[ case report of short bowel syndrome]

Short bowel syndrome in adult means the condition that length of short bowel is less than 200 cm. Functional definition of this syndrome refers to decreased absorption capacity of intestine. This problem will cause some clinical manifestations such as diarrhea, dehydration and malabsorption. Our studied case was a 31 years old man who had pain in his left flunk since three weeks ago. After the peritonitis and gangrene diagnosis, he was operated and just 10-15cm from proximal of jejunum and 30cm from distal of ileum remained. His colon had not any problem. The patient one year after operation came back to the normal life without any need to the Total Parenteral Nutrition [TPN]. In patients with acute mesenteric ischemia due to gangrene of intestine, resection and anastomosis is not usually recommended because it decreases the patient's survival. We concluded that if colon has not any problem and 10 to 15cm from proximal of jejunum and 20 to 30cm from distal of ileum were remained, it's better to do the complete resection and anastomosis. In this paper we showed that these patients could really survive

[Patient with mirizzi syndrome in 501 hospital]

Background: mirizzi syndrome is a rare complication of prolonged cholelithiasis with presence of large, impacted gallstone into the Hartman's pouch, causing chronic extrinsic compression of common bile duct [CBD]. Fistula formation between the CBD and the gallbladder may represent the outcome of that condition; representing a diagnostic challenge

Case report: a 72 year old woman referred to 501 hospital complaining of epigastric and right upper quadrant pain with repeated cholangitis. Laboratory and radiologic investigations revealed biliary obstruction, presence of gall stone and common hepatic duct fistula. The definitive diagnosis was made intra-operatively. Patient underwent partial cholecystectomy, choledochoplasty and removal of stone from biliary duct. The patient was discharged from hospital in good condition

Discussion: it is important to identify Mirizzi syndrome and fistula formation because of morbidity and mortality as a sequence of the condition. Treatment is equally important as the chronic biliary tree inflammation and subsequent bile ducts anatomic alterations necessitate a meticulous surgical approach. Our patient suffered mirizzi syndrome type III. Type III is stenosis at the confluence of the cystic duct and the hepatic duct due to a stone as was in the present case