A Case Report of Polyarteritis Nodosa in Small Bowel

Polyatreritis nodosa is a rare autoimmune disease (the immune system attacking its own body) characterized by spontaneous inflammation of the arteries (arteritis) of the body. Because arteries are involved, the disease can affect any organ of the body. The most common areas of involvement include the muscles, joints, intestines (bowels), nerves, kidneys, and skin. Gastrointestinal involvement is reported in about 50% of the cases, but bleeding complications are rare and result in a poor prognosis. Polyarteritis nodosa is most common in middle-age persons. Recently, we experienced polyarteritis nodosa which presented as small bowel bleeding and which was diagnosed by angiography, a small-bowel series, and patholgic examination of the surgically removed ileum specimen. We report this case with a brief review of the literature.

A Clinical Analysis of 195 Cases of Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy is the newest treatment modality to be introduced for the management of the gallstone disease and is gaining rapid acceptance elsewhere. Despite its rapid and widespread acceptance, early data suggest that some complications and limitations are common when compared to standard cholecystectomy. The aim of this study was to identify problems in laparoscopic cholecystectomy and the reasons for secondary or operative conversion. From August 1991 to December 1994, 195 consecutive patients were treated with laparoscopic cholecystectomy at the Department of General Surgery, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University. The results were as follows; 1) The most prevalent age group was the 5th decade (24.6%) and the sex ratio (M : F) was 1 : 1.4. 2) The most common symptom was right upper quadrant pain (66.2%). 3) The majority (66.7%) of the admitted patient came to our hospital within 6 months of the onset of symptoms. 4) The number of patients with previous abdominal operations was 44 patients (22.6%), and the most common operation was an appendectomy (8.2%). 5) The patients with associated diseases were 124 patients (63.6%), gastritis being noted in 35 patients (17.9%). 6) The preoperative diagnostic rate was 96% by abdominal ultrasonography and 23.6% by ERCP 7) The average operative time was 103 minutes. 8) The most frequent operative finding was adhesion (72.3%). 9) The mean period of hospitalization after operation was 3.5 days. 10) The most dominant type in pathologic classification was chronic cholecystitis (86.7%). 11) The number of conversions to an open cholecystectomy was 14 (7.2%). 12) Among 195 patients, complications were noted in 10 patients (5.1%) : bile leakage from the bile duct or the liver bed(3 patients), bile duct injury (2 patients), subphrenic abscess (2 patients), atelectasis (1 patient), wound hematoma (1 patient), and drain site bleeding (1 patient).