Inguinal Hernia and Airport Scanners: An Emerging Indication for Repair?

The use of advanced imaging technology at international airports is increasing in popularity as a corollary to heightened security concerns across the globe. Operators of airport scanners should be educated about common medical disorders such as inguinal herniae in order to avoid unnecessary harassment of travelers since they will encounter these with increasing frequency

Complex Liver Resections for Colorectal Metastases: Are They Safe in the Low-Volume, Resource-Poor Caribbean Setting?

Introduction. Although many authorities suggest that major liver resections should only be carried out in high-volume specialized centres, many patients in the Caribbean do not have access to these health care systems. Presentation of a Case. A 50-year-old woman with a solitary colorectal metastasis invading the inferior vena cava underwent an extended left hepatectomy with caval resection and reconstruction. Several technical maneuvers were utilized that were suited to the resource-poor environment. Conclusion. We suggest that good outcomes can still be attained in the resource-poor, low-volume centres once dedicated and appropriately trained teams are available

Revisiting Current Strategies for Primary Prevention of Motorcycle Collisions in Jamaica

Motorcycle Road Traffic Collisions place a heavy burden on emergency medical ‎services in Jamaica. We explore the existing strategies and legislative policies that ‎may prevent or reduce the severity of these injuries in Jamaica. This is an important ‎aspect of health care as it may minimize the impact of these preventable injuries on ‎the limited resources of the health services.

Colonic Foreign Body Retrieval Using a Modified TAMIS Technique with Standard Instruments and Trocars

Background. Reports of retained colorectal foreign bodies (CFBs) are no longer considered uncommon. We present a case where a retained CFB was retrieved using a modified TAMIS technique using standard instruments and trocars. Case Report. A 52-year-old man presented with a CFB. We report our technique of extraction with standard laparoscopic instruments without specialized access platforms. Conclusions. This modified TAMIS technique is well suited for resource poor environments because it requires no specialized equipment, platforms, or additional skill sets compared to conventional laparoscopy

Stump Cholecystitis: Laparoscopic Completion Cholecystectomy with Basic Laparoscopic Equipment in a Resource Poor Setting

Introduction. Stump cholecystitis is a recognised condition in which a large gallbladder remnant becomes inflamed after subtotal cholecystectomy. When this occurs, a completion cholecystectomy is indicated. Traditionally, these patients were subjected to open surgery because the laparoscopic approach was anticipated to be technically difficult. We present a case of completion cholecystectomy using basic laparoscopic equipment in a resource poor setting to demonstrate that the laparoscopic approach is feasible. Case Description. A 57-year-old woman presented with right upper quadrant pain and vomiting. She had an elective open cholecystectomy seven years before but reported remarkably similar symptoms. Abdominal ultrasound suggested calculous acute cholecystitis. MRCP confirmed the presence of a large gallbladder remnant with stones. Gastroduodenoscopy excluded other differentials. She had an uneventful laparoscopic completion cholecystectomy performed. Discussion. Although traditional dogma suggested that a completion cholecystectomy should be performed through the open approach, several small studies have demonstrated that laparoscopic completion cholecystectomy is feasible and safe. This report adds to the existing data in support of the laparoscopic approach

Hepatic surface grooves in an Afro-Caribbean population: a cadaver study

Introduction: There have been no previous reports on hepatic surface grooves in an Afro-Caribbean population. This information is important to optimize radiology and hepatobiliary surgical services in the region. Methods: Two investigators independently observed 69 cadaveric dissections performed over five years at the University of the West Indies. Variations in surface anatomy were described. Results: In this Caribbean population the majority of patients had conventional hepatic surface anatomy (88%). However, we found a greater incidence of hepatic surface grooves (12%) than reported in international literature. Conclusion: Abnormal surface anatomy is present in 12% persons in this population. Interventional radiologists and hepatobiliary surgeons practicing in the Caribbean must be cognizant of these differences in order to minimize morbidity during invasive procedures

Accessory renal arteries in a Caribbean population: a computed tomography based study

INTRODUCTION: The commonest variation to the classic anatomic description of renal arterial supply is the presence of accessory renal arteries. The incidence varies widely according to ethnicity. There is no data on the prevalence of these anomalies in persons of Caribbean ethnicity. METHODS: All CT scans done over two years from July 1, 2010 to June 30, 2012 were retrospectively evaluated. The anatomy of the renal arterial supply was reported from these studies and the anatomy of accessory renal arteries was documented. RESULTS: There were 302 CT scans evaluated and accessory renal arteries were present in 109/302 (36.1%) CT scans, 95% confidence interval 30.6%, 41.4%. There were 71/309 (23.5%) patients with accessory arteries on the left and 54/309 (17.9%) had them on the right (p 0.087). Of these, 16 (14.7%) patients had bilateral accessory renal arteries present. The most common origin for the accessory arteries was the abdominal aorta in 108 (99.1%) cases and in 1 case the accessory artery arose from the coeliac trunk. There were 80 left sided accessory renal arteries: 17 (21.3%) upper polar and 27 (33.8%) lower polar arteries. Of 62 right sided accessory arteries, 14 (22.6%) were upper polar and 26 (42%) were lower polar arteries. CONCLUSION: This is the first population-based report of anatomic anomalies in renal arterial supply in a Caribbean population. These are important findings that may affect vascular and urologic procedures on persons of Caribbean ethnicity

The impact of helmets on motorcycle head trauma at a tertiary hospital in Jamaica

<p>Abstract</p> <p>Background</p> <p>Although the Jamaica road traffic act mandates motorcycle riders to wear approved helmets, opponents suggest that the local road conditions obviate any benefits from helmet use that have been proven in Developed countries. They suggest that the narrow, winding, poorly surfaced, congested local highways do not allow motorcyclists to sustain high velocity travel. The accidents then tend to occur at lower speeds and are accompanied by less severe injuries. This study was carried out to determine the impact of helmet use on traumatic brain injuries from motorcycle collisions in patients admitted to a tertiary referral hospital in Jamaica.</p> <p>Methods</p> <p>A prospectively collected trauma registry maintained by the Department of Surgery at the University Hospital of the West Indies in Jamaica was accessed to identify all motorcycle collision victims from January 2000 to January 2007. The therapeutic outcomes of traumatic brain injuries were compared between helmeted and un-helmeted riders. The data was analyzed using SPSS Version 12.</p> <p>Results</p> <p>Of 293 motorcycle collision victims, 143 sustained brain injuries. There were 9 females (6.3%) with an average age of 23 +/- 7.3 years and 134 males (93.7%) at an average age of 33.4 +/- 11.2 years (mean +/- SD). Only 49 (34.3%) patients wore a helmet at the time of a collision. Helmet use at the time of a collision significantly reduced the severity of head injuries (28.6% vs 46.8%, P = 0.028) and the likelihood of sustaining intra-cranial lesions (26.5% vs 44.7%, P = 0.03) from head injuries.</p> <p>Conclusion</p> <p>Wearing a helmet at the time of a motorcycle collision reduces the severity of head injuries. However, the prevalence of helmet use at the time of a collision is unacceptably low.</p

A case of a paraduodenal hernia

Paraduodenal hernias are rare hernias that result from error of rotation of the mid-gut. It can be discovered incidentally at laparotomy, seen on radiological imagining or infrequently cause intestinal obstruction. We report a case of a left paraduodenal hernia diagnosed intraoperatively after being operated on in the emergency setting for generalized peritonitis. He required resection of multiple loops of small bowel with primary anastomosis. The mouth of the sac was obliterated by suture apposition to the posterior wall. The patient was discharged on day 4 after an uneventful recovery