Post-cholecystectomy bile leak new classification and management

The aim of this prospective study was to identify the cases of bile leak and their subsequent management in view of the up-to-date Gouma classification. Twelve patients with bile leak and suspected biliary tract injury were included in the study [11 females and one male with a mean age of 46 years]. Ten patients underwent laparoscopic cholecystectomy and two patients had open cholecystectomy; they were subjected to history, clinical examination, liver function tests, ultrasound and ERCP. They were classified by Gouma 1998 into four groups [A, B, C and D] according to the type of the lesion. The study concluded that most of the patients with bile leak can be classified and managed successfully by ERCP and those who had concomitant bile duct injury that be treated surgically with Rou en Y biliary enteric bypass

Prognostic scoring systems to predict outcome in peritonitis and intra-abdominal sepsis

In this study evaluation of the value of various scoring systems [acute physiology and chronic health evaluation [APACHE] II, simplified acute physiology score, sepsis severity score, multiple organ failure, Mannheim peritonitis index [MPI], Ranson and Imrie] was performed in 25 patients. Additionally, scoring systems were combined to obtain a combined score for the prediction of peritonitis-related in-hospital death. Hazard ratios were calculated in univariate and multivariate analysis. In the univariate analysis, all scoring systems, except Ranson and Imrie, predicted the primary outcome. In the multivariate analysis, only the APACHE II score [hazard ratio 6.7] and the MPI [hazard ratio 9.8] contributed independently to the prediction of the outcome. All patients with an APACHE II score of 20 or more and a MPI of 27 or more died in hospital