Diagnosis and Surgical Management of Intestinal Intussusception by Open Lumina Technique in Dairy Heifers (Bos taurus)

The present study was conducted in ten dairy heifers (Bos taurus) suffering from intestinal intussusception. All these cases exhibited the clinical signs of bouts of colicky pain for 6-12 hours followed by anorexia and cessation of faeces. In all cases, the onset of disease was between 72-120 hours. Per-rectal palpation revealed spiral-shaped mass and distended intestinal loops. Ultrasonographically, distended loops, ileus, passive movement of ingesta and presence of peritoneal fluid were consistent findings. The diagnosis of intestinal intussusception was made on the basis of clinical signs, per-rectal palpation and trans-abdominal ultrasonography. Further it was confirmed on full abdominal right flank exploratory laparotomy. All the heifers were subjected for standing right flank laparotomy under linear infiltration of local anaesthesia followed by exteriorization and resection of intussucepted intestinal mass. The side-to-side entero-anastomosis was done by open lumina technique using gastro-intestinal anastomotic (GIA) stapled devices. Signalment, duration of surgery and anastomotic time were recorded in all cases. Thus, Intestinal intussusception in dairy heifers was diagnosed on the basis of clinical signs, per-rectal palpation, trans-abdominal ultrasonography which was further confirmed by full abdominal right flank exploratory laparotomy. The GIA staples applied for side-to-side entero-anastomosis by open lumina technique took less total surgical and anastomotic time. Moreover, there was reduction in tissue trauma/manipulation and in contamination by intestinal contents. The closure of bowel was easy and secured. GIA staples can be used effectively for entero-anastomosis in cattle affected with intestinal intussusception.

Paragastric, lesser omentum neural block to prevent early visceral pain after laparoscopic sleeve gastrectomy: A randomized clinical trial protocol

The somatic pain induced by surgical trauma to the abdominal wall after laparoscopic sleeve gastrectomy (LSG) is effectively managed using conventional analgesia and transversus abdominis plane (TAP) blocks. In contrast, the visceral, colicky, pain that patients experience after LSG does not respond well to traditional pain management. Patients typically experience epigastric and retrosternal pain that begin immediately after LSG and lasts up to 72 hours after LSG. This visceral type of pain has been ascribed to the spasm of the neo-gastric sleeve. The pain is often severe and requires opioid derivatives. Patients frequently have associated autonomic symptoms such as nausea, retching and vomiting. In the last 15 years at our institutions, we have used many analgesic strategies to manage this burdensome symptom in the more than 2000 LSG procedures we have performed, but none have been satisfactorily effective1,2.

THE ROLE OF LAVANGCHATUHSAMACHURNA IN MANAGEMENT OF UDARSHOOL (ABDOMINAL PAIN) DISEASE IN CHILDERN – A CASE STUDY

Udarshool is one of the common prevalent disease is in pediatric age Abdominal group .it is defined as pain in children is dened as, atleast three episodes of pain that at least 3 months and affects the child's ability to perform normal activities.Udarshool can be correlated with Abdominal pain as both the terminology have similar feature like , ( stanamvyudasyate Refusal of feed), Rauti (Excessive crying), Udarsthabdhata (Abdominal distension), Mukhasweda(Sweating over face),Shaityam ( . Cold extrimities).ect We are discussing here a case report of 7 years old male child having history of Udarshool for last 15 days . he came to us with complaint of loss of appetite, Abdominal distention and pain , poor intake ,bowel irritability .since last 4days. Generally he got relief from morden medicine , but this time symptoms reoccur after 7days. He was treated with ayurvedic medicine which gave effective result from the day of treatment. In a search of new potent option, is in the management of udarshool (colicky pain) in children. there drugs Lavangchatuhsama Churna when used in the management of give long lasting effect with minimal or no side effect.

