ABSTRACT
Computed tomography scanning has become one of the prime modalities in the diagnosis of trauma to the spleen (1-6). We present three cases of potential pitfall in computed tomography scan diagnosis. In the first case, computed tomography scan showed a high-attenuation perisplenic density in the superio-lateral region of the spleen compatible with a perisplenic hematoma. Exploratory surgery showed a left lobe of the liver draping around the spleen. The second case showed similar computed tomography findings as in the first case, but the perisplenic density showed enhancement after contrast infusion. Also, on careful evaluation, the perisplenic density was traced as part of the left lobe of the liver. The third case, an alcoholic without any history of trauma, showed a perisplenic density of lower attenuation. On careful screening, this was traced as part of the left lobe of the liver. The lower attenuation value of the liver was due to fatty infiltration. The importance of performing computed tomography with and without contrast infusion in these cases is discussed.
Subject(s)
Hematoma/diagnostic imaging , Liver/diagnostic imaging , Spleen/injuries , Splenic Diseases/diagnostic imaging , Tomography, X-Ray Computed , Adult , Contrast Media , Female , Hematoma/etiology , Humans , Liver/anatomy & histology , Male , Splenic Diseases/etiologyABSTRACT
A case report of giant sigmoidal diverticulum and a review of the relevant medical literature are presented. Only 20 cases have previously been reported. Diagnosis is dependent on a gradually enlarging mass, usually found on physicial examination. Radiologic study usually confirms the diagnosis and differentiates this condition from others, such as intestinal duplication, emphysematous cholecystitis, cholecysto-enteric fistulas, etc. The treatment is prophylactic. It is important to undertake early surgical intervention before the condition progresses to perforation or other complications.
Subject(s)
Colon, Sigmoid , Diverticulum, Colon , Aged , Barium Sulfate , Biliary Fistula/diagnosis , Cholecystitis/diagnosis , Colon, Sigmoid/diagnostic imaging , Colon, Sigmoid/pathology , Diagnosis, Differential , Diverticulum, Colon/diagnostic imaging , Diverticulum, Colon/pathology , Emphysema/diagnosis , Gallbladder Diseases/diagnosis , Humans , Intestinal Fistula/diagnosis , Intestines/abnormalities , Male , Middle Aged , RadiographyABSTRACT
A retention suture using the buried technique has been developed. This retention suture encompasses fascia, muscle and subcutaneous tissue and remains extraperitoneally and just below the skin. Since the suture material is not in contact with the skin, complications, such as skin damage, stich abscesses and infection at exit points, are avoided. Severe postoperative pain related to retention sutures is minimized.
Subject(s)
Suture Techniques , Abdomen/surgery , Fascia , Humans , MusclesABSTRACT
A case is presented of pancreatic pseudocyst which ruptured as a result of an automobile accident. Sixty-three cases from the literature of ruptured pseudocyst of the pancrease due to a variety of causes are reviewed. Special reference is made of the site of perforation and treatment. It is concluded that each case should be individualized, tailoring the operative procedure to the operative findings. While external drainage may be life saving in some cases and sometimes the only procedure possible, internal drainage is superior and should be considered when it can be done without endangering the patient's life.
Subject(s)
Abdominal Injuries/complications , Pancreatic Cyst/complications , Peritoneal Cavity , Accidents, Traffic , Drainage , Humans , Male , Pancreatic Cyst/surgery , RuptureABSTRACT
The left internal mammary artery implant combined with epicardiectomy and free omental graft provides three extra-coronary sources of blood. This operation tested in dogs with 92% main-stem occlusion of three coronary arteries protected 75% of the animals. Applied clinically in over 100 patients, the operation resulted in 90% improvement. To obtain complete myocardial revascularization, the right internal mammary artery has been used as a fourth source of extra-coronary blood. In 57 animals, the right internal mammary arteries were implanted into the anterior walls of the right ventricle; in 80% this vessel formed anastomoses with the right coronary tree, and in 65% with the right and left coronary arteriolar systems. Six patients are described who underwent right internal mammary artery implantation; five of these in addition had the combined operation of left internal mammary artery implant, epicardiectomy and free omental graft. All patients had completely blocked right coronary arteries; in addition, five had advanced disease of the left coronary arterial tree.
