Carcinoid Tumor of the Common Bile Duct

A case of a primary carcinoid tumor of the common bile duct is presented. Diagnostic and therapeutic uncertainties of this extremely rare cause of jaundice are discussed

Two weeks delayed bleeding in blunt liver injury: case report and review of the literature

Most cases of blunt hepatic trauma are treated nowadays non-operatively. This type of conservative treatment has resulted in increased complication rate. Delayed complications occur in cases that didn't require surgical intervention during the first 24 hours. The most common late complication is hemorrhage. We report a case of two weeks delayed hemorrhage after blunt hepatic trauma in an adult. We describe the diagnostic procedures, the surgical treatment and review the relevant literature

Acute cholecystitis managed in a rural surgical department

ObjectivesTo define the outcome over a prolonged period of an unselected cohort of patients presenting with acute cholecystitis (AC) to a 560 bed rural hospital in Israel.Design, setting and participantsRetrospective case series analysed from a single referral centre between 2006 and 2015. Separated into Group 1 managed by emergent cholecystectomy, Group 2 treated with antibiotics and delayed cholecystectomy, Group 3 treated with percutaneous cholecystostomy (PC) and selected delayed cholecystectomy and Group 4 managed entirely conservatively with no subsequent cholecystectomy.Methods Assessment of complication rates: in-hospital and delayed cause-specific morbidity and mortality along with conversion rates and the risk of intraoperative stone spillage. Results Of 321 patients hospitalized for AC, there were 50 in Group 1, 68 in Group 2, 59 in Group 3 and 98 in Group 4. Group 3 were older with more comorbidities and when coming to surgery had more open conversions. Intraoperative stone spillage was more common in Groups 2 and 3. The length of hospital stay was greater for Groups 1 and 3. Of the Group 4 cases, 63.2 per cent remained asymptomatic over a median follow-up of 78 months. Of those with recurrent biliary symptoms, 58.3 per cent were ASA Grade III/IV with 25/36 late deaths 80 per cent of which were from non-biliary causes. ConclusionIn the management of AC, early cholecystectomy is favored with non-operative approaches like PC drainage or antibiotic treatment alone being reserved for frailer comorbid cases. The absolute need for subsequent cholecystectomy is not supported by this series and requires further investigation

A pandemic recap : lessons we have learned

On January 2020, the WHO Director General declared that the outbreak constitutes a Public Health Emergency of International Concern. The world has faced a worldwide spread crisis and is still dealing with it. The present paper represents a white paper concerning the tough lessons we have learned from the COVID-19 pandemic. Thus, an international and heterogenous multidisciplinary panel of very differentiated people would like to share global experiences and lessons with all interested and especially those responsible for future healthcare decision making. With the present paper, international and heterogenous multidisciplinary panel of very differentiated people would like to share global experiences and lessons with all interested and especially those responsible for future healthcare decision making.Non peer reviewe

Endoluminal compression clip: full-thickness resection of the mesenteric bowel wall in a porcine model

Background: Performing a full-thickness intestinal wall resection Of a sessile polyp located on the mesenteric side with a compression clip may lead to compression of mesenteric vessels. The application of such a clip may therefore cause a compromised blood supply in the particular bowel segment, leading to perforation. Objective: To evaluate the performance of a newly developed, nitinol compression clip, called the NiTi clamp, for full-thickness resection of the bowel wall, while the clip is deliberately deployed endoluminally on the mesenteric side. Design: Prospective animal study. Multinational, multidiciplinary; gastroenterology and general surgery, research Cooperation. Setting: Animal research laboratory. Intervention: Six pigs were operated upon and endoscopically evaluated and then killed after 3 weeks. Linear compression closure clips based on nitinol springs were used. Three longitudinal enterotomies were performed: in the cecum, spiral colon, and proximal rectum. Four clips were deployed in each animal. Main Outcome Measurements: A total of 23 clips were deployed. The average expulsion day was 9 days. Results: All but 3 clips were normally expelled. One pig developed bowel ischemia due to intussusception. In endoscopic procedures, no signs of significant segmental mucosal ischemia were found. The macroscopic appearance of the compression closure lines was thin and delicate, but epithelialization was significantly delayed at 5 sites. Limitation: Differences between porcine and human colorectal anatomy. Conclusion: Full-thickness clamping of the bowel with the NiTi clamp, including the local mesenteric vasculature does not significantly impair local healing of the clamp site and gives hope to further development of novel full-thickness endoscopic resection technologies. (Gastrointest Endosc 2009;70:1146-57.