Choledochal cyst mimicker-When small bowel length matters.

OBJECTIVE: Due to the risk of malignancy, the established management of choledochal cysts mandates bile duct excision and biliary reconstruction. While the reconstructive procedure of choice for most surgeons has traditionally been hepatico-jejunostomy, this may not be feasible in selected cases due to immobility or inadequacy of the jejunum. The following case will outline the management of a 32-year-old woman with short bowel syndrome, who was diagnosed with choledocholithiasis and a type 1 choledochal cyst. METHOD AND MATERIALS: As a child, our patient suffered midgut volvulus secondary to malrotation which resulted in extensive bowel resection and developed short bowel syndrome. She presented with recurrent bouts of cholangitis. Imaging of her biliary tree confirmed common duct stones extending into the branched hepatic ducts, as well as a fusiform dilatation of the common bile duct, that appeared consistent with a type 1 choledochal cyst. Laparoscopic excision of the cyst with reconstruction using a hepatico-duodenostomy was planned. RESULTS: The patient underwent successful laparoscopic cholecystectomy, CBD clearance with excision of the bile duct and reconstruction with hepatico-duodenostomy. Recovery was uneventful and she is asymptomatic on subsequent follow-up. Histology is consistent with a markedly dilated bile duct rather than a choledochal cyst. CONCLUSIONS: This case illustrates the dilemma of diagnosis and treatment of a dilated bile duct mimicking a choledochal cyst in the setting of short bowel syndrome and the feasibility of a laparoscopic approach in such cases. Also, it demonstrates that hepatico-duodenostomy may be a safe alternative in cases with limited material for conduit.

A cross-sectional study of isolates from sputum samples from bacterial pneumonia patients in Trinidad.

We determined the frequency of Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, and Gram-negative enteric bacteria (GNEB) in pneumonia patients, determined the antibiograms of these pathogens, and investigated the relationship between pneumonia and selected risk factors. Sputum and demographic data were collected from 124 pneumonia patients. Sputum was cultured for S. aureus, GNEB, H. influenzae and S. pneumoniae. The disc diffusion method was used to determine resistance to eight antimicrobial agents. Among the 124 sputum samples, eight (6.5%) were positive for S. aureus, 15 (12.1%) for GNEB, two (1.6%) for S. pneumoniae and one (0.8%) for H. influenzae. Hospitals, gender, ethnicity, co-morbidities and symptoms did not significantly (p > 0.05; chi2) affect the prevalence of these bacteria. GNEB infection was most prevalent (47%) in patients over 70 years old. Gentamicin and levofloxacin were the most effective against these bacteria.

A cross-sectional study of isolates from sputum samples from bacterial pneumonia patients in Trinidad

We determined the frequency of Streptococcus pneumoniae, Haemophilus influenzae,Staphylococcus aureus, and Gram-negative enteric bacteria (GNEB) in pneumonia patients,determined the antibiograms of these pathogens, and investigated the relationship between pneumonia and selected risk factors. Sputum and demographic data were collected from 124pneumonia patients. Sputum was cultured for S. aureus, GNEB, H. influenzae and S. pneumoniae.The disc diffusion method was used to determine resistance to eight antimicrobial agents. Amongthe 124 sputum samples, eight (6.5%) were positive for S. aureus, 15 (12.1%) for GNEB, two(1.6%) for S. pneumoniae and one (0.8%) for H. influenzae. Hospitals, gender, ethnicity, comorbidities and symptoms did not significantly (p > 0.05; ö2) affect the prevalence of these bacteria.GNEB infection was most prevalent (47%) in patients over 70 years old. Gentamicin and levofloxacin were the most effective against these bacteria.

A cross-sectional study of isolates from sputum samples from bacterial pneumonia patients in Trinidad

We determined the frequency of Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, and Gram-negative enteric bacteria (GNEB) in pneumonia patients, determined the antibiograms of these pathogens, and investigated the relationship between pneumonia and selected risk factors. Sputum and demographic data were collected from 124 pneumonia patients. Sputum was cultured for S. aureus, GNEB, H. influenzae and S. pneumoniae. The disc diffusion method was used to determine resistance to eight antimicrobial agents. Among the 124 sputum samples, eight (6.5 percent) were positive for S. aureus, 15 (12.1 percent) for GNEB, two (1.6 percent) for S. pneumoniae and one (0.8 percent) for H. influenzae. Hospitals, gender, ethnicity, co-morbidities and symptoms did not significantly (p > 0.05; chi2) affect the prevalence of these bacteria. GNEB infection was most prevalent (47 percent) in patients over 70 years old. Gentamicin and levofloxacin were the most effective against these bacteria.