Incidence, dianosis and management of Mirizzi syndrom in Kuwait

Mirizzi syndrome is an obstructive jaundice associated with pressure on the common hepatic duct from gallstones in Hartmann's pouch or the cystic duct. The stones sometimes erode through the main duct, leaving a fistula. We reviewed cases encountered between January 2001 and November 2002. Retrospective review of seventeen patients with diagnosis of Mirizzi syndrome managed in the surgical wards of Farwaniya Hospital. Patients were fully investigated including liver function tests, abdominal ultrasonography, ERCPand/or intra-operative cholangiography. During the study period 625 cholecystectomies were performed. Out of these, 17 were found to have Mirizzi syndrome which accounts for an incidence of 2.72%. In 11 patients, jaundice resulted from gallstone pressure [type I] and in the remaining six patients, the stones had eroded into the common hepatic duct producing a fistula [type II]. The diagnosis can usually be made preoperatively, especially if a large single stone is seen in conjunction with a dilated common hepatic duct and normal caliber common bile duct. We favor partial cholecystectomy, adding choledochoplasty using the gallbladder remnant, to close the fistula in type II cases

Primary infarction of the gastro-colic omentum and review of the literature

A 31-year-old male patient presented with epigastric pain and right-sided abdominal pain of one-day duration. He was later diagnosed as having a gastro-colic omental infarction [fixed part of the omentum]. To our knowledge this is the first case to be reported in the literature. In all other reports, infarctions were localized to the free omentum. We report this case to highlight the importance of omental infarction in the differential diagnosis of acute abdominal pain, since the management is mainly conservative

Acute appendicitis: review of 716 patients

To audit our result of all appendectomies performed during 1994 to assess a method by which to improve our results and to reduce our rate of negative appendectomy. A total of 716 patients, clinically diagnosed with acute appendicitis during 1994, were included in this study. The independent variables defined for each patient were age, sex, nationality, clinical diagnosis, operative finding, postoperative complication and length of hospital stay During 1994, 716 appendectomies were performed in Farwaniya Hospital. These accounted for 72% of all emergency abdominal operations and 33.3% of all general surgical operations, the male to female ratio was 2.7:1. Normal appendixes were reported in 131 [18.2%] patients; 52 females [26.8%] and 79 males [15.1%]. The perforation rate was 7.8%. Preoperative surgeon's sensitivity and specificity of diagnosis were studied. Surgeon's specificity was found to be only 46.4%. Overall, postoperative complications were seen in 4.3% of patients. Though correct and early diagnosis of appendicitis remains difficult despite the advanced investigations available, laparoscopy has the potential of improved diagnostic accuracy and post-operative recovery