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2004| January-April | Volume 10 | Issue 1
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Shabir Ahmad Qazi, Shaukat Mahmood Mirza, Abdul Majeed Abdul Hameed Muhammad, Mohammed Hussain Al Arrawi, Yousuf Abdullah Al-Suhaibani
January-April 2004, 10(1):1-7
Wandering spleen is a rare clinical entity, characterized by splenic hypermobility that results from elongation or maldevelopment of its suspensary ligaments. The wandering spleen is in constant danger of torsion and infarction. This condition poses a great diagnostic challenge due to lack of awareness and paucity of symptoms. Among adults, it usually occurs in females of childbearing age, the children below ten years of age are other sufferers. The clinical presentation may be acute or chronic; such as asymptomatic abdominal mass, an acute abdomen, or, most commonly, a mass associated with vague abdominal symptoms. Computed tomography and duplex ultrasonography are best diagnostic modalities. The traditional conservative approach carries high risk of infarction leading to splenectomy and postsplenectomy sepsis. Splenopexy is the treatment of choice for all noninfarcted wandering spleens. Splenectomy should only be performed when there is no evidence of splenic blood flow after detorsion of the spleen. The present study, reviews the presentation, course, diagnostic modalities and management options of wandering spleen
Management of postlaparoscopic cholecystectomy major bile duct injury: Comparison of MRCP with conventional methods
Khalid Mohammad Abou El-Ella, Osama Nafea Mohamed, Mohamed Ibrahim El-Sebayel, Saleh Ali Al-Semayer, Ibrahim Abdulkarim Al Mofleh
January-April 2004, 10(1):8-15
Postlaparoscopic cholecystectomy bile duct injury remains one of the devastating complications seen in current surgical practice.
Aim of Study:
This study describes the diagnostic role of magnetic resonance cholangiopancreatography (MRCP) in such injuries compared with conventional methods.
Patients and Methods:
Eighteen patients referred to the Division of Hepatobiliary Surgery, King Khalid University Hospital from July 1998 to September 2000 were retrospectively studied. The technique of the repair was by utilizing Roux-en-Y hepaticojejunostomy with establishment of mucosa-to-mucosa anastomosis.The study included presentation, age and gender.
The presentation of patients were variable and frequently included pain, jaundice with or without cholangitis in 13 patients, bile leakage with development of biliary peritonitis in three, and development of external biliary fistula in two patients. Besides lower incidence of complication, MRCP was more diagnostic and informative in planning surgery by mapping both ducts proximal and distal to site of injury or stricture in 14 out of 18 patients. The Bismuth level of bile duct injuries were type I in one, type 11 in five, type III in 11 and type IV in one patient. All patients are alive, well and no complications occurred in the immediate postoperative period. Only two patients developed stricture within four months after surgery, one of them treated conservatively with repeated dilatation and stenting was done for the other.
Hepaticojejunostomy is the procedure of choice for repair of bile duct injuries and provides adequate bilairy drainage. MRCP is an ideal diagnostic test when bile duct injury is suspected following laparoscopic cholecystectomy
Solid and cystic papillary epithelial neoplasm of the pancreas
Sarah Kuruvila, Dushyanti Samarasinghe, Mohammed Mahmoud Musa, Salah Mohammed Khalaf
January-April 2004, 10(1):29-31
Ulcerative colitis: Al-gassim experience
Qais Qutub Contractor, Tasneern Qais Contractor, Imran Ul Haque, El Mahdi El Badawi El Mahdi
January-April 2004, 10(1):22-27
Ulcerative colitis (UC) is being reported more frequently among the Arabs. Information on the clinical severity, endoscopic and histological grading is scanty.
To assess the severity of the disease and its response to therapy in patients referred to a tertiary care referral centre in Gassim region, Kingdom of Saudi Arabia (KSA).
Patients and Method:
Hospital records of thirty-four patients found to have UC from 1990-2002 were analyzed. The study included clinical severity, endoscopical and histological assessment, response to therapy and frequency of complications.
There were 21 males and 13 females with median age 35 (range: 18-76) years. The disease was clinically mild in seven patients (21%), moderate in 11 (32%) and severe in 16 (47%). Endoscopically UC was graded as 2 in three patients (9%), 3 in 21 patients (59%) and 4 in ten patients (29%). Histologically UC was mild to moderate in 11 patients (32%) and severe in 23 (68%). Extent of UC was total in nine patients (26%), up to transverse colon in six (18%), splenic flexure in 14 (41%), rectosigmoid region in four (12%) and only up to the rectum in one (3%). Twenty-nine patients (85%) were treated with salazopyrine and five patients (15%); (two of them were hypersensitive to salazopyrine) received 5aminosalicylic acid. Proctocolectomy was performed in two with a focus of malignancy. No patient died during the median follow-up period of 48 months (range: 4 months to 12 years).
Ulcerative colitis presented with varying severity, more frequently in males in the population studied. Most of the patients responded to salazopyrine and surgery was necessary when malignancy was detected
The frequency of upper gastrointestinal malignancy in Gizan
Mohammed Osman Gadour, Ephraim Ayobanji Ayoola
January-April 2004, 10(1):16-21
Upper gastrointestinal malignancy occurs in variable frequencies among different populations and there is an increasing epidemiological data in The Kingdom of Saudi Arabia.
Aim of the Study:
To determine the frequency of upper gastrointestinal malignancy in an endoscopic population in Gizan.
Patients and Methods: A
retrospective analysis of 63 patients who had esophageal or gastric malignancy among 2572 patients evaluated in a 6-year period ( July 1992 to June 1998) at King Fahad Central Hospital in Gizan.
Esophageal cancer was found in 39 patients (20 males and 19 females), whereas gastric malignancy in 24 (22 males and two females). The majority of the patients were in their seventh and eighth decade of life with male predominance. Seven patients had primary gastric lymphoma and one patient had primary malignant melanoma of the esophagus.
Upper gastrointestinal malignancy represented 2.4% of 2572 endoscoped patients, occurring more commonly among elderly male
Herbal-induced dysphagia by granules containing starch and morphine
Mohammed Ali Al-Karawi, Ali Suliman Al-Blowi, Mansour Suliman Al-Said, Yosra Bakit Al-Rweli
January-April 2004, 10(1):32-33
An unusual cause of acute abdomen in an adolescent
Asal Izzidien Al-Samarrai
January-April 2004, 10(1):34-36
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