Successful management of chylous ascites using omental patch

To assess possible factors that may play a role in the etiology of chylous ascites formation, to determine the management of each type according to its causation, and to compare between the results of conservative and operative management. This is a prospective study conducted from 1990 to 2004 in the surgical department of Erbil, Iraq. A group of 46 patients with chylous ascites were subdivided into five subgroups according to the etiological factors. The initial assessment included: age, sex, history of trauma and previous surgery, time between the trauma, if it was present, and the appearance of chylous ascites, and aspiration of ascetic fluid for chemical and bacteriological analysis. Further assessment included the use of ultrasonography, computerized axial tomography, and Magnetic resonance imaging [MRI]. There were 12 female and 34 male patients. Their ages ranged form one year to 63 years [mean age 37 years]. There was abdominal distention resulting from the accumulation of chyle in the peritoneal cavity in all five subgroups of patients. A definitive diagnosis was made by paracentesis and laparotomy. Thirty-eight patients [82.6%] underwent explorative laparotomy. The surgical success rate for trauma patients was about 93.7%, while it was very poor for malignant cases. The surgical technique in this study with the best results was overswing with omental patch. The results indicate that patients with chylous ascites caused by trauma to the abdomen who undergo surgery may have a success rate up to about 93.7% using omental patches, especially if preoperative resuscitation is done. The outcome of patients with malignant chylous ascites, however, was very poor. Conservative treatment was not satisfactory in any of these cases

Twisted mixed germ cell tumor of the ovary in a child

We report an 8-year-old female patient with a mixed germ cell stromal tumor MGCT of the left ovary. Exploration revealed that the tumor had been twisted around its pedicle. These ovarian tumors are classified among interesting type of tumors due to the variability of neoplastic tissues in the same tumor mass, in the twisted ovarian tumor. Four histological types of tumor tissues were found: well-differentiated adenocarcinoma, dysgerminoma, immature teratoma, and focus of papillary serous cyst adenoma as well. During our review of the literature, this reported case of MGCT of the ovary was among the extremely rare cases, which had been reported. Mixed germ cell tumor is well documented in the literature since 1950

Satellite implantation of the skin with malignant melanoma

We report a 68-year-old female patient referred to the Surgical Department of Erbil Teaching Hospital university hospital, Erbil, Iraq with the diagnosis of malignant melanoma of the right upper thigh of one-year duration. Six months after primary lesion, she developed a satellite skin nodule of malignant melanoma over the unhealthy skin of the anterior abdominal wall in direct contact with the primary lesion. She also had a pendulous abdominal wall. This kind of spread of melanoma is unusual, and of non-classical route. We also discussed herein, similar cases admitted to our hospital