Running sutures anchored with square knots are unreliable.

BACKGROUND: A previous study showed that running polypropylene sutures anchored with square knots retain only 75% of their strength compared with half hitches. The aim of this study was to investigate whether anchor knot geometry similarly affects the tensile strength of other types of sutures used in continuous closures. METHODS: Monofilament and multifilament sutures (all 3-0) were anchored with either square knots or half hitches to 1 tensionometer post, and the running ends were secured to the other. The force required to break the running suture and the site of suture failure were recorded. RESULTS: The running sutures anchored with square knots retained only 50% to 84% of the strength of the identical sutures secured with half hitches (P < .001). CONCLUSIONS: A running suture anchored with half hitches is stronger and safer in comparison with the same suture anchored with square knots. This study provokes a fundamental reconsideration of the use of square knots to anchor running sutures.

Infarcted epiploic appendage of the vermiform appendix masquerading as acute appendicitis.

Infrequent causes of right lower quadrant pain that mimic acute appendicitis include infarcted epiploic appendages. Although usually located in the colon, we report the very rare case of an infarcted epiploic appendage located directly on the serosal surface of the appendix itself. In a patient with right lower quadrant pain, the diagnosis of infarcted epiploic appendages is rarely made preoperatively and the incidence is rare. Definitive treatment is excision.

Damage control for blunt hepatic trauma: case presentation and historical review.

A 15-year old female with a Grade V liver injury from blunt trauma underwent therapeutic packing for uncontrolled hemorrhage. Pack removal in 72 hours following transfer to a major trauma center showed complete hemostasis. Six years later, CT scans revealed minimal liver sequella. Damage control surgery with initial therapeutic packing in blunt hepatic trauma is a valuable option for the community surgeon.

Appendiceal colic: A rare complication of colonoscopy.

We report a case of appendiceal colic presenting as chronic right lower quadrant abdominal pain, without leukocytosis or other inflammatory signs, following an uneventful colonoscopic exam without biopsy or polypectomy. The resected appendix appeared grossly abnormal and was engorged with fecal material. The patient was immediately relieved of pain and remains so four years postoperatively. We conclude that insufflation of the cecum caused inspissation of fecal material into the lumen of the appendix. The ensuing incomplete or partial obstruction of the appendiceal lumen resulted in development of appendiceal colic without any signs or symptoms of inflammation.

Outpatient laparoscopic cholecystectomy: experience of a nonovernight surgicenter.

From April 1994 to September 1998, a total of 66 laparoscopic cholecystectomies were performed at the same-day freestanding Surgicenter of the Yankton Medical Clinic. All patients (ages 15 to 62 years; 91% women) were discharged the same day, and no patient required hospitalization despite two conversions to open cholecystectomy. Cholangiofluoroscopies were completed in 70% of the patients. Pathologic evaluation showed chronic cholecystitis in all patients except one, who also had acute disease. No patient was lost to follow-up, and 98% responded that they "would do it again." These results confirm the safety of laparoscopic cholecystectomy in selected patients in a low- and controlled-cost environment of a freestanding surgical facility. Interestingly, Medicare does not allow facility reimbursement for cholecystectomy in any nonovernight outpatient surgery center in South Dakota.

Delayed presentation of splenic trauma following colonoscopy.

Splenic trauma is a rare complication of colonoscopy, and diagnosis of such an injury is often delayed and made only at laparotomy. Although computerized tomography may be helpful, a knowledge of this complication is the best tool to aid in early diagnosis. In this article, a case of splenic trauma is presented that was associated with a flexible fiberoptic colonoscopy and required an urgent splenectomy five days after the procedure.

Overwhelming postsplenectomy sepsis twenty-two years after operation risks management and prevention.

A new case of fatal postsplenectomy sepsis occurring 22 years after operation for splenic rupture is described. There are now 30 published cases in which this complication occurred 10 or more years after operation. The microorganism responsible for the vast majority of cases is Streptococcus pneumoniae. The causative pathogen identified in the present case was a Viridans Streptococcas, Strep. sanguis, an opportunistic, low virulence pathogen. The clinical presentation of this patient is characteristic of the syndrome of overwhelming postsplenectomy infection and exemplifies the dramatic suddenness with which it develops.

Parathyroid cyst: case report of a rare surgical lesion of the neck.

A thirty-two year old female presented with a neck mass of probable thyroid origin. Repeated fine needle aspirations failed to provide diagnostic tissue or long-term resolution of the cystic mass. The clinical and pathologic findings in this case of a parathyroid cyst are presented. Parathyroid cyst is a rare cause of neck mass. Recurrence of a cyst is also unusual following aspiration. The aspiration of clear watery fluid from a neck mass offers presumptive evidence of a parathyroid cyst. The demonstration of parathyroid hormone in the cyst fluid is considered diagnostic.