ABSTRACT
INTRODUCTION: Laparoscopic cholecystectomy (LC) is the most frequent surgical operation in general surgery. The focus of recent research has been on improving the procedure's safety. Over 80% of healthy livers have Rouviere's sulcus (RVS), which is a natural notch in the right lobe that is present in proximity to the confluence of the bile duct. It is frequently considered an important component of safety during LC. RVS demarcates the area of the common bile duct (CBD) from the liver bed for the gall bladder. This research intends to evaluate the frequency, its relation to CBD, and the critical view of safety (CVS) during LC. MATERIALS AND METHODS: An observational study was performed in a cohort of 50 patients listed for LC between September 2021 and September 2022. The presence of RVS was confirmed after liver retraction and dissection commenced. After the creation of CVS, its relationship with CBD was documented. Additionally, the position of the cystic lymph node was also documented during the dissection. RESULTS: The findings of this study revealed that out of 50 patients, only 40 (80%) had RVS. However, cystic lymph nodes were present more frequently in 48 (96%) patients. CVS was achieved in all the patients, and it revealed the presence of RVS above the cystic duct-CBD junction in 37 (74%), at the level of the junction in 11 (22%), and in two (4%) where the junction could not be demarcated. CONCLUSION: RVS is a reliable marker to dissect laterally to CBD while doing LC, which does not require any dissection and can be appreciated early during the procedure. However, its presence along with the cystic lymph node gives a better anatomical understanding of the area of CBD, thereby assisting in conducting the procedure safely.
ABSTRACT
Background The aim of this retrospective study is to establish a correlation between clinical features, surgical diagnosis, and the final diagnosis of laparotomies, as well as to establish the relationship between preoperative delay on the outcomes of surgery in the form of mortality and morbidity. Emergency surgery is high-risk in patients with acute abdomen with uncertain diagnosis. The results of surgery are remarkable and provide quick relief to the suffering and agony of patients with the dreadful condition of acute generalized peritonitis. Methodology Patients presenting with complaints of acute abdomen who needed laparotomy based on clinical judgment and investigations were included in this study. The study data were reviewed from April 2007 to January 2011 and March 2014 to February 2016 in a government hospital. Results A total of 174 patients with acute abdomen in whom there was an indication of laparotomy based on clinical judgment and radiological investigations were selected. Most patients had gastrointestinal perforation (n = 115) and acute intestinal obstruction (n = 23). The most important clinical features analyzed were abdominal tenderness (n = 160), guarding (n = 153), distention (n = 75), and tachycardia (n = 63). Conclusions Among the total patients, 150 underwent surgery within 24 hours of the presentation in the emergency and the remaining after 24 hours. The most common cause of laparotomy was a duodenal perforation in 79 patients and gastric perforation in 24 patients. A total of 114 patients developed no complications postoperatively. Among patients who developed postoperative complications, wound sepsis and acute respiratory distress syndrome were the most common. Mortality was noted in three patients.
ABSTRACT
The function of the portal vein is to drain the blood mainly from the gastrointestinal tract to the liver and its thrombosis is an extremely unexpected outcome of an uncomplicated laparoscopic cholecystectomy. It is believed to be a rarely reported case to date in non-cirrhotic patients. A female patient, aged 43 years, presented to the surgical outpatient department with unexplained severe abdominal pain soon after laparoscopic cholecystectomy. A relative workup was done and radiological evidence revealed the thrombosis in the distal part of the portal vein at its bifurcation which completely occluded the left branch of the vein. Although rare, portal vein thrombosis should be concluded in the differentials for unexplained causes of abdominal pain in the postoperative period of laparoscopic cholecystectomy.
ABSTRACT
Hydrocele of the canal of Nuck is a rare condition seen in younger females which is an extension of the peritoneum into the inguinal canal. Incomplete proximal obliteration and collection of serous fluid in the sac leads to the formation of a hydrocele of the canal of Nuck. A 28-year-old woman presented with swelling in her right groin for 5 months of 6cm × 5 cm. Ultrasound revealed a well-defined tubular cystic structure, measuring 5 cm × 3.5 cm × 5 cm with a volume of 50-60 ml. The cyst was dissected and the neck of the sac was extended up to the deep ring. Clear fluid was found on opening the sac. Clinically, it appears either as a painless or a moderately painful fluctuant inguinal mass. Clinical findings alone do not help in diagnosing the disease. Treatment includes surgical excision of the mass but without puncturing it as aspiration is inadequate and results in recurrence.
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Background: Acute abdomen is the most commonly attended surgical emergency. It can be caused by intra-abdominal, extra-abdominal and metabolic causes. A few imaging modalities are at disposal of primary care physicians like plain x-ray and ultrasonography. Materials and Methods: This study has been done to compare the efficacy of clinical diagnosis, plain radiography and sonography in diagnosis of non-traumatic acute abdomen. Every patient under study admitted in the Department of General Surgery underwent thorough clinical evaluation, biochemical investigations, X-rays and sonography. Findings of clinical evaluation, X-Rays and sonography were compared to the final diagnosis found intraoperatively. Results: Clinical diagnosis was made in 47 (94%) out of 50 patients. X-rays were able to diagnose in 20 patients (40%) whereas sonography diagnosed 26 patients (52%). Conclusion: The present study showed that clinical evaluation, x-rays or Ultrasound alone are not sufficient to diagnose cause of non-traumatic acute abdomen in all cases. Clinical evaluation combined with x-rays and ultrasound increases the number and accuracy of pre-operative diagnosis in non-traumatic acute abdomen.
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BACKGROUND: Relationship between postcholecystectomy bile duct dilatation and associated symptomatology is a potential dilemma for treating surgeon for which various studies with variable results have been documented. MATERIALS AND METHODS: This study is a 1 year prospective study conducted at IGMC, Shimla after taking proper consent and ethical approval from institutional ethical committee. Total 50 cases of symptomatic cholelithiasis belonging to either sex admitted in surgical wards of IGMC, Shimla for elective surgery were selected for present study. Cholecystectomy was done in all cases after doing all investigations. RESULTS: Postoperatively within 48 h symptoms were observed in 29 patients. Out of these, flatulence was present in 1, nausea and vomiting in 7 and 8, respectively. Combined flatulence vomiting in 5 and flatulence-reflux-nausea in 1 patient. After 1 month of interval, all patients were symptom free. CONCLUSION: Symptoms which were present in the postoperative patients were unrelated to dilatation of common bile duct. Either these symptoms were the persistent symptoms present before the operation or related to anaesthetic drugs.
ABSTRACT
Gastric outlet obstruction caused by duodenal impaction of a large gallstone migrated through a cholecystoduodenal fistula has been referred to as Bouveret's syndrome. We present a case of gallstone-induced duodenal obstruction in an elderly female patient, diagnosed on a 64-slice MDCT scanner. One-stage surgery, that is, stone removal and cholecystectomy, was performed resulting in relief of obstruction and complete cure. Clinical features, multidetector computed tomography (MDCT) findings, and surgical management are discussed.
