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Objectives The aims of this study were to establish the use of single-dose prophylactic intravenous antibiotics in the prevention of postoperative wound infection following clean surgeries in a government setup in India and to assess the efficacy of single-dose prophylactic ceftriaxone in preventing surgical site infection following clean surgeries by a prospective randomized trial. Methods A prospective study was done on patients in the Department of General Surgery in Karnataka Institute of Medical Sciences, Hubli, Karnataka, India, from January 2011 to December 2014. A total of 822 patients were divided into 2 groups. The first group (A), consisting of 406 patients, received a single-dose antibiotic prophylaxis, and the second group (B), consisting of 416 patients, received 3 days or more of postoperative doses of antibiotic therapy. Only clean procedures are included, and results were compared. Results In the first group (A), the rate of infection was 4 of 406. In the second group (B), the rate of infection was 6 of 416. Overall wound infection rate was 0.95%; wound infection rate after administration of single-dose preoperative antibiotic was 0.96%, and in the routine postoperative group, it was 0.94% (P = 0.9). Conclusions This study concludes that single-dose preoperative antibiotic alone is as effective as the use of empiric antibiotics given for 3 days or more in clean surgeries. It will facilitate in decreasing superinfections among and resistance to bacterial strains, health care costs, and morbidity secondary to antibiotic administration (eg, drug toxicity, antibiotic-related diarrhea) in a developing country such as India.

Background: Acute gastrointestinal (GI) haemorrhage is a common clinical problem with diverse manifestations. Such bleeding may range from trivial to massive and can originate from virtually any region of the GI tract, including the pancreas, liver, and biliary tree. Several risk scoring systems have also been proposed to classify patients into high and low risk groups for complications, like re-bleeding or mortality, based on multivariate analyses. Kollef and colleagues identified the BLEED criteria: (a) ongoing Bleeding, (b) Low systolic blood pressure (BP), (c) Elevated prothrombin time (PT), (d) Erratic mental status, and (e) unstable comorbid Disease as risk factors for complication of GIH at any time during hospitalization after an initial 24 hours of stabilization. The objective of this study was to predict outcome according to a risk stratification BLEED criterion, independent of endoscopic findings. Methods: We studied all patients who presented with acute gastrointestinal bleeding to emergency department. patients with epistaxis, paranasal sinuses bleed, upper GI bleed secondary to endoscopic procedure, patients with chronic Anemia and those patients which admitted with Primary diagnosis other than UGIB were excluded. Patients meeting the BLEED criteria at their initial assessment were classified as high risk (66) and all others were categorized as low-risk (10). In-hospital complications were defined as recurrent UGIB, surgery to control the source of hemorrhage, hospital mortality, length of hospital stay and units of blood transfused. Results: There were 76 patients, with mean age of 46.37 years, 56 patients (73.3%) were case of Upper gastrointestinal bleeding, 20 patients (26.7%) were case of lower gastrointestinal bleeding. 66 (86.84%) of patients were categorized as high-risk patients and 10(13.2%) of patients were categorized as low risk patients. 14(21.1%) of patients were admitted in ICU ,13 Patients had undergone surgery (17.10%), 1 (1.5%) of patient had Re bleeding, nine (13%) had died. Stastical analysis showed significant association between components like low SBP (P=0.008), elevated prothrombin time (P=0.04), erratic mental status(P=0.001) and in hospital complications. All nine deaths were found in high risk group. Conclusions: BLEED criteria can be used as triage tool for stratifying the patients of acute gastrointestinal haemorrhage into high risk and low risk category without endoscopic findings and useful in predicting outcome in such patients and plan the treatment accordingly.

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ABSTRACT:A Caecum perforation is a very rare identity. Traumatic caecal perforations are even rare. Exteriorization of the caecum may be necessary when the duration of the perforation has been prolonged, here in the present case an attempt was made with primary repair with peritoneal lavage and patient recovered uneventfully. KEYWORDS: Primary repair, cecal perforation. CASE REPORT:A 72-year-old female patient was referred to department of surgery for generalized abdominal pain of 3 days duration. There was a history of constipation lasting for 3 days. There was no vomiting. Patient had undergone open reduction and internal fixation for right intertrochanteric fracture femur following self-fall six days ago in the orthopedic department. Patient was started on oral diet 6 hours following the surgery and had only complaints of pain at the surgical site. There were no known co-morbidities.On physical examination, she had tachycardia (pulse rate of 110/ min). Abdomen was distended. There was generalized abdominal tenderness and guarding. Liver dullness was obliterated. The bowel sounds were absent. The haemogram showed leucocytosis (11000/Cu mm). Chest X-ray showed free air under the diaphragm. A preoperative diagnosis of hollow viscus perforation with peritonitis was made and the patient was taken up for emergency laparotomy.On laparotomy, there was caecal perforation with faecal peritonitis. The perforation was 0.2 X 0.2 cm with healthy margins. There were no adhesions and rest of the bowel loops, appendix and liver and spleen were normal.