Great saphenous vein diameter at different regions and it's relation to reflux

Background: Great saphenous vein (GSV) incompetence is involved in the majority of cases of varicose disease. Standard pre-interventional assessment is required to decide the treatment modalities. GSV diameter measured at sapheno-femoral junction, proximal thigh, distal thigh, knee, proximal leg, distal leg. Analysis done to find at which diameter size the reflux expected to occur.Methods: The study involved 100 limbs from outpatient vascular clinic. GSV diameter measurement was done at the sapheno-femoral junction, at the proximal thigh, at the distal thigh, below the knee, mid leg in correlation to the reflux.Results: SFJ reflux (group I) was observed at 7.16±2.30 mm, proximal thigh (group II) at 6.60±1.89 mm, distal thigh (group III a) at 6.12±1.63 mm, knee (group III b) at 5.78±1.60 mm, proximal leg (group IV) at 4.6±1.24 mm, and mid leg (group V) at 3.59±1.16 mm.Conclusions: Measurement at six sites revealed higher sensitivity and specificity to predict reflux, GSV diameter correlates with reflux, sites to predict reflux not only at SFJ and proximal thigh but GSV measurement at knee joint can predict reflux. Measurement of GSV at knee joint can predict reflux if more than 5.5 mm.

Perforated appendicitis presenting with ileo-caecal ulceration and mechanical intestinal obstruction.

A 30-year-old lady presented with a 6-month history of recurrent partial intestinal obstruction associated with intermittent fever, anorexia and weight loss. Barium meal follow-through and colonoscopic evaluation suggested ulceration of the ileum and caecum with small bowel obstruction. Histology of the lesions showed marked acute and chronic inflammation consistent with ulceration and granulation tissue. Abdominal CT revealed circumferential thickening of the ascending colon, caecum and terminal ileum with extraluminal air pockets. Surgical exploration revealed a large conglomerate mass involving the terminal ileum, caecum and ascending colon. Histopathology of the resected specimen revealed perforated appendix with nonspecific ulceration of the surrounding bowel. She recovered completely after surgery and did not suffer from gastrointestinal symptoms in the 14 months of follow-up.