Primary cystic duct carcinoma case report and literature review

Primary cystic duct carcinoma is rare. To date only 27 cases have been reported in the English literature, and 17 cases in the Japanese literature. This paper reports another case of primary cystic duct carcinoma. A 70-year-old male presented with signs and symptoms of acute calcular cholecystitis and dilated extrahepatic bile ducts. An ERCP failed technically. An ultrasound-guided aspiration was performed to drain an obstructed gall bladder and an adjacent pyogenic liver abscess. A cholecystogram showed an obstructed cystic duct. On table a tumour was suspected at the junction of the cystic duct and common hepatic duct [CHD]. En masse excision of the gall bladder, cystic duct, tumour, part of the CHD and the supraduodenal part of the common bile duct was performed with a Roux-en-Y hepatico-jejunostomy. Histopathologically the tumour fulfills all of Farrar's criteria for primary cystic duct carcinoma. Our case is of interest since it is the 2nd case to present with Mirrizzi-like syndrome

Silent regurgitation during general anesthesia

Regurgitation of acidic gastric fluid and subsequent pulmonary injury still remain a major cause of morbidity and mortality in clinical anesthesia. In this case report we describe our experience with a 39-year-old Indian woman who developed silent regurgitation [SR] during induction of general anesthesia for an emergency surgery. SR was manifested by hypoxaemia [SaO2 90%] and bronchospasm. Her chest x-ray revealed collapse and consolidation of the right upper lobe of the lung. She was treated with corticosteroids, aminophylline, antibiotics and fibreoptic bronchoscopic lavage and ultimately recovered without any long-term sequelae

Ankle block for diabetic foot surgery

Forty-one patients undergoing foot surgery due to complications from diabetes were anesthetized using the ankle block technique. All patients were ranked in the American Society of Anesthesiologists grades II and III. The study included both male and female patients ranging in age from 30 to 86 years [mean 56.45 +/- 10.77]. The duration of surgery was 35-60 min [mean 49.20 +/- 6.39]. Eleven patients required 2-7 repeat surgeries. Twenty-six patients were given local anesthetic [18- 40 ml of lignocaine; 0.75%]. Fifteen patients, judged to be apprehensive, were also sedated using intravenous injections of diazepam, 5 mg, with or without alfentanil, 0.5 mg. The block was fully successful on 61/62 occasions [98.4%]. One block was partially effective. There were no complications intraoperatively or postoperatively

Cystic retroperitoneal lymphangioma in an adult

This is a report of a histologically proven case of a retroperitoneal cystic lymphangioma in a 50 year old woman. Ultrasound [US] examination of the abdomen was a useful tool in establishing the preoperative diagnosis and computerized axial tomography [CT] in delineating the relation of the mass to intra-abdominal structures. The cyst was successfully excised and no recurrence have been documented after 9 months