Schwannoma of bile duct--a case report.

This is a case report of a 29 year old woman who presented with painless and progressive obstructive jaundice. Imaging investigations of the abdomen revealed a tumour of the common bile duct. She was treated by complete excision of the bile duct and hepaticojejunostomy. The histopathology report of the tumour read as benign schwannoma.

Management of adult choledochal cysts--a 15-year experience.

BACKGROUND: Choledochal cyst, a common surgical problem of childhood, can have a delayed presentation in adults. The clinical course in adults differs from that in children because of a higher incidence of associated hepatobiliary pathology. METHODS: The clinical data of 57 adults with choledochal cyst managed in a general surgical unit between January 1988 and March 2003 were analysed. RESULTS: The male:female ratio was 1:1.38 and the mean age was 34.5 years; 71.9% of the cysts belonged to Todani type I, 26.3% to type IV and 1.8% to type V. Abdominal pain and recurrent cholangitis were the commonest presentations followed by acute pancreatitis, palpable mass and bronchobiliary fistula. Anomalous pancreaticobiliary ductal junction was demonstrated in 14% of the cases. In all, 37% of the patients had undergone either wrong or suboptimal surgical procedures prior to presentation. All patients underwent complete excision of the cyst and hepaticojejunostomy. Two patients required cholangiojejunostomy and three patients required resection of the involved segments of the liver in addition. There were three anastomotic leaks and two postoperative deaths. Two anastomotic leaks resolved spontaneously while the third required surgical intervention. Forty-eight patients were available for follow-up and have remained symptom-free over a mean period of 17.6 months. CONCLUSIONS: Choledochal cyst should be considered in all patients below 40 years of age presenting with biliary colic, pancreatitis or recurrent cholangitis with associated dilatation of bile duct. Complete excision of the cyst with restoration of biliary-enteric communication by hepaticojejunostomy form the basis of ideal treatment.

Mycobacterium fortuitum: an iatrogenic cause of soft tissue infection in surgery.

BACKGROUND: Mycobacterium fortuitum is an uncommon cause of soft tissue infections. Treatment is often inadequate with persistence of infection unless the aetiological agent and its antibiotic sensitivity are accurately established. METHODS: Medical records of 23 patients with chronic soft tissue infection caused by M. fortuitum over a 12-year period from 1991 to 2002 were studied. RESULTS: In 20 patients the cause was iatrogenic, following intramuscular injections (12), laparoscopy (5) and other surgical procedures (3) and in three patients discharging sinuses developed spontaneously. Patients presented with recurrent abscesses or chronic discharging sinuses that did not respond to conventional surgical drainage. The diagnosis was established by isolating M. fortuitum from the tissues in all cases. The treatment consisted of a more aggressive surgical intervention in form of excision, debridement and extensive lay open with curettage and prolonged administration of appropriate antibiotics. The organism showed maximum sensitivity to amikacin and ciprofloxacin. Healing occurred in all cases. Three patients suffered recurrences: two responded to further debridement and antibiotics and are well at 2 and 5 years, respectively. CONCLUSION: A high index of suspicion based on clinical presentation is essential to diagnose M. fortuitum as a cause of soft tissue infection. Treatment involves aggressive surgical debridement and administration of combination antibiotics based on sensitivity, which should be continued for a period that will ensure complete healing and prevent recurrence.

Left paraduodenal hernia: an uncommon cause of chronic abdominal pain.

We report the case of a paraduodenal hernia treated by reduction of the hernia and closure of the hernial orifice.