Journal of Surgery

Journal of Surgery, Impact Index: 4.86,  ISJN: 7687- 7184,  Imprint: Photon,  Category: Peer Reviewed Indexed International Journal


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Gastrograffin for adhesive small bowel obstruction (ASBO) – hype or beneficial? A completed loop audit 


Abhilash J. Pailya*, Jalpa Kotechab , Loveena Sreedharanc , Bhaskar Kumara 


a Department of General Surgery, Norfolk and Norwich University Hospital, Norwich, Norfolk, 

   UK 

b Department of Cardiology, Royal Brompton Hospital, Chelsea, London, UK 

c Department of General Surgery, Addenbrookes Hospital, Cambridge, UK 


Keywords: adhesive, obstruction, gastrograffin, bowel 


Corresponding Author: Paily J.A. * 


Abhilash J. Paily is Specialty Registrar General Surgery 

Jalpa Kotecha is Core Medical Trainee 

Loveena Sreedharan is Specialty Registrar General Surgery 

Bhaskar Kumar is Consultant Oesophago-Gastric Surgeon



Abstract 

Introduction Adhesive small bowel obstruction (ASBO) accounts for the majority of patients with small bowel obstruction. Although most are managed conservatively, frequent admissions create a huge burden. We sought to examine the adherence to the Bologna guidelines for the management of ASBO in a high volume tertiary centre. Additionally, we examined whether or not gastrograffin had a therapeutic effect on resolving ASBO. Methods and materials A comparison was made between a retrospective audit looking at ASBO and a prospective re-audit using standards derived from the Bologna guidelines with the aim of identifying and implementing change. Results More patients underwent conservative management and fewer patients had surgery as first line management during the re-audit possibly because of the increased usage of gastrograffin. Those who had to undergo surgery within/after a period of 72h of conservative management were also fewer in the re-audit phase. Whether they were managed surgically primarily or after a period of conservative management, the average length of stay was shorter in the re-audit phase. In comparison to the preliminary audit, there appeared to be no change in the way history and physical examination was documented during the re-audit. However, there was a marked difference in the use of appropriate blood tests and CT scans. Conclusion Changes were made successfully during the re-audit and have been implemented in the management of ASBO thus closing the audit loop. Significantly, the use of gastrograffin has decreased the need for surgical intervention in this group of patients with small bowel obstruction. 


Citation: Abhilash J. Paily, Jalpa Kotecha, Loveena Sreedharan, Bhaskar Kumar, 2019. Gastrograffin for adhesive small bowel obstruction (ASBO) – hype or beneficial? A completed loop audit. Journal of Surgery . Photon 114, 135-143 


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Photon Ignitor: ISJN76877184D881206102019






Anterior mandible Central Giant Cell Granuloma in 60 year old. A rare case report 


Shetty L.*, Kulkarni D., Sabhlok S., Patwa R., Mc Ghee S., Londhe U. 


Department of Oral and Maxillofacial Surgery, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune -411018, India 


Keywords: Central Giant cell granuloma, enuncleation, age 



Abstract 

Central giant cell granuloma is an intraosseous lesion constituting of cellular fibrous tissue that contain multiple foci of haemorrhage, multinucleated giant cells and trabeculae of woven bone. Central giant cell granuloma is a benign lesion of the jaws with an unknown etiology. Clinically and radiologically, a differentiation between aggressive and non-aggressive lesions can be made. The incidence in the general population is very low and patients are generally younger than 30 years. This lesion accounts for less than 7 % of all benign jaw tumors with female predilection. In this report, there is presentation of Central giant cell granuloma in the mandibular anterior region and to discuss differential diagnosis, radiographic presentation and management of this lesion. This lesion is found in patient with 60 years of age which is unusual with history of trauma 20 years back .A 60 year old female reported with chief complaint of painless swelling in the anterior region of the mandible. Swelling was present since 20 years and gradually increased in size over last two years. Incisional biopsy was taken and lesion was confirmed as central giant cell granuloma. Treatment was planned as enucleation and surgical curettage under general anesthesia. Surgical curettage or, in aggressive lesions, resection, is the most common therapy. However, when using surgical curettage, undesirable damage to the jaw is often unavoidable and recurrences are frequent. Therefore, alternative therapies such as injection of corticosteroids in the lesion or subcutaneous administration of calcitonin or interferon alpha are described in several case reports with variable success. Unfortunately, randomized clinical trials are very rare or nonexistent. Hence, we opted for the routine surgical treatment. Though, there are different treatment modalities, one has to always assess the type of lesion, location and its aggressiveness and accordingly suitable treatment options should be selected and carried out. 






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