This is a case report of ascaris worm in the common bile duct in a 61 year old lady. Ultrasound diagnosis was initially made based on the presence of linear hyperreflective foci within the common bile duct. ERCP confirmed a single worm within the duct. Balloon extraction was then successfully carried out following papillotomy. This case illustrates the value of ultrasound in the definitive diagnosis of biliary ascariasis and the therapeutic role of ERCP.
The ultrasound findings of 100 patients with chloedocholithiasis documented by cholangiography and/or surgery were reviewed retrospectively. Common duct stones were detected in 45% of patients. This detection rate which is comparable with most series confirmed the lack of reliability of ultrasound in the diagnosis of choledocholithiasis. All the stones detected were in dilated common ducts. The main limiting factor was overlying bowel gas which impair visualisation of the lower part of the common duct. Despite the apparent insensitivity of ultrasound to detect common duct stones, the modality is still a valuable non-invasive screening diagnostic tool, because in positive cases, patients may be spared from invasive cholangiographic procedures.
A 50-year-old male had an acute jejunogastric intussusception complicating a Bilroth 11 gastrectomy done 20 years previously for peptic ulcer. Preoperatively, the diagnosis was suspected from the plain abdominal radiograph which was subsequently confirmed by barium meal. The patient had an uneventful recovery following resection of the intussuscepted segment and an end-to-end anastomosis. Although rare, the condition is serious and should be recognised promptly and treated surgically. The diagnosis should always be considered in a patient who has had a previous gastrojejunostomy presented with a sudden onset of epigastric pain, bloody vomitus and epigastric mass.
In a two year period between 1985 and 1986, eight children presented with impacted blunt foreign bodies in the oesophagus were successfully treated by removal using a Foley catheter without anaesthesia. There were no complications. All patients were discharged well after one or two days in hospital. The technique is safe, rapid and easy to perform.
Malperfusion syndrome (MPS) complicating acute type A aortic dissection (ATAAD) poses a continuing challenge and management dilemma for cardiovascular surgeons. MPS may involve any of the major arterial side branches resulting in myocardial, cerebral, spinal cord, visceral, and/or limb ischemia with varying frequency and severity. Despite the continuous improvement in diagnosis and management strategies for MPS with ATAAD, clinical outcomes remain poor and the optimal therapy is still debatable. The present review aimed to assess current evidence on ATAAD patients with MPS and how best to handle the challenge.
The diagnosis of mullerian duct or utricular cyst should be considered in a child with urinary difficulties and a palpable midline, anterior rectal mass. Endoscopic cannulation of the cyst has been found to be the most useful diagnostic test. Infection should be treated with the appropriate antibiotics before definitive treatment. Surgical excision offers the best result. The transperitoneal and posterior parasacral approaches have been described but we favour the transvesical, transtrigonal approach which we find highly satisfactory. The risk of malignancy at a later age is an added indication for surgery.
A successful retrieval of a detached segment of a CVP catheter by percutaneous right transfemoral venous route, using a Dotter intravascular retriever basket, is reported. The procedure was monitored under fluoroscopy. Only local anaesthesia, which was infiltrated around the puncture site, was given to the patient. No significant complication was encountered. Successful retrieval of the detached catheter fragment by percutaneous means obviates the need for thoracotomy.
Ultrasound examinations were done to evaluate clinically palpable abdominal masses in 125 children. The examinations were normal in 21 patients. In 15 patients, the clinically palpable masses were actually anterior abdominal wall abscesses or hematomas. Final diagnosis was available in 87 of 89 patients with intraabdominal masses detected on ultrasound. The majority (71%) were retroperitoneal masses where two-thirds were of renal origin. Ultrasound diagnosis was correct in 68 patients (78%). All cases of hydronephrosis were correctly diagnosed based on characteristic ultrasound appearances. Correct diagnoses of all cases of adrenal hematoma, psoas abscess, liver hematoma, liver abscess and one case of liver metastases were achieved with correlation of relevant clinical information.
This is a case report of single-stage total thoracic aortic repair by the frozen elephant trunk technique for a 75-yearold female with a complex aortic pathology of mega-aorta extending from the ascending aorta to the descending aorta. We used a Thora flex™ Hybrid device, a frozen elephant trunk device with four branched grafts and the distal stent graft. The distal stent graft was inserted into the downstream descending aorta via an aortic arch and positioned 15 cm beyond the left subclavian artery after total arch replacement had been performed using a four-branch graft. The postoperative course was unremarkable with no complications. A post procedural computed tomography scan demonstrated complete exclusion of the descending thoracic aneurysm without endoleak. Therefore, fixing the whole mega-aorta in a single stage using the frozen elephant trunk was effective and safe.
A 45-year-old Malay lady who presented with intermittent abdominal pain and a left hypochondrial mass was found to have a 10 x 8 x 5 cm duodenal tumour without local invasion at laparotomy. En bloc resection of the tumour with adequate margin of clearance was done and histopathological diagnosis of low grade leiomyosarcoma was made. Fourteen months later, she returned with multiple metastases in the liver and needed palliative chemotherapy for pain relief. Duodenal leiomyosarcomata are very rare tumour. Their prognostic indicators include biological grading, tumour size and presence of metastases. Recognition of its high malignant potential calls for close surveillance calls even after apparent curative surgery.