No abstract

Dog bite injuries are common in children. They are a major cause of morbidity and mortality involving commonly the extremities, head, and neck. Injuries to the torso represent only 10% of injuries. Visceral injury by a dog bite in children is a rare clinical scenario with very few cases reported. We present a 2-year-old female child who suffered a severe dog bite injury causing colonic perforation.

Background Huge variation in the prevalence of post cholecystectomy syndrome (PCS) is because PCS can include a wide variety of disorders that can be both related and unrelated to cholecystectomy. Hepatobiliary scintigraphy (HBS) is a noninvasive nuclear medicine scan that can evaluate a delay in the transit of bile from the hepatic hilum to the duodenum using a radiotracer 99mTc-Mebrofenin that can be associated with a functional ampullary obstruction. The aim of this study was to assess the role of 99mTc-Mebrofenin HBS in the detection of the cause of PCS among the patients undergoing cholecystectomy. Methods Twenty-one patients who presented with PCS from September 2018 to February 2020 were included in the study. These patients were characterized based on history, examination, liver function test, and abdominal ultrasound. Sphincter of Oddi dysfunction (SOD) was diagnosed using the Rome 3 criteria and the Milwaukee classification. Magnetic resonance cholangiopancreatography (MRCP) and upper gastrointestinal endoscopy and biopsy were done when indicated, to establish the diagnosis. These patients were further subjected to 99mTc-Mebrofenin HBS, and the findings were analyzed. Results The most common symptom in PCS was biliary pain occurring in 85.7% of the patients. The average time of presentation since surgery was 1.9 years. The most common cause of PCS was SOD, occurring in 52.3% of the patients, followed by benign biliary stricture occurring in 23.8% of the patients. The mean bile duct (common bile duct) visualization time in patients with PCS was 25.2 minutes, the mean duodenal visualization time was 38.2 minutes, and the mean jejunal visualization time was 60.5 minutes. The mean bile duct to duodenum transit time was 12.7 minutes, while the mean bile duct to jejunum transit time was 30.1 minutes. HBS showed consistent findings with the final diagnosis made by other diagnostic modalities (clinical criteria/MRCP/intraoperative findings) in 80.9% of the patients. Conclusion 99mTc-Mebrofenin HBS has a significant role in the evaluation of PCS.

All patiets who underwent radical cholecystectomy during the study period of 1 year were enrolled. Result: Out of total patients operated for radical cholecystectomy with uneventful postoperative period, average preop albumin was found to be 4.22. In complicated postoperative patients' average albumin was 3.39. Average albumin levels in patients with SSI-3.38, Pneumonia-2.69, DVT-3.2, Wound dehiscence-2.58, Postop biliary fistula-3.6 and UTI-3.45. There was no postoperative myocardial infarction and mortality in any of the patients enrolled in this study. The incidence of SSI-35.2% , DVT-14.2% , Pneumonia-14.2% , UTI-7.1% & Postop biliary fistula-7.1% Conclusion: After detailed analysis it was found that low serum albumin was found to be associated with increased risk of postoperative complications including surgical site infection, pneumonia, urinary tract infection and DVT. Hence preoperative optimization of serum albumin levels by providing adequate nutrition supplementation will be beneficial to all patients of carcinoma of gall bladder undergoing radical cholecystectomy. This study is able to highlight preop albumin as a predictor for the postop outcomes in patients of GB Carcinoma.

Peritoneal inclusion cysts have been described in females of reproductive age. It is a rare cause of intestinal obstruction. Causes include pelvic inflammatory disease and prior abdominal surgery. We here present a case of young female of peritoneal inclusion cyst who presented with intestinal obstruction.