European Journal of Cardiovascular Medicine

Background: Bile duct injury is severe and potentially life threatening complication of cholecystectomy. It ruins the patient physically, mentally, socially and financially. The incidence of bile duct injury is alarming in our country. Management of such patients needs to be explained. Methods: It is a cross- sectional descriptive study carried out in the Department of Surgery, Mymensingh Medical College Hospital, Mymensingh, Bangladesh during the period January 2018 to July 2020. A total of 70 patients diagnosed as bile duct injury were included in the study. Bile duct injury that occurs during liver or pancreases surgery or accident was excluded. Data were collected using a predesigned data collection sheet and analyzed using computer software SPSS (Statistical Package for Social Sciences) version 22. Results: Young and female patients suffer more 44(62.9%) than male. Occurrence was common during laparoscopic cholecystectomy 42(60%). Most of bile duct injury occur when cholecystectomy done on acute condition of gall bladder 59(84.3%). Most of bile duct injury patient came to specialized center after several week of injury with billiary stricture 54 (77.14%) with jaundice, some patients presented with abdominal pain 48(68.6%), abdominal distension 18(25.7), biliary peritonitis 16(22.9) and biliary fistula 14(20%). Patients with bile duct injury were evaluated by USG, liver function test, ERCP and MRCP. Maximum BDI patients were Bismath Type II 32(45.7%) and Bismath Type III 18(25.7%). Out of 70 cases USG performed 68 cases (2 patients repair at the time of surgery) and these investigations provided valuable information about condition of biliary tree, hepatic parenchyma and ductal system also intra-abdominal collection. 14 patients were done ERCP. Billiary stricture in different level seen among most of the patients (10). Bile leakage seen among 4 patients and all were underwent ERCP stenting. Conclusion: The present study showed that bile duct injury occurs mostly in young female with acute cholecystitis. Common presentation was obstructive jaundice and biliary sepsis. Bismuth Type II and III were most common form of stricture. Biliary reconstruction (Roux-en-Y hepaticojejunostomy) was the treatment for biliary stricture. Peritoneal toileting, controlled fistula and later on biliary reconstruction was the treatment of biliary sepsis.

Objective: The role of drains in uncomplicated acute cholecystitis is a topic of debate. In this study, we aimed to prospectively evaluate the benefits and complications of prophylactic drains in both open and laparoscopic cholecystectomy following a case of uncomplicated acute cholecystitis. Materials and Methods: A total of 100 cases, under unit 1 of the department of Surgery at Nimra Institute of Medical Sciences over a period of 12 months were observed in this study. Demographic details of the patients were compared. Patients were followed for up to 1 week after the surgery to assess different complaints such as nausea/vomiting, postoperative pain, shoulder tip pain, rise in temperature, mean duration of operation and the amount of fluid collected in the drain bag. Incidence of surgical site infections were also compared. The sample consisted of both open and laparoscopic cholecystectomy cases. Results: Drains were placed in 50 patients. The overall complication rate was higher in the group of patients who underwent open cholecystectomy followed by a placement of prophylactic drain. Pain score on the NRS scale was highest for the group of patients who underwent open cholecystectomy followed by placement of a prophylactic drain. There was more incidence of surgical site infection in the drain group than in the no drain group. The mean duration of drain placement was 2.76 ±0.77 following open cholecystectomy and 1.84 ±0.37 following laparoscopic cholecystectomy. The mean duration of hospital stay was higher in the drain group than in the no drain  group. Patients in no drain group who underwent laparoscopic cholecystectomy complained of shoulder tip pain and nausea/vomiting more in comparison to other groups. Conclusion: There is no role of prophylactic drains following cholecystectomy in cases of uncomplicated acute cholecystitis in draining of abdominal fluids. Abdominal drains lead to increased hospital stay and the incidence of surgical site infections. Thus, routine use of abdominal drains is not advised

