Dog Bite Causing Intestinal Perforation in a Child: A Case Report with Review of Literature.

Dog bite injuries are common in children. They are a major cause of morbidity and mortality involving commonly the extremities, head, and neck. Injuries to the torso represent only 10% of injuries. Visceral injury by a dog bite in children is a rare clinical scenario with very few cases reported. We present a 2-year-old female child who suffered a severe dog bite injury causing colonic perforation.

Role of 99m Tc-Mebrofenin Hepatobiliary Scintigraphy in the Diagnosis of Post Cholecystectomy Syndrome.

Background Huge variation in the prevalence of post cholecystectomy syndrome (PCS) is because PCS can include a wide variety of disorders that can be both related and unrelated to cholecystectomy. Hepatobiliary scintigraphy (HBS) is a noninvasive nuclear medicine scan that can evaluate a delay in the transit of bile from the hepatic hilum to the duodenum using a radiotracer 99m Tc-Mebrofenin that can be associated with a functional ampullary obstruction. The aim of this study was to assess the role of 99m Tc-Mebrofenin HBS in the detection of the cause of PCS among the patients undergoing cholecystectomy. Methods Twenty-one patients who presented with PCS from September 2018 to February 2020 were included in the study. These patients were characterized based on history, examination, liver function test, and abdominal ultrasound. Sphincter of Oddi dysfunction (SOD) was diagnosed using the Rome 3 criteria and the Milwaukee classification. Magnetic resonance cholangiopancreatography (MRCP) and upper gastrointestinal endoscopy and biopsy were done when indicated, to establish the diagnosis. These patients were further subjected to 99m Tc-Mebrofenin HBS, and the findings were analyzed. Results The most common symptom in PCS was biliary pain occurring in 85.7% of the patients. The average time of presentation since surgery was 1.9 years. The most common cause of PCS was SOD, occurring in 52.3% of the patients, followed by benign biliary stricture occurring in 23.8% of the patients. The mean bile duct (common bile duct) visualization time in patients with PCS was 25.2 minutes, the mean duodenal visualization time was 38.2 minutes, and the mean jejunal visualization time was 60.5 minutes. The mean bile duct to duodenum transit time was 12.7 minutes, while the mean bile duct to jejunum transit time was 30.1 minutes. HBS showed consistent findings with the final diagnosis made by other diagnostic modalities (clinical criteria/MRCP/intraoperative findings) in 80.9% of the patients. Conclusion 99m Tc-Mebrofenin HBS has a significant role in the evaluation of PCS.

Laparoscopic Management of Double Gall Bladder: A Case Series.

Double gall bladder or duplication of the gall bladder is a rare congenital malformation. It poses a challenge to the surgeon and the radiologist, both in preoperative evaluation and intraoperative management. In the era of minimal invasive surgery, clear knowledge of extrahepatic biliary anatomical variations is very much essential. The operating surgeon should be very careful and overcautious in identifying such variations to prevent untoward biliary tract injury. In this series of two cases, we present the clinical peculiarities, preoperative diagnosis, and laparoscopic management of the duplicate gall bladder.