No abstract

SummaryFollowing two deaths from respiratory failure secondary to opioid toxicity in patients admitted for surgical repair of fractured neck of femur, we retrospectively studied the serum urea and electrolyte concentrations of 1511 consecutive patients requiring surgery for proximal femoral fracture, and calculated their glomerular filtration rate. Five hundred and forty-five (36.1%) patients had renal dysfunction on admission (glomerular filtration rate < 60 ml.

Background: Malrotation of gut presenting in adolescents and adults though rare but exists. Also its presentation is nonspecific.  Hence its diagnosis needs high index of suspicion. Material and methods: This prospective study was done  the of department of surgery SMHS hospital at GMC Srinagar over a period of 5.5 years  from July 2012 to December 2017.The patients included all  the adolescent and adult patients who proved  to be cases  of malrotation of gut on intraoperative  visualisation. Results: During the study period of 5.5 years, a total of 14 patients with malrotation of gut (belonging to adolescent and adult age group) were recorded. Age of the patients ranged from 16 to 54 years with an average of 26.21± 11.15years (SD=11.149). Majority of the patients belonged to adolescent age group. Preoperatively CT (computed tomography) was done only in 4 patients, thereby making the diagnosis of malrotation preoperatively in these 4 patients. In all other patients, the diagnosis was made only after laparotomy (done for acute abdomen) and intraoperative visualisation. Ladd´s procedure was done successfully in majority of patients with two patients requiring resection of gangrenous small bowl with stoma formation. Conclusion: Malrotation of gut presenting in adolescents and adults is a rare phenomenon and also the symptoms are similar to several other abdominal pathologies, hence it represents a diagnostic challenge. Hence a high index of suspicion is needed to diagnose this rare entity early without undue delay, so as to avoid or limit further complications .Threshold for CT scan should be kept a little low in suspicious cases so as diagnose and intervene in time. Well trained senior person should be involved during the surgical intervention of this rare condition. Further studies and reporting is needed to get familiar with this rare condition. Key words: Malrotation; adolescents and adults; Ladd´s procedure; gangrene.