Presentation of hospital outcomes and different treatment methods of patients with Budd-Chiari syndrome: a report from two tertiary hospitals in Iran

The aim of this study was to report common presentations of Budd-Chiari syndrome [BCS] and the early outcome of different treatment methods in two tertiary hospitals in Iran. This case series study was performed on 21 patients [mean age: 42 +/- 13.09 years; 11 male, 52.4%, and 10 female, 47.6%] admitted for treatment of BCS in two tertiary referral centers in Mashhad, Iran, between 2002 and 2008. All required data of signs, underlying etiology, treatment methods and in-hospital mortality were gathered from patients' medical records. Angiographic and sonographic findings showed that the most frequent isolated location of obstruction was the inferior vena cava [n = 12, 57.1%]. No distinct underlying disease was found in 6 [28.6%] patients. Eleven [52.4%] patients had web obstruction and 4 patients had other related underlying diseases. Treatment modalities consisted of medical follow-up in 12 [57.1%], angioplasty in 6 [28.6%], and surgery in 3 [14.3%] patients. Medical follow-up of 3 patients, 1 with angioplasty and 2 who had undergone surgery, disclosed that they had died before discharge from hospital. Higher age at diagnosis may reflect late diagnosis at an advanced stage of disease. We suggest that the early symptoms of this disease should be taken into account more seriously in differential diagnosis. Balloon angioplasty seems to be a more efficient method for treatment of BCS

[Laparoscopic evaluation for chronic post operative abdominal pain]

Approximately 20% of patients undergoing laporotomy experience chronic postprandial abdominal pain for months after operation. Most surgeons are wary of re-operation in this condition, and opt for conservative treatment with analgesics and sedatives. This study was performed to determine the cause of this chronic abdominal pain by means of laparoscopy. Elective laparoscopic surgery was performed on 76 patients suffering from chronic post-operative abdominal pain. They did not have any signs and/or symptoms of acute intestinal obstruction; the most common complaints were: abdominal pain in 100%, nausea in 30%, vomiting in 10%. Diagnostic laparoscopy was performed and cases with positive findings were treated by laporoscopic surgery. In 81% of patients the cause of pain was obvious intestinal adhesions, 10% had adhesions without any correlation to patient's symptoms and the remaining 9% did not have any positive finding on diagnostic laparoscopy. Adhesiolysis, [sharp release with scissors] is the treatment of choice. 95% of those patients who underwent Adhesiolysis became pain free for a mean average of 11 months follow up [pre-operative average of pain episode was 4 time per week]. Laparoscopic diagnosis and treatment of chronic post-laparotomy pain is the gold standard method, it is minimally invasive and has good results