Patterns and management of liver trauma in Riyadh Central Hospital

A retrospective study is presented of all patients undergoing laparotomy for liver trauma during a one period at the Riyadh Central Hospital. The total number of patients was 38, the majority [36] were men between 21 and 30 years old. Blunt abdominal trauma from road traffic accidents was the predominant cause in 36 patients [95%], and two patients [5%] suffered penetrating injury from gunshot wounds. Associated injury of other organs or systems frequently accompanied the blunt abdominal trauma and was responsible for mortality in four patients. Three patients with extensive liver damage as well as juxtahepatic injury to the hepatic veins or inferior vena cava died from major hemorrhage. The overall mortality was 18%.4. The majority of liver injuries can be managed surgically by simple suture techniques. A scheme for the surgical management of liver trauma is outlined

Hydatid disease of the liver in Riyadh

Sixty-eight patients with hydatid disease involving various organs were admitted to Riyadh Central Hospital during a two-year period. The liver was involved in 42 patients, and 33 of them were treated surgically. Casoni's intradermal test [87% positive] and ultrasonography were the two most helpful investigations for establishing the diagnoss. Computerized tomography helped in better localization of the cyst and planning a suitable surgical procedure. Total cystoperiocystectomy was carried out on five patients, and thre patients were treated by endocystectomy with omentoplasty. No complications were noted among these patients. Endocystectomy with tube drainage was performed on 23 patients. This procedure was found most suitable for the majority of patients. Complications can be minimized by careful attention to any biliary communications and earlier removal of the drainage tube. There was no mortality following surgery in this series, but one patient died of anaphylaxis following percutaneous transhepatic cholangiography. Twenty percent hypertonic saline was used as a scolecidal agent in this series, and mild hypernatremia was noted among some patients. Serum sodium monitoring is recommended during the immediate postoperative period

Chronic acalculous cholecystitis

Chronic acalculous cholecystitis is a controversial disorder, and surgeons are reluctant to perform cholecystectomy in the absence of clear evidence of biliary calculi. This report describes the clinical picture, investigations, and results of cholecystectomy in 20 patients diagnosed as having chronic acalculous cholecystitis. All the patients had right upper quadrant pain, highly suggestive of gallbladder origin. In six patients ultrasonography and cholecystography were completely normal, two patients showed evidence of "biliary sludge" in the gallbladder, and in the remaining 12 patients, the sole abnormality was ultrasonographic demonstration of a thickened gallbladder wall. At assessment 1 year after cholecystectomy, 17 patients were completely relieved symptoms, two were improved, and only one patient failed to benefit. Despite the increasing sophistication of biliary tract investigative methods, the diagnosis of chronic acalculous cholecytitis remains predominantly clinical. In the presence of typical symptoms, and with exclusive of other upper abdominal pathology, cholecystectomy successfully relieves the majority of symptoms

Evaluation of peritoneal lavage in the early diagnosis of blunt abdominal injury

Of 142 patients admitted with suspected blunt abdominal injuries following road traffic accidents, 88 were selected for diagnostic peritoneal lavage on the basis of established criteria. 85.2% showed positive lavage results for injury and were submitted to laparotomy. There were four false-positive results in this group of patients. Of the remaining patients with negative lavage findings, two subsequently underwent laparotomy on clinical grounds. One laparotomy proved negative but the other led to operative repair thus showing one false-negative result in this group of patients. The overall accuracy rate of 94.3% recorded in our series of patients justifies the use of peritoneal lavage in all patients suspected of blunt abdominal injury