Post radiation chylous ascites: a case report.

We report a 64 years old gentleman with unresectable right-sided retroperitoneal liposarcoma, who underwent radiotherapy & subsequently developed chylous ascites. He failed conservative management of chylous ascites and this was successfully managed with a peritoneovenous shunt. The pathophysiology and management of post radiational chylous ascites is discussed.

Splenic infarction. A rare presentation of anaplastic pancreatic carcinoma and a review of the literature.

CONTEXT: Anaplastic carcinoma of the pancreas is a rare variant of ductal adenocarcinoma. The histogenesis and biologic behavior of these tumors are still controversial. They occur in elderly men and are associated with a very poor prognosis. CASE REPORT: We report a case of advanced anaplastic carcinoma in a 41-year-old man who presented with splenic infarction. He had a prolonged survival of 16 months from diagnosis. CONCLUSION: Splenic infarction is a most unusual acute presentation of pancreatic carcinoma, which may require emergency tumor resection and splenectomy.

Emphysematous gastritis: a case report and a review of literature.

INTRODUCTION: Gas is rarely found within the viscera outside the lumen of the gastrointestinal tract. Emphysematous gastritis is a rare form of infection of the stomach wall by gas producing organisms. CLINICAL PICTURE: A 45-year-old Chinese lady underwent hepatectomy for hepatocellular carcinoma. Postoperatively, she turned septic and encephalopathic with worsening liver function. Computed tomography scan revealed a thickened, oedematous stomach wall with air pockets within. TREATMENT: The patient was started on a course of broad spectrum antibiotics. OUTCOME: She responded and was discharged well. CONCLUSION: Emphysematous gastritis is a rare condition with high mortality. There is however, still no preferable approach of treatment despite therapeutic advances.

Acute acalculous cholecystitis: challenging the myths.

BACKGROUND: Acute acalculous cholecystitis (AAC) is traditionally known to occur in critically ill patients, following cardiac surgery, abdominal vascular surgery, severe trauma, burns, prolonged fasting, total parenteral nutrition, or sepsis, and is believed to have a worse prognosis as compared with acute cholecystitis associated with stones. Our observation of de novo presentation of AAC in several outpatients in the absence of critical illness or predisposing factors prompted us to undertake this study. The aims of the present study were to examine the prevalence of AAC patients in the outpatient setting in our hospital, to identify associated risk factors and to assess the clinical course and outcome of these patients. PATIENTS AND METHODS: All patients who had a cholecystectomy (laparoscopic or open surgery) for acute cholecystitis at National University Hospital from January 2001 to May 2005 were reviewed from a prospectively maintained database. The demographic characteristics, clinicopathologic features, operative parameters, postoperative course, and histopathology of the patients were reviewed. RESULTS: Eleven of 133 patients with acute cholecystitis fulfilled the criteria for the diagnosis of AAC. Patients' ages ranged from 30 to 69 years (mean 52.39 years). All these patients presented as outpatients. None of the patients had any critical illness predisposing to AAC. The mean age was slightly less in the AAC group as compared with the remaining patients with acute cholecystitis (52.39 years vs 55.22 years, p=0.54). There was male predominance in the AAC group (male:female = 9:2). The time from admission to surgery, operative procedure, operative time, and postoperative stay were not statistically different from the remaining patients with acute cholecystitis. DISCUSSION: AAC can occur in young and middle-aged healthy individuals, the presentation is no different from acute calculous cholecystitis, the prognosis is good if diagnosed and treated early.