DISCUSSION Meckel’s diverticulum is a common congenital anomaly of the small intestine occurring in up to 3% of the population, typically 55 cm from the ileocecal valve. Surgical resection is indicated for complicated Meckel’s diverticulum (MD). Most reported complications include hemorrhage, perforation, obstruction (from intessusception or volvulus) and neoplasia. In our case the patient had a proximal small bowel obstruction secondary to gallstone ileus with impaction of two smaller stones at a MD. This is exceptionally rare with only 3 cases having been reported in the literature. The techniques for surgical resection of MD are simple diverticulectomy or a segmental small bowel resection. As far as we know, there are no studies directly comparing these two resection techniques. However, as in our case, if the small bowel lumen is in danger of being narrowed or the neck of the diverticulum is wide, a segmental resection is favored over a simple diverticulectomy. [3] …show more content…
Gallstone ileus is an uncommon complication, occurring in 0.3 to 0.5% of all cases of cholelithiasis, and accounting for 1 to 4 % of mechanical small bowel obstructions. However, while gallstone ileus is rare in the general population, it accounts for 25% of mechanical bowel obstructions in patients over 65 years of age. Gallstone ileus also affects predominantly females with the ratio of women to men ranging from 3:1 to 16:1. [7-8]. Because of the advanced age at presentation, patients often have multiple comorbidities, which contribute to the high morbidity and mortality of gallstone ileus. Due to improvements in perioperative management and critical care mortality rates associated with gallstone ileus have decreased over the last several decades from approximately 40% in the 1960s to 18% in the 1990s. [9-10] The pathophysiology of gallstone ileus involves the formation of adhesions between the chronically inflamed gallbladder and an adjacent part of the gastrointestinal tract.
One or more gallstones erode into the gastrointestinal tract, creating a cholecystenteric fistula, most commonly between the gallbladder and the duodenum. Gallstones less than 2 to 2.5 cm generally pass into the intestine without causing obstruction while stones 5 cm or larger are more likely to impact usually at the distal ileum, the narrowest part of the small bowel. Other reported sites of impaction include proximal ileum, jejunem, colon, and rarely the duodenum or stomach (bouveret’s syndrome). [11] In our case, a large, approximately 5 cm, gallstone was found impacted at the jejunum while a smaller stone was found impacted at a Meckel’s
diverticulum. Clinical presentation of gallstone ileus is variable and often insidious. Patients can have painless intervals due to “tumbling” or incomplete small bowel obstruction in which the impacted stone intermittently passes and lodges in the intestinal lumen, until the stone either passes through the gastrointestinal tract or is impacted. Diagnosis of gallstone ileus is difficult with definitive diagnosis often made only at the time of surgery. The classic radiological sign on plain film is Riglers triad: pneumobilia, the presence of an aberrant gallstone and enteric obstruction. However the presence of all three criteria on plain film have only been reported in 15 to 35% of cases [12-14]. Overall sensitivity of abdominal plain film remains poor ranging from 17 to 43% but increases to 96% with the combined use of ultrasound with plain film [15]. In our case, the definitive diagnosis was made by CT of abdomen and pelvis. CT is the ideal diagnostic modality with sensitivity, specificity and diagnostic accuracy of 93%, 100% and 99%, respectively [16]. However, gallstone ileus is often diagnosed only at the time of laparotomy in up to 25 to 50% of cases [8, 10, 17].
Gallstones form when the liquid stored in the gallbladder hardens into pieces of stone-like material. The liquid, called bile is used to help the body digest fats. Bile is made in the liver, and then stored in the gallbladder until the body needs to digest fat. At that time, the gallbladder contracts and pushes the bile into a tube—called the common bile duct—that carries it to the small intestine, where it help with digestion.
Strasberg SM (2008). "Acute Calculous Cholecystitis". New England Journal of Medicine 358 (26): 2804–2811. doi: 10.1056/NEJMcp0800929. PMID 18579815
The first laparoscopic cholecystectomy (LC) using keyhole approach was done by Professor Mouret of Lyon, France in 1987, when he was completing a gynecologic laparoscopy on a woman also suffering from symptomatic gall stones, he removed it laparoscopically instead of opening up. Dr. Eddie Reddick reported 100 cases of laparoscopic cholecystectomy in 1989. The classical four port technique of LC as described by Reddick became the most widely adopted technique.
Out of 22 patients 15 had multiple stone removal less than 1 cm, On the other hand out of the 7 patients with stone more than 1cm. Balloon dilation of biliary sphincter (n=28) in most of the patient Dilatation caliber (9*12)-(10*12) mm, Biliary stent placement isn made of plastic caliber ranging from 10-French 5-cm to 9-French 7-cm in 45 ERCP.
Tokuhara, K., Hamada, Y., Yui, R., Tanano, A., Takada, K. and Kamiyama, Y. 2005. Congenital biliary dilatation in dizygotic twins. Pediatric surgery international, 21 (1), pp. 17-19.
