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  • ISSN: 2573-1017
    Early Online
    Volume 3, Issue 1
    Case Report
    William A. Kunkle, Bijan J. Ameri*, Michael O. Madden, Stuart H. Hershman, and Justin J. Park
    High cervical disc herniation (C2/3 and C3/4) is a rare and potentially debilitating injury. Most cervical disc herniations occur at C5/6, or C6/7; less than 1% occurs at C2/3 and only 4% to 8% at C3/4. Patients with a high cervical disc herniation can present with headache, neck pain, and unilateral numbness and weakness. Diagnostic tests such as non-contrast computed tomography (CT) of the brain and angiogram of the neck are commonly utilized to rule out cerebral vascular accident (CVA) and/or carotid artery dissection; these pathologies can present with similar symptoms, however these commonly obtained tests will often fail to diagnose a high cervical disc herniation.
    We present a review of the literature regarding the incidence of high cervical disc herniation and its clinical manifestations. Differences in the signs and symptoms of CVA, carotid artery dissection, and high cervical disc herniation are discussed. A case of a 57-year old male who presented with headache, neck pain, and left sided deficits secondary to a high cervical disc herniation is also reviewed.
    Julius Gbenga Olaogun*, Olusoga Olusola Akute, Innih Kadiri, and Ifeoluwa Gbadamos I
    A case of retroperitoneal abscess (RPA) complicated by necrotizing fasciitis is presented. RPA by virtue of its anatomical location usually has occult and insidious presentation that may be a diagnostic challenge to the clinician but when this is complicated by necrotizing fasciitis, a rapidly progressing fulminant infection ensues. Delay in instituting drainage and aggressive surgical debridement with appropriate antibiotic cover are usually associated with high morbidity and mortality. Our index patient is a 45 year old woman admitted on 2nd November, 2017 for a conservative management of a suspected appendicular mass. The inflammatory process soon progressed rapidly with overlying abdominal skin necrosis and involvement of the ipsilateral thigh. An emergency abdominal exploration revealed a retroperitoneal abscess with extensive necrotic tissues in the right flank spreading to the right thigh. Patient had drainage of abscess, aggressive debridement of the necrotic soft tissue with antibiotic treatment. She had a satisfactory surgical outcome though following a prolonged hospital stay of 22 days.
    Research Article
    Mohamed Samir Abou-Sheishaa*, Ahmed Negm, Mohamed Abdelhalim, Ashraf Abbas, Mohamed Ibrahim, Hosam Elghadban, and Mohamed Elmetwally
    Background: Laparoscopic appendectomy is now the standard of care for cases of acute appendicitis. It has all the benefits of minimal access surgery like rapid recovery, shorter hospital stay and better cosmetic result. There are many methods for securing the base of the appendix, some of which are expensive; others are not available or technically demanding. In our study we compared between intra-corporeal ligation and metallic clip application for securing the appendicular stump.
    Aim of the work: Aim of the work was to compare between intra-corporeal ligation and metallic clip application as methods of securing the appendicular stump regarding their safety, simplicity, competence and complications.
    Patients and methods: We conducted the study in the period between December 2015 and May 2017 in Mansura university hospitals on 80 patients.
    40 patients were randomized to metallic clip application (group A) and the other 40 patients to intra-corporeal ligation (group B). Inability to do one technique is considered failure and an indication to do the other.
    Results: There was failure of the technique in 4 cases of the clip group (group A) 36/40 that were managed by intra-corporeal ligature (group B) 40/40 with p value of 0.12.
    The mean operative time in group A was 44.8 minutes and 54.6 minutes for group B, P value < 0.05.
    The mean hospital stay in group A and B was 1.8and1.9 days respectively, P value > 0. 05. No intra- operative complications in both groups.
    Conclusion: Both techniques of metallic clip application and Intra-corporeal ligation are cost effective in securing the appendicular stump in laparoscopic appendectomy. The only limitation of the clip application is the large diameter of the appendicular stump and in these cases Intra-corporeal ligation can be done.
