ABSTRACT
Background. The aim of this study was to evaluate the preliminary results of a new dissection technique in acute cholecystitis. Material and Method. One hundred and forty-nine consecutive patients with acute cholecystitis were operated on with continuous pressurized irrigation and dissection technique. The diagnosis of acute cholecystitis was based on clinical, laboratory, and radiological evidences. Age, gender, time from symptom onset to hospital admission, operative risk according to the American Society of Anesthesiologists (ASA) score, white blood cell count, C-reactive protein test levels, positive findings of radiologic evaluation of the patients, operation time, perioperative complications, mortality, and conversion to open surgery were prospectively recorded. Results. Of the 149 patients, 87 (58,4%) were female and 62 (41,6%) were male. The mean age was 46.3 ± 6.7 years. The median time from symptom onset to hospital admission 3.2 days (range, 1-6). There were no major complications such as bile leak, common bile duct injury or bleeding. Subhepatic liquid collection occurred in 3 of the patients which was managed by percutaneous drainage. Conversion to open surgery was required in four (2,69%) patients. There was no mortality in the study group. Conclusion. Laparoscopic cholecystectomy with continuous pressurized irrigation and dissection technique in acute cholecystitis seems to be an effective and reliable procedure with low complication and conversion rates.
ABSTRACT
Pneumatosis intestinalis (PI) is a rare clinical condition, which is commonly associated with mesenteric vascular ischemia, bowel obstruction, and chemotherapy. Although the pathophysiology of PI remains unclear, 2 theories, one mechanical and the other bacterial, have been proposed. Nonoperative medical treatment and observation should be considered in mild cases, but occasionally, the situation requires emergency surgical intervention. In cases of suspectful complicated PI, the clinician should not avoid performing diagnostic laparoscopy to rule out bowel ischemia and perforation.
Subject(s)
Laparoscopy , Pneumatosis Cystoides Intestinalis/diagnosis , Diagnosis, Differential , Humans , Lymphoma, Large B-Cell, Diffuse/complications , Male , Middle Aged , Pneumatosis Cystoides Intestinalis/complications , Pneumatosis Cystoides Intestinalis/surgeryABSTRACT
Carotid blowout syndrome (CBS) is an emergency complication in patients undergoing treatment for head and neck cancers. The classical management of CBS is the ligation of the common carotid artery, because suturing is not be possible due to infection and necrosis of the field. In this case report, we present a patient with CBS, in whom we applied a self-expandable polytetrafluoroethylene (PTFE) stent and observed no morbidity. Endovascular stent is a life-saving technique with minimum morbidity that preserves blood flow to the brain. We believe that this method is preferable to ligation of the artery in CBS.
Subject(s)
Carcinoma, Squamous Cell/radiotherapy , Carcinoma, Squamous Cell/surgery , Carotid Artery Diseases/therapy , Endovascular Procedures/methods , Head and Neck Neoplasms/radiotherapy , Head and Neck Neoplasms/surgery , Hemorrhage/therapy , Laryngeal Neoplasms/radiotherapy , Laryngeal Neoplasms/surgery , Stents , Cutaneous Fistula/therapy , Fistula/surgery , Granulation Tissue , Humans , Male , Middle Aged , Pharyngeal Diseases/surgery , Polytetrafluoroethylene/therapeutic use , Squamous Cell Carcinoma of Head and Neck , SyndromeABSTRACT
OBJECTIVE: The aim of our study was to compare the diagnostic ability of oral added intravenous (IV) contrast-enhanced multidetector computed tomography (MDCT) versus only IV contrast-enhanced MDCT in diagnosing of acute appendicitis. MATERIALS AND METHODS: MDCT images of 200 patients were evaluated prospectively in this study. Patients were randomized into one of two groups: Group 1 (Gp1) patients underwent 16-MDCT performed with oral and IV contrast-enhanced and Group 2 (Gp2) subjects underwent 16-MDCT with only IV contrast-enhanced protocol. Final decision was based on histopathologic operative data and follow-up of patients. RESULTS: In Gp1, Reader1 had 96.9% and 98.5% and Reader2 had 84% and 94.7% sensitivity and specificity values respectively. For Gp2, the values for Reader1 were 81% and 94%. For Reader2 in Gp2, the values were 76% and 91%. We achieved higher sensitivity and specificity values with combined contrast administration versus only IV contrast-enhanced MDCT imaging. However, there was no statistically significant differences between two readers in the AUC values of each group for the detection of acute appendicitis. CONCLUSION: It is statistically concluded that oral contrast do not contribute to the a better accuracy. So in the routine practice, oral contrast has not to be recommended.
