Primary Cecal Pathologies Presenting as Acute Abdomen

Primary Cecal Pathologies Presenting as Acute Abdomen and Critical Appraisal of Their Current Management Strategies

Sponsors

Lead Sponsor: Jawaharlal Nehru Medical College

Source Jawaharlal Nehru Medical College
Brief Summary

Background: The importance of cecal pathologies lie in the fact that being the first part of large intestine, any disease involving the cecum affects overall functioning of the large bowel. Primary cecal pathologies presenting as acute abdomen have not been described in any previous study in terms of presentation, management and outcome.

Objectives: The objective of this study was to identify the reported causes of primary cecal pathologies presenting as acute abdomen and the various causes presenting in Indian setting, to discuss morbidity and mortality associated with cecal pathologies and to critically analyse the various management modalities employed in emergency setting.

Detailed Description

The importance of cecal pathologies lie in the fact that being the first part of large intestine, any disease involving the cecum affects overall functioning of the large bowel. Primary cecal pathologies presenting as acute abdomen often pose a challenge to their optimal management due to requirement of urgent intervention in most cases and being a common source of misdiagnosis. These pathologies often mimic acute appendicitis and commonly misdiagnosed as one. This misdiagnosis can lead to under-treatment of the underlying pathology and this results in high morbidity and mortality associated with these conditions. So the accurate identification of such conditions is required so that the patients can be optimally managed and patient outcome can be improved.

Overall Status Completed
Start Date January 1, 2016
Completion Date July 15, 2017
Primary Completion Date May 31, 2017
Study Type Observational
Primary Outcome
Measure Time Frame
Pattern of primary cecal pathology in Indian setting 10 years
Enrollment 43
Condition
Intervention

Intervention Type: Procedure

Intervention Name: Operated

Description: Patients were either managed conservatively or underwent emergency laparotomy

Eligibility

Sampling Method: Non-Probability Sample

Criteria:

Inclusion Criteria:

- All adult patients presenting in emergency department with acute abdomen were included in study in whom cecal pathology as the cause of acute abdomen was suspected clinically and/or on imaging and further confirmed per-operatively and/or on histopathological examination (HPE) or on imaging. Patients identified with primarily a cecal pathology who had acute pain abdomen as the initial symptom but who didn't presented immediately due to various reasons were also included in the study as it is a well-documented fact that patients in developing countries like India, especially those who live in rural areas or who are illiterate often resort to indigenous methods of treatment or take symptomatic treatment from local practitioners before presenting to a tertiary centre for definitive treatment. Also, only those patients who were operated within 24 hours of index admission in the emergency operation theatre (EOT) by a registrar or faculty member after initial resuscitation were included in the study.

Exclusion Criteria:

- Patients with sub-acute, intermittent or chronic pain; when predominant symptoms were attributable to some other cause even with concomitant presence of a cecal pathology; when predominant pathology was not cecal and patients with cecal pathology operated as an elective case were excluded from this study. Thus patients diagnosed to be having appendiceal stump blowout, perforation of base of appendix, ileocecal tuberculosis or intussusception were not included.

Gender: All

Minimum Age: 18 Years

Maximum Age: N/A

Healthy Volunteers: No

Overall Official
Last Name Role Affiliation
Kaushal D Singh, MS Surgery Principal Investigator Jawaharlal Nehru Medical College, Aligarh
Verification Date

August 2017

Responsible Party

Type: Principal Investigator

Investigator Affiliation: Jawaharlal Nehru Medical College

Investigator Full Name: Kaushal Deep Singh

Investigator Title: Principal Investigator

Keywords
Has Expanded Access No
Condition Browse
Arm Group

Label: Operated patients who survived

Description: Patients who were discharged in index hospital admission after operative intervention

Label: Operated patients who expired

Description: Patients who expired in index hospital admission after operative intervention

Label: Non-operated patients who survived

Description: Patients who were discharged in index hospital admission after being managed conservatively

Label: Non-operated patients who expired

Description: Patients who expired in index hospital admission after being managed conservatively

Patient Data Undecided
Study Design Info

Observational Model: Case-Only

Time Perspective: Retrospective

Source: ClinicalTrials.gov