint of dull-itching pain, localized initially to the submandibular area and subsequently involving the oropharyngeal, neck, and descending to the chest and mediastinum. He was diagnosed with a complicated retropharyngeal abscess extending to the mediastinum (mediastinitis) and thoracic empyema as a complication of odontogenic infection in origin. Besides intravenous antimicrobial therapy, deep neck incision and drainage, and thoracotomy was done under general anesthesia. After adequate venous access and the patient positioned in head-up position, premedication was given. General anesthesia with an endotracheal tube was provided with a ready tracheostomy set. Inhalational induction was conducted and laryngoscopy was performed after the adequate depth of anesthesia was achieved. We experienced anticipated difficult intubation after induction. After multiple attempts, the tracheal tube was placed correctly by using a bougie. Halothane was used for maintenance anesthesia with intermediate-acting muscle relaxant under controlled ventilation. Conclusion: On top of a detailed review of the patient’s history, physical examination, laboratory investigations, and imaging profiles; early recognition of the airway compromise from the complicated retropharyngeal abscess, and proper readiness to manage potentially challenging airway compromise, and difficult airway management during the perioperative period.","PeriodicalId":56363,"journal":{"name":"Open Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46097588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mvuyo Maqhawe Sikhondze, Deus Twesigye, C. Odongo, D. Mutiibwa, Edson Tayebwa, Leevan Tibaijuka, Samuel D Ayana, Carlos Cabrera Dreque
Background: Diabetic foot ulcers (DFUs) are a prevalent and serious consequence of poorly controlled diabetes. Hospitalizations are frequent among DFU patients, and these patients are at risk of lower extremity amputations (LEA). Uganda has few studies detailing DFUs and their management. We described the surgical characteristics, treatment modalities and short-term treatment outcomes of DFUs at Mbarara Regional Referral Hospital, in southwestern Uganda. Methods: A prospective cohort study involving 62 patients with DFUs was conducted from February 2021 to September 2021. We captured socio-demographic data, surgical characteristics, treatment and treatment outcomes of DFUs over a 5-week follow-up period, through an interviewer-administered structured questionnaire. Descriptive statistics were used at analysis. Results: The mean age of participants was 57.0 ± 12.27 years, comprising 35 (56.5%) females. Majority had diabetes mellitus (DM) for more than 10 years, predominantly type 2 (93.5%), and 33.9% with very poor glycaemic control (HBA1c>9.5%). Most ulcers involved the toes (27.4%), with 80.7% being large (>3 cm 2 ). Severe DFUs (Wagner grade 3–5) were seen in 66.2% of patients. Clinically infected ulcers mainly had Pseudomonas spp cultured. Arterial occlusion was detected in 35.5% through lower extremity Doppler ultrasonography. Initial surgical interventions were surgical debridement and LEA performed in 50.0% and 46.8%, respectively. Eight (42.1%) patients suffered surgical site infection, while 26.3% had persistent gangrene after initial surgery. Revision surgery was performed in 25.8% of the participants. Mortality rate was 1.6%, and mean length of hospital stay was 17.0 ± 11.1 days. Conclusion: More than half of the patients had advanced DFUs (Wagner grades 3–5). Poor glycemic control and late presentation were common. Lower extremity amputation was a common initial treatment modality for DFUs. Routine lower extremity Doppler ultrasonography is recommended to assess peripheral arterial disease for DFU patients. Wound swabbing for culture and sensitivity testing is encouraged for appropriate antibiotic coverage.
{"title":"Diabetic Foot Ulcers: Surgical Characteristics, Treatment Modalities and Short-Term Treatment Outcomes at a Tertiary Hospital in South-Western Uganda","authors":"Mvuyo Maqhawe Sikhondze, Deus Twesigye, C. Odongo, D. Mutiibwa, Edson Tayebwa, Leevan Tibaijuka, Samuel D Ayana, Carlos Cabrera Dreque","doi":"10.2147/oas.s384235","DOIUrl":"https://doi.org/10.2147/oas.s384235","url":null,"abstract":"Background: Diabetic foot ulcers (DFUs) are a prevalent and serious consequence of poorly controlled diabetes. Hospitalizations are frequent among DFU patients, and these patients are at risk of lower extremity amputations (LEA). Uganda has few studies detailing DFUs and their management. We described the surgical characteristics, treatment modalities and short-term treatment outcomes of DFUs at Mbarara Regional Referral Hospital, in southwestern Uganda. Methods: A prospective cohort study involving 62 patients with DFUs was conducted from February 2021 to September 2021. We captured socio-demographic data, surgical characteristics, treatment and treatment outcomes of DFUs over a 5-week follow-up period, through an interviewer-administered structured questionnaire. Descriptive statistics were used at analysis. Results: The mean age of participants was 57.0 ± 12.27 years, comprising 35 (56.5%) females. Majority had diabetes mellitus (DM) for more than 10 years, predominantly type 2 (93.5%), and 33.9% with very poor glycaemic control (HBA1c>9.5%). Most ulcers involved the toes (27.4%), with 80.7% being large (>3 cm 2 ). Severe DFUs (Wagner grade 3–5) were seen in 66.2% of patients. Clinically infected ulcers mainly had Pseudomonas spp cultured. Arterial occlusion was detected in 35.5% through lower extremity Doppler ultrasonography. Initial surgical interventions were surgical debridement and LEA performed in 50.0% and 46.8%, respectively. Eight (42.1%) patients suffered surgical site infection, while 26.3% had persistent gangrene after initial surgery. Revision surgery was performed in 25.8% of the participants. Mortality rate was 1.6%, and mean length of hospital stay was 17.0 ± 11.1 days. Conclusion: More than half of the patients had advanced DFUs (Wagner grades 3–5). Poor glycemic control and late presentation were common. Lower extremity amputation was a common initial treatment modality for DFUs. Routine lower extremity Doppler ultrasonography is recommended to assess peripheral arterial disease for DFU patients. Wound swabbing for culture and sensitivity testing is encouraged for appropriate antibiotic coverage.","PeriodicalId":56363,"journal":{"name":"Open Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44103672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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