Surgical options in the management of cystic duct avulsion during laparoscopic cholecystectomy

<p>Abstract</p> <p>Background</p> <p>Avulsion of cystic duct during laparoscopic cholecystectomy (LC) is not a common intraoperative complication, but may be encountered by any laparoscopic surgeon. Surgeons are rarely familiar with management of this condition.</p> <p>Methods</p> <p>Patients with gall stone related problems who were scheduled for LC at the minimal invasive surgery unit of a tertiary referral hospital during a 5 years period (April 2002–April 2007) were prospectively enrolled.</p> <p>Results</p> <p>12 cases were identified (incidence: 1.15%). All 12 patients had gallbladder inflammation. Five patients had acute and seven patients had chronic cholecystitis. The avulsed cystic duct (ACD) was managed by clipping in 4, intracorporeal suturing in 3, converting to open surgery with suture ligation in 2, and lonely external drainage in 3 patients. Bile leakage had ceased within 3 days in 2, 14 days in one, and 20 days in the other patient. Bile volume increased gradually in one of the patients, which stopped only after endoscopic sphincterotomy (ES) at 25^thpostoperative day. No major late complication or mortality occurred.</p> <p>Conclusion</p> <p>ACD during LC is a rare complication. Almost all standard methods of treatment yield to successful outcomes with low morbidity. According to the situation, ACD may be successfully managed laparoscopically. Available cystic stump remnant was clipped. Intracorporeal suture ligation was performed when short length of stump precluded clipping. Deeply retracted cystic duct with active bile leak led to conversion to open surgery. With minimal or no bile leak at ACD stump, closed tube drainage of sub-hepatic area was attempted. Persistent bile leak was assumed to be controlled by ES, successfully accomplished in one patient.</p

Ileal intussusception secondary to both lipoma and angiolipoma: a case report

Lipoma and angiolipoma are common benign neoplasms that occur in the subcutaneous tissue and rarely in the gastrointestinal tract. These tumors are usually asymptomatic but may present with abdominal pain, bleeding and obstruction. We present a 53-years-old woman with abdominal discomfort for several weeks accompanied with bloody diarrhea and recurrent vomiting. Ileo-ileal invagination was diagnosed by computed tomography scan. Laparotomy revealed five intraluminal masses that caused intussusception. Histopathological study showed that one was angiolipoma and other lesions were lipoma. We have described some aspects of diagnosis and treatment of this rare cause of intestinal intussusception

Asymptomatic carotid artery stenosis in patients with severe peripheral vascular diseases

&lt;ul&gt;&lt;li&gt;&lt;strong&gt;BACKGROUND&lt;/strong&gt;: The prevalence of carotid artery stenosis (CAS) in the&amp;nbsp; eneral population is not high enough to justify screening programs. This study was done to determine the prevalence of asymptomatic carotid artery stenosis (ACAS) among patients with severe peripheral vascular disease (PVD).&lt;/li&gt;&lt;li&gt;&lt;strong&gt;METHODS&lt;/strong&gt;: Between March 2005 and February 2006, 54 consecutive&amp;nbsp; atients with severe PVD admitted at a vascular surgery unit and underwent carotid duplex scanning in a prospective study. A&amp;nbsp; uestionnaire was used to collect data concerning known risk factors. Significant CAS was defined as a stenosis of 70% or greater.&lt;/li&gt;&lt;li&gt;&lt;strong&gt;RESULTS&lt;/strong&gt;: The mean age was 62.5 years (51-72). Out of 54 patients, 2 (3.7%) had an occluded internal carotid artery. Significant CAS was found in 9 (16.7%) and its presence was correlated with diabetes, hypertension, hypercholesterolemia, hypertriglyceridemia, coronary artery disease, severity of symptoms, ankle-brachial index, and carotid bruit. On multivariate analysis, only hypercholesterolemia and carotid bruit seemed to have independent influence.&lt;/li&gt;&lt;li&gt;&lt;strong&gt;CONCLUSION&lt;/strong&gt;: The prevalence of significant ACAS is higher among&amp;nbsp; atients with severe PVD. This patient population may indicate a&amp;nbsp; uitable subgroup for screening of ACAS, especially when hypercholesterolemia and carotid bruit are present.&lt;/li&gt;&lt;li&gt;&lt;strong&gt;KEYWORDS&lt;/strong&gt;: Carotid artery stenosis, duplex ultrasound scanning, peripheral vascular disease, carotid endarterectomy,&lt;/li&gt;&lt;li&gt;cerebrovascular accident.&lt;/li&gt;&lt;/ul&gt

Intra-Abdominal Desmoplastic Small Round Cell Tumor in A 45-Year-Old Man: A Case Report

