Courvoisier's law revisited

According to Courvoisier's law; if gallbladder is palpable in a jaundiced patient, it is unlikely to be due to gallstones, because stones would have given rise to chronic inflammation and subsequently fibrosis of gallbladder therefore, rendering it incapable of dilatation. Conversely, the causes other than stone [principally tumours], would result in the distension of gallbladder, felt on abdominal palpation. However, in Courvoisier study of 109 cases of dilatation of gallbladder, 17 were due to impacted stones. Therefore, Courvoisier concluded that dilatation of gallbladder was rare with stones obstructing the common bile duct. Despite this fact it is always assumed that the palpable gallbladder is due to malignancy [pancreatic or periampullary etc.]. Here, we report a rare case of palpable gallbladder in a jaundiced patient due to multiple cholelithiasis and a large choledocholithiasis causing obstruction of CBD

Role of laparoscopic cholecystectomy in the management of acute cholecystitis

To evaluate the safe technique of surgery in patients with acute cholecystitis and to highlight the better method in which patient can be prevented from complications. A descriptive study. This study was conducted at Larkana, Sindh from February 2002 to August 2004. A total of 504 patients underwent laparoscopic cholecystectomy. Out of these, 398 patients were treated by elective laparoscopic cholecystectomy and 106 patients underwent emergency laparoscopic cholecystectomy for acute cholecystectitis. Among 106 patients, females were double [73.1%] than males and most of these patients were received within 24 hours of the onset of symptoms. In 56 [52.83%] patients, ultrasound revealed odematous gall bladder, mucocele, empyma, contracted, perforated and gangrenous gall bladder. Per-operative complication was encountered in 71 [66.98%] patients including bleeding, minor injury to common bile duct [CBD] and liver, adhesions of gall bladder with omentum, stomach, colon, CBD, and distorted anatomy of Calot's triangle. The minimum time taken during the procedure was 50 minutes. In 5 [4.72%] patients, the laparoscopic procedure was converted to open and reasons for conversion were bleeding, tight, dense adhesions and perforated gallbladder leading to biliary peritonitis. Emergency cholecystectomy is reliable and safe modality in the management of acute cholecystitis. Certain factors are responsible for the conversion, which include delayed arrival of patient, patients with perforated gall bladder, bleeding and adhesions. Hence, emergency laparoscopic cholecystectomy seems to be safe, cost effective, and timely surgery with modern conception. This timely surgery prevents the complications associated with acute cholecystitis

Laparoscopic cholecystectomy experience of 100 cases at a teaching hospital of Sindh

To study the complications, conversion rate and hospital stay during the initial experience with the laparoscopic cholecystectomy. A case series. Chandka Medical College Hospital, Larkana - Sindh from March 2003 to February 2004. Total 100 patients suffering from symptomatic gallstone disease were admitted for laparoscopic cholecystectomy. Out of 100 laparoscopic cholecystectomies performed, 85 [85%] patients were females and 15 [15%] males. Age range was 25 to 70 years. Only 8 [8%] patients were converted to open surgery. Mean operative time was 60 minutes. Post-operative hospital stay was 24 to 48 hours for uncomplicated cases. Post-operative complications included biliary leakage 3% minor and 1% major, duodenal perforation 1% and port site infection 8%. Laparoscopic cholecystectomy is the ideal procedure for gallstone disease. However, the complications and conversion rate can be minimized by the appropriate training and experience

Symptomatic meckel's diverticulum

A study was conducted to look out for the incidence and management of symptomatic Meckel's Diverticulum at Peoples Medical College Hospital, Nawabshah [Pakistan].Twenty-two patients admitted between January 1996 and December 1998 over a period of 3 years were included in the study. Fifteen Patients presented with acute / subacute intestinal obstruction, 3/22 with peritonitis due to perforated Meckel's Diverticulum and 4/22 with bleeding per rectum 17/22 patients [77.27 percent] had wedge resection of Meckel's Diverticulum's and 5/22 [22.72 percent] were treated with segmental resection. The incidence of complicated Meckel's Diverticulum is fairly common in our area. Though laparoscopy is a preferred diagnostic as well as therapeutic procedure, laparotomy still remains the procedure of choice for both purposes in case of suspected or complicated Meckel's Diverticulum when Laparoscope is not in practice