Endometrioma in a virgin abdomen masquerading as an intramuscular lipoma.

Endometriosis is the presence of endometrial tissue outside the uterine cavity. It has been previously reported in the abdominal wall secondary to gynaecological surgery. We present the case of a 32-year woman with endometrioma of the abdominal wall masquerading as an intramuscular lipoma with no previous surgical history.

Volvulus of the liver with intrathoracic herniation.

INTRODUCTION: We present a rare case of a liver volvulus, stomach and transverse colon herniating through the diaphragm. This scenario has not been reported previously. We discuss the presentation and management of this interesting case. CASE HISTORY: A 65-year-old woman with a history of sarcoidosis and recurrent pericardial effusions, treated previously with a subxiphoid pericardial oval window fenestration, presented with acute upper abdominal pain radiating to the chest. High contrast computed tomography showed a volvulus of the liver with consequent venous congestion, and herniation of the liver, stomach and transverse colon through an anterior diaphragmatic defect. With liver perfusion threatened, an urgent laparoscopic repair was performed. The stomach and transverse colon were reduced, and the twisted left lobe of the liver was unrotated and reduced into the abdominal cavity. A double-sided synthetic mesh was used to repair the defect. The patient made an uneventful recovery. CONCLUSIONS: This is a novel complication of a patient presenting with abdominal pain with a previous history of pericardial window fenestration. A laparoscopic reduction and repair can be performed safely with excellent postoperative results.

Caecal volvulus as a rare complication of laparoscopic adjustable gastric banding.

Adjustable gastric band insertion is performed for the treatment of morbid obesity. There are multiple complications associated with this procedure but caecal volvulus is not commonly associated with this procedure. A case of caecal volvulus as a late complication post laparoscopic gastric band insertion is presented requiring surgical repair with uncomplicated post-operative recovery.

Randomized clinical trial of perioperative systemic warming in major elective abdominal surgery.

BACKGROUND: Hypothermia is common in the operating theatre and may increase susceptibility to postoperative complications. Intraoperative systemic warming has been shown to improve outcomes of surgery. This study aimed to examine the effects of additional perioperative systemic warming on postoperative morbidity. METHODS: All patients admitted for elective major abdominal surgery and fulfilling the inclusion criteria were randomized into control or warming groups. Both groups were warmed during surgery, but patients in the warming group were additionally warmed 2 h before and after surgery using a conductive carbon polymer mattress. RESULTS: The trial recruited 103 patients (56 in the control group, 47 in the warming group). Both groups were well matched for age, sex and clinical state. Patients in the warming group had lower blood loss (median 200 (range 5-1000) ml versus median 400 (range 50-2300) ml in the control group; P = 0.011) and complication rates (15 (32 per cent) of 47 versus 30 (54 per cent) of 56 in the control group; P = 0.027). There were three deaths; two in the control group (P = 0.566). CONCLUSION: Extending systemic warming to the perioperative period had additional beneficial effects, with minimal additional cost and patient discomfort.

Management of symptomatic liver cysts.

Non-parasitic liver cysts are seen in up to 5% of the population. They become symptomatic when they are large and can cause pain, nausea, vomiting, early satiety and obstructive jaundice. Treatment modalities include percutaneous drainage, open deroofing, hepatic resection and lately, laparoscopic deroofing. We assessed our management of eleven symptomatic patients over the last five years between May 1996 and August 2001. Two of these had mild symptoms and were kept under review. The remaining nine were treated surgically. Of these, eight were treated by laparotomy and open deroofing with argon laser coagulation of the cut edges while one was treated with left hepatic resection. Three of these had been previously treated with laparoscopic deroofing at other hospitals and had been referred after having developed recurrent symptomatic cysts. Two patients developed post-operative complications--bile leakage that resolved with conservative management. The patients were followed up for a median period of twelve months ranging from 3-62 months. One patient died of liver failure 12 months after surgery. There was no symptomatic recurrence. We conclude that open cyst deroofing gives marked symptomatic relief with a very low complication rate. In today's era of laparoscopic surgery, it has a definite role in the management of symptomatic liver cysts, more so in recurrent cysts following laparoscopic treatment.

Transduodenal excision of ampullary tumours.

The commonly recommended treatment for ampullary tumours--pancreaticoduodenectomy results in significant morbidity and mortality. This study is a retrospective evaluation of the procedure of transduodenal local excision of ampullary tumours. Demographics, symptoms, histological findings and outcomes were retrospectively analysed in 15 patients. Survival analysis was done by the method of Kaplan-Meier and log-rank test. The median age was 68 years (range 54-78). Endoscopic biopsy was accurate in only 41% of cases. CT scan demonstrated a mass in 50% cases. Definitive histology reported 4 adenomas, 2 carcinomas-in-situ and 9 adenocarcinomas. Median hospital stay was 13 days. There was no operative mortality. Mean duration of follow-up was 31 months (range 7-70 months). The procedure appears curative for adenomas and in-situ carcinoma. Overall 3 year actuarial survival for ampullary tumours is 65% while that for moderately differentiated carcinomas is 50%. Pre-operative investigations provide inadequate histological information. Wide local excision is a safe operation with low morbidity and good survival in carefully selected cases. However, the role of local excision for carcinoma appears to be palliative rather than curative.

Endometrioma of the liver.

Hepatic endometriosis is extremely rare. The diagnosis is often missed and treatment is delayed. A 37-year-old woman was referred to the gynaecology department with vague abdominal pains. She had a past history of pelvic endometriosis and hysterectomy with bilateral salpingo-oophorectomy. Further investigations in due course confirmed it to be endometriosis of the liver. She was eventually referred to the hepatobiliary unit, almost three years after her first presentation, where she was operated on with good results.

True aneurysm of a femoropopliteal vein graft.

Aneurysmal dilatation of saphenous vein grafts mostly represent thin-walled pseudoaneurysms at anastomotic sites. True aneurysmal dilatation of femoropopliteal bypass vein grafts is rare. We report this unusual case, which was repaired with a prosthetic graft.

Antibacterial effect of some leaf extracts on Salmonella typhi.

Aqueous and methanol extracts of fresh leaves of twenty desert plants of Rajasthan state were tested for their antibacterial activity against human pathogenic bacteria Salmonella typhi, causal organism of typhoid fever in human beings. 10% concentrate extracts of leaves of various plant species were used for testing antibacterial potential. Five plant species were found to have inhibitory effect against the organism. Fagonia cretica leaf extracts were found most effective against Salmonella typhi.