rare late complication of Meckel's diverticulum: diverticulitis induced parietal abscess presenting with multiple abdominal wall fecal fistulae. a case report and review of the literature

This paper presents a case report of 5 years old boy who presented with abdominal pain and fever to the pediatric reception room since four weeks. He was examined and investigated and the possibility of appendiciditis was excluded and a diagnosis of acute non specific mesenteric adenitis was coined. Follow-up medical treatment with antibiotics and conservative measures yielded a parietal abscess in the right iliac region. Simple incision drainage revealed pus and intestinal fecal content. A fecal fistula of appendicular origin was thought for and conservative management continued. However, investigation revealed a communication to the small intestines, and the multi-orifices draining fistulae caused a severe water and electrolyte imbalance with acidosis and emaciation. A decision at exploration revealed a complicated Meckel's diverticulitis, stuck to the abdominal wall and penetrating the muscular wall to end in an arborisation of fistulae in the right iliac fossa and right lumbar region. Resection anastomosis ensured a sound healing of the condition. The peritoneal cavity was exempted from any leak or peritonitis

Colonic valve end-to-side in rectum preliminary report on animal model

This study was carried out to evaluate a new simple technique for the construction of a stable colorectal valve that can avoid regurgitation of rectal contents to the colon without temporary faecal diversion. This new technique was applied in four mongrel dogs. The sigmoid is separated from the rectum. The terminal end of the sigmoid is everted to form a nipple valve that is anastomosed obliquely end-to-side in the distal part of the opened rectum. Therefore, the distal half of the nipple valve is projecting inside the rectal lumen. The proximal part of the rectum is closed after leaving a stent reaching from the anus up to the area above the valve. Postoperative descending and ascending proctographic studies revealed a non-obstructed unidirectional flow of rectal contents to the exterior. We therefore conclude that this technique is relatively simple and safe and successfully allows easy unidirectional flow of rectal contents to the exterior without impediment to the faecal stream and without the need for temporary proximal colostomy

Dry vesicostomy in the management of urinary incontinence and bladder dysfunction in children

Experience in using a vesicostomy technique in the management of urinary incontinence and bladder dysfunction in children and adolescent is presented. The operation creates a permanent, dry, catheterizable cutaneous vesicostomy. Clean intermittent catheterization [C.I.C.] via the vesicostomy stoma keeps the intra- vesical pressure below the urethral closing pressure and prevents urinary leakage. Sixteen patients with incontinence and lower urinary tract dysfunction were operated. Dryness was achieved in nine patients and compliance in using catheterization perstoma was excellent in 13 out of 16. The operation described when performed in selected patients proved to be simple with low morbidity and good functional result

Clinical assessment of laryngeal mask airway in intra-ocular ophthalmic surgery in comparison with tracheal intubation

Clinical studies were performed on 20 patients from both sexes and different ages [55 - 65 years] to compare between the effects of laryngeal mask airway and tracheal intubation on the intraocular ophthalmic surgery under general anesthesia. All patients were assessed as regards the changes on B.P., H.R. and intraocular pressure before induction of anesthesia, after induction of anesthesia and after insertion of the laryngeal mask or tracheal intubation. The development of coughing, straining or breath holding at the termination of anesthesia was recorded. Any postoperative sorethroat in both groups was recorded. Patients with raised intraocular pressure, history of reflux or hiatus hernia and patients with decreased lung compliance or increased airway resistance were excluded from the study. The changes in intraocular pressure, heart rate and mean arterial pressure after the insertion of the laryngeal mask airway or the tracheal tube were not significantly different. However, at the end of surgery, a significantly higher percentage of patients with a tracheal tube coughed [80%] react to head movement [70%] and suffered breath-holding [40%], in addition, significantly more patients in tracheal tube group complain of sorethroat [30%] [P < 0.05]

Acute intraocular pressure response to argon laser iridotomy

Argon Laser iridotomy was performed in thirty eyes, for therapy of chronic angle closure glaucoma and thirty eyes, for prophylactic narrow angles. Eighty-four percent [84%] of the chronic angle closure glaucoma cases and sixty percent [60%] of the narrow angles showed acute intraocular pressure response to argon laser iridotomy. Additional medical therapy was effective in lowering the acute Laser induced elevation in intraocular pressure