Surgery for bleeding esophageal varices

A total of 72 patients were operated for bleeding esophageal varices over five years. Cause of portal hypertension was cirrhosis in 33, Schistosomal fibrosis in 23 and a combination of the two diseases in 3 cases. Biopsy was not available in 13 patients. Fifty-eight patients were child grade A and B, while 14 patients were grade C. Overall, there were 16 hospital deaths [22.2%] and 28 patients had complications [38.8%]. Specifically, Hassab's operation was done in 40 patients with 12.5% mortality and 11.7% incidence of rebleeding. Hassab's operation plus esophageal transection in 13 patients was associated with 46.1% morality and no incidence of rebleeding. Warren's splenorenal shunt, done in 11 patients, was accompanied by 1 [9%] death and no incidence of rebleeding. Mortality rate increased significantly when esophageal transection was added to Hassab's operation. It is concluded that for low risk patient being operated electively, Warren's shunt is an acceptable alternative to Hassab's operation which is better suited to emergency situations. Esophageal transection should not be added to Hassab's operation because this increases the mortality

Pectoralis major myocutaneous flap for reconstruction of defects following resections in head and neck area

Pectoralis major myocutaneous flap [PMMF] has become the standard for reconstruction of major defects in head and neck area. Eleven cases, operated over a three year period, in which PMMF was used for reconstruction have been reviewed retrospectively. Nine patients had oral squamous cell carcinoma, one had a basal cell carcinoma of the external ear and one had lost skin and soft tissue of neck following synergistic gangrene. Ten of the eleven flaps survived [success rate 91%]. One of the three rib grafts used to reconstruct mandible got infected and had to be removed. Three patients developed wound infections and one had a temporary orocutaneous fistula which closed spontaneously. This brief experience confirms the reliability and efficiency of PMMF for head and neck reconstruction

Splenic abscess presentation, diagnosis and management

Splenic abscess is infrequently encountered. This paper reports on the diagnosis and management of six cases from Southern Saudi Arabia. Common presenting features were diffuse abdominal pain and fever. Signs localized to left upper quadrant of the abdomen were present in only two patients. The difficulty of diagnosis is signified by the fact that two cases were overlooked during initial surgery. The computed tomographic [CT] scan was quite accurate in three cases while ultrasound was reliable in five patients. Known causes of splenic abscess were present in four of the six patients. Two patients had gangrenous bowel and one each had bacterial endocarditis and sickle cell trait. All patients were managed by perioperative antibiotics and splenectomy. Review of the literature shows that splenectomy remains the treatment of choice while CT-guided aspiration is being increasingly employed especially for the poor-risk patients with unilocular abscesses

Transfer of latissimus dorsi muscle as myocutaneous flap

Latissimus dorsi muscle can be transferred as a muscle flap, myocutaneous flap or as a functioning muscle. It can also be used as free muscle or myocutaneous flap. Its long vascular pedicle makes it possible to rotate this muscle through a wide arc of rotation covering neck and upper extremity. It is a large muscle with extensive area and is ideally suited to cover large areas of skin defect. We are reporting eight cases of latissimus dorsi transfer as a myocutaneous flap to cover the skin defects in neck, axilla and upper extremity. Two cases were post-burn and five post-traumatic. One defect was secondary to excision of a large neurofibroma in the area of elbow. Most of the defects at donar sites could be closed primarily. There was only a partial marginal necrosis of transferred tissue in one case. Based upon the knowledge of its vascular anatomy, part of the muscle can be used for transfer which makes the flap less bulky and it can be tailored exactly to the primary defect