Total colectomy and ileoanal endorectal pull-through for ulcerative colitis and familial polyposis

Thirteen young adults [8 familial polyposis and 5 ulcerative colitis] underwent total colectomy and straight endorectal ileoanal pull- through operation. They were 7 males and 6 females. Their age ranged from 18 to 32 years. The diagnosis was confirmed by histopathological examination. Standard bowel preparation was done. Follow up period ranged from 6 to 36 months. There were no operative or postoperative mortality, also there was no major complications. Two patients developed pelvic cellulitis, which were responded to antibiotic therapy, 3 patients developed minor wound sepsis, one patient developed adhesive intestinal obstruction, which resolved by nasogastric suction. Three patients developed stenosis of the anastomotic line which was relieved by digital dilation. In one patient loop ileostomy was done because he was not satisfied from the operation. Rectal sphincter tone had been good on physical examination in all patients. All patients showed normal bladder function. There was definite increase in stool frequency. In spite of this, it was accepted by the patient as a price to avoid ileostomy. The absence of major complications and the accepted functional and social results supported the recommendation of these procedures as an acceptable alternative to proctocolectomy and permanent ileostomy in patients with familial polyposis and ulcerative colitis

Nissen fundoplication for the treatment of chronic asthmatic patients

This study was applied on 30 adult patients [21 males and 9 females] presented by chronic bronchial asthma and symptoms of GERD who were refractory to conservative anti-asthma medical lines. Clinical assessment, X-ray chest, esophagography, pulmonary function tests before and after bronchodilators, tests to confirm GERD and upper GI endoscopic examination including lower esophageal multiple biopsies were done to all cases. Six out of 30 patients underwent Nissen fundoplication as a selected surgical anti-reflux technique. Esophagitis was detected in 96.6% of cases, endoscopic evidence of GERD was shown in 63.3%, anti-reflux treatment together with bronchodilators have caused clinical reversibility of airway obstruction by 20% or more as proved by pulmonary function parameters tested. Anti-reflux conservative treatment has achieved good response in 24 patients. Regarding the 6 patients who were subjected to surgery, 5 of them showed marked clinical and pulmonary functions improvement with decreased frequency of exacerbations, reduction of bronchodilator dose and disappearance of reflux symptoms. One patient failed to show clinical response

Laparoscopic cholecystectomy initial experience in Assiut University Hospital

The initial experience with laparoscopic cholecystectomy [LC] for symptomatic cholelithiasis and non-calculus cholecystitis has involved 60 selected patients, their ages ranged from 20 to 65 years with a mean of 39.8 years. Most patients [51 of 60] were females. Calculus cholecystitis represented 93.3% of indications. Selection of patients was done after exclusion of patients with upper abdominal scarring coagulopathies, morbid obesity, pregnancy, associated bile duct stones and those unfit for general anesthesia. Eight patients [13.33%] required conversion to open surgery, causes were difficult dissection due to marked adhesions and troublesome bleeding in other cases. In one of three patients with acute cholecystitis, LC was not possible due to edema and friability of gallbladder wall, beside marked adhesions. Operative time ranged from 60 to 180 minutes and averaged 97.7 minutes. Mean hospital stay time was 2.66 days. Most of patients were discharged in the second postoperative day. Complication rate was 6.6% major, 1.6% life threatening and 15% minor complications. Most of complications encountered in the work were met in the early cases of this series

Study of portal hypertension in young age [below 15 years-old]

During the period from January 1990 to June 1992, 26 young patients were diagnosed as having portal hypertension, their ages ranged between 2 and 15 years. Bilharzial hepatic fibrosis represented the etiology in 38.5% of cases, following by post- hepatic cirrhosis in 30.7%, non-Hodgkin's lymphoma and portal vein thrombosis [11.5% for each], and lastly congenital hepatic fibrosis with an incidence of 7.7%. Symptoms included hematemesis and abdominal enlargement as the commonest presentations. Signs included splenomegaly in 77% of patients, ascites in 46.1% and jaundice in 38%. Investigation included blood picture, liver function tests, hepatitis B-surface antigen, abdominal sonography, liver biopsy, Doppler ultrasound, splenoportography, proctosigmoidoscopy with fresh mucosal biopsy for B-ova detect, and endoscopic upper GI examination. Portal vein dilatation was present in all, but 3 cases, and esophageal varices were detected in 80%. Treatment strategies included conservative, endoscopic and surgical lines. Esophageal sclerotherapy was done safely with a success rate of 76.5%

