Mesenteric vein thrombosis: is it one disease?

OBJECTIVES: to compare the clinical course and outcome of mesenteric vein thrombosis due to known causes and mesenteric vein thrombosis of unknown aetiology. DESIGN: a retrospective study. SETTING: two major general hospitals in Kuwait. SUBJECTS: 12 patients who had mesenteric vein thrombosis due to known causes and seven patients who had mesenteric vein thrombosis of unknown aetiology were treated over eight years. CHIEF OUTCOME MEASURES: severity of clinical findings and outcome. RESULTS: There was no statistical difference between the two groups in the clinical presentation or in outcome. CONCLUSION: 36% of mesenteric vein thrombosis occurred without an obvious cause although the disease appeared to be the same. More work on the aetiology of this condition is required.

Torsion of a mucocele of the appendix in a pregnant woman.

A case of torsion of a large appendicular mucocele presenting as acute abdomen in a 38-week pregnant woman is reported. Ultrasound showed a localized cystic lesion with internal echoes on the right side of the abdomen. It was diagnosed preoperatively as twisted ovarian cyst. The patient was treated surgically with cesarean section and curative appendectomy.

Riedel's thyroiditis. Case report.

A case of Riedel's thyroiditis in a young euthyroid man is presented. The diffusely enlarged and uniformly hard gland extended laterally beyond the sternomastoid muscles. Aspiration cytology suggested malignancy. Isthmectomy with excision of 50% of the fibrous gland and clearance of two-thirds of the tracheal circumference gave a good result.

Tuberculous appendicitis with perforation.

A young female who had been investigated for vague abdominal complaints and marked loss of weight was discovered only after laparotomy, carried out for acute appendicitis, to have primary tuberculosis of the vermiform appendix with perforation. The rarity of tuberculosis of the appendix, the types of presentation and the pitfalls of diagnosis are discussed. The literature on appendicular tuberculosis is reviewed.

Solitary caecal diverticulitis. Recognition and management.

Nine cases of solitary caecal diverticulitis treated in Kuwait are presented and the literature is reviewed. The preoperative diagnosis was acute appendicitis in all cases, but diverticulitis was detected during surgical exploration and histologically confirmed. The surgical management in seven cases was simple excision of the diverticulum with closure of resultant defect or invagination of the mucosal bulge with suture of the colonic wall. Right hemicolectomy was performed in two cases because of gangrenous patches in the caecal wall and suspicion of carcinoma. Recognition of solitary caecal diverticulitis requires considerable experience, especially in order to avoid more radical procedures such as right hemicolectomy. Solitary caecal diverticulum does not seem to occur in the indigenous people of Kuwait. All nine patients were of other nationalities, including five from countries of the Far East.