Drainge of pancreatic pseudocysts. the importance of cyst wall biopsy in the recent era

While open internal drainage has been the standard treatment for pancreatic pseudocysts, less invasive techniques which pay little attention to cyst wall biopsy, are becoming popular. The aim of this study is to report on our experience in draining pancreatic pseudocysts and probe the necessity or otherwise of obtaining a wall biopsy at drainage. Operation theatre registry, operation log books and medical records at Aseer Central Hospital, Abha, Kingdom of Saudi Arabia, were reviewed to retrieve the clinical details of patients with pancreatic pseudocyst who required a drainage procedure in a 13 years period from August 1989 to November 2002. Sixteen patients were identified. Cyst wall biopsy was obtained in 10 cases, in 8 of them the diagnosis was confirmed, while a true cyst was found in the remaining 2 excluding them from further analysis. In the remaining 14 cases [8 males, 6 females, mean age 38 years, range 4-60], pain was the main presenting feature. Open internal drainage was offered to 12 cases while one patient received external drainage under ultrasound guidance and the other received open external drainage. The type of operation was cystogastrostomy in 9 patients and cystojejunostomy in 3 patients. The recurrence rate after internal drainage was 16.7%, while after external drainage was 100%. There was no mortality in this series. A procedure-related complication occurred in 3 [21.4%] patients. The mortality, morbidity and recurrence rates in this series are compared favorably with other reports. The final diagnosis of a presumed pancreatic pseudocyst should rest on the histopathologic examination of the cyst wall

Meckel diverticulum revisited

Nine cases of Meckel diverticulum seen over a period of four years are presented. Six presented with gangrene, perforation, intestinal obstruction, intraabdominal abscess and pain related to Meckel diverticulum. The remaining three were incidental findings. Seven of the patients were males and two females. Average age of the patients was 25.5 years. The paper reaffirms the well-known practice that Meckel diverticulum should be looked for at laparotomies and resected when seen

Gallbladder stones analyzes, bile and wound cultures in cholelithiasis

One hundred and fifty-two consecutive cases of cholelithiasis were studied. The gallbladder stones were analyzed to determine the constituents, the bile specimens were cultured and correlated with the cultures when wound infection occurred. Mixed gallstones were the commonest type [58.5%], pigment stones [27%] and cholesterol stones [14.5%]. Positive bile cultures were found in 41 patients [27%] and Escherichia coli was the commonest organism isolated. The rate of wound infection was 14.5% and the most common organism cultured from the wound was staphylococcus epidermidis

Parotid gland swellings in Asir region of Saudi Arabia

This is a study of parotid swellings that required surgery seen at Asir Central Hospital, during the first six years 1988 [1408H] to 1993 [1413H] of its being commissioned. There were a total of 32 cases of parotid swellings. Eleven [34.4%] were benign tumours, nine [28.1%] were malignant tumours and twelve [37.5%] were inflammatory lesions. There was no significant preference for any side of the face in the three groups. The malignant lesions were more common in males than females by a ratio of 8:1, but in the benign, the ratio was found to be 1:1.8. In inflammatory cases they were evenly distributed between the two sexes. The average age for benign parotid lesions was 36.2 years, for malignant lesions it was 55.6 years, for inflammatory lesions it was 22.4 years. Pleomorphic adenoma was the commonest benign parotid lesion seen of both benign and malignant neoplasms [7/20 = 35%] and mucoepidermoid carcinoma [4/20 = 20%] was the commonest malignant parotid lesion seen, of both benign and malignant neoplasms

Surgical audit: a prospective study of the morbidity and mortality of acute appendicitis

Between March and September 1989, acute appendicitis was clinically diagnosed in 317 patients who were studied as part of a prospective surgical audit. The study was designed to determine the accuracy of diagnosis, comparison of the macroscopic appearance of the appendix at operation, and subsequent histopathology and complications associated with the morbidity and mortality of emergency appendectomy. The clinical diagnosis was correct in 278 patients [88%]. Thirty-nine [12%] of the patients had a negative laparotomy. There was no mortality, and wound infection was the source of increased morbidity in 37 [12%] patients. The highest incidence of wound infection was among those who had pus in the peritoneum [20%] or had a perforated or gangrenous appendix [25%]. When the macroscopic appearance of the appendix was compared with the subsequent histopathological findings, a false positive error of 7% and a false negative error of 42% was found. During appendectomy the gross appearance of the appendix must be carefully noted so that a meticulous surgical technique can be complemented by appropriate antibiotic prophylaxis against wound infection, started at the time of surgery

Damage to the bile ducts at cholecystectomy

Six patients who incurred iatrogenic injury to the extrahepatic bile duct following elective cholecystectomy are described. All cases were diagnosed three weeks to one year after operation. In none of the patients was an operative cholangiogram performed during the original cholecystectomy to detect congenital biliary tree anomalies or obstruction. Possible risk factors contributing to such injuries were intraoperative bleeding, common bile duct exploration in patients with obstructive jaundice, and poor surgical assistance. Obesity was not found to be of significance since all six patients were thin. Iatrogenic bile duct injuries are best managed at the time of injury during the primary operation. When recognized later in the postoperative period, choledocho/hepaticojejunostomy gives the best result