Hemorrhagic cholecystitis presenting as obstructive jaundice

No abstract available.

An Ileocutaneous Fistula That Developed 12 Years after Repair of an Abdominal Wall Defect Using Intraperitoneal Placement of High-density Polypropylene Mesh (Marlex(R))

Although prosthetic materials are commonly used to repair abdominal wall defects, they are also associated with postoperative complications. These complications could be prevented by the adoption of uniform guidelines on surgical methods and materials, but the best anatomical position for placement of prosthetic meshes is unclear. We report a case of an enterocutaneous fistula that developed after an abdominal wall defect was repaired by intraperitoneal application of a prosthetic mesh (Marlex(R)) to raise awareness of the consequences of improper use of prosthetic materials.

Successful Treatment of Hypercalcemia During Continuous Renal Replacement Therapy in Patient with Rhabdomyolysis Following Cardioversion and Cardiopulmonary Resuscitation / 대한신장학회지

Rhabdomyolysis is a common clinical and laboratory syndrome resulting from reversible skeletal muscle injury, with release of muscle cell contents into the plasma. Cardioversion, and cardiopulmonary resuscitation may produce rhabdomyolysis and myoglobinuria. We report a 5-year-old boy surviving after cardiopulmonary resuscitation and repeated 5 times of cardioversion. He showed elevated serum BUN and creatinine levels, requiring hemodialysis treatment. We had tried 5 times of intermittent hemodialysis, but oliguria was continued and there was no change of serum BUN and creatinine. His urine output was less than 100 cc per day and he showed severe edema and weight gain of 7 kg, and so we started the continuous renal replacement therapy (Prismaflex(R), gambro). After 12 days of continuous venovenous hemodiafiltration (CVVHDF), his urine output recovered and his BUN, creatinine, liver enzyme, creatine kinase, and lactate dehydrogenase levels returned to normal. During the treatment of CVVHDF, he had shown persistent hypercalcemia, and so we changed dialysate and replacement solution from hemosol B0 to calcium free solution. The hypercalcemia was controlled successfully using this calcium free pharmacy-made bicarbonate solution.

Small bowel obstruction in early pregnancy: A case report / 대한산부인과학회지

Intestinal obstruction occurs rarely as a cause of acute abdominal pain during pregnancy. It is very difficult to make diagnosis, as nausea, vomiting and abdominal pain are commonly associated with pregnancy, and X-rays are avoided if possible. However, delayed diagnosis can cause intestinal strangulation, which results in a high incidence of maternal morbidity, mortality, premature labor, and fetal loss. The incidence of intestinal obstruction seems to increase at the time of rapid uterine size changes such as between 16~20 weeks, 32~36 weeks or even in the puerperium. The possibility of intestinal obstruction must always be kept in mind when a pregnant woman with an operation scar on her abdomen develops abdominal pain. We present a case of small bowel obstruction during early pregnancy with a brief review of the literature who had the history of right salpingo-oophorectomy and appendectomy operation

Cholestatic Jaundice Associated with Juxtapapillary Diverticula without Common Bile Duct Stones

BACKGROUND/AIMS: Cholestatic jaundice caused by a juxtapapillary diverticulum can be treated by excision of the diverticula or endoscopic sphincterotomy(EST). The aim of this study is to evaluate the effectiveness of EST for cholestatic jaundice in patient with juxtapapillary diverticulum with absence of common bile duct stones. METHODS: We recruited patients who underwent Endoscopic Retrograde Cholangio Pancreatography(ERCP) between September 2000 and May 2005. The presence of Juxtapapillary diverticula was seen in 92(29.3%)) out of 315 patients underwent ERCP. Cholestatic jaundice associated with juxtapapillary diverticula was considered when patients have jaundice, elevated serum bilirubin and alkaline phosphatase more than normal, and there are no other obstructive lesion on abdominal ultrasonography or computed tomography(CT) scan. The number of the patients were 13 who had cholestatic jaundice associated with juxtapapillary diverticula without common bile duct stones. All 13 patients underwent EST and had no complications. The patients were followed up to visit outpatient department or interviewed on the telephone. RESULTS: Of the 13 patients, 10 were male and 3 were female. The mean age was 70.4 years and mean duration of follow-up were 28.9 months. All 13 patients who had gallbladder presented RUQ discomfort and jaundice. Seven patients presented gallstone pancreatitis with jaundice. Nine patients had GB stone, 1 patients had GB sludge. In the follow-up period, from 1month to 46 months after EST, 1 patient died of unknown cause within 1 year. One patient had recurred gall stone pancreatitis with jaundice 12 months later. CONCLUSIONS: EST can be considered as a useful therapeutic modality especially in eldery patients with cholestatic jaundice and gallstone pancreatitis associated with juxtapapillary diverticulum.

Laparoscopic Management of Complicated Urachal Remnant in a Child

A few cases of laparoscopic surgery for urachal remnant in children has been reported in English literature. With recent developments in minimal invasive surgery, laparoscopic approach for urachal remnant in adulthood is recommended by some laparoscopic surgeons because of its technical feasibility and safety as well as cosmesis. Recently we experienced a case of complicated urachal remnant in a 14-month-old girl, who was managed by laparoscopic approach. At presentation, she complained of high fever and lower urinary tract symptoms. After 6 weeks of antibiotics therapy, laparoscopic surgery was performed transperitoneally via 3 ports. Our experience suggests that laparoscopic excision of urachal remnant can be performed easily and safely in children.

