Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
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Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

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Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

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Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Case report
Year : 2011 | Month : October | Volume : 5 | Issue : 5 | Page : 1120 - 1122

Isolated “Blow Out” Jejunal Perforation Following Blunt Abdominal Trauma- Experience of Two Cases

B.V. Goudar, Uday Ambi, Y. Lamani, Sunil Telkar

Associate Professor, Dept. of Surgery, SN Medical College and HSK Hospital, Bagalkot, Karnataka, India. Assistant Professor, Dept. of Anaesthesiology, SN Medical College and HSK Hospital, Bagalkot, Karnataka, India. Assistant Professor, Dept. of Surgery, SN Medical College and HSK Hospital, Bagalkot, Karnataka, India. Assistant Professor, Dept. of Surgery, SN Medical College and HSK Hospital, Bagalkot, Karnataka, India.

Correspondence Address :
B V Goudar
Associate Professor, Dept. of Surgery,
SN Medical College and HSK Hospital,
Bagalkot, Karnataka, India-587101.
Telephone: +918354-235400


Small bowel injury following blunt abdominal trauma has been widely reported. Isolated jejunal perforation which is caused by blunt abdominal trauma is rare and is most often seen in road traffic accidents. Here, we present two cases of isolated jejunal perforation due to raised intra abdominal pressure in the form of abdominal tightening by the dhoti after it was caught in the belt of an engine and a fall from the stairs while stepping down. Explorative laparotomy revealed the slit-like perforation on the anti mesenteric border. Early surgical intervention led to good recovery in both the cases. A high index of suspicion, repeated clinical examination and the proper utilization of investigational tools definitely helped us in managing these kinds of rare cases.


Jejunum, Perforation, Blunt Trauma

Small bowel injury following blunt abdominal trauma is the commonest presentation in road traffic accidents. The isolated blowout perforation of the jejunum is extremely rare. We came across two cases of isolated jejunal perforations following blunt abdominal injury during 2010–2011 in our hospital.

Samuel Annan reported the first case of intestinal perforation following blunt abdominal trauma in 1837 (1). Punctate or slit like perforations often occurring on the anti mesenteric border are probably the consequence of a sudden increase in the intraluminal pressure in a fluid or air filled loop. Robbs et al. (2), in 1980, reported five such lesions in Zulu tribesmen, which were mostly caused by a blow to the abdomen with a heavy, round-headed weapon. These perforations were not surrounded by damaged tissue and did not appear to result from a crushing type injury (2), (3). They are referred to as “blowout” perforations. These perforations may be missed initially and may become apparent around three days after the injury (4). or bowel ischaemia which is secondary to contusion, leading to stricture and delayed perforation occurs after 4 weeks. The two cases were reported almost 2 months following blunt abdominal trauma (5).

Case Report

A 34-year old male patient was admitted to the hospital with intense abdominal pain after his dhoti was caught in the wheel belt of the engine while working in the field. Bruise marks were noted in the flanks. Palpation revealed tenderness and guarding all over the abdomen. Liver dullness was obliterated and free fluid was noted. Bowel sounds were absent. His blood parameters were normal. The erect abdomen showed gas under the diaphragm. Ultrasound of the abdomen revealed free fluid in the peritoneum. Written informed consent was obtained from him.

Laparotomy revealed bile stained fluid and an isolated perforation which was sized 2cms in the jejunum, on the anti mesenteric border,25 cms distal to the ligament of Treitz was seen (Table/Fig 1). The rest of the bowel and other organs were normal. The perforation was closed primarily. The postoperative course was uneventful.

A 45-year old female patient was admitted to the hospital with a history of fall from the stairs. The patient had intense abdominal pain and vomiting. The patient was in hypotension and had tachycardia. Her abdomen was slightly distended and tenderness was present. Her blood parameters revealed leucocytosis. The erect X –ray of the abdomen did not show free gas (Table/Fig 2), but ultrasonography and CT revealed free gas and fluid in the peritoneum (Table/Fig 3). The patient consented for the surgery.

The laparotomy of the patient showed isolated jejunal perforation with bile stained fluid. The perforation was along the longitudinal axis of the anti mesenteric border and 20cms away from the ligament of Treitz. No other injury was seen. The ruptured jejunum was sutured primarily.


