ABSTRACT
Liver is the most common organ involved in echinococcosis. Organs affected by E granulosus are the liver (63%), lungs (25%) and muscles (5%). Rest of the organs are rarely affected. Adrenal cysts are uncommon. Their size may range widely and the origin of large adrenal cysts is often difficult to distinguish from other organs, including the kidney, pancreas, spleen, and liver. A large right-sided adrenal cystic mass can rarely be mistaken for a hepatic cyst by imaging. In this report, authors have described an adrenal cyst in a 28 year old lady, who was diagnosed preoperatively to have a hepatic hydatid cyst but intraoperatively it was found to be of adrenal origin. The size of the adrenal cyst can vary from a few millimetres up to 50 cm in diameter. Majority of the adrenal cysts are unilateral, while 8-10% of those cysts have been noted to be present bilaterally. The majority of cases are diagnosed between the 3rd and 6th decades. Although uncommon, Adrenal cyst should be considered as one of the differential diagnosis of upper abdominal cysts. Surgical excision is advisable when the cysts are symptomatic, greater than 5 cm in diameter and in the case of suspecting malignancy.
ABSTRACT
Background: Gall stone disease remains one of the most common medical problem leading to surgical intervention. Cholecystitis accounts for 3-10% of abdominal pain worldwide. Acute cholecystitis is the most common complication of cholelithiasis accounting for 14 to 30% of cholecystectomies performed in many countries. Symptoms in cholecystitis are due to impaction of stone and subsequent distention of gallbladder with inflammation. Study is aimed to clarify the role of ultrasound guided transhepatic gallbladder aspiration in the early management of acute calculous cholecystitis.Methods: The study was conducted in total of 40 patients presenting with acute cholecystitis. 20 patients underwent ultrasound guided transhepatic aspiration of gallbladder with antibiotics (group A) and 20 patients were given antibiotics only (group B). Data were collected before intervention and post intervention duration of stay, pain according to visual analog scale, leucocytosis and fever were recorded for analysis. No complications were related to aspiration procedure.Results: Both groups were comparable. Group A patients had better pain relief (p=0.0001 day on 2 and p=0.004 on day 3 post aspiration), percentage reduction of leucocyte count (p=0.041 on day 3) and duration of hospital stay (p=0.004) which were statistically significant.Conclusions: Ultrasound guided transhepatic aspiration of gall bladder with antibiotics in acute cholecystitis results in better pain profile, faster reduction in leucocyte count and shorter duration of hospital stay when compared to antibiotics alone.
ABSTRACT
Aim: To ascertain the common causes of LGIB in the elderly and to evaluate sigmoidoscopy and colonoscopy as the initial investigation for diagnosing LGIB in the elderly in the developing world. Materials and Methods: The study was conducted over a period of two years at SMHS Hospital and Government Medical College Srinagar, a tertiary care centre, Jammu & Kashmir. All the patients above the age of 60 years, presenting with symptoms or complaints of LGIB to the OPD’s and casualty services of the said hospital were enrolled in the study. Exclusion Criteria: Cases presenting with LGIB which were proved by any diagnostic procedures or during laparotomy to originate from any source proximal to ligament of Treitz. Results: The commonest cause of LGIB in our study was local anal disease [haemorrhoids and anal fissures] followed by carcinoma colorectum, inflammatory bowel disease [IBD], solitary rectal ulcers [SRUS] and colonic polyps, in the order of decreasing frequency. Colonoscopy was able to detect the cause of LGIB in all our study subjects. Conclusion: Despite the small number of patients in our study group, it can be concluded that the cause of LGIB in the elderly in our part of the world differs from that of the developed world, although the reasons for this remain unexplained and require more research. As such, elderly patients with complaints of LGIB should be offered the benefits of colonoscopy unless contraindicated by their co-morbidities because of the fact that they may be harbouring a sinister cause of LGIB, i.e., colorectal malignancy.