A Case of Intracolonic Surgical Sponge misdiagnosed as Intraperitoneal Foreign Body / 대한산부인과학회잡지

Intraperitoneal foreign body is a rare but extremely troublesome condition. Such as forceps, rubber tubes, pieces of broken instruments can retained during surgery but most commonly foreign body is the surgical sponge. The retained foreign body produce intra-abdominal abscess, peritonitis, intestinal obstruction in the postoperative period or even after weeks, months or years and very uncommonly migrate into the bowel. We report a case of intracolonic surgical sponge misdiagnosed as retained intraperitoneal foreign body with brief review of literatures.

A Case of Pelvic and Abdominal Actinomycosis Associated with wearing an Intrauterine Device / 대한산부인과학회잡지

Actinomycosis, rare in pelvic localization and a severe condition not well known to gynecologists, is an uncommon entity caused by anaerobic bacteria, Actinomycosis israelii. After trauma, surgery, or other infections that alter the host's mucosal barriers, these organisms advance to invade surrounding tissue and organs. The pelvic loculation of the disease generally presents as a pseudoneoplastic formation, so it is very difficult to make an accurate diagnosis initially. We experienced a pelvic and abdominal actinomycosis confirmed by pathology in a woman who had been wearing an IUD and complained fever, chill, headache for one month, and lower abdominal pain and palpable mass. This case illustrates the importance of considering the possibility of actinomycosis when we met a vague abdominal mass.

Differences Between Gallstone Patients Over and Under 65 Years of Age

BACKGROUND: Recently the number of elderly gallstone patients has increased, in Korea. The aim of this study is to analyze and to measure the risk factors associated with operation on elderly gallstone patients. METHODS: We reviewed the medical records of 206 gallstone patients who had been admitted and operated on in the department of general surgery. Konkuk University Hospital, between January, 1993 and December, 1999. The patients were divided into 2 groups, over and under age 65. In each group, analysis was done on sex distribution, the ratio according to location of gallstone, duration of hospital stay, duration of general anesthesia and operative mortality, and then the above factors of each group were compared. RESULTS: 1) The ratio of common bile duct stones in patients over age 65 was two times of that in patients under age 65(48%,24%) 2) The overall operative mortality was 1.9% and has no correlation with old age. 3) Severe coexisting disease may seem the risk factor for operative mortality. CONCLUSION: In the diagnosis and management of gallstones in the elderly, the possibility of common bile duct stone should be suspected. And in order to reduce the operative mortality, careful preoperative evaluation and treatment of coexisting disease should be done.

Factors Which Influence Mortality Following Operation on Patients over 65 Years of Age

BACKGROUND: There is a continuing increase in geriatric population. Many workers have reported an increased mortality rate after operation on patients over 65 years of age. The aim of this study is to analyze and to measure the risk factors associated with geriatric surgery. METHODS: We reviewed the medical records of 467 patients over 65 years of age who had been admitted and operated on in the department of General Surgery, Konkuk University Hospital, between January, 1993 and December, 1999. An analysis was done on age and sex distribution, duration of admission, type of anesthesia, duration of general anesthesia, number of benign and malignant disease, number of coexistent disease, number of emergency and elective operation, and then, we analyzed the above factors to know whether they influence mortality rate or not. RESULTS: 1) Overall operative mortality rate was 4.3%, and the factors influencing mortality rate were, malignant disease, coexisting disease, emergency operation and long duration of general anesthesia. 2) Old age in itself did not affect the mortality. CONCLUSION: In order to reduce the operative mortality in geriatric surgery, careful preoperative evaluation and elective surgery rather than emergency operation must be done, and the operation chosen should be the one of less magnitude, not very radical operations to achieve permanent cures.

A Clinical Analysis of Thyroid Nodules / 대한이비인후과학회지

The thyroid nodules are the most frequent encountered disorders of the endocrine system. A clinical study of 34 cases with thyroid nodules, which were treated by surgical excision and confirmed pathologically at the department of otolaryngology-head and neck surgery, Kon-Kuk University hospital, from January 1990 to July 1995, was conducted. This study was designed for early diagnosis and proper treatment of thyroid nodules through clinical analysis. The clinical analysis results were obtained as follows: 1) The sexual distribution showed the preponderance of female with 1:5.8. 2) The most prominent sign was palpable nodule on anterior neck. 3) The duration of illness within 3 months was most common(51.5%), and the size of thyroid nodules was parallel to the duration of illness. 4) Most nodules were unilateral in 29/34(85.2%), among them, right lobe in 47%, lower lobe in 38.2%. 5) The consistency of nodules was soft in 12 cases(31.5%) and most nodules were single in 26 cases(76.4%). 6) Fine needle aspiration biopsy showed consistent with surgical result in 13/19 cases(70%) at benign nodules and in 3/4 cases(75%) at malignant nodules. 7) The histopathologic classification of benign diseases in decreasing order of the frequency were adenomatous goiter, 17.28 cases(60.7%); follicular adenoma, 7/28 cases(25%); Graves' disease, 0 cases. The malignant diseases were papillary carcinoma, 6/6 cases(100%). 8) The frequent performed operative procedure was unilateral lobectomy 28/34(82.3%) in both benign and malignant disease. 9) The postoperative complication occured in 12/34 cases(35.2%) including 5 cases of mild dysphagia(14.7%) and 2 cases of transient hoarseness(5.8%) and 1 case of hypocalcemia(2.9%) and 1 case of ecchymosis(2.9%) in wound and were related to the extent of the surgical procedure.