Ultrasound guided percutaneous drainage of intra-abdominal abscesses and fluid collections

Percutaneous image-guided drainage is the first-line treatment for infected or symptomatic fluid collections in the abdomen and pelvis, in the absence of indications for immediate surgery and considered potentially a life saving therapeutic surgical procedure in high risk patients . To evaluate the efficacy of US-guided percutaneous drainage in treating intra-abdominal abscesses and fluid collections. Patients with intra-abdominal collections underwent percutaneous drainage under ultrasound [US] guide were studied prospectively in the Gastro-enterology and hepatology hospital in baghdad from April 2008-Sept 2009. The procedure done under local anesthesia and aseptic technique, needle access obtained before placing the catheter .Peritoneal Dialyses catheter was used in our study. There were 43 patients [29 females and 14 males], Age ranging 8-67 years. The collections diagnosed basically on US in 33 patients [76.7%] and US and CT-scanning needed in 10 [23.3%]. These collections were post-operative in 36 patients [83.7%] and primary [spontaneous] in 7 [16.3%]The post-operative cases were as follow:18 patients [50%] operated on for gall bladder diseases, 6 [16.7%] for abdominal trauma, 4 [11%] for acute abdomen, 4 [11%]for Hydatid cyst, 2 [5.6%] colonic surgery and one patient [2.8%] operated on for acute appendicitis and one [2.8%] after ERCP. Twenty three [53.5%] of the collections were single and 20 [46.5%] were multiple. The single collections were located as: Right Hypochondrial[Right subphrenic,Subhepatic and Hepatic] in 15 patients [65.2%], Epigastric in 4[17.4%],2 of them were pancreatic, Pelvic in 3 [13%], and paracolic in one patient [4.4%]. Six patients[14%] have hepatic collections, 4 of which were following Hydatid Cyst Surgery, the remainder were Pyogenic hepatic abscesses. Material drained was Bile in 24 patients [56%],Pus in 17[39.5%] and blood and urine in one patient [2.25%] for both, Fourteen patients [32.6%] underwent more than single drainage procedure, nine of them [64.3%] twice, three [21.4%] three times and two [14.3%]more than 3 re-interventions. The operations has been avoided in 26 patients [60.5%] but was not avoidable in 17 [39.5%], because of the ultimate need of the condition for operation in 15 patients [88%]and failure of drainage in 2 patients [4.7%] US guided drainage is an efficacious therapy for intra-abdominal collections and have become the treatment of choice for a wide variety of collections. It helps to obviate or delay a major surgery

Gastric cancer staging comparism and role of EUS

The tumor stage of gastric cancer in the preoperative period must be evaluated to choose the type of therapy so the preoperative imaging diagnosis is the basis for a tumor-stage -adapted therapy of each patient. Is to compare between the preoperative staging of gastric cancer which includes the ultrasound scan, CT scan and EUS findings and the postoperative staging which include the histopathological finding and to assess the efficacy of EUS in determining the tumor and lymph node stage of tumor. Prospective study of 32 patients with gastric cancer admitted to the surgical word in the gastroenterology and hepatology teaching hospital, medical city, Baghdad over the period from Nov. 2005 to Nov. 2007 who underwent gastric resection, all the cases were proved to be gastric cancer by endoscopic biopsy or by histopathological examination of the gastric specimen after operative resection, and all the cases radiologically investigated in the preoperative period by abdominal ultrasound, endoluminal ultrasound and abdominal CT scan. Show that there is increase in the staging in 18 [56.25%] cases and same staging in 8 [25%] cases and decrease staging in 6 [18.75%] cases. Endoluminal ultrasound is most accurate preoperative investigation to determine staging of gastric malignancy. Ultrasound and CT scan although it is important in the assessment but they downstage the tumor in about half of cases. So we recommend that EUS is done for all patients with gastric cancer for accurate planning for surgery

Colorectal carcinoma presentation and management

Colorectal carcinoma is the most common gastrointestinal tract cancer worldwide. In men, it is the third cancer after lung and prostate cancer, while in women; it is the third common cancer after lung and breast cancer. Despite the clear relationship with aging, colorectal carcinoma is not strictly a disease of elderly and 6-8% of cases occur in patients below 40 years of age. Colorectal cancers are of favorable prognosis provided they are diagnosed and treated in early stage. This study aims to assess the patterns of presentation, distribution, and management of colorectal carcinoma in Gastroenterology and Hepatology Teaching Hospital. From November 2005 to November 2007, 80 patients with colorectal carcinoma 50 males and 30 females were admitted to the Gastroenterology and hepatology center. The age, sex, presentation, modes of investigation, stage of the cancer, treatments as well as complications have been described. Male: female ratio about 1.6:1 with peak age of incidence is 60-69 year age group, 17.5% of cases are below age of 40 most of them were with worse histopathological types and advanced stage. The main presenting symptom was bleeding per rectum 63%.The mean period between onset of presenting symptoms and final diagnosis was 7 months The most common sites were rectum 35%, Fiftythree percent were moderately differentiated, 47.5% were Dukes-C. The study highlights the distribution of colorectal carcinoma, presenting symptoms, modalities of treatment, keeping in mind the increasing incidence of colorectal carcinoma in younger age groups

