Case Report-Delayed cholangitis due to a retained T-tube fragment

Biliary drainage with T-tube after bile duct exploration has some advantages. However, the use of T-tube is associated with significant complications. Retained T-tube fragment is a rare complication after biliary surgery. We present an unusual case of delayed cholangitis resulting from a retained T-tube fragment and common bile duct stones, occurring four years after previous bile duct exploration in the case of colon cancer. We recommend early removal of a missing fragment to avoid potential serious complications

Case Report-Delayed cholangitis due to a retained T-tube fragment

Biliary drainage with T-tube after bile duct exploration has some advantages. However, the use of T-tube is associated with significant complications. Retained T-tube fragment is a rare complication after biliary surgery. We present an unusual case of delayed cholangitis resulting from a retained T-tube fragment and common bile duct stones, occurring four years after previous bile duct exploration in the case of colon cancer. We recommend early removal of a missing fragment to avoid potential serious complications

A new look at an old dogma: Wound complications in two methods of skin closure in uncomplicated appendicitis

Background: Appendicitis is more common during the second and third decade of life and appendectomy scar is important in terms of cosmetic issues. The scar is an important factor in the patient's satisfaction. Conventional teaching has an emphasis on the closure of skin incision with "separate" sutures. The aim of this study was to reconsider this dogma.\ud \ud Methods: Among 321 patients with acute appendicitis who came to the emergency unit of Imam Khomeini Hospital in Tehran, Iran since april 2007 till april 2008, 278 (86.6%) patients had uncomplicated appendicitis and were enrolled in our clinical trial. The patients were randomly assigned to two groups of interrupted suture closure (n=139) and subcuticular suture closure (n=139). Anesthesia method and surgical technique were similar between the two groups. All patients were followed up post-operatively (four weeks) for the presence of infectious drainage, pain, erythema, swelling and warmness at the surgical site.\ud \ud Results: The patients' sex and their mean age were not statistically different between the groups. There was no significant difference in the frequency of surgical site complications between the two groups (five cases in the "interrupted" group and eight cases in the "subcuticular" group p=0.415).\ud \ud Conclusion: This study showed that appendectomy incision closure with subcuticular sutures did not increase the risk of wound complications. From the point of better cosmetic outcome of subcuticular sutures, this method may be the method of choice for the closure of appendectomy incisions in uncomplicated appendicitis