Gas in the portal system in a patient with an irreversible bowel ischaemia: a case report

The presence of gas in the portal system is an ominous radiological sign. We report a 63-year-old male patient presented on 27th of March 2003 with acute peritonitis secondary to acute irreversible intestinal ischemia caused by acute thrombosis of the superior mesenteric artery. Abdominal computerized tomography scans showed hepatic portal venous gas. The etiology, imaging features and clinical significance of hepatic portal venous gas are discussed. The computerized tomography scan signs of strangulation include thickening of the bowel wall, pneumatosis intestinalis, and portal venous gas

Local infiltration anesthesia versus spinal anesthesia in pilonidal sinus surgery

To compare local infiltration anesthesia plus sedation with spinal anesthesia for pilonidal sinus surgery, with respect to recovery time, postoperative complications and patient satisfaction. This study was conducted at Prince Hashem Military Hospital, Zarqa. A total of 64 patients were randomized into two groups; local infiltration anesthesia group [n=32] received local anesthesia of 20 ml 0.5% bupivacaine infiltrated around the pilonidal sinus plus 1.5-3 mg intravenous midazolam and spinal anesthesia group [n=32] received 1.5 ml of 0.5% bupivacaine into the subarachnoid space as spinal anesthesia. Perioperative side effects, visual analogue pain scale score for three days, patient satisfaction and hospital stay were recorded and assessed. Patients in the spinal anesthesia group spent more time in the operating theater and recovery room. Two thirds of the patients in the local infiltration anesthesia group [65.6%] left the hospital on the day of surgery, compared to only [34.4%] in the spinal anesthesia group. About 91% were satisfied in-group local infiltration anesthesia in comparison to 75% in the spinal anesthesia group Postoperative complications occurred in five patients of spinal anesthesia group [3 urinary retention and 2 spinal headache]. Sacrococcygeal local infiltration anesthesia for pilonidal sinus resulted in lower complications, shorter hospital stay and more postoperative patient's satisfaction

Agenesis of gall bladder, A case report

Congenital absence of gall bladder is a rare anomaly, we report a case of agenesis of gall bladder in a 62-year-old female patient who presented with obstructive jaundice misdiagnosed as a gall bladder and common bile duct stones on a pre-operative ultrasound and computerized tomography. The diagnosis of absent gall bladder was confirmed during laparotomy by per-operative cholangiogram. The relative embryological development, diagnostic pitfalls, intra operative management, and therapeutic strategies are discussed