HighlightsIntermammary region is a rare area for pilonidal sinus affection.Nothing known about its presentation and management, as there are few reported cases.This case series is about presentation and management of intermammary pilonidal sinus.
Background: Currently, several therapies are used for symptomatic hemorrhoidal disease with various degrees of accepted treatment modality, but information on long-term outcomes is limited. Objectives: This study aimed to compare ligation and cauterization of hemorrhoidal pedicles with Milligan-Morgan hemorrhoidectomy. Patients and methods: This prospective cohort study was conducted on 200 patients with symptomatic hemorrhoidal disease in Sulaimani Surgical Teaching Hospital from January 2014 to January 2021. Patients were divided into 2 groups of 100 patients each. Group A underwent ligation and cauterization, while group B underwent Milligan-Morgan hemorrhoidectomy. Then, postoperative pain, urinary retention, and bleeding were collected. Patients were followed up for one year and data were collected regarding incontinence, anal stenosis and recurrence. Results: The mean age of patients was 37.19±9.7 years, and most were females. The most common symptom was mucosal prolapse, followed by bleeding per rectum, then discharge, pruritis, and perianal pain/discomfort. Patients in group A experienced less pain than those in group B. Regarding the postoperative complications, surgical site infection was the most common one in both groups (34%), followed by bleeding per rectum (26%), then urinary retention (20%), incontinence (15%), and recurrence (11%). In comparison, anal stenosis was only found in 3% of group B patients. Conclusions: The ligation and cauterization technique was safer, less costly, less painful, and had lower postoperative complication rates compared to the Milligan-Morgan procedure for the treatment of hemorrhoids.
Diagnosis of acute appendicitis can be challenging in some cases as the differentials can be exhaustive. Previous studies have demonstrated that hyperbilirubinemia is a more specific marker for appendicitis than white blood count (WBC) and C-reactive protein (CRP), but this investigation is still not commonly used in the diagnostic workup of appendicitis. This prospective study aims to evaluate serum bilirubin as a laboratory marker for simple and complicated appendicitis. We also investigated the diagnostic value of bilirubin in acute appendicitis and compared it with the WBC. In this prospective study, all patients who underwent appendicectomy at the Sulaimani Emergency Teaching Hospital between 1st November 2016 to 1st January 2017 were included. Preoperative total serum bilirubin was measured and compared with the final histopathology report. Patients were divided into 3 groups: non-inflamed appendix, simple appendicitis and complicated appendicitis. One hundred and 75 patients were analysed, 90 of them were females and 85 were males. Hyperbilirubinemia was found in 63% of patients with complicated appendicitis (p=0.001). Mean of bilirubin was significantly different between patients with complicated appendicitis and non-complicated appendicitis (1.101 vs 0.75 mg/dl; p= 0.0017). Bilirubin had a higher specificity (85%) than WBC (36%), but a lower sensitivity (63% vs 89%) for differentiating complicated appendicitis. Patients with suggestive features of acute appendicitis and raised serum bilirubin indicate a complicated case requiring early intervention to prevent peritonitis and septicaemia. Hyperbilirubinemia is a good indicator for complicated appendicitis and serum bilirubin measurement can be included in the work up of patients with suspected appendicitis.
Fascioliasis is one of the oldest zoonotic infestations, which returned back to 3000 years B.C., it is caused by Fasciola hepatica or gigantica. It is a widespread disease throughout the world; nearly (2.4 – 17) millions of people is infected. Human is an accidental final host by ingestion of contaminated plants and water by metacircaria. Most of patients suffer from right upper abdominal pain with eosinophilia. Diagnosis is made on clinical background with imaging studies or laboratory (like stool and examinations biliary aspirate, intradermal test or ELISA to detect antibody). It must be taken into consideration as newly emerging infestation in our country. The aim of this study is to highlight on the magnitude of Peri Cholecystectomy Bile Analysis for Fasciola hepatica in Sulaimani province, Kurdistan region and even in Iraq as a whole. A prospective study was performed at Sulaimani Teaching Hospital. Bile samples were collected from who had cholecystectomy. Microscopical analysis was archived for finding egg of the parasite. In 129 samples, there were 7 (5.4%) positive cases of Fasciola hepatica 2 were adult worms, all were swimming in the gall bladder. 5 (3.9%) out of 7 (5.4%) samples were females and only 2 (1.5%) of cases were males. 4 (3.1%) out of 7 were from Sharazur terrain, and 3 (2.3%) of them from the center of Sulaimani city. Fascioliasis is a zoonotic problem. It must be put in differential diagnosis of any vague upper abdominal pain. It is a public health issue, so health worker must give awareness to the society about this disease, which is more easily preventable.
Background Iatrogenic perforation of the gallbladder has been reported in 28% of those patients who undergo laparoscopic cholecystectomy. It has been pointed out that gallbladder perforation can result in spillage out gallstones and bile. Objectives To investigate the perioperative incidence of iatrogenic gallbladder perforation during laparoscopic cholecystectomy in Sulaimani Teaching Hospital. Patients and Methods The present investigation was a single-centre, prospective observational study that was carried out in Sulaimani Teaching Hospital in 2018-2019. The study sample included 99 patients who had undergone elective cholecystectomy by multiple surgeons. Required data on the possible risk factors and early outcomes and the patients’ demographics, including age, BMI, and gender, were collected. The collected data were analyzed through the Statistical Package for the Social Sciences (version 22.0). Results The results revealed that 80% of the patients were females. Also, 42.4% had no chronic diseases. At the same time, diabetes mellitus (DM), DM along with hypertension (HT), and HT were the most prevalent chronic diseases among them with 18.2%, 16.2%, and 10.1% of prevalence, respectively. (Multiple attacks of cholestasis). Only 17.2% of the patients had an abdominal operation before, and acute cholestasis and chronic cholestasis were seen respectively in 13% and 17% of them. The most common causes of gallbladder perforation (GP) were found to be electrocautery (16.2%) and grasper (7.1%). 33.3% of the patients were overweight (BMI between 25 and 29.9), 45.5% were obese (BMI between 30 and 34.9), and 20.2% had a BMI of over 35. (Overweight or obese patients have a problematic view in laparoscopy) Most of the patients were aged 30 to 49 (62.6%). A majority of the patients (94.9%) were found to have gallstones. Conclusion Iatrogenic gallbladder perforation is prevalent among patients who undergo laparoscopic cholecystectomy. However, laparoscopic cholecystectomy is still a better choice and is associated with fewer complications than open cholecystectomy. Required measures need to be adopted for patients with perforated gallbladder to minimize spillage and remove as much spilt gallbladder content as possible.
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