Gastrointestinal tract (GIT) is the portal through which nutritive substances; vitamins, minerals and fluids enter the body. The digestive tract is more than 10 metres long from one end to the other. It is continuous starting from the mouth, passing through the pharynx and the oesophagus, to the stomach, the small and large intestines, ending in the rectum, and finally into the anus. The GI tract is divided into two main sections: the upper GI tract and the lower GI tract. Upper GIT includes the mouth, pharynx, oesophagus and stomach. The lower GI tract includes the small and large intestines and anus. The accessory organs of digestions are the gallbladder, liver and pancreas. Diseases that may occur in upper and lower GIT can be divided as oesophageal diseases, gastric diseases and intestinal diseases.
The falchion was conceptualized in the 11th century.it was a derivitve of both the scimitar and the machete.due to its low consumption of resources neccessary for construction,the falchion became a staple weapon of the dark ages and was mass produced by blacksmiths across the region;as there was a large demand for them.the falchion was soon incorporated into military training exercises.two designs of the falchion developed as close combat tactics developed.as new armor and techniques were devied;new weapon designs were created to rebut the strengths of the opposing variable.the first design was known as the cusped falchion.the cusped falchion bore a sharp tip allowing for thrusting techniques to be used as well as slashing.as the point narrowed the blade elongated and narrowed allowing for greater reach and quicker retraction.the cleaver falchion was the original design of the falchion.the cleaver falchion resembled the scimitar and machete in design,likely influenced by these designs.the curvature of the blade allowed greater apportionments of the blade to be concentrated at the en...
The ascending colon starts at the ileocecal valve and journeys up the right side of the abdominal cavity, ending at the hepatic flexure. The ascending colon is secured in its position by peritoneum to the posterior abdominal wall and the hepato-renal ligament at the hepatic flexure. The ascending colon is roughly
More than 40,000 people a year are so desperate to lose weight they turn to the controversial, sometimes life-threatening surgery such as Gastric Bypass. I will be explaining what the surgery entitles, disadvantages vs. advantages. And most important, is Gastric bypass surgery the right choice when considering the risks. The most common form of “stomach stapling” is gastric bypass. In this procedure, a small pouch is formed in the stomach and stapled shut. The small intestine is then cut and stapled onto the pouch, shrinking the stomach’s ability to take in food. The technique involves removing a section of the stomach and rearranging the small bowel to divert bile and pancreatic secretions away from the food stream. Fats and starches flow through without being absorbed. In order to be a candidate for the surgery, patients must be considered morbidly obese or at least 100 pounds overweight. Before an individual gets the go-ahead, he or she meets with doctors and psychologists to rule out all other ways of help. Surgery may sound like the best option for a morbidly overweight person, but a small figure comes at a high price. There are health risks and the side effects can be fatal. Three people will die during every 1,000 procedures, according to the ASBS. Let me tell you about more disadvantages. More than one-third of obese patients who have gastric surgery develop gallstones. Nearly one in three develop nutritional deficiencies. Patients could also be at risk for anemia, osteoporosis and metabolic bone disease.
A ventriculoperitoneal (VP) shunt is a small, plastic tube used to drain fluid from your brain and into a sac in your belly (peritoneum). The peritoneum absorbs this fluid and gets rid of it. Normally, the brain releases the fluid that cushions the brain and spine (cerebrospinal fluid, CSF). The brain then reabsorbs it through drainage channels. If your brain's drainage channels are not working properly, fluid builds up in your brain and needs to be redirected with a shunt. You may need a VP shunt if you have too much CSF inside your brain (hydrocephalus).
Digestion is defined as the process of transforming foods into unites for absorption. The Digestive System is a complex network of organisms that have six major processes: The digestion of food, the secretion of fluids and digestive enzymes, the mixing and movement of food and waste throughout the body, the digestion of food into smaller pieces, the absorption of nutrients, and the excretion of wastes (Inner Body (1).)
...ve eaten, to break down the food into a liquid mixture and to slowly empty that liquid mixture into the small intestine. Once the bolus has entered your stomach it begins to be broken down with the help of the strong muscles and gastric juices which are located in the walls of your stomach. The gastric juices are made up of hydrochloric acid, water, and mucus- and the main enzyme inside of your stomach is what is known as pepsin, which needs to be surrounded in an acidic setting in order to do its job, that is to break down protein. Once the bolus has been inside of your stomach for long enough it begins to form into a liquid called chyme, and what keeps the chyme from flowing back into our esophagus are ring shaped muscles known as sphincters located at the beginnings and ends of the stomach and they have the task of controlling the flow of solids and liquids.
"What You Can Expect." Tests and Procedure’s Colectomy. Mayo Clinic, 3 Nov. 2012. Web. 16 Sept. 2015.
4. Enterostomy: Includes gastrostomy or jejunostomy- here feeding tube is inserted directly into stomach or jejunum either endoscopically or surgically and brought out through the peritoneal cavity. Complications include displacement or infection. It is often preferred in patients requiring nutritional support for more than a month.
...treatment, surgery may be required, commonly in cases of intestinal hemorrhage. In very rare cases, where the antibiotics do not eradicate the disease, surgical removal of the gallbladder may be required. Although rare, the Cholecystectomy may not always be effective in eradicating the disease, due to it’s persisting hepatic infection state.