Case-based review: bile peritonitis after T-tube removal.

T-tube placement into the common bile duct (CBD) is most commonly performed after CBD exploration for cholelithiasis or repair of an iatrogenic CBD injury. Bile peritonitis occurring after T-tube removal is generally considered an exceedingly rare complication, which on occurrence necessitates urgent intervention. No clear guidance exists on the timing of T-tube removal and its relationship to the development of bile peritonitis. This study aimed to determine the incidence of bile peritonitis after T-tube removal, its relationship to the timing of removal and how knowledge of this can help the general surgeon.

Chylous ascites: a rare complication of radical gastrectomy.

Chylous ascites is the accumulation of lymphatic fluid within the peritoneal cavity, due to trauma or obstruction to the lymphatic system. Postoperative chylous ascites is a rare complication of abdominal surgery. This is frequently reported after retroperitoneal dissections, and results in high morbidity and mortality. The treatment options are varied and include total parenteral nutrition (TPN), elemental diet with medium chain triglycerides (MCT), repeated paracentesis and surgical ligation. We report a case of post-operative chylous ascites after D2 distal gastrectomy. Treatment by fasting, TPN followed by fat-free diet resulted in complete resolution of ascites within 3 weeks. To our knowledge this is the first report of such a complication following radical gastrectomy. We review the literature and briefly discuss the management options.

Comparison of light reflection rheography with ascending venography in the diagnosis of lower limb deep venous thrombosis.

A prospective evaluation of light reflective rheography (LRR) in the diagnosis of acute lower limb deep venous thrombosis (DVT) has been conducted by the comparison of rheographic changes with ascending venography. LRR reliably predicts the absence of DVT, but cannot accurately detect its presence. It is suggested that the technique may be used for surveillance but should not replace venography as a method for establishing the diagnosis of DVT.

Orocaecal transit time in health and in thyroid disease.

Altered bowel habit commonly occurs in thyroid disease. We measured orocaecal transit in healthy volunteers and in hyperthyroid and hypothyroid patients before and after treatment, using the lactulose hydrogen breath test incorporating a standard liquid meal to obtain a more physiological assessment. Mean transit time in 12 control subjects was 85 (8) minutes (mean (SE)) (mean coefficient of variation between replicate studies, 8.6% (3%)). In eighteen hyperthyroid patients transit was more rapid at 49 (4) minutes (p less than 0.01). Ten hypothyroid patients had a transit time similar to controls at 91 (9) minutes. Transit time returned to normal in thyrotoxic patients after treatment but in eight hypothyroid patients retested, it remained unchanged. Our findings suggest that (a) the inclusion of a liquid meal provides a reproducible method of measuring orocaecal transit using the lactulose hydrogen breath test, (b) rapid small bowel transit in thyrotoxicosis may be one factor in the diarrhoea which is a feature of the disease and (c) if altered gut transit is the cause of sluggish bowel habit in hypothyroidism, delay in the colon, and not small bowel, is likely to be responsible.

R2/3 gastrectomy for gastric carcinoma: an audited experience of a consecutive series.

A consecutive series of 27 patients with gastric neoplasm (24 carcinoma, 3 lymphoma) have been staged at laparotomy using the Japanese criteria for macroscopic staging. In 20 patients the radical R2/3 resection was considered potentially curative as defined by the Japanese Society for Research in Gastric Cancer. The operative mortality in this subgroup was 1/20 (5 per cent) and 3/27 (11 per cent) in the entire series. Locoregional recurrence was not observed in the potentially curative group. Follow-up has varied from 6 months to 7 years. An overall survival of 12/27 (48 per cent) has been observed to date. Death from cancer dissemination is maximal in the first and second year after resection. The R2/3 resection was considered non-curative in seven patients. In this subgroup there were two postoperative deaths and four have died of metastatic disease within 12 months of the resection. The only 5 year survivor in this group had a gastric lymphoma.

The effect of dose and osmolality of lactulose on the oral-caecal transit time determined by the hydrogen breath test and the reproducibility of the test in normal subjects.

The lactulose hydrogen breath test was used to determine the oral-caecal transit time in healthy volunteers. An inverse relationship between the dose of lactulose ingested and the oral-caecal transit time was found. The osmolality of the lactulose solution did not effect the transit time. Results obtained from the test were found to be reproducible in normal subjects. Standardization of the meal and what constitutes a sustained rise in the breath hydrogen excretion following administration of lactulose are essential in the valid interpretation of this test as a measure of oral-caecal transit time.