Synchronous presentation of acute acalculous cholecystitis and appendicitis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Acute acalculous cholecystitis is traditionally associated with elderly or critically ill patients.</p> <p>Case presentation</p> <p>We present the case of an otherwise healthy 23-year-old Caucasian man who presented with acute right-sided abdominal pain. An ultrasound examination revealed evidence of acute acalculous cholecystitis. A laparoscopy was undertaken and the dual pathologies of acute acalculous cholecystitis and acute appendicitis were discovered and a laparoscopic cholecystectomy and appendectomy were performed.</p> <p>Conclusion</p> <p>Acute acalculous cholecystitis is a rare clinical entity in young, healthy patients and this report describes the unusual association of acute acalculous cholecystitis and appendicitis. A single stage combined laparoscopic appendectomy and cholecystectomy is an effective treatment modality.</p

Transarterial haemorrhoidal dearterialization versus open haemorrhoidectomy for symptomatic haemorrhoids- a meta-analysis of randomized controlled trials

To compare outcomes between trans arterial haemorrhoidal dearterialization (THD) versus open haemorroidectomy (OH) for symptomatic grade 2-4 haemorrhoid

Mesenteric manifestations in Crohn’s disease

Background Mesenteric manifestations are of pathobiologic relevance in Crohn’s disease. Clarification of mesenteric morphology provides an opportunity to re-appraise their pathogenic significance. Therefore, we examined the relationship between mesenteric, mucosal and systemic manifestations in Crohn’s disease. Methods A multi-institutional study was conducted in which mesenteric disease was quantified (mesenteric disease score) in patients undergoing resection (n=34) for CD. The mesenteric disease score was correlated with a mucosal disease score, and Crohn’s Disease Activity Index (CDAI). The relationship between mesenteric manifestations and surgical recurrence was retrospectively determined in a second cohort (n=94). Local mesenteric and systemic fibrocyte levels were determined using a combination of histology, immunohistochemistry and flow cytometry. Mesenteric and mucosal gene expressions were compared in Crohn’s disease patients, in silico using Chipster©, an R based bio-informatic software. Results Mesenteric disease scores correlated with mucosal disease scores (r=0.8, p<0.0001) and CDAI (r=0.7, p<0.0001) and were significantly increased in smokers (p<0.04). Mesenteric disease manifestations independently predicted increased risk of surgical recurrence (HR 4.7, 95% CI: 1.71-13.01, p=0.003) and reduced time to recurrence (p<0.001). Mesenchymal abnormalities included fibrocytosis and adipocyte hyperplasia and were contiguous between mesentery and adjacent intestine. The fibrocyte proportion of circulating monocytes was increased in Crohn’s disease compared with healthy controls (6.4 ± 2.82% vs. 2.0 ± 1.04%, p<0.001). Levels normalized following ileocolic resection (5.7 ± 2.12% vs. 1.7 ± 1.20%, p=0.005), in patients with ileocolic disease. Fibrocyte percentages correlated with mesenteric and mucosal disease scores as well as with the CDAI (r=0.94, p<0.0001). Mesenteric, but not mucosal, gene expression profiles were associated with connective tissue, immunologic and inflammatory disorders. Conclusions Mesenteric manifestations are an important part of the pathogenesis of Crohn’s disease; they are associated with smoking and disease severity, and have predictive value for surgical recurrence. Therefore, they should be formally scored and recorded at the time of surgery

Grading operative findings at laparoscopic cholecystectomy- a new scoring system

Introduction: Variation in outcomes from surgery is a major challenge and defining surgical findings may help set benchmarks, which currently do not exist in laparoscopic cholecystectomy. This study outlines a new surgical scoring system incorporating key operative findings. Methods: English language studies (from January 1965 to July 2014) pertaining to severity scoring and predictors of difficult laparoscopic cholecystectomy were searched for in PubMed, Embase and Cochrane databases using the search terms \u27Laparoscopic cholecystectomy or Lap chole\u27 and/or \u27Scoring Index or Grading system or Prediction of difficulty or Conversion to open\u27 in various combinations. Cross-referencing from papers retrieved in the original search identified additional articles. Results: Sixteen published papers report a gallbladder (GB) scoring system, but all relate to pre-operative clinical and imaging findings, rather than operative findings. The current scoring system, using operative findings incorporates the appearance of the GB, presence of GB distension, ease of access, potential biliary complications and time taken to identify cystic duct and artery. A score of &amp;lt;2 would imply mild difficulty, 2-4 moderate, 5-7 severe and 8-10 extreme. Conclusion: This paper reports one of the first operative classifications of findings at laparoscopic cholecystectomy. It has the potential to allow benchmarks for international collaboration of operative and patient outcomes in patients undergoing laparoscopic cholecystectomy