RESUMO
Bile leak is an uncommon complication post cholecystectomy. The bile may originate from the cystic duct stump and less commonly from the aberrant ducts of Luschka. Such complications may occur when anatomical variations in the biliary tree go unnoticed. This case report presents a 24-year-old otherwise healthy female who presented with abdominal pain and distension that began 3 days after she underwent open cholecystectomy for symptomatic cholelithiasis. Imaging revealed choledocholelithiasis in the distal common bile duct, and free intrabdominal fluid collection. Endoscopic retrograde cholangiopancreatography done showed contrast leak from the duct of Luschka to the gall bladder bed. The biliary tree has many anatomic variations. These variations have clinical significance for surgical treatment of patients with biliary pathology. Surgeons should be aware of such variations to decrease the risk of bile leak post cholecystectomy.
RESUMO
INTRODUCTION: Small bowel bleeding can be overt or occult. Despite advances in imaging and endoscopy, the diagnosis and treatment of small bowel bleeding remain challenging due to its length and location. Diagnostic procedures such as push enteroscopy, capsule endoscopy and intraoperative enteroscopy are recommended to identify the source of bleeding. CASE PRESENTATION: A 33-year-old female with no prior history of bleeding diathesis presented with massive lower GI bleeding. Although she was in hypovolemic shock from bleeding, physical exam, splanchnic angiography and colonoscopy were unable to localize the source of bleeding. The patient continued to bleed and deteriorate despite transfusions. Exploratory laparotomy was done but localizing the source with manual palpation of small bowel was difficult. Intraoperative enteroscopy was done and showed a 2 by 1 cm ulcerative lesion at mid jejunum. Part of jejunum containing the ulcer was resected and anastomosis done. The patient did well postoperatively and on follow up. CLINICAL DISCUSSION: A bleeding primary jejunal ulcer is rare clinical scenario difficult to diagnose. Intraoperative enteroscopy is useful in cases where initial diagnostic workups are inconclusive. It can be performed using various types of endoscopes, such as a standard or pediatric colonoscope, push enteroscope, or a sonde enteroscope, during laparotomy. CONCLUSION: Primary jejunal ulcer is a rare cause of massive lower GI bleeding. Although minimally invasive deep endoscopic techniques to diagnose small bowel ulcers are evolving, intraoperative enteroscopy remains to be technically easy and helpful tool to make a diagnosis and guide intervention especially in a patient undergoing laparotomy for bleeding small bowel ulcer.
RESUMO
Background: Despite the availability of evidence-based and effective treatments, significant numbers of people living with mental illness do not receive treatment or do not seek help from providers of formal modern treatment. Although numerous primary studies have been conducted on patterns of help-seeking behavior among individuals with mental illness with respect to modern therapy, the evidence has not been aggregated nationwide. Therefore, the aim of this review was to investigate pooled data on patterns of help-seeking behavior among individuals with mental illness in Ethiopia. Methods: All available primary studies were searched via the Google Scholar, HINARI, and PubMed databases from June 22 to December 20, 2023; 912 articles were identified. Sixteen articles were included in the final review; data from them were extracted to an Excel spreadsheet and exported to Stata version 17 for analysis. The search terms used were: "Pattern of help-seeking behavior'' OR "Pattern of treatment-seeking behavior" OR "Health care-seeking behavior" OR "Help-seeking intention" OR "Help-seeking preferences" OR "Perceived need" OR "Pathways to psychiatric care", AND "Common mental disorders" OR "Mental illness" OR "Mental health problems" OR "Depression", AND "Predictors" OR "Determinate factors" OR "Associated factors", AND "Ethiopia". The quality of the studies included was critically appraised using the modified The Joanna Briggs Institute (JBI) Joanna Briggs Institute quality assessment tool, adapted for observational studies. During critical appraisal, disagreements between the two authors conducting the assessment were resolved by the involvement of a third author. Effect sizes were pooled using the random effects model, and the presence of publication bias was detected based on asymmetry of the funnel plot and a statistically significant result of Egger's test (p<0.05). Results: The pooled rate of positive help-seeking behavior with respect to modern treatment among people living with mental illness was 42.21% (95% CI: 29.29, 55.12; I2 = 99.37%, P=0.00). Factors significantly associated with a positive pattern of help-seeking behavior were: having a secondary education or above (AOR=5.47, 95% CI: 2.33, 12.86); believing that mental illness requires treatment (AOR=2.76, 95% CI: 2.02, 3.78); having strong social support (AOR=2.00, 95% CI: 1.64, 2.44); having a family history of mental illness (AOR=2.68, 95% CI: 1.38, 3.97); having awareness of the availability of treatment (AOR=2.92, 95% CI: 1.56, 5.46); having previously engaged in positive help-seeking behavior (AOR=3.28, 95% CI: 1.63, 6.60); having comorbid disorders (AOR=4.25, 95% CI: 1.69, 10.66); not using alcohol (AOR=3.29, 95% CI: 1.73, 6.27); and the perceived severity of mental illness (AOR=2.54, 95% CI: 1.490, 4.33). Conclusions: The majority of people with mental illness in Ethiopia exhibited a poor pattern of help-seeking behavior with respect to modern treatment. Therefore, mobilization of the community should be encouraged via regular public awareness campaigns regarding mental illness and the availability of evidence-based and effective modern treatment in Ethiopia. Moreover, the design of effective community-based mental health interventions is recommended in order to improve public attitudes and rates of help-seeking behavior in relation to mental health problems.