surgical treatment for chronic pancreatitis: report of three cases

"nBackground: Chronic pancreatitis is a progressive fibrosis of the pancreas that leads to loss of endocrine and exocrine function of pancreas. The most common symptom is intractable pain. Which adversely effects quality of life, remains the most common indication for surgery in patients with chronic pancreatitis. Case report: Three patients underwent operations for chronic pancreatitis at the Ghaem hospital, Mashhad University of Medical Sciences Mashhad, Iran. Indication for operation in all cases were intractable abdominal pain. In all of the three patients complete relief of symptoms was obtained. There was no morbidity and mortality. In one patient exocrine function of pancreas and malabsorpation resolved after surgery. Conclusions: Although chronic pancreatitis is uncommon, but in persistent abdominal pain surgery should be considered. Surgery for patients with chronic pancreatitis can be performed safely with minimal morbidity and effective in control of pain and malabsorption. &nbsp

Adult choledochal cysts in 23 patients: a brief report

Background: Choledochal cyst is a congenital disease of hepatobiliary system. Patients with the disease differ in terms of gender and symptoms. In this study, we aimed to evaluate the patients from clinical signs and symptoms, diagnostic methods and treatment perspectives.Methods: In this retrospective study, we evaluated the data from the medical records of patients with choledochal cyst admitted in Ghaem and Omid hospitals affiliated to Mashhad University of Medical Sciences in Mashhad, Iran during 1994 to 2011.Results: The medical records of 23 (18 women and 5 men) patients were evaluated. The mean age of the patients was 24.6 years. The most common type of the disease was choledochal cyst type 1. The most common type of surgery performed in the patients, respectively was resection of biliary cyst, cholecystectomy and Roux-en-Y hepaticojejunostomy. No mortality was observed during the hospital stay or follow-up period. Surgical complications were minor and patients recovered by conservative measures.Conclusion: Regarding the favorable results of surgical treatment of choledochal cysts, timely and definite diagnosis of this congenital anomaly and proper planning for its surgery are of special importance

Massive upper gastrointestinal bleeding due to esophago- thyroidal artery fistula following foreign body aspiration: a case report

Background: Immediate treatment when an esophageal foreign body is suspected is critical because of the possibility of serious complications. The presence of foreign bodies in the esophagus usually occurs accidentally in children and mentally retarded adults. A greater risk of perforation of the esophagus, development of a mediastinal, as well as airway compromise is present when a foreign body is lodged longer than 24 hours. Furthermore, this condition results in complications, such as hemorrhage or esophageal fistula, when treatment is delayed. We herein report a case of esophageo-thyroidal artery fistula, a rare complication resulting from the delayed removal of an esophageal foreign body. Patient presentation: A 34 year-old female who had swallowed her dental prosthesis one week previously was referred for severe gastrointestinal bleeding. Surgery to remove the foreign body was performed. To determine the cause of continued bleeding after the endoscopy and angiography, we performed a neck exploration, which revealed hemorrhage from a fistula between thyroid vessels and the esophagus. After surgical resection of the fistula, the patient was discharged from the hospital in good condition and has had no related problems for six months.Conclusions: Considering the complications resulting from the delay of the removal of foreign bodies from the esophagus, these objects should be removed as soon as possible

Primary paravertebral hydatid cyst: a case report

Background: Eating the egg of Echinococcus granulosus tapeworm in vegetables contaminated with dog's fecal material is the main cause of hydatid cyst. The most common involved organ is liver and the second are lungs. Spinal involvement especially primary involvement of paravertebral soft tissue without vertebral and extradural involvement is very rare. We report a case with paravertebral hydatid cyst without vertebral involvement.Case presentation: A 61 years old man patient resident of Torbatjam, Khorasan Razavi provience, was admitted to our department complaining a mass in back from six years ago. In physical examination he had several right paravertebral masses. MRI reveals a huge multilocular mass in the right paraspinal from T1 to L5 that is accompanied by ribs erosion without destruction. Operation was performed and the cyst was completely removed while contained several liquid-filled cysts, the hydatid-like cysts. Pathological findings were confirmed the diagnosis. Albendazole (10mg/kg) was prescribed post-operatively for six months. Recurrence has not occurred after two years follow up.Conclusion: Hydatid disease is a major infectious disease that is a main problem in many countries. In some articles paravertebral involvement without vertebral and extradural involvement is reported but primary paravertebral involvement with hydatid cyst is very rare. In this case we report paravertebral without vertebral involvement and the patient did not show any sign of spinal and vertebral pressure. In spite of the fact that hydatid cyst involves liver and lungs more than other organs, it can involve any organ and this point should be taken into consideration especially in the endemic areas

Management of Severe Perineal Injuries in Major Pelvic Fractures

Introduction: Significant perineal injuries and major pelvic fractures resulting from blunt trauma manifest a high-energy injury. Open pelvic fractures (with perineal injury) are associated with higher mortality rates of 40 to 60 %. Methods: This study was a review of patients with multiple traumas comprising of major pelvic fracture and severe perineal injuries (Shahid Kamyab hospital in Mashhad from 2002- 2005). A total of 11 patients, with pelvic fracture and perineal injuries (injury to urethra and anal canal) were entered in the study. The data was gathered by a checklist and analyzed with SPSS software. Results: The population under study included 11 patients (9 male, 2 female) with a mean age of 35years. Cause of trauma in all patients was motor vehicle accidents. All of the patients in the first 6 hours of admission received at least 4 liters of serum ringer lactate and 3 units of packed cells. The mean of packed cell received was 8 units and one patient needed 21 units of packed cells. All of patients were taken to the operating room for diverting colostomy, distal rectal washout, cystostomy and radical debridment and irrigation of devitalized tissue. Good results were achieved in 9 patients and there was one case of mortality and one morbidity (ARF). Conclusion: Open pelvic fractures and perineal injuries are associated with higher mortality rates. Prompt diagnosis and proper treatment (reanimation, colostomy, cystostomy, debridment and irrigation) is the key to success

EHS clinical guidelines on the management of the abdominal wall in the context of the open or burst abdomen.

To provide guidelines for all surgical specialists who deal with the open abdomen (OA) or the burst abdomen (BA) in adult patients both on the methods used to close the musculofascial layers of the abdominal wall, and regarding possible materials to be used