Jejunal Diverticulitis: A Rare Case of Severe Peritonitis

A 25-year-old African American female with no prior medical/surgical history presented with abdominal pain and fever. A computed tomography scan of the abdomen and pelvis showed jejunal wall thickening with an air-fluid-filled mass in the adjacent mesentery. At laparotomy, a segmental jejunal resection with the abscess cavity followed by primary anastomosis was performed. Pathological evaluation of the specimen revealed a large mesenteric abscess contiguous with a perforated solitary jejunal diverticulum. We provide a discussion of jejunal diverticulitis as an unusual cause of peritonitis

Laparoscopic Cholecystectomy Conversion Rates Two Decades Later

Male patients greater than 50 years of age and cases performed by low-volume surgeons were found to have a higher rate of conversion to open procedures

Eosinophilic Cholangitis and Cholangiopathy: A Sheep in Wolves Clothing

Background. Eosinophilic cholangitis (EC) is a rare benign disorder of the biliary tract which can cause biliary obstruction. Similar to other disease processes involving the bile ducts, this disorder can pose a difficult diagnostic challenge as it can mimic cholangiocarcinoma. Methods. A systematic search of the scientific literature was carried out using PubMed to access all publications related to EC. Search keywords that were utilized included “eosinophilic cholangitis,” “etiology,” “treatment,” and “obstructive jaundice.” Results. Twenty-three cases of EC have been reported. Nineteen patients (82.6%) who presented with EC remain disease-free; 15 of these 19 patients (78.9%) with followup time remain disease-free at a mean of 9.7 months (range, 2–24 months). Conclusion. EC is a rare form of biliary obstruction which can masquerade as a malignancy. Unlike cholangiocarcinoma, EC occurs more commonly in younger patients and in men. Most patients will require surgical treatment

Transplant Critical Care: Is There A Need for Sub-specialized Units? — A Perspective

The critical care involved in solid-organ transplantation (SOT) is complex. Pre-, intra- and post-transplant care can significantly impact both – patients’ ability to undergo SOT and their peri-operative morbidity and mortality. Much of the care necessary for medical optimization of end-stage organ failure (ESOF) patients to qualify and then successfully undergo SOT, and the management of peri-operative and/or long-term complications thereafter occurs in an intensive care unit (ICU) setting. The current literature specific to critical care in abdominal SOT patients was reviewed. This paper provides a contemporary perspective on the potential multifactorial advantages of sub-specialized transplant critical care units in providing efficient, comprehensive, and collaborative multidisciplinary care

Extended Pancreatectomy for Pancreatic Cancers.

Pancreatic cancer carries a poor prognosis. A minority of patients are considered for surgical excision. Local extension, lymph node metastasis, poor prognosis with distal spread and the lack of effectiveness of chemo and radiotherapy, have led to a nihilistic approach to this disease. This review outlines the rationale for and technique of extended resections in pancreatic cancer

Rectal Cancer: Current Recommendations on Screening, Diagnostic Investigations and Treatment.

Despite periodic efforts in creating health awareness, no focused screening or early detection programmes for cancers have been strictly implemented within India. Rectal cancers have a relatively low incidence within the Indian population in comparison to those of the Western World. Combined with cancers of the colon, rectal cancers rank amongst the top five digestive malignancies in India with an apparently increasing incidence in sync with urbanization. Notably, if detected early these cancers could be completely cured or at the least treated to prolong survival. We provide a systematic guideline to screen, diagnose and treat rectal cancers

A Comprehensive Review of Single-Incision Laparoscopic Surgery (SILS) and Natural Orifice Transluminal Endoscopic Surgery (NOTES) Techniques for Cholecystectomy

INTRODUCTION: Surgery of the gallbladder has evolved tremendously over the last century. Laparoscopic cholecystectomy is the gold standard for gallbladder removal and the most common laparoscopic procedure worldwide. In recent times, innovative techniques of natural orifice transluminal endoscopic surgery (NOTES) and single-incision laparoscopic surgery (SILS) have been applied in gallbladder removal as a step towards even more less-invasive procedures. DISCUSSION: While NOTES and SILS represent the advent of essentially scarless surgery, limited applications of these technologies in human subjects exists. In this article, we present a comprehensive review of the potential benefits, limitations and risks of these novel techniques. CONCLUSION: While much remains unknown and unanswered surrounding these procedures, it is clear that extensive research and development with regards to the ethics and the technical aspects of these procedures as well as randomized studies to compare them with traditional laparoscopy are essential

Pancreato-Enteric Anastomosis: The Duct Evagination Technique.

Pancreatic anastomotic failure remains the most frequent and potentially life-threatening complication following Pancreatoduodenectomy. Numerous modifications in the technique of the pancreatoenteric anastomosis have been reported. We suggest a simple modification which involves evaginating the cut end of the pancreatic duct. This technique helps avoid a compromise of the pancreatic ductal patency, and by achieving a wide pancreatic ductal opening can facilitate a safer pancreato-enteric anastomosis. In addition, by possibly decreasing the likelihood of post-operative pancreatic ductal stenosis, it has the potential to reduce post-Pancreatoduodenectomy pancreatic exocrine insufficiency. The modification acts as an adjunct to an already established technique yielding good results

Current Status of Laparoscopic Surgery in Gastrointestinal Malignancies.

Laparoscopy has become a significant tool in a surgeon\u27s armamentarium since the first laparoscopic cholecystectomy in 1989. Oncological surgeons have been slow in adopting laparoscopy for fear of inadequate cancer operation and occurrence of port site metastasis. Neither of these concerns have stood the test of time. Laparoscopy is being used increasingly in oncological surgery both for staging and respective surgery. This article outlines the present use of laparoscopy in GI cancer surgery