Burkitt’s Lymphoma of Intestine Presenting as Ileocolic Intussusception

Burkitt lymphoma, as the most common non-Hodgkin Bcell lymphoma of childhood, is rarely detected in the gastrointestinal tract. Intussusception secondary to Burkitt’s lymphoma is an uncommon presentation. We describe an unusual case of intestinal Burkitt’s lymphoma in a four and the half-year-old girl who presented with intermittent colicky pain three times. Imaging studies were suggestive of intussusception. The patient was subjected to the surgery of bowel resection, which revealed a creamy-gray oval-shaped mass. Histopathology through immunohistochemistry study confirmed the Burkitt lymphoma. Owing to rather nonspecific clinical and radiological features, the preoperative diagnosis of Burkitt lymphoma remains a challenging task for pediatric surgeons and radiologists. Therefore, in case of any clinical suspicion, further examinations, such as CT scan in children are recommended.

Laparoscopic Cholecystectomy for Large/Giant Gallstones: Case Report and Brief Review of Literature.

Background Gallstones disease (GSD) is the most common biliary pathology. GSD is one of the common surgical problems in which lead people admit to the hospital in Nepal. Its prevalence is found to be 4.87%. The size of a gallstone is important, as giant/large gallstones have a higher risk of complications and present technical difficulties during laparoscopic cholecystectomy (LC). Open cholecystectomy is preferred in most cases with giant gallstones. With the availability of experienced laparoscopic surgeons and modern laparoscopic equipment LC is also feasible in large/giant gallstones. In this case report, we report 2 cases of one large and one giant gallstone each which were successfully done laparoscopically.Case Presentation Case 1 A 51 years old female presented with 5 months history of intermittent right upper quadrant colicky pain related to fatty food with no significant past medical and surgical history.Ultrasound abdomen showed normal gallbladder with multiple gallstones, largest measuring approximately 4cms. She was planned for elective LC. The gallbladder was removed out after extension of the infra-umbilical incision. On the cut section, we found multiple gallstones with one large gallstone measuring 4*3.3*3 cm and weighted 23.2 gm. Her post-operative period was uneventful. Case 2 A 39 years old female, known case of hypertension under calcium channel blocker(CCB) and angiotensin receptor blocker(ARBs) presented with 5 months history of intermittent right upper quadrant colicky pain related to fatty foods with non-significant surgical history. Ultrasound abdomen showed a normal gallbladder with a single large gallstone (approximately 4.7 cm). Elective LC was performed and the gallbladder was removed out after extension of infraumbilical incision. On the cut section, we found a single giant gallstone measuring 5* 3*2.8 cm and weighted 24.7 gm. Her post-operative period was uneventful.Conclusion Large/giant gallstones are associated with a high risk of complications and cholecystectomy is warranted in symptomatic and asymptomatic patients. Even for large/giant gallstones, LC appears to be the treatment of choice over open cholecystectomy and should be performed by an experienced laparoscopic surgeon, taking into consideration the possibility of conversion to open in case of inability to expose the anatomy and any intraoperative technical difficulties.

Acute life-threatening hyperkalaemia in a patient with giant hydronephrosis: a case report

A 52-year-old man with a history of urolithiasis presents to the emergency department with a sudden, sharp, continuous right flank colicky pain. Laboratory workup demonstrates acute kidney injury with a mild hyperkalaemia. During the observation period, the patient develops an atypical broad complex sinus bradycardia and eventually short asystolic periods. This was caused by a severe therapy-resistant hyperkalaemia, wherefore emergency haemodialysis was necessary. Radiographic results showed a giant hydronephrosis with a blowout of the right kidney and an obstructing calculi of 21 mm in the distal ureter. We will discuss the mechanism of reversed intraperitoneal dialysis causing the refractory hyperkalaemia and the need of close ECG monitoring in patients where kidney blowout is considered.

35. Т. Cramer: Parametritis abscedens bei einem 12 jährigem Mädchen (Deutsche med. Wochenschr., 1892, № 33). Parametritis abscedens y 12 year old girl.