Short term total parenteral nutrition [TPN] after major gastrointestinal surgery

Forty adult male patients were admitted to ICU of Assiut University Hospital following major gastrointestinal surgery. They were randomly allocated into two groups each of 20 patients. The first group received conventional I.V. fluid therapy. The TPN group received parenteral formula in a central vein as Vamine N., Lipids [Intralipid], glucose 25% as well as vitamins and minerals. Estimation of plasma proteins, liver functions and immunologic parameters was done to evaluate cause-effect response after therapy. Daily monitoring of vital signs, serum electrolytes and blood gases was carried out. Condition of the wounds and bowel were looked for and any abnormality was recorded. Nutritional status of patients was evaluated pre and after fluid therapy. Significant difference between all measured serum proteins was observed in patients received TPN, with no catabolic stress that was manifested clearly in conventional group. Immunologic parameters were suppressed preoperatively in both groups [mostly cancer patients], with no significant difference after therapy. Two patients died in the conventional group [one from entercutaneous fistula developed in the fifth day and was complicated by pneumonia and ARDS, and the other due to septicaemia and septic shock] while morbidities were common also in this group in the form of fecal fistula, wound sepsis, wound deheisene and metabolic complications. TPN therapy proved to be effective to control catabolism after major GIT surgery, with better outcome, less stay in hospital and less mortality and morbidity

Helicobacter pylori and post gastric surgery symptoms: a study of 36 operated patients

A total of thirty six operated subjects [31 for duodenal ulcer and 5 for gastric ulcer] were retrospectively selected 6 months to 8 years postoperatively, and studied for the effect of peptic ulcer surgery upon Helicobacter pylori [H.pylori] colonization in the gastroduodenal mucosa and its correlation with post gastric surgery symptoms. Twenty five patients represented the symptomatic group, while eleven patients had no gastroduodenal troubles [non symptomatic group]. Upper G.I endoscopic examination was performed to all subjects, using a modified endoscopic mucosal changes score and a bile reflux score to assess objectively the gastroduodenal mucosal changes. Endoscopic biopsies were obtained and examined using Clo test to detect H.pylori colonizations. Mucosal changes scores were significantly higher in symptomatic group. H.pylori colonization was significantly lower in symptomic group, specially when bile reflux score was high. The eradication power of bile upon H.pylori was assured. H. pylori infection played a minor role in causing post gastric surgery symptoms in this study. It's role could be of importance only when enterogastric reflux is absent

Helicobacter pylori in gastroduodenal diseases in upper Egypt

The discovery of Hellicobacter Pylori has introduced the new infection theory for explanation of gastroduodnal diseases. H.pylori is thought to be an important cause of gastritis, an aetiologic factor in peptic ulcer, and possibly a related factor to cancer stomach. In this study H.pylori was looked for in endoscopic biopsy specimens from 37 patients with gastroduodenal lesions and in 20 controls using both Clo test and culture as methods for diagnosis. H.pylori was present in about 86% of gastric cases, 91% of duodenal ulcer cases, 67% of gastric ulcer cases, one of two cancer stomach cases and 70% of control cases. Also it was found that H. pylori prevalence increased with the increase of age in control cases, however the presenc of H.pylori was unrelated to sex, symptomatology and smoking. In this work Clo test was far more superior than culture technique in detecting H.pylori

Sonographic guidance of percutaneous drainage of abscesses and fluid collections as an alternative to surgery

Availability and advances in ultrasound instrumentation have improved the ability of ultrasonic guidance of interventional procedures. In this article we describe our technique of puncture and aspiration followed by percutaneous catheter drainage for 124 cases with 137 abscesses and fluid collections; discovered on abdominal sonographic examination. Defervescence was attributed to reduction of bacterial flora and institution of proper antibiotic treatment based on culturing of the aspirate and sensitivity of the organism; as well as on providing a mean for continuous drainage of the abscess through a catheter Daignostic puncture and aspiration was successful in all cases [100%]. Catheter drainage was curative in 92 of the total number of abscesses and fluid collections [74.1%]. Partial success followed by surgery occured in 19 cases [15.3%]. The technique failed to cure the abseess or the fluid collection in the rest of cases [13 cases-10.4%].Complications occured in 20 cases; 7 majors and 13 minors. The method is recommended for the initial management of abdominal abscesses and fluid collections

Primary carcinoma of the gallbladder: experience of 18 cases in Assiut University Hospitals

Carcinoma of gallbladder is not a rare entity. This study presents 18 cases [15 females and 3 males] of histologically proven primary carcinoma of the gallbladder among 866 patients operated in the General Surgery Department of Assiut University Hospital for different billiary troubles during the last 4 years. In only five cases the diagnosis of gallbladder tumour was suggested preoperatively by the help of CT scan and abdominal sonography. In 83.3% of cases [15 out of 18] gallstones were associated. Diagnosis was confirmed only by laparotomy and histopathological examination. Adenocarcinoma [77%], undifferentiated carcinoma [16%] and squamous cell carcinoma [5%] were the pathological types of the tumours. Areas of spread included liver bed, portahepatis and caeliac lymph nodes. Distant metastasis included mesenteric lymph nodes, bones and umblicus. Clinical presentations included pain, fever, vomiting, jaundice, dyspepsia and upper right quadrant mass. Surgical manoeuvers included laparotomy and biopsy, cholecystectomy, CBD exploration, internal and external billiary drainage, gastrojejunostomy and wedge hepatic resection. The mean survival time postoperatively was 7 months with 2 cases living for 18 and 22 months. The best hope to improve this dismal lies in earlier cholecystectomy in patients with calcular or benign gallbladder disease