Liver hydatid cyst: pattern and methods of surgical treatment

Hydatidosis of liver is very old surgical problem worldwide and one of the commonest parasitic diseases that affect the man's health. In humans, 50% to 75% of hydatid cysts occur in the liver. The radical surgical removal of the cystic lesion remains the mainstay of treatment with a high success rate. The aim of this paper to report the surgical management of liver hydatid diseases in Iraq. 34 patients [59% males, 41% females] were observed during the period from April 2008 to May 2010, the mean age is 42 years. All patients were examined clinically and diagnosis obtained radiologically [ultrasonography, CT scan and in selected cases MRI], operative and postoperative details were recorded for every patient. The mean age of the patients was 42 years [range, 16-62 years]. 20 patients [59%] were males and 14 patients [41%] were females. The peak age group affected was between 3[rd] - 6[th] decades in 70.5%. The disease was primary in 23 patients [68%] and recurrent in patients [32%]. The cyst was single in 14 patients [41%] and multiple in 20 patients [59%]. Fifty percent multiple hydatid disease was recurrent, while the other 50% was primary. The Rt. Lobe of the liver was affected in 19 cases [56%], the Lt. lobe was affected in 4 patients [12%], and both lobes were involved in 11 patients [32%]. The clinical presentation include: upper abdominal pain/ discomfort in 18 patients [53%], palpable mass in 5 patients [14.7%], jaundice in 3 patients [8%], acute abdomen in 2 patients [6%], incidental findings in 6 patients [17.5%]. Mode of surgical treatment was as follow: excision and external tube drainage in 14 patients [41%], excision and partial pericystectomy [resection of redundant cyst wall and the residual cavity left open] in 7 patients [20.5%], excision and omentoplasty in 6 patients [17.5%], excision and primary suturing of the cyst wall and filling the cavity with normal saline in 5 patients [15%], and excision and marsupialization in 2 patients [6%]. No significant statistical difference in terms of morbidity and mortality between different surgical procedures, however cystectomy with external drainage was considered the standard surgical procedures especially in large sized cysts and bile communicate done

Peritoneal complications of ventriculo-peritoneal shunt: retrospective review of 23 cases

The management of hydrocephalus most commonly involves placement of ventriculoperitoneal shunts. However, high rates of complications have been reported, ranging from 24-47%, among which abdominal complications account for approximately 25%. The aims were evaluation of symptoms, diagnosis and surgical treatment in abdominal complications following ventriculoperitoneal shunt. Between June 2007 and August 2010 a retrospective review of 23 patients suffering from late complications of ventriculoperitoneal shunt were done at Al-Kadhimyia teaching hospital, Baghdad, Iraq. Patient presenting symptoms, time between the insetion of ventriculoperitoneal shunt, onset of abdominal complications and the operative time were recorded. Methods of diagnosis were also recorded. There were 4 male and 19 females, F:M ratio 4-75:1 and mean age of 11.5 years. Methods of diagnosis were as follows: abdominal CT in 10 patients, abdominal Ultrasound in 8 patients and x-ray in remaining 5 patients. Clinical presentations: fever in 26.1%, abdominal distension in 26.1%, abdominal pain in 21.7%, nusea and vomiting in 13% and headache in 13%. Abdominal complications include: infections [abscesses and peritonitis] in 26.1%, shunt disconnection with intraperitoneal distal catheter migration 21.7%, coiled catheters in the subcutaneous tissue in 21.7%, pseudocysts 17.4%, CSF ascites 8.7%, and excessive length of intraperitoenal tube 4.3%. Surgical treatment was: extraction of the foreign body in shunt disconnection with intraperitoneal distal catheter migration, evacuation, debridement, lavage and drainage for pseudocysts, abscess and peritonitis, shortening of the intraperitoneal tube in excessive length. The operative time ranged from 45-150 minutes. Shunts replacement or revision was ultimately successful in all patients. Infection is the most common abdominal complication after ventriculoperitoneal shunt. Infected shunt should be removed and replaced when all signs of infection subside. Reimplantation is successful in patients with CSF pseudocyst and ascitis

Laparoscopic cholecystectomy for acute cholecystitis an experience of 64 cases

To evaluate the feasibility and safety of laparoscopic cholecystectomy in severe acute cholecystitis, and to assess the incidence of complications. A prospective study included Sixty four patients with a confirmed diagnosis of acute cholecystitis at Al-Kadhimyia Teaching Hospital, over a period of 18 months from march 2009 to August 2010. Sixty four patients with diagnosis of acute cholecystitis were enrolled in our study. All of cases underwent laparoscopic cholecystectomy during the first 72 hours of their admission. Of the 64 patients there were 48 female and 16 male with a female to male ratio of 3:1. The age of our patients ranged from 19 years to 63 years with mean age of 35.6 years in female and 49.8 years in male. Cholecystectomy was completed successfully in 52 patients [81%], conversion to open conventional surgery was necessary in 12 patients [19%]. The main reasons were obscured anatomy [calot's triangle], excessive bleeding and dense adhesions. Data on presenting symptom, ultrasound findings, operative findings, hospital stay and complications were recorded. In the presence of severe acute cholecystitis laparoscopic cholecystectomy is feasible in most patients, with minimal risk of injury to surrounding structures, shorter hospital stay and considerable benefits. It is recommended that laparoscopic cholecystectomy should be attempted in these patients when appropriate surgical skill is available

Retained foreign bodies after abdominal surgery

To look into clinical presentations of intra-abdominal foreign bodies, identify risk factors for incorrect sponge and towel counts. Describe complications that can occur from retained sponges and towels, to see measures for prevention. The records of twelve patients with a confirmed diagnosis of gossypiboma after abdominal surgery at AL - Kadhimyia teaching hospital and private hospital, in Baghdad, between January 2007 and January 2010, were retrospectively reviewed. Nine of the twelve patients were female and three male. Previously, of the patients, three underwent elective operations and nine were operated on for emergency. Among retained surgical foreign bodies, sponges accounted for 66.6% of patients, gauze were found in 33.3% of patients. Operated in emergency 75% and elective 25%. Clinical presentations were intestinal obstruction 25%., abdomen Mass 25%, Discharging Sinus 16.6%, Intra abdominal abscess 16.6%, Persistent abdominal pain 16.6%. Retained foreign bodies commonly occur during an emergent procedure when the surgical team's efforts are completely focused on saving the patient's life. In that scenario, speed is essential and taking the time to perform a surgical count may not be an option. Other situations or factors that may lead to a retained foreign body include unplanned changes in the surgical procedure, patients with increased body mass, and procedures involving increased blood loss