Impact of Biliary Calculi on the Liver.

INTRODUCTION: Gallstone is implicated for hepatocellular injury due to chronic extra hepatic large bile duct obstruction with or without repeated episodes of cholangitis. AIM: To study the liver changes in patients undergoing operative procedure for gallstone disease and to determine the relationship between severity of these changes with position of biliary calculus in biliary tree. MATERIALS AND METHODS: Sixty patients who underwent operative procedure for gallstone disease between October 2013 and September 2015 were evaluated. The Liver Function Test (LFT) was done preoperatively and postoperatively. Intraoperative liver biopsy was taken. The histopathological changes of liver and their severity were noted. RESULTS: The most commonly observed liver function abnormality both in cholelithiasis (12.8%) and choledocholithiasis patients (50%) was increased alkaline phosphatase. Most commonly observed liver histology changes in patients with cholelithiasis was nonspecific reactive hepatitis (46.9%) and in choledocholithiasis was chronic cholestasis (50%). Patient with choledocholithiasis showed significant changes (p<0.001) in liver histopathology and LFT as compared to cholelithiasis. CONCLUSION: Patients with gallstone diseases developed significant functional as well as structural hepatic changes. Though the change was more significant in patient with choledocholithiasis compared to cholelithiasis, early operative procedure is recommended in all gallstone disease patients to prevent potential liver damage, irrespective of position of biliary calculi in biliary tree to prevent morbidities associated with it.

The Role of Serum Fibrinogen Level in the Diagnosis of Acute Appendicitis.

INTRODUCTION: Acute appendicitis is the most common indication for emergent surgery and affects a wide range of patients at any age group. However, inspite of the presence of various imaging modalities, biochemical markers, and scoring systems the negative appendectomy rate remain high. Serum fibrinogen, an acute inflammatory mediator is usually raised in any acute inflammatory condition and the same is expected to rise in acute appendicitis, which may be used as a new inflammatory marker in the diagnosis and more importantly in decision making of management of acute appendicitis. AIM: To determine the relationship between the rise in the level of serum fibrinogen and acute appendicitis and its role in reducing the negative appendectomy rate. MATERIALS AND METHODS: A total of 82 patients with clinical signs and symptoms of acute appendicitis who underwent emergency appendectomy were included in the study, the serum fibrinogen level were measured just before the operation and the sensitivity and the specificity was calculated. The final diagnosis was based on the histopathological examination. RESULTS: In our study, the Mean±SD of serum fibrinogen in mg/dl in those patient proved to be having acute appendicitis by histopathology was 436.6±40.6 while those with normal appendix was 391.91±66.54. The area under the curve was 0.697 i.e., it has an accuracy of around 70% and this is statistically significant (p=0.018). On further sub-analysis when the cut off level of fibrinogen level was reduced to 397, it resulted in a sensitivity of 82% and specificity of 60% and if the level was further reduced to 375 it increased the sensitivity to 88% with a specificity of 55%. CONCLUSION: In the diagnosis of acute appendicitis, use of fibrinogen blood level may be a new diagnostic acute-phase reactant with possible role in reducing negative appendectomy rate.

Horseshoe Appendix: An Extremely Rare Appendiceal Anomaly.

Appendiceal anomalies are extremely rare malformations that are usually found incidentally. Agenesis and duplication of the appendix has been well documented however, the cases of horseshoe appendix reported is very limited, only four cases reported so far. Here, we report a four and half-year-old who underwent interval appendectomy. Intraoperatively both the ends of the appendix were found to be communicating with the cecum with two separate base or stump located at a sagital disposal- the so called "horseshoe appendix".

Enteric Duplication Cyst Leading to Volvulus: An Unusual Cause of Acute Intestinal Obstruction - A Case Report.

Enteric Duplication Cysts (EDC) is a rare congenital malformation, usually found in mesenteric side of Gastrointestinal (GI) tract. Generally patients present with non-specific symptoms depending on size and location of the cyst in GI tract. EDC presenting as small bowel volvulus is a rare clinical entity. Herein, we are reporting a 16-year-old adolescent girl who presented to Emergency Department (ED) with the features of acute bowel obstruction with septicemia. Patient underwent exploratory laparotomy which revealed dilated, twisted, gangrenous bowel due to a cystic lesion adjacent to the mesenteric side. Resection of the cystic lesion along with the affected gangrenous segment of bowel with an end to end anastomosis performed.