Intra-abdominal desmoplastic small round cell tumor is a rare entity with a few reports worldwide. This tumor commonly occurs in children and adolescent and occurrence in adult age group is very rare. Here, we describe an adult male with symptoms of intestinal obstruction due to abdominal mass, located in splenic flexure. After resection, the diagnosis of intra-abdominal desmoplastic small round cell tumor was established by pathologic and immunohistochemical studies. We emphasize that albeit being rare, this tumor should be mentioned as one of the differential diagnoses of widespread intra-abdominal lesions in any age group.  A brief review of epidemiology, clinical manifestations as well as pathological and molecular features is also included in the paper

The effect of age on the outcome of esophageal cancer surgery

Background: Surgery is still the best way for treatment of esophageal cancer. The increase in life expectancy and the rising incidence of esophageal tumors have led to a great number of elderly candidates for complex surgery. The purpose of this study was to evaluate the effects of advanced age (70 years or more) on the surgical outcome of esophagectomy for esophageal cancer at a single high-volume center. Materials and Methods: Between January 2000 and April 2006, 480 cases with esophageal cancer underwent esophagectomy in the referral cancer institute. One hundred sixty-five patients in the elderly group (70 years old or more) were compared with 315 patients in the younger group (&#60; 70 years). All in-hospital morbidity and mortality were studied. Results: The range of age was 38-84 years, with a mean of 58.7. The mean age of the elderly and younger groups was 74 and 53.2, respectively. In the younger group, 70 patients (22.2&#x0025;) and in the elderly group, 39 patients (23.6&#x0025;) were complicated ( P 0.72).The most common complications in the two groups were pulmonary complications (9.8&#x0025; in younger and 10.3&#x0025; in elderly) ( P 0.87). Rates of anastomotic leakage and cardiac complications were also similar between the two groups. Hospital mortality rates in younger and elderly patients were 2.8&#x0025; and 3&#x0025;, respectively. There was no significant difference between the two groups in morbidities and mortality ( P -value &gt; 0.05). Conclusions: With increased experience and care, the outcomes of esophagectomy in elderly patients are comparable to young patients. Advanced age alone is not a contraindication for esophagectomy

Diagnostic Performance of Sonoelastography in Addition to Ultrasound in Investigating Breast Lesions: Can Concomitant Use of These Techniques Lead to Improvement of Differentiation?

Background: Sonoelastography (SE) is introduced as a complementary technique for ultrasoungraohy (US) to evaluate breast lesions. This method is based on tissue strain in response to compression and decompression. The current study was designed to investigate the diagnostic performance of SE for differentiating between benign and malignant breast lesions Methods: A total of 35 women with 45 breast lesions who were referred to a university affiliated hospital in Tehran were enrolled. All patients were visited and examined by a same radiologist. A five-point scale was applied for categorizing lesions in SE as malignant or benign. The results of US and SE were compared with histopathological results to calculate sensitivity and specificity of each mentioned techniques. Results: Histopathological evaluations in 12 cases were in favor of malignancy, and the rest of cases were classified as benign. The sensitivity and specificity for US were 100% and 69.7%, respectively. On other hand, SE obtained a lower sensitivity (58.3%) and higher specificity (90.9%) in comparison with US. Conclusions: simultaneous evaluation of suspicious breast lesions with both US and SE can have high sensitivity and specificity and prevent the unnecessary invasive interventions

Minimal access mediastinal surgery: One or two lung ventilation?

Background : Minimal access mediastinal surgery (MAMS) is usually performed under general anaesthesia with double lumen tubes (DLT). The aim of this study is to evaluate two lung ventilation through single lumen tubes (SLT) during thoracoscopic sympathectomy for hyperhidrosis and thoracoscopic thymectomy for myasthenia gravis. Methods : In this prospective non-randomized study, MAMS was performed in 58 patients with hyperhidrosis and 42 patients with myasthenia gravis, from January 2002 to December 2008. Patients were intubated with a DLT or SLT, 50 patients in each group. In the DLT group, endobronchial tubes were placed using the traditional blind approach and one lung ventilation was confirmed clinically. In the SLT group, the hemithorax was insufflated with CO2 in conjunction with two-lung anaesthesia. All the patients were evaluated for haemodynamic stability, oxygen saturation of haemoglobin (Spo2), end-tidal Pco2 (ETPco2), times required for intubation and surgery, satisfaction of surgeon with regard to exposure and postoperative complications. Results : In the SLT group, all the patients had stable haemodynamic and ventilation parameters. In the DLT group, haemodynamic instability occurred in two, decrease in Spo2 in four and increase in ETPco2 in three patients. One patient in the DLT group developed vocal cord granuloma two months later. Time required for surgery and the surgeon′s opinion with regard to exposure were similar for both groups. Conclusion : Thoracoscopic surgery when used in cases where a well-collapsed lung may not be essential, since surgery is not performed on the lung itself, does not require DLT. SLT is safe in MAMS. It provides good surgical exposure and decreases the cost, time and undesirable complications of DLT