Gallbladder Perforation :Report of 10 cases

 A Retrospective study at Srinagarind Hospital during the 5 year period of 1983-1987 , These were 10 cases of perforated gall bladders, an average of two cases per year, Five cases were free perforation with generalized peritonitis and another five were Subacute perforation with pericholecystic collection. These were 6 male and 4 female with an average age of  55.5 years. These were no serious associated diseases found on these patients. All cases had their gall bladders removed. Nine out of ten had common bile duct exploration . Two cases of tumour and 4 cases of common bile duct stone were found as the cause of obstruction. There were no perioperative-death . Only 3 minor operative complications were encountered younger age without associated disease and early cholecystectomy may be the main contribution to the good result.

Palpable tender lumps Over the right illiac fossa

 Among the most interesting and challenging clinical problems, pain and palpable tender lumps over the right illiac fossa are still in the fore-front both in general and surgical practice. Furthermore even the provisional diagnosis is almost certain to be an appendiceal mass its management of either early surgery or conservative is still controversy. In this study we reviewed cases admitted during 1985-1987 who presented with provisional of acute appendicitis 500 cases, there were 22 cases with palpable tender lumps over the right illac fossa. These 22 cases were treated by early surgery. The nature of their pathology were 15 appendiceal mass and 7 nonappendiceal mass which belonged to more serious pathological conditions with doomed prognosis should the operations be delayed. The clinical features of these 2 groups were statistically compared and there were no significant difference except in the appendiceal group the duration of abdomianl pain was usually not more than 14 days (p \< 0.05). The complication of early surgical management of appendiceal mass was 6.7 % . This compared favorably with general figure of 7-20% in appendicectomy complication. In our opinion , it would seem therefore reasonable to support early surgical management when one consider the advantage of early and correct diagnosis on one hand and an acceptable morbidity on the other.