An unusual cause of pain in the right hypochondrium.

Choledochal cyst is an uncommon anomaly of the biliary system. It manifests by cystic dilation of the extra or intrahepatic biliary tract or both. Three cases of choledochal cysts are reported, who had presented with pain in right hypochondrium. All the three patients presented in one Surgical Unit of a Teaching Hospital within a span of three months. The first patient was initially managed as obstructive jaundice, second as acute pancreatitis and third patient as a case of pancreatic pseudocyst. However, after investigations, the final diagnosis in all three of them was the same i.e. choledochal cyst which was managed by Roux-en-Y hepatico-jejunostomy.

Surgical management of epithelial parotid tumours.

OBJECTIVE: To describe the clinicopathological presentation and treatment options in epithelial parotid tumours with emphasis on surgery. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: ENT Departments of Pakistan Institute of Medical Sciences, Islamabad and Holy Family Hospital, Rawalpindi and Surgical Units at Rawalpindi General Hospital and DHQ Teaching Hospital, Rawalpindi, during a ten year period 1993-2003. SUBJECTS AND METHODS: Epithelial parotid tumours diagnosed and operated by an ENT surgeon and a general surgeon in 10 years during their posting in different teaching hospitals were included in the study. Clinical presentation, preoperative investigations, operative procedure, histopathology report, postoperative complications and further management were recorded. The data was collected and reviewed from the records of all the patients maintained by the authors. RESULTS: Fifty-two patients presented with parotid tumour. Average age was 38 years. Commonest presentation was a painless lump over the parotid region (85%), pain (15%), facial palsy, and enlarged neck nodes. Majority of tumours were benign, only two were recurrent. Parotid pleomorphic Adenoma (PPA) was the commonest benign tumour, others being Warthin's tumour and monomorphic adenoma. Adenoid cystic carcinoma was the commonest malignant tumour 29% followed by mucoepidermoid carcinoma. Others were carcinoma in PPA, squamous cell carcinoma, malignant mixed tumour, malignant lymphoepithelioma and undifferentiated carcinoma. Superficial parotidectomy (SP) was the commonest operation performed in 69%. Other procedures were total conservative parotidectomy in 11%, total radical surgery in 9% and enucleation in only one patient earliest in the series. Neck node dissection was done in 2 patients. Except for one child, rest of the 13 patients received postoperative radiotherapy and one patient of lymphoepithelioma received chemotherapy in addition. Commonest postoperative complication was temporary facial weakness in 35% (18/52). Permanent facial palsy occurred in 08 patients. Of these 07 had a malignant process and only one patient had excision biopsy. CONCLUSION: Benign and malignant epithelial parotid tumours can be diagnosed by their clinical presentation supplemented with FNAC. Superficial parotidectomy (SP) was the operation of choice. Facial nerve can be saved in total conservative parotidectomy for benign tumour in deep lobe and early malignant tumour. Radical parotidectomy followed by radiotherapy and in selected cases neck node dissection are the recommended procedures for advanced malignant parotid tumours.