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Gallstones are a major cause of morbidity worldwide, and cholecystectomy is the most commonly performed abdominal surgery m medicine. Gallstone-induced complications have a limited and overlapping pattern of clinical presentation. In this article, morphology, composition of gallstones as well as diagnosis and therapeutic options employed in their management are reviewed. The study is to define the different types of gallstones, and to identify their characteristics and chemical coemposition in 150 patients A retrospective study was performed on one hundred and fifty patients who were subjected to cholecystectomy during the period from January 1992 to January 2007, in the gastro-enterology and hepatology center and Al-Mustansyria Private Hospital in Baghdad by one consultant surgeon. The female: male ratio was 4:1 and the peak age group was that between 41-50 years. Thirteen percent of patients required explorations of the common bile duct [CBD], 72.7% of them were jaundiced, and 27.3% of those who had CBD exploration were not jaundiced. Ninety point seven percent of cholecystectomies were perfornied for calculus ebolecystitis and 9.3% were for acalculus cholecystitis. Of the 136 patients with calculus cholecystitis, 19.9% had a solitary stone, and 32.4% had 2-10 stones; the highest number of stones was 250. Forty nine percent of stones were less than one centimeter in size; with the biggest stone being 4.5 cm in size. Unlike what is expected of "mixed stones ", they were not more than 30.9% of cases, while "cholesterol stones "constituting 40.4% of cases." pigment stones" constituted only 8.8% of stones; with "combined stones" constituting 17.6% of cases. There is an increased prevalence of gallstones in females and the frequency of gallstones increases with age in both sexes. In this article, there has been recognized three types of gallstones, cholesterol, mixed and pigment [black and brown] stones. The cholesterol stones account for more than 40% [the highest percentage of gallstones in the study]
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The aim of this study is to present our experience in the management of gastrointestinal tuberculosis in Iraq. 86 cases with intestinal tuberculosis were histologically proven by endoscopy or surgery, during the period 1965-2004 at the Medical City Teaching Hospital, and two private hospitals [Alousi and Mustansiria], Baghdad. 54[62.8%] were female and 32[37.2%] were male. Age ranged from 6-82 years [mean 33yrs], peak 30-39 years. Clinical presentation were; intestinal obstruction 44[51.2%], abdominal mass 20[23.3%], malabsorption 13[13%], massive gastrointestinal bleeding 3[3.5%], peritonitis 3[3.5%], pyloric obstruction 2[2.3%] and dysphagia 1[1.2%] patients. Chest X-ray reported; normal in 62[72.1%], active pulmonary tuberculosis in 3[3.5%], and healed lesion in 21[24.4%] patients. Barium study revealed dilated bowel loops in 31[45.6%]; other less frequent findings were strictures, filling defect, shortening and bowel irregularity. OGD showed a significant pathology in 7 out of 11 patients examined. Ultrasound showed helpful imaging modality in 15/21 patients; ascitis, masses, enlarged lymph nodes, and thick bowel loops in some cases. Site of lesions were; ileocecal 42[48.8%], small bowel 33[38.4%], colorectal 8[9.3%] and stomach 3[3.5%] patients. Gross appearance were hyperplastic 33[38.4%], ulcerative 20[13.9%], strictures 21[24.4], and mixed 12 [13.9%] patients. Surgical procedures were; right hemicolectomy 38[44.2%], resection of small bowel 23[26.7%], colectomy 4[4.7%], by-pass 4[4.7%], stricturoplasty 2[2.3%], and subtotal gastrectomy 1[1.2%] and biopsy only 14[16.3%] patients. One patient died post-operatively from pulmonary embolism, 6 lost to follow, 4 had relapse after stopped treatment within 3-5 months [one of them died from intestinal obstruction] while the result in those followed 74 [including 3 who relapsed and re-treated] patients whom received chemotherapy for over one year were very satisfactory. Gastrointestinal tuberculosis affects females more than males. No age is immune, peak in 3rd decade. Symptomatology is non-specific, it should be suspected in patients having abdominal pain, weight loss, anorexia, fever, ascites and abdominal mass. Sub-acute or acute intestinal obstruction is the most common presentation followed by abdominal mass or malabsorption in our study. Normal chest radiograph does not exclude the presence of abdominal tuberculosis, but it should be suspected in high ESR patients. Surgical interventions is not alternative to standard anti-tuberculous therapy
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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
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A one-stage conservative surgical procedure for 27 patients with spontaneous biliary-enteric fistula is presented. Seventeen cases were secondary to cholelithiasis and 10 due to chronic duodenal ulcer. There were 13 males and 14 females. Their ages ranged between 45 and 75 years for the biliary group with an average of 57 years, while for the peptic ulcer group the ages ranged between 27 and 65 years with an average of 49 years. The type of the fistula was cholecysto-duodenal in 19 cases, choledocho-duodenal in six cases, one cholecysto-colic, and one cholecysto-duodeno-colic. The surgical management consisted of closure of the enteric end of the fistula together with definitive treatment of the underlying pathology in a one-stage surgical procedure. The surgery included cholecystectomy and dealing with the pathological common bile duct, for the biliary cases, together with vagotomy and pyloroplasty for the peptic ulcer group. There was no mortality and the operative morbidity was low so that we may conclude that the procedures were safe and effective for spontaneous biliary-enteric fistulae
Sujets)
Voies biliaires , Système digestif , FistuleRésumé
The effect of post-operative antibiotics on wound infection is studied in a prospective clinical trial. Four commonly used antibiotic regimens were used on patients undergoing surgical operations on the G.I.T. and biliary system. 230 patients were included and the results compared with a control group. The regimens used were Cephalothin, Ampicillin with Cloxacillin, Gentamycin, and Gentamycin with Metronidazole. There were 122 males and 108 females. Age ranged between 4 and 80 years with an average of 45 years. The total wound infection rate of antibiotic group was 7.7% compared to 8.1% of the control, which was not statistically significant [P>0.05]. Biliary operations were associated with more wound infections than G.I.T. operations. In all 72% of wound infections were minor in degree, and 50% were delayed in onset. In conclusion antibiotics given post-operatively have no true benefit in reducing the incidence of wound infection