In blunt trauma abdomen, liver is the most commonly injured organ after spleen. Management of blunt hepatic injury has shifted from operative to non-operative management NOM in hemodynamically stable patients. Main cause of failure of NOM is hemodynamic instability due to re-bleeding or secondary hemorrhage due to rupture of capsular hematoma. Post traumatic hepatic artery pseudoaneurysm HAP as a cause of failure of NOM is rare, reported in about 1.2%. HAP requires early intervention by angiographic embolisation or surgery to prevent catastrophic event. Here, we report our experience with four cases of HAP managed in our centre in past three years. Three patients were managed by selective angioembolisation and one patient was treated by surgery. All patients had uneventful recovery and are asymptomatic on follow-up. HAP is a rare life threatening complication which can present even after successful NOM as a delayed presentation. All symptomatic pseudoaneurysm has to be managed by angioembolisation or surgery depending on hemodynamic stability.
Pyogenic liver abscesses are uncommon but still challenging diagnosis, which demands multidisciplinary approach. They develop following intraabdominal infection with subsequent spread to liver via portal circulation or via direct spread from biliary tract infection. Also hematogenous spread is possible. Modern management of pyogenic liver abscess prefer antibacterial and minimally invasive procedures over surgical treatment.The aim of this study is to review our experience in pyogenic liver abscess management, compare it with literature data and to develop local guidelines. Method: in 5 year period 41 patient presented in a single teaching hospital with pyogenic liver abscess. Clinical presentation, demographic, diagnostic, treatment and aethiological details were reviewed. Results: Mean age was 63 years. Male to female ratio-51%: 49%. Common clinical features: abdominal pain 41%, weakness and fatigue 36%, fever 36%. All patients received antibacterial therapy and percutaneous drainage as first treatment in 88% of cases. Antibacterial therapy alone was sufficient in 5 cases where abscesses were under 5 cm in diameter. In one case open surgical approach was needed due to failure of percutaneous drainage. One patient died right after percutaneous drainage due to multiorgan failure. Median abscess diameter was 6,8 cm, localized in right liver lobe in 73%. In 61% solitary abscess was found. Most common causative microorganisms were Escherichia coli and Klebsiella pneumoniae. Conclusions: Modern management of liver abscesses include treatment in tertiary medical center, antibacterial therapy and percutaneous drainage. Surgical approach is still an option in selected cases, when percutaneous drainage fails.
OBJECTIVE The incidence of adenocarcinoma of esophagogastric junction is on the rise. The optimal treatment strategy for these tumours has not been clearly established. The aim of this study is to analyse the clinical presentations, management and outcomes following surgery in patients with adenocarcinoma of the esophagogastric junction presenting to a tertiary care centre in South India. METHODS Retrospective analysis of prospectively maintained database was performed. Data of all patients operated for adenocarcinoma of esophagogastric junction was analysed with regards to surgical management and clinico-pathological outcomes. RESULTS Fifty two patients underwent surgery for esophagogastric junction malignancy in our institution from January 2015 to December 2018. Among them, type I, type II and type III tumours contributed to 6, 16 and 30 patients, respectively. Thirty-four patients (65.4%) were male. Mean age of the patients was 57 years. Six patients (11.5%) received neoadjuvant therapy. Fourteen patients (26.9%) were found to have unresectable or metastatic disease during surgery. Six patients (11.5%) underwent multiorgan resection. Mean tumour length was 5.4cm. Number of lymph nodes retrieved ranged from 2 to 25. Majority of the patients had stage 3 disease on histopathological examination. Major postoperative morbidity (Clavien Dindo grade ≥ 3) was seen in 9 patients. Reoperation was required in 4 patients. In-hospital mortality rate was 11.53%. On follow up, locoregional recurrence was documented in 5 patients. CONCLUSION Esophagogastric junction adenocarcinoma is an aggressive malignancy with high incidence of unresectable or metastatic disease. Majority of patients presented with larger tumours and at an advanced stage of the disease leading to poor outcomes.
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