Introduction: Pancreatitis is one of most complex and clinically challenging of all abdominal disorders. USG and abdominal CT are the most commonly used diagnostic imaging modalities for the evaluation of pancreas. Computed Tomography (CT) is highly accurate and sensitive than USG in both diagnosing as well as demonstrating the extent. Early assessment of the cause and severity of acute pancreatitis is of utmost importance for prompt treatment and close monitoring of patient with severe disease. CT is the imaging method of choice for assessing the extent of acute pancreatitis and for evaluating complications. Materials and methods: This is a prospective study was conducted in the Department of Radiology at Dr. VRK Women's Medical College, Teaching Hospital and Research Centre Hyderabad, among 70 cases of acute pancreatitis. All the cases of acute pancreatitis referred under department of radiology in a tertiary healthcare institute, and fulfil the set inclusion criteria, who consented to participate in the study were included in the present study. It was carried out among 46 indoor cases of acute pancreatitis referred under department of radiology for further diagnostic evaluation, in a tertiary healthcare teaching institute in Maharashtra during study period. Ethical Approval was taken from the college ethics committee. Result: In our study, a total 70 patients were studied using CT scan, who was suspected to have acute pancreatitis. Among them, 50 (71.5%) were males and 20 (28.5) were females. Necrosis of the pancreatic gland parenchyma was seen in 17 (24.3%) patients. 12 patients (17.1%) showed <30% necrosis. 8 patients (11.4%) showed 30-50% necrosis, and 10 patients (14.3%) showed more than 50% necrosis. Conclusion: In conclusion CECT was found to be an excellent imaging modality for diagnosis, establishing the extent of disease process and in grading its severity. The Modified CT Severity Index is a simpler scoring tool and more accurate than the Balthazar CT Severity Index. In this study, it had a stronger statistical correlation with the clinical outcome, be it the length of hospital stay, development of infection, occurrence of organ failure and overall mortality. It could also predict the need for interventional procedures

Background:   Bactibilia, or the presence of bacteria in bile from the gallbladder, may contribute to the development of septic complications. It has been related to increased rates of surgical site infection after cholecystectomy. Laparoscopic cholecystectomy is the definitive treatment for cholelithiasis and cholecystitis. Advanced age, acute cholecystitis, ERCP, and gallstones are important risk factors for the development of bactibilia. This study aims at showing the effect of bactibilia on the course of laparoscopic cholecystectomy. Materials and methods: This are a prospective case-control study to be conducted at Govt. General Hospital, Vijayawada at Dept. of General Surgery over 1 year on 50 patients. Patients with asymptomatic Cholelithiasis of age 18-60 are included in the study and patients with hemoglobin < 10 gm%, hypoalbuminemia < 2.5 gm/dL, patients in acute sepsis, patients with HbA1c >6.5%, hypertension (>139/89 mm of Hg) and BMI > 30 and patients in an emergency setting and patients who have not consented for the study were excluded from the study. None of the patients received pre-operative antibiotics. Intra-operatively, bile is collected from the gall bladder and sent for microbiological culture in aerobic and anaerobic media for 3-5 days. Patients are divided into: Group A - Microbiological culture positive for microbes and Group B - Microbiological culture sterile. Both groups will be analyzed for the duration of hospitalization after surgery, post-operative wound infection, and any other complications encountered. Results: Out of the 50 patients, 32 were males and 18 were females. The mean age of the patients was 43.5 ∓ 9.6 years. The mean BMI was 27.1 ∓ 4.7. Of the total 25 samples positive for bile culture, 11 were E.coli, 7 were Klebsiella, 3 were Enterobacter spp., 2 were Acinetobacter spp., and the remaining were 2 Viridans streptococci. All the bacteria were sensitive to Amikacin. All except Acinetobacter were sensitive to gentamycin and imipenem. All except one case of E.coli were susceptible to ciprofloxacin. The incidence of port site infection, prolonged fever, intra-abdominal abscess, pneumonia, wound healing duration, and hospital stay were significantly higher in group A compared to group b (p-value < 0.05). Conclusion: Bactibilia affects the outcomes of laparoscopic cholecystectomy in terms of prolonged hospital stay, increased incidence of wound infection, duration of wound healing, and fever.

