Management of cholelithiasis during pregnancy

Twenty-seven pregnant women, with symptomatic gallstone disease, were admitted to this prospective study. All patients received initial medical therapy, and surgical intervention was performed in cases with frequent relapses or no response to medical treatment. Twelve patients underwent surgery during pregnancy, 2 in the first and 10 in the second trimester. Eight patients underwent laparoscopic cholecystectomy, while 4 had open cholecystectomy [one had exploration of the common bile duct]. While no maternal or fetal deaths occurred secondary to medical treatment, one spontaneous abortion occurred following open cholecystectomy in the first trimester. Patients, after receiving primary medical treatment, had 74.1% rate of relapse and additional days in hospital, compared to no relapse and less hospital stays after surgery. Patients acute cholecystitis had increased incidence of medical treatment failure and need of surgery. It is concluded that management of biliary tract disease during pregnancy should follow a protocol, with clear indications for the role of surgical intervention during the second trimester of pregnancy does not increase maternal or fetal morbidity. It may in fact reduce the number of relapses during pregnancy, hence reduces the consequent complications and additional hospital stay. Laparoscopic cholecystectomy is feasible in the great majority of patients, except those with large uteri in the late second trimester and the presence of common bile duct stones

Colorectal cancer in young patients

Twenty three patients with colorectal cancer under the age of 40, were presented in the study over a period of 4 years. Fourteen patients were males while nine patients were females. Their age ranged from 12-39 years. Four cases were presented with acute emergency conditions, while 19 patients were discovered during routine work up for symptomatically ill patients. The most common presenting symptoms were abdominal pain, change in bowel habit, bleeding per rectum and weight loss. Carcinomata were found most commonly in rectosigmoid region [Rectum 8 cases sigmoid 7 cases] whereas the remaining eight cases were distributed in the proximal colon. Only one case had multifocal lesions. On pathologic staging Dukes' B and C stages represented the most common pathologic stages being 7 and 11 cases, respectively. While only 2 cases had Dukes' A lesion and 3 cases had Dukes' D lesion. Various surgical procedures have been used according to the site of the tumour. Resection was aiming at cure in 18 cases. All the tumours were adeno carcinoma. Mucin producing tumours were documented in 3 cases. Follow up continued for 26-61 months postoperatively. Only 6 patients developed recurrences in the first-two postoperative years. The overall survival after 2 years was 86.9% and the rate of disease free follow up for two years was 69.5%. The duration of symptoms before presentation did not seem to carry a significant relation with the Dukes', stage or with the survival rate