    Mohamed Samir Abou-Sheishaa*, Waleed Ahmad Burham, Ashraf Elsayed Abbas, Ibrahim Elsayed Dawoud, Mahmoud Ahmed Shaker, Ahmed Negm Abdrahman Albany, Nashat Abd El Razek, Magdy Basher
    Background: Timing of cholecystectomy in acute biliary pancreatitis has always been a point of debate among surgeons. Our study has been conducted aiming to compare the safety and efficacy of early versus delayed laparoscopic cholecystectomy in patients with mild acute biliary pancreatitis. Objective: This study was conducted to compare the benefits and disadvantages of early versus delayed laparoscopic cholecystectomy in patients with mild acute biliary pancreatitis.
    Patients and methods: The 96 eligible patients were randomly distributed into two groups, Group I underwent cholecystectomy during index admission, and group II underwent late laparoscopic cholecystectomy 25-30 days after discharge. The operative data were recorded for each patient in special sheets. The patients were followed up for 3 months postoperatively to detect any complications.
    Results: 125patients presented with acute biliary pancreatitis between November 2014 and June 2016, 25 patients were excluded because they did not meet inclusion criteria and 4 patients refused to participate in this study. The remaining 96 patients were randomly distributed into 2 groups by computer generated program. Group I (50 patients) underwent cholecystectomy during index admission, group II (46 patients) underwent late laparoscopic cholecystectomy 25-30 days after discharge. There was no statistically significant difference between both groups regarding baseline characteristics including age and sex. The overall hospital stay was significantly lower in group I than group II. No cases in both groups reported to have biliary injuries.
    Conclusion: Early laparoscopic cholecystectomy is preferred over delayed laparoscopic cholecystectomy for cases of acute mild biliary pancreatitis because it is associated with faster and easier operation, shorter hospital stay and lower recurrence rate with no significant difference regarding postoperative complications.
    Mohamed Samir Abou-Sheishaa*
    No doubt that scientific research is one of the most important tools for improving the quality of medical services in general and especially in the surgical field; it also helps us to solve the different problems that we face during our practice in the different surgical fields. Of course, this will be reflected on the degree of the patient satisfaction. Scientific research is one limb of the triangle presented by any university or scientific institute besides teaching the undergraduates and social services to the surrounding community. There are many obstacles that face us during our practice in scientific research especially in the field of surgery.
    Case Report
    Rajesh Chaudhary*, Neraj Gupta, Ram Kishan Abrol, Saloni Sood, Mohamad Muzamil Ambekar, and Suneet Katoch
    Spontaneous gallbladder perforation in a patient is a management challenge. This condition is usually seen after Acute Cholecystitis in old age or immunocompromised patients, thus it is misdiagnosed and hence mistreated. Although ultrasonogram (USG) of the abdomen is the initial investigation, contrast enhanced computerised tomographic (CECT) scan of the abdomen is more sensitive in picking up the gallbladder perforation, hence is the investigation of choice. A delay in the treatment of type 1 gallbladder perforations is still fatal although the mortality has come down dramatically in the past 50 years. We present the case of a 77 year old lady presenting with type 1 gallbladder perforation having acute generalised peritonitis. The patient underwent exploratory laparotomy and cholecystectomy with peritoneal toileting and drainage.
    Case Report
    Nicholas Rawson and Kathleen Dominguez
    Bowel obstruction is a common cause of surgical admission and operation. Uncommonly, this can be caused by a congenital defect in the fusion of the peritoneum and mesocolon called a paraduodenal hernia. These internal hernias range in presentation from asymptomatic incarceration to complete bowel obstruction. Most patients present at middle age and require surgery even if they are asymptomatic at the time. Laparoscopy is a relatively new modality for intervention, but is feasible. In this case, a 15-year-old patient presented with subacute bowel obstruction due to a left-sided paraduodenal hernia associated with an atrophic left kidney.
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