Traumatic arterial aneurysm and arterio-venous fistula

Vascular trauma is most commonly the result of urban violence or military conflicts .It may be caused by bullet injuries, stab wounds, shell injuries and to lesser extent by blunt trauma. Study details the late presentation and management of traumatic vascular injury which leads to arterial aneurysm alone, arterio-venous fistula alone or concomitant aneurysm and fistula. This is a retrospective study of thirty patients who sustained different kinds of vascular trauma which occurred between months to years prior to diagnosis and management .The patients were admitted to the Medical City Teaching Hospital during a two year period between 2001 and 2002. Details of patient sex, age distribution; time of presentation; types of injury; clinical presentation and angiographic findings will be presented. Distribution of these aneurysm or fistulae and their surgical management will be discussed. Vascular injuries should always be kept in mind whenever a patient sustained a trauma of any kind to an area in a proximity to the course of a major vessel .A palpable pulse by no means exclude significant vascular injury and early recognition of these types of vascular injury leads to early management and thus eliminate the chance of future complications

Congenital right intra-thoracic hiatal hernia

Congenital right sided intra-thoracic hiatal hernia is an uncommon clinical entity consisting of herniation of a viscous through congenitally abnormal esophageal hiatus into an intra-thoracic location. Is to present the diagnostic challenge and the surgical management of eight cases of this uncommon congenital anomaly admitted during asix years period [2000 - 2005] to the medical city teaching complex in Baghdad. Iraq and to compare the study with other international studies. Eight patients were studied retrospectively in details as regard the age, sex, clinical manifestations, radiological findings. Details of the operative findings and the surgical outcome. All the patients had right sided intra-thoracic abdominal organ herniation mostly the stomach, all the patients ahad large hiatus, the patients were managed successfully through laparatomy with uneventful postoperative course. This uncommon variety of the congenital hiatal hernia presented a diagnostic challenge to the pediatrician, pediatric surgeon and the thoracic surgeon .Laparatomy was the procedure of choice and adding an anti -reflux procedure is highly indicated