Amoebic peritonitis secondary to rupture of amoebic liver abscess (ALA) has been reported to occur in 2.4 to 13% of cases with a high fatality rate. There is still no consensus as to how a ruptured ALA associated with diffuse amoebic peritonitis be optimally managed. The mortality rates following surgical therapy in patients with ruptured ALA freely into the peritoneum have ranged from 20%‐ to 50%. The introduction of percutaneous catheter drainage (PCD) has opened a new therapeutic possibility for this group of patients and emerging data suggest that PCD should be the preferred option in such group of patients.
The management of mesh erosion following rectopexy should be individualized. Although it is complex, acceptable functional outcome and quality of life can be achieved with proper treatment.
Background
Post‐cholecystectomy bile duct injury (BDI) is a serious complication that often requires surgical repair. This study aimed to analyze the outcomes of surgery performed for BDI and to determine the factors associated with post‐surgical complications.
Methods
A retrospective analysis was conducted using a prospectively maintained database of 105 patients who underwent surgical repair for post‐cholecystectomy BDI between March 2013 and March 2020. BDI was classified based on the Strasberg‐Bismuth system, and the outcomes were graded using the McDonald criteria. Multivariable logistic regression was used to identify the significant variables associated with postoperative complications.
Results
In a cohort of 105 patients with post‐cholecystectomy BDI who underwent bilioenteric repair, 71 (67.6%), 25 (23.8%), 2 (1.9%), and 7 (6.7%) patients had excellent, good, fair, and poor outcomes, respectively, during a median follow‐up of 64 months. The incidence of recurrent biliary stricture after definitive surgical hepaticojejunostomy was 6.7% (n = 7). The presence of cholangitis, choledochoduodenal fistula, and hilar biliary strictures was among the significant variables associated with the development of both short‐term and long‐term complications following surgery.
Conclusions
Surgical repair of BDIs with bilioenteric anastomosis can yield excellent results when managed in a tertiary care center where expertise in the reconstruction of the biliary tree is prioritized.
Obstructive jaundice caused by periampullary duodenal diverticulum in absence of choledocholithiasis or tumor is known as Lemmel syndrome. This is a rare cause of obstructive jaundice. We report here a patient of blunt trauma abdomen who underwent emergency laparotomy whose sequelae was a controlled external biliary fistula which healed and led to obstructive jaundice. What appeared to be a clear cut diagnosis of benign biliary stricture or bilioma gave a surgical surprise on opening the pandoras box. The uniqueness of this case lies in its etiopathogenesis as well as the dearth of available literature related to post traumatic Lemmel syndrome. This case provides us with a insight into an easy to be overlooked cause of obstructive jaundice in the absence of duodenal diverticula.
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