The disease begins with headaches lasting 2 days, then colicky pains in the abdomen come to the fore, with painful sensations on palpation in the Colon descendens area. Opіy only slightly and for a short time reduces pain and as a result of this rinsing of the intestines is impossible. Acceptance 01. Ricini induces vomiting. Warm poultices relieve colicky pain only when they are applied. As soon as it cools, the pain intensifies. This Status continues from September 7 to September 15, when a clearly flattened defecation appeared. Intestinal stenosis is diagnosed. Despite the use of narcotic drugs, colicky pains are so excruciating that the child rushes about in bed and screams good obscenities. The new study shows increased sensitivity in the left groin area, in the right groin area the pain is much less. Due to this edge of intestinal stenosis, an inflammatory process of the peritoneum of this space is assumed. Examination under anesthesia showed: an abscess in the left posterior fornix, which protrudes more posteriorly and presses the anterior wall of the recti into the intestinal lumen. Trial puncture into the posterior fornix. A large amount of green pus is erupting. The trocar tube is left in the abscess opening. Warm baths and warm flaxseed poultices are prescribed. Colicky pain after puncture is significantly reduced; appetite appeared. On September 20, pains again come as a result of stagnation of expiration. September 23 secondary punctuation. Significant relief of all symptoms. In the next days, the puncture site again overgrown and the pains resumed, but on September 27. during defecation, a mass of pus came out. Since then, the patient began to slowly recover. On October 15, pus came out of the last cut. The next day the temperature dropped to 36.5 . In 3 months after the onset of the disease, the patient began to attend school.

A rare case of bowel intussusception due to adenocarcinomatous polyp in a 14 year-old child: case report

Background Intussusception is a form of intestinal obstruction in which a segment of the bowel prolapses into a more distal segment. It is an uncommon condition in children older than 2 years and causes intestinal obstruction. On the contrary of adult intussusception, childhood intussusception does not usually happen on a lead point of a malignant organic lesion. Case presentation A 14-year-old male presented with complaints of heavy, bilious emesis and periumbilical colicky pain. Ultrasonography showed a dilated intestinal loop with absent bowel movement. CT scan revealed two masses in the abdomen. We performed an exploratory laparotomy that revealed invaginated intestines and showed a polyp near the area of interest. Necrotic segments and the polyp were removed and examined pathologically. Pathology showed adenocarcinoma in the polyp. After surgery, the general condition of the patient was normal and no complications occurred. Conclusions Intussusception mainly occurs during infancy and early childhood. Mostly it is an idiopathic ileo-colic invagination. In our case, the patient had a jejuno-jejunal intussusception in his late childhood, and the lead point was an adenocarcinomatous polyp, which is rare in children. Amongst the many types of treatment, we chose surgical resection because of patient’s age.

A Five Years Old Child with Failure To Thrive and Vomiting Presenting as a Diagnostic Dilemma: A Case Report

Vomiting with failure to thrive in older children is a diagnostic challenge due to the diversity in the diagnosis. We report a case of a five-years-old girl with failure to thrive, history of recurrent vomiting and intermittent colicky pain abdomen since 45 days of life. Intestinal malrotation with Ladd’s band was diagnosed based on clinical acumen, high- resolution computed tomography, barium follow through and intraoperative findings. Exploratory laparotomy with Ladd’s procedure was performed under general anesthesia which showed malrotation at the duodenojejunal junction with a short route of mesentery with floating caecum with Ladd’s band. Failure to thrive with malrotation of the gut in the older age group is rare in itself. As there are very few cases reported in this age group, so we undertook to report this case to increase the awareness of knowledge concerning the diagnosis and timely management to prevent the comorbidity of this condition.

LEFT PARADUODENAL HERNIA AS A RARE CAUSE OF INTESTINAL OBSTRUCTION-LAPAROSCOPIC MANAGEMENT

We report a case of 33 years old male, presented with colicky pain in left upper abdomen on and off since 15 days, one episode of bilious vomiting and abdominal distension with constipation since 2 days. A case of intestinal obstruction was diagnosed as a Left Paraduodenal Hernia[PDH] on contrast enhanced computed tomography of the abdomen(CECT) and managed with laparoscopic repair. Through this case report, we want to give the message that PDH though rare should be considered as a differential diagnosis in a case of intestinal obstruction and can be managed successfully with laparoscopic approach even in an emergency situation.