Laparoscopic cholecystectomy for acute cholecystitis an experience of 64 cases

To evaluate the feasibility and safety of laparoscopic cholecystectomy in severe acute cholecystitis, and to assess the incidence of complications. A prospective study included Sixty four patients with a confirmed diagnosis of acute cholecystitis at Al-Kadhimyia Teaching Hospital, over a period of 18 months from march 2009 to August 2010. Sixty four patients with diagnosis of acute cholecystitis were enrolled in our study. All of cases underwent laparoscopic cholecystectomy during the first 72 hours of their admission. Of the 64 patients there were 48 female and 16 male with a female to male ratio of 3:1. The age of our patients ranged from 19 years to 63 years with mean age of 35.6 years in female and 49.8 years in male. Cholecystectomy was completed successfully in 52 patients [81%], conversion to open conventional surgery was necessary in 12 patients [19%]. The main reasons were obscured anatomy [calot's triangle], excessive bleeding and dense adhesions. Data on presenting symptom, ultrasound findings, operative findings, hospital stay and complications were recorded. In the presence of severe acute cholecystitis laparoscopic cholecystectomy is feasible in most patients, with minimal risk of injury to surrounding structures, shorter hospital stay and considerable benefits. It is recommended that laparoscopic cholecystectomy should be attempted in these patients when appropriate surgical skill is available

Acute abdominal pain in Iraqi children: causes and management

Acute abdominal pain is the most frequent gastrointestinal complaint that brings children and adolescent to physicians and the one that frequently requires urgent evaluation in the office or emergency department. The challenge for the clinician is to identify those patients with abdominal pain who have either serious, potentially life-threatening conditions, such as appendicitis or bowel obstruction. The difficulty in this problem resides in the great diversity of underlying pathologies and poor localization of pain. To study different etiologies' of acute abdominal pain in children and their incidence in our locality to offer a clinical issue helping relevant doctors in management of their child patients. In this study, we enrolled children with age ranged from 4 months to 12 years, from April 2007 to April 2009 during which every child visit outpatient clinic or emergency unit complaining of acute abdominal pain was included; full clinical evaluation and necessary laboratory tests was obtained. Follow up data of these children in the emergency room, pediatric and surgical ward and after discharge were obtained. The study include 566 child with age range from 4 month to 12 years with overall mean age was 5.8+2.4 years, female children were 58% while male were 42%. 36% of children sustained emergency surgical operation [surgical group], the other 64% were treated conservatively [conservative group]. The commonest pathologies in surgical group were acute appendicitis 73%, intussusceptions 13%, primary peritonitis 5% and incarcerated hernias 2%. While that in conservative group, they were non-specific abdominal pain 44%, gastroenteritis 23%, UTI16% and ML 8%. The incidence of acute abdominal pain in relation to the age group was as following: Group l [age of 1 year and below] was 45 cases [8%], Group2 [2-5 years] was 294 cases [52%], Group 3[6 - 12 years] were 227 cases [40%].The commonest medical cause of acute abdominal pain is nonspecific abdominal pain followed by gastroenteritis while the surgical cause is acute appendicitis followed by intussusceptions. The age is fundamental clinical factor in assessing any child with acute abdominal pain and the underlying pathologies are closely related to the child's age. The repetitive gentle clinical examination is superior to most sophisticated investigations and it is considered a cornerstone in pediatrics' clinical practice