Background: The timing of laparoscopic cholecystectomy (LC) performed for surgical management of acute calculous cholecystitis has always been a contentious topic. The rate of conversion from laparoscopic to open cholecystectomy is a significant factor contributing to the choice between acute versus delayed surgery for acute calculous cholecystitis. Methods: This was a prospective randomized study carried out between December 2022 and June 2024; 462 patients with acute calculous cholecystitis were divided into two groups (early and delayed groups), each comprising 231 patients. Patients treated with LC within 3 to 5 days of arrival at the hospital were assigned to the early group. The other patients were placed in the delayed group, first they were managed conservatively followed by LC 3 to 6 weeks later. Rate of conversion from laparoscopic to open cholecystectomy was compared between the 2 groups. Results: The conversion rates in both early and delayed groups were 7.36% and 11.26% respectively. The operating time was 40.38 ± 9.67 minutes in the early LC group and 48.52 ± 9.83 minutes in the delayed LC group. Early LC group, on the other hand, required a shorter postoperative hospital stay (4.90 ± 1.59 vs. 6.89 ± 1.70 days) compared to the delayed LC group. Conclusion: Early LC might have benefits over late LC when we consider shorter operative time and hospital stay without significant increase of open conversion rates.

Introduction: Rat poisoning, often known as rodenticide poisoning, is still the second most prevalent swallowed poison in our area, behind organophosphorus poisoning. Present study was aimed to study clinical features and outcome of rodenticide (ratkill) poisoning. Material and Methods: Present study was prospective, observational study, conducted in patient of above 18 years age, admitted with rodenticide poisoning. Results: In present study, among 115 patients, majority of patients belong to age group of 21 to 30 years (50.4%) followed by age group of 11 to 20years (27.8%). Mean age of patients was 26.48 ± 9.48 years. 49.6% of patients were males whereas 50.4% of patients were males. In current study, majority of patients had vomiting (60.9%) followed by hematemesis and melena (each 27.8 %), abdominal pain (12.2 %), chest pain and breathlessness (each 9.6 %), fever and hematuria (each 8.7 %) & bleeding gums and seizures (each 7.8 %). In current study, 27.8% of patients had occult blood in stool, 6.9% of patients had arrthymias & 4.3% of patients showed lung infiltration. 93.9% of patients had normal USG abdomen, 3.5% of patients had fatty liver and 2.6% of patients had cholecystitis. In current study, in X-ray chest whereas 95.7% of patients had normal chest x-ray findings. 15 patients underwent CT brain. 20% of patients who underwent CT showed intra-cranial haemorrhage. In current study, the mortality rate among the study participants was 7% whereas 93% of patients survived. Conclusion: Compared to other pesticides, rodenticide poisoning is more prevalent manageable, and typically suicidal in nature. A few risk factors include being too aged or young, reaching at the hospital too late, and ingesting too much of the poison.

Background: Laparoscopic cholecystectomy (LC) is the gold standard treatment for gall bladder disease. Methods: We retrospectively reviewed charts of patients who underwent LC. Four LC groups were defined: elective LC-Group I; interval LC-Group II; LC during acute cholecystitis-Group III; and LC following percutaneous cholecystostomy (PCC)-Group IV. Results: The study comprised 1658 patients [mean age: 51.0 years (range 17-94)]: Group I: 1221 patients (73.6%); Group II: 271 patients (16.3%); Group III: 125 patients (7.6%); Group IV: 41 patients (2.5%). The operative time was significantly different between the groups (p <0.05). The conversion rate was highest in Group III (24.8%) and was significantly higher than all the other groups. Group II had a higher conversion rate than Group I (p<0.05). The length of hospital stay was not significantly different between Groups I and I I(1.5 and 1.96 days, respectively), and between Groups III and IV (4.46 and 4.78 days, respectively). The differences between Groups I and II, and between Groups III and IV were significant. Complication rates were significantly different between Groups I (2.2%), II (5.6%), and III (13.6%) (p <0.05.) There were no differences between Groups III and IV and there were no significant differences in 30-day read mission rates between the groups. Conclusions: The highest conversion and complication rates were encountered in patients undergoing LC during acute cholecystitis. A gradual increase of conversion and complication rates was noted between the groups of elective LC, interval LC and LC post PCC