Adenocarcinoma at angle of treitz: a report of two cases with review of literature.

We report two patients with adenocarcinoma at angle of treitz who presented with upper GI(gastrointestinal) obstruction and underwent segmental resection of duodeno-jejunal junction. Preoperative investigations failed to reveal the nature of the lesion suggesting the elusive nature of these lesions, importance of clinical suspicion and decision-making.

Hepatic trauma: experience of 110 cases.

A total of 110 patients with hepatic injuries was treated at a major urban trauma centre between June 1988 and December 1991. The mechanism of injury was blunt trauma in 86 patients (78 per cent). Non-operative treatment was given in six patients (5 per cent). Simple hepatorrhaphy, use of topical haemostatic agents or peritoneal drainage alone were performed in 79 (72 per cent) cases. Extensive hepatorrhaphy, hepatotomy with selective vascular ligation, resection and débridement or resection, perihepatic packing and major vascular ligation were undertaken, often in combination, in 25 (23 per cent) cases. Percutaneous arterial embolization was carried out in one case. The mortality rate was 18 per cent. The most frequent postoperative complications related to hepatic injury were intra-abdominal abscess (7 per cent) and coagulopathy (5 per cent); prolonged biliary leak (3 per cent), late haemorrhage (2 per cent) and hepatic necrosis (1 per cent) were also observed.

Gastrostomy without laparotomy--a percutaneous endoscopic technique: review of 35 cases.

Percutaneous endoscopic gastrostomy (PEG) was performed in 33 patient with head injury, one with laryngeal cancer, and one with gastric volvulus. The gastrostomy tube was prepared from 20 F Foley catheter and a plastic micropipette tip. The complications encountered included peritubal leak in three patients (9%) and abdominal wall hematoma in one patient (3%). There was no procedure-related mortality. We recommend PEG for tube enteral feeding in patients who have lost the swallowing reflex.

Ambulatory hydrocele surgery: a review of 50 cases.

In a prospective study, 50 cases of hydrocele were treated by ambulatory surgery. Lord's technique was performed under local anaesthesia. A modified simple scrotal dressing was used to facilitate ambulation. In one case (2%), haematoma was reported. There were no wound infections. Patients tolerated the procedure well and ambulation was excellent in all cases. On the grounds of safety and cost effectiveness, most hydrocele repair procedures should be performed on ambulant patients.

Spontaneous regression of large gastric carcinoid.

We report a female patient who presented with an epigastric lump proved on open biopsy to be a carcinoid tumor. She had raised serum glucagon level and increased excretion of 5-hydroxy indolacetic acid in the urine. She refused surgery and was followed up at 3 monthly intervals. At 6 months the tumor had decreased considerably in size. At one year it was no longer palpable and ultrasound examination clarified that there was no tumor. This was confirmed by the finding of normal levels of 5-HIAA in the urine.