Gall bladder perforations.

Twenty-seven patients with gall bladder perforation were reviewed. Free perforation into the peritoneal cavity producing bile peritonitis occurred in 45% of patients. Bilio-enteric fistulae were encountered in 48% of our patients. Five patients had gall stone ileus. A mortality of 11% reflects the serious nature of the condition. Selection of the optimum surgical procedure is based on the evaluation of the individual patient which should include an estimate of the general condition of the patient as well as the evaluation of anatomic situation at operation. Our experience suggests that cholecystostomy may be life-saving in these patients. Surgery in patients with gall stone ileus should be directed towards relief of obstruction only.

Acute segmental enteritis.

PIP: Clinicopathological features and follow-up of 13 cases of acute segmental enteritis, representing the Chandigarh experience over the last 4 years, are reviewed. Symptoms and signs were those of small bowel obstruction, lower gastrointestinal hemorrhage and peritonitis. The ischemic lesions mainly affected the proximal jejunum. The involved segment was edematous, congested, and spastic with loss of normal luster. The mesenteric vessels and vascular arcades were pulsatile. The lesion was characterized by mucosal ulceration of variable lengths in the small bowel, progressing to full thickness necrosis in some cases. The histopathological examination revealed a number of scattered segments of acute necrotizing enteritis. Resection of the diseased segment was performed in all the patients. 1 patient died, giving an operative mortality of 7.7%. No single cause was implicated. Although the disease is not common, it should be considered in the differential diagnosis of acute abdomen when diarrhea or intestinal bleeding is present at the onset.^ieng

Amebic perforation of the colon.

Acute necrotising colitis and perforation of the colon due to amebic infection is usually fatal. Only three patients in the present series of nine survived surgery. Preoperative diagnosis was not possible and because of an extremely friable, blotting paper like colon, this condition was only suspected at laparotomy. Examination of ulcer scrapings for the presence of Entamoeba histolytica or histopathology is confirmatory. Resection anastomosis is mandatory as less extensive local procedures or bypass surgery are not always feasible.

Massive lower gastrointestinal bleeding in patients with typhoid fever.

The classical approach to management of intestinal hemorrhage due to typhoid ulceration has been conservative. In, however, the event of massive, persistent and life-threatening hemorrhage not responding to conservative measures, early surgical intervention is life-saving, controls typhoid toxemia rapidly and presents no special difficulties. A right hemicolectomy is recommended. Four such patients treated by us with bowel resection have had an uneventful recovery.

Large nonfunctioning adrenal cortical tumor: a case report.

A case of large nonfunctioning adrenal cortical tumor treated surgically is reported, with a short review of the relevant literature. The pathologic findings, including light and electron microscopic features, are described.