Propranolol alone for preoperative preparation of thyrotoxic patients

Thyrotoxicosis is a common disease which might require surgery, Thyroidectomy without preoperative preparation exposes the patient to the fatal risk of thyrotoxic crisis. Neomercazole is the standard preoperative regimen. Propranolol might be an ideal alternative. This study aims to demonstrate the safety and the convenience of the Beta-blocker propranolol in the preoperative preparation of the thyrotoxic patients. Over a period from. 1998 to 2006 fifty patients undergoing thyroidectomy for thyrotoxicosis in private and governmental hospitals were preoperatively prepared using propranolol alone. Propranolol was very rapid in controlling thyrotoxicosis in a dose of 160-480 mg/day. The operative and postoperative periods went on smoothly without any complications. Propranolol is a cheap, safe and effective in the preoperative preparation of the thyrotoxic patients and might be used as a routine

Shoelace darn repair of abdominal incisional hernias

Abdominal incisional hernias are a common condition in practice. Numerous surgical procedures have been used to repair them with different results. This study aims to find the place of shoelace darn in the repair of incisional hernias. One hundred patients with abdominal incisional hernias have been managed by a shoelace darn repair. The details of the operative technique have been described. Shoelace darn repair was an easy procedure associated with some complications, and followed by recurrence in 4 patients. The age, sex, clinical presentation, the type of previous surgery, the type of incisional hernia, the body built of the patients were discussed. Shoelace darn repair have got a good place in managing abdominal incisional hernias

Total colectomy and ileo-rectal anastamosis versus total procto-colectomy and Ileo-anal [j] pouch anastamosis for ulcerative colitis

The aim of this study is to compare the outcome of two sphincter-saving operations for ulcerative colitis namely total colectomy and ileorectal anastamosis [TC-1R] retrospectively with total procto-colectomy and ileo-anal [j] pouch anastamosis [TC-IA] prospectively. Surgery was indicated in 89[7.84%] among 1135 patients with ulcerative colitis of these; 57 subjected to TC-IR [Group A] during period 1968-1990 and 32 to TPC-IA [Group B] between 1991-2005, by Z R Al-Bahrani at the Medical City Teaching Hospital and Al-Mustansiria Private Hospital, Baghdad. Of these 89 patients, 41 were males and 48 were females. Mean [range] age in years was 35.5 +/- 13.3 [12-65]. Indications for surgery were; intractability 59[66.2%], carcinoma 13[14.6%], toxic colon 8[9%], sever bleeding 7[8%] and intestinal obstruction 2[2.2%] patients. The type of colitis were; pan-colitis 72[81%], left colitis 16[17.9%] and procto-sigmoiditis one [1.1%] patient. Pseudo-polyposis was seen in 52[58.5%] patients. The outcome of Group A [57 patients] were; post-operative mortality 2[3.5%], 1-3 complications minor and/or major in 31[53.4%] patients. After operation; normal defecation, bowel motion/day reduced from 8 to 5 [P<0.001], body weight/Kg increased from mean 53 to 62.5 [P<0.001] and the Hb gm/dl rose from mean 10.2 to 12.2 [P<0.001]. The outcome of Group B [32 patients]: post-operative mortality 1[3.1%], 1-3 complications minor and/or major in 16[50%] patients. After operation; control on defecation took few weeks-months to settle, bowel motion/day was reduced from a median 10 to 5 [P<0.001], body weight/kg increased from mean 52.9 to 56.2 [P=0.59[ns], and Hb gm/dl rose by a mean 03[P=0.68[ns]. Both surgical operations are super major and carry potential risk of complications and should be advised when medical treatment fails or serious complications of the disease arise which risk the patient's life or interfere with his normal life. Both procedures improve bowel motion, general health and quality of life without incontinence but total procto-colectomy and ileo-anal with pouch is considered superior to total colectomy and ileor-rectal anastomosis because excluding to a great extent the risk of rectal cancer

Comments on surgical management of penetrating duodenal injuries

Duodenal injury is one of the most serious a otherwise it may result in lethal complications. Is to apply simplified guidelines for the surgical management of duodenal injuries so that it might reduce the incidence of morbidity and mortality. During the last three years, nine patients with duodenal fistula as a result of penetrating duodenal injury were referred to Gastrointestinal and Hepatology Teaching Hospital, all these patients were reviewed to determine the severity of the duodenal injury according to the Organ Injury Scale and to discuss the surgical procedure which was performed. The recommended operative management for grades I and II duodenal injury is simple primary repair, for grade III is pyloric exclusion or jejunal serosal patch, for grade IV is duodenal diverticulization, and for grade V is Whipple's operation. In addition to that damage control surgery can be applied in certain circumstances. The simple primary repair is not sufficient treatment of moderate to severe duodenal laceration and the surgeons should adopt more advanced