Saudi Journal of Gastroenterology
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   2001| September-December  | Volume 7 | Issue 3  
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Duplication of hepatic artery
Muhammad Saeed, Amin Ahmad Rufai
September-December 2001, 7(3):103-108
Background: The hepatic arterial anatomy is aberrant in almost 33-41% of individuals. The variant arterial anatomy recognized during routine cadaveric dissection offers great learning potential. Such findings provide an alternative perspective to view common morphology and its structural and functional importance. These impart the concept of patient individuality and subsequent individualization of medical and surgical therapies. Adequate knowledge of normal and abnormal arterial anatomy is essential for peripancreatic surgery and liver transplantation. Aims of the study: To report on hepatic artery variations observed in the dissecting room and to find out the macroscopic pattern of varied human hepatic arterial vascularization by cadaveric dissection. Patients and Methods: Twenty human cadavers of caucasian origin were dissected to study the source and topographic pattern of hepatic arterial supply. Results: Nineteen cadavers exhibited typical hepatic arterial supply from the celiac axis. Only one female body out of twenty cadavers exhibited a dual arterial supply to all parts of liver and gallbladder. One artery originated from the celiac axis whereas the other was given off by the superior mesenteric artery. Conclusion: No doubt, aberrant hepatic vascularization should be assessed preoperatively by invasive and noninvasive techniques to avoid fatal complications, but we favour careful dissection over angiography as a means of defining the arterial anatomy.
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Hepatopulmonary syndrome
Mohammed Osman El-Hassan Gadour, Ayobanji Ayoola, Abdullah Zaruq Yousuf, El Tayeb El Wasela El Sammani
September-December 2001, 7(3):85-94
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Large liver abscess: Unusual presentation of fascioliasis: Case report and literature review
Hedayat Riazi
September-December 2001, 7(3):113-115
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Serological profile of sporadic acute viral hepatitis in an area of hyper-endemic hepatitis B virus infection
Ayobanji Ayoola, Aderemi Aderoju, Mohammed Osman El-Hassan Gadour, Mohammed Al-Hazmi, Mirghani Khalifa Hamza, Dan Ene, Magdy Hafeez, David Anderson, Michelle Riddell
September-December 2001, 7(3):95-102
Background: Located in the south western part of Saudi Arabia, the Gizan region is largely a rural community in which hepatitis B and chronic liver disease including hepatocellular carcinoma are highly prevalent. Aim of study: To determine the relative frequencies of acute hepatitis A, B, C and E in acute viral hepatitis in an area of hyperendemic hepatitis B infection. Methods and materials: In a prospective study 246 consecutive patients (179 males and 67 females) diagnosed in a 2-year period were tested for markers of Hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C (HCV) and hepatitis E virus (HEV). Results: Of the patients tested, 131 (53.3%) were children (<10 years), and 42 (17%) were 11 - 20 years in age. Ig M anti -HAV, IgM anti-HBV, anti- HCV and IgM anti-HEV were positive in 37%, 19.1%, 3.7% and 13.7% respectively. Markers of these viruses were absent in 24.4%. Among 131 children (< 10 years) the commonest cause of AVH was HAV occurring in 57.3% of the cases. In adults (> 21 years) HBV was found in 35.6% and IgM anti -HAV was detected in only 6.8%. In contrast to the age- related decline in the frequency of acute HA, the proportion of acute HE were similar in all age groups (13.7% in children, 16.7% in adolescents and 11.0% in adults). Conclusion: The study indicated that HAV is still a common cause of AVH particularly among children in Gizan. Acute 1-113 had a low occurrence among the children, evidently as a consequence of the integration of HB vaccine into the Saudi Arabian national EPI, 10 years ago. With the availability of combined HB and HA vaccines, It should be possible to graft the vaccination against HAV on to the existing program in Saudi Arabia. Affecting 13.4% of the group studied, sporadic HEV constitute a significant cause of AVH in this population. Until HEV vaccine becomes widely available, its prevention would be mainly by the improvement of socio - economic and hygienic standards of the population.
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Primary intestinal lymphangiectasia, nephrotic syndrome and clomid-induced triplet pregnancy
Ahmad A Al-Mushaikih
September-December 2001, 7(3):116-118
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Ulcerative colitis and chronic granulomatous disease: A case report and review of the literature
Khalid F Al-Mobaireek
September-December 2001, 7(3):119-121
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Diverticular disease: An experience at King Faisal specialist hospital
William H Isbister
September-December 2001, 7(3):109-112
Background: Diverticular disease of the colon is rarely seen in Saudi Arabia and this paper describes our experience with 16 patients admitted to hospital during an 8-year period (March 1990 - February 1998). Patients and Methods: A computerized data base of patients having colorectal surgery was searched to identify patients admitted to the colorectal unit suffering from diverticular disease of the colon or it's complications. The records of these patients were examined and form the basis of this report. Results: Sixteen patients were admitted to the colorectal unit for the management of diverticular disease or it's complications during an 8-year period. One patient presented with a localized abscess which was drained percutaneously. Fifteen patients underwent one or more surgical interventions. There were three female patients. One patient was referred for stoma closure, four for elective surgery and ten with acute perforation of whom one underwent right hemicolectomy for a perforated caecal diverticulum and nine underwent Hartmann's procedure for sigmoid perforation. Two patients required multiple abdominal washouts. Post-operatively two patients developed severe chest infections, one developed renal failure and two urinary infections. Four wounds became infected and two intra abdominal collections were drained percutaneously. No patient died. Eight stomata (89%) were subsequently closed. The mean duration of follow up was 2.7 yr. Four patients were lost to follow up. Conclusion: This small series documents the presence of diverticular disease and it's complications in the Kingdom of Saudi Arabia and suggests that the commonest method of presentation may be an acute one. Surgeons must thus be mindful of the condition and take appropriate action. Hartmann's' operation was safe and resulted in a low morbidity and no mortality. 89% of the stomata were closed at a later procedure.
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C Noel Williams
September-December 2001, 7(3):122-123
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