Objective: The aim of this study was to assess the initial outcome of non-operative, conservative management in selective penetrating abdominal injury in a tertiary care hospital. Material and Methods: This was a cross sectional study done on purposively selected 36 patients with penetrating abdominal injuries of all ages admitted within 6 hours of the incident. All patients confirmed peritoneal breach and standard algorithm of management was followed. Closed monitoring was ensured with repeated investigations at regular intervals. Outcome parameters included surgical site infection (SSI), fever, hypothermia, wound dehiscence, fecal fistula, length of stay, pulmonary complication and death. Results: A total of 36 patients with a mean age of 30 years (SD= 6.7), consisting all males, mostly (58%) from rural areas and 73% from low socioeconomic condition. Site of injury was noted in the epigastrium (42%) and right iliac region (22%). Among them, 33 (92%) patients were successfully managed with non-operative management and 3 (8%) patients needed laparotomy. Routine imaging and clinical observation could detect hollow viscus injury within 36 hours in 3 patients. Hospital stay was significantly lower (< 7 days) in conservative management. Conclusion: Clinical examination alone and/or together with different diagnostic methods could reduce the number of negative laparotomies and associated morbidities. Single surgeon must closely monitor a patient of penetrating abdominal injury and take vital decisions from the time of admission until discharge.

Background: Chest trauma implies trauma to anyone or combination of different thoracic structures. Approximately in one quarter of civilians, trauma deaths are caused by trauma to thorax. Many of these deaths can be avoided by precise clinical diagnosis and immediate management. Most wounds under these situations could be managed conservatively with or without tube thoracostomy. This study aims to assess and analyze the mode of presentation, pattern and management of chest injuries in rural areas. Methods: One hundred consecutive patients within the period of 14 months with thoracic trauma presenting in emergency department were evaluated. Results: Most of the patients (87%) were treated conservatively with minor wound repair and medical treatment and 13% patients had been treated with intercostal chest drain. Among these 13% patients, three were referred to higher centers due to massive initial hemothorax and longstanding pneumothorax. Conclusions: Majority of the chest injury patients can be treated satisfactorily in general surgery unit by conservative management or chest drain.

Minimal access surgery is nowadays widely practiced in both diagnosis and management of various infective conditions of abdomen. Laparoscopic appendicectomy (LA) is a procedure of choice in acute or chronic appendicitis in any age group. Laparoscopy is also recommended in appendicolithiasis, perforated appendicitis, and appendicular abscess with evidence of less morbidity and hospital stay in comparison to open approach.Some studies reported formation of postoperative intraabdominal abscess (IAA) and challenged the laparoscopic management in perforated appendicitis. We searched through internet for relevant articles with the keywords like LA in acute appendicitis, burst appendix, appendicular abscess, intraabdominal abscess, perforated appendicitis, etc. Individual case report or case series lack in control group for comparison were excluded from our review.This study reviewed the efficacy of LA in perforated appendicitis. Parameters we concentrated were on operation techniques related to operation time, conversion rate, surgical site infection, IAA formation, hospital stay, use of analgesics, and the cost.

No abstract

Great toe injury is common in athletes. Besides violence, the sports injuries to the great toe vary according to the sharing force or impact. However, some great toe injuries can seriously affect the daily activities and some could also remain unnoticed. This case report documents an athlete with an unnoticed avulsion fracture of distal phalanx of the left great toe during karate practice on regular mat.