Giant saccular abdominal aortic aneurysm with manifestation of gastric inlet obstruction mimicking a fundal gastrointestinal stromal tumor: A report on an unexpected case.

We present an extremely rare report on gastric inlet obstruction due to giant abdominal aortic aneurysm. Despite the rare occurrence of this manifestation, it should be considered in the differential diagnosis of gastric inlet obstructions.

A Double Cystic Duct With a Single Gallbladder Successfully Treated With Laparoscopic Cholecystectomy: A Challenge to Laparoscopic Surgeons.

Although the cystic duct has diverse variations, a double cystic duct is rarely found. Only 20 cases had been reported until late 2017. In the present study, we describe a 58-year-old woman with a double cystic duct who initially presented with a passed stone and pancreatitis concomitant with a gallbladder containing microlithiasis. The double cystic duct was not detected in preoperative endoscopic ultrasonography; and the anomaly was an incidental finding during laparoscopic cholecystectomy. The patient had no postoperative complications and was discharged uneventfully. Postoperative magnetic resonance cholangiography showed a normal biliary tree structure.

Whipple procedure: a review of a 7-year clinical experience in a referral center for hepatobiliary and pancreas diseases.

BACKGROUND: Pancreatic cancer is generally found in the older population Pancreaticoduodenectomy seems to be the only way in resolving these resectable tumors. Allen. O Whipple was the first to describe pancreaticoduodenectomy in 1935 as a modified procedure. This article is a case series with respect to the 7-year experience of the Whipple procedure in Firoozgar Teaching Hospital. METHODS: Patient surgery details were gathered from the surgical records of the operating room and their clinical records from the hospital archives. Data was analyzed with SPSS software (version 16.0.1). Those patients, whose tumor had invaded the superior mesenteric artery, had extensive portal vein involvement or distant metastasis was considered as unresectable. RESULTS: The first Whipple procedure was recorded in our hospital in 2008. From 2008 till 20 March 2014, 70 cases were collected and analyzed. The mean age of cases was 58.4 years, the mean hospital stay length was 12.9 days (±6.23 days), mean operation time was 376 min (±37.3 min),. The most common presenting symptom was jaundice (78.6 %). Delayed gastric emptying was the most common post-operative complication. The most prevalent cause of reoperation was intra-abdominal abscess. Major morbidities of these patients consisted of cardiac arrhythmias (21.4%) and pneumonia (10%). Minor complications were wound infection (17.1%) and delayed gastric emptying (32.9%). The statistics revealed pancreatic anastomosis failure as 2.9% and a decrease in mortality rate from 50% during the first years of this study to 16% to 20% during the last years. CONCLUSIONS: In this case series, the time of operation decreased during the recent years .Analysis shows a correlation between operation time and pack cell transfused during the operation, but no correlation was found between operation time and post-operation hospitalization course. It is true that hospital setting, socioeconomic level of the patients including their compliance, and the expertise of the surgeons and surgical staff can have an influence on the result of this operation, but it seems that the magnitude of the surgical stress of this procedure and the (compromised) functional reserve of this patient population can be a notable factor influencing the outcome.

Proper management for morbid iatrogenic retroperitoneal barium insufflation.

A barium enema is a diagnostic and therapeutic procedure commonly used for colon and rectum problems. Rectal perforation with extensive intra- and/or extraperitoneal spillage of barium is a devastating complication of a barium enema that leads to a significant increase in patient mortality. Due to the low number of reported cases in recent scientific literature and the lack of experience with the management of these cases, we would like to present our treatment approach to a rare case of retroperitoneal contamination with barium, followed by its intraperitoneal involvement during a diagnostic barium enema. Our experience with long-term management of the patient and the good outcome will be depicted in this paper.

Delayed colonic perforation following stent placement for colorectal obstruction: a description of two cases with stent palliation.

Bowel stent insertion has a variety of complications one major of which is colonic perforation. The purpose of this article is to reveal two cases with delayed colonic perforation after stent placement to relieve bowel obstruction caused by rectal cancer. The first patient was a 55 year-old man who was a candidate for stent placement to avoid palliative surgery and relieve his bowel obstruction. Although the procedure resulted in complete relief of patient symptoms, but he returned with signs of peritonitis 10 days after the stent placement. A perforation was found at rectosigmoid junction on laparotomy. The second patient was a 60 year-old man who underwent a successful stent placement and returned 3 months later with a complaint of abdominal pain that showed up to be due to a rectal perforation on investigations. In conclusion, bowel perforation following stent placement can be a major complication, so close follow-up is necessary to detect it as soon as possible and prevent it from becoming an irreparable complication.

Impact of morphine dependency on secondary intention wound healing in rat.

Wound healing has always been among important and crucial subjects in medicine. Morphine dependency has also been a social and health problem in the Middle East. This study was aimed to investigate the effects of morphine dependency on pro-inflammatory and fibroblast cell recruitment, as well as re-epithelialization and the revascularization processes involved in secondary intention wound healing in rats. A full-thickness wound (2×2 cm in diameters) was created on the dorsum of two groups of rats, a control group and a second group consisted of morphine dependent rats. During the first 14 days of post wounding the wound was excised consecutively at priorly planned days with peripheral margins of normal skin. The specimens were evaluated by two pathologists, who were blind to the study design, and the cellular population, re-epithelialization and revascularization were reported by them. Histological examination of the wound tissue showed evidence of increased population of fibroblasts and a plateau or decreased recruitment of macrophage and neutrophile cells. In the dependent group re-epithelialization was observed to be enhanced significantly in comparison to the control group while having an inhibitory effect on revascularization. The present study demonstrates that morphine dependency enhances re-epithelialization as well as tissue recruitment of fibroblasts; thereby probably enhancing secondary intention wound healing.

Necrotizing fasciitis of the upper extremity, case report and review of the literature.

ABSTRACT: Necrotizing fasciitis is a rare, life-threatening infection most commonly seen in patients with diabetes mellitus, intravenous drug abuse, and immunocompromised conditions. The extremities are the primary sites of involvement in as many as two thirds of the cases. In a significant proportion of patients, the extremities are involved as a result of trauma, needle puncture or extravasation of drugs. The infection is usually polymicrobial. Treatment involves broad-spectrum antibiotics and multiple surgical debridements or amputation. We present a patient with necrotizing fasciitis of the upper limb and present our experience with this often lethal condition.