Seventy-five percent of the blunt abdominal trauma cases are caused by motor vehicle accidents (1). Although small bowel injuries have been reported to be the third most common injuries in blunt abdominal trauma, they occur in less than 1% of the blunt trauma patients (6), (7). The mechanisms of small bowel injuries with blunt trauma include shearing forces, compression between the abdominal wall and the vertebral column and bursting injury due to a sudden increase in the intraluminal pressure. The isolated “blowout type” of rupture of the jejunum following constriction by a dhoti or fall from the stairs is extremely uncommon. This leads to a sudden increase in the intra-abdominal pressure, which in association with a full stomach, can lead to this kind of perforation. A similar mechanism of small bowel injury was caused by physical assault (8) and knee kick (9) during a game of foot ball.

Physical examination is not adequate on its own for the diagnosis of such cases, and it was found to be reliable in only 30% of the blunt trauma cases (7). Fakhry et al (10) observed that 67.7% out of 198 patients with blunt small bowel injury, initially presented with signs or symptoms which were highly suggestive of perforative peritonitis and 84.3% were taken to the operating room without delay. X rayof the erect abdomen, USG, diagnostic peritoneal lavage and CT of the abdomen are most commonly used diagnostic aids other than physical examination. In the first case, the diagnosis of the hollow viscous perforation was not problematic, but in the other case, the persistent physical findings forced us to opt for CT of the abdomen. CT of the abdomen definitely helped us in the diagnosis. According to Burney et al (11), peritoneal lavage has proven to be sensitive for the demonstration of the haemoperitoneum, but it was found to be less reliable in the early diagnosis of intestinal injuries. The gold standard for the assessment of blunt trauma diagnosis is C T scanning, with a sensitivity of 92% and a specificity of 94% (12). In recent times, laparoscopy has played an important role in the diagnosis as well as in the treatment of blunt abdominal trauma. Diagnostic laparoscopy should be preferred instead of diagnostic peritoneal lavage in relatively haemodynamically stable patients. Most of the patients will be having punctuate or slit like perforations on the anti mesenteric border and so, ideally they require laparotomy and the primary closure of the perforation, with peritoneal lavage. Now, with the advent of laparoscopy, it is possible to close the perforation by using endosutures or staplers (13). Small bowel perforation has low mortality and complication rates if it is treated before 24 hours after the injury (8). Delayed jejunal perforation is often associated with high mortality and morbidity. Since 1990, 9 cases of isolated jejunal perforations have been reported (Table/Fig 4), but the nature of the injury which was seen in our cases was different.

Clinical observation was not sufficient to justify the diagnosis and so the pre operative diagnosis of isolated jejunal perforation was definitely challenging. A high index of suspicion, repeated clinical examinations and the utilization of imaging modalities really helped us to diagnose these kinds of clinical entities.


We would like to thank Dr A S Mallapur, Principal and Dr E B Kalburgi Professor and Head, Dept. of Surgery, S N Medical College and HSK Hospital, Bagalkot for the valuable support that they rendered for preparing this article.


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Robbs JV, Moore SW, Pillay SP. Blunt abdominal trauma with jejunal injury: a review. J Trauma 1980; 20:308-11.
Dauterive AH, Flancbaum L, Cox EF. Blunt intestinal trauma. A modern day review. Ann Surg 1985; 201:198-203.
Sule AZ, Kidmas AT, Awani K, Uba F, Misauno M. Gastrointestinal perforation following blunt abdominal trauma. East Afr Med J 2007; 84:429-33.
Subramanian V, Raju RS, Vyas FC, Joseph P, Sitaram V. Delayed jejunal perforation following blunt abdominal trauma. Ann R Coll Surg Engl 2010; 92:23-4.
Guarino J, Hassett JM Jr, Luchette FA. Small bowel injuries: mechanisms, patterns, and outcomes. J Trauma 1995; 39:1076-80.
Allen GS, Moore FA, Cox CS Jr, Wilson JT, Cohn JM, Duke JH. Hollow visceral injury and blunt trauma. J Trauma 1998; 45:69-78.
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Fakhry SM , Brownstein M, Watts DD, Baker CC, Oller D. Relatively short diagnostic delays [8 hours] produce morbidity and mortality in blunt small bowel injury: an analysis of time to operative intervention in 198 patients from a multicenter experience. J Trauma. 2000; 48:408-15.
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Sherck J, Shatney C, Sensaki K, Selivanov V. The accuracy of computed tomography in the diagnosis of blunt small bowel perforation. Am J Surg 1994; 168:670-5.
Townsend MS, Pelias ME. A technique for the rapid closure of traumatic small intestinal perforation without resection. Am J Surg 1992; 164:171-2.

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