Pneumatosis intestinalis of small bowel in an adult: a case report

Pneumatosis Intestinalis [PI] is rare in adults although it can be seen in the pediatric population as a complication of necrotizing enterocolitis. We report a case of PI affecting the small bowel in a 27-year-old patient who presented with signs and symptoms of acute abdomen due to perforated duodenal ulcer. Histopathologic findings are demonstrated and the pathogenesis is discussed with the objective of highlighting that PI is not a diagnosis but a finding which needs further evaluation and management in view of the underlying etiology

Incidence, dianosis and management of Mirizzi syndrom in Kuwait

Mirizzi syndrome is an obstructive jaundice associated with pressure on the common hepatic duct from gallstones in Hartmann's pouch or the cystic duct. The stones sometimes erode through the main duct, leaving a fistula. We reviewed cases encountered between January 2001 and November 2002. Retrospective review of seventeen patients with diagnosis of Mirizzi syndrome managed in the surgical wards of Farwaniya Hospital. Patients were fully investigated including liver function tests, abdominal ultrasonography, ERCPand/or intra-operative cholangiography. During the study period 625 cholecystectomies were performed. Out of these, 17 were found to have Mirizzi syndrome which accounts for an incidence of 2.72%. In 11 patients, jaundice resulted from gallstone pressure [type I] and in the remaining six patients, the stones had eroded into the common hepatic duct producing a fistula [type II]. The diagnosis can usually be made preoperatively, especially if a large single stone is seen in conjunction with a dilated common hepatic duct and normal caliber common bile duct. We favor partial cholecystectomy, adding choledochoplasty using the gallbladder remnant, to close the fistula in type II cases