Enterocutaneous fistula: a reconstructive dilemma.
Duncan CO. Earley MJ. O'Connell PR.
Department of Plastic, Mater Misericordiae Hospital, Dublin 7.
Surgical repair of enterocutaneous fistulae in Crohn's disease may result in large skin defects of the anterior abdominal wall. We present a case in which a large defect was managed with reconstruction using a pedicled rectus abdominis myocutaneous flap in a single procedure. The case highlights the technical challenge of such a case and the value of a joint surgical approach between plastic and colorectal services.
Symptoms of oesophageal reflux are more common following laparoscopic cholecystectomy than in a control population.
McNamara DA. O'Donohoe MK. Horgan PG. Tanner WA. Keane FB.
Department of Surgery, Meath/Adelaide Hospitals, Dublin 8.
Previous studies have shown that up to 40 per cent of patients have symptoms after cholecystectomy or laparoscopic cholecystectomy (LC). There are concerns, however, that these symptoms reflect those of the general population and are not a specific post-operative phenomenon. Abdominal symptoms of 212 patients following LC were compared to a healthy acalculous control population (n = 62). Patients and controls were assessed by questionnaire. Age and sex profiles were similar in both groups. There was no significant difference in the incidence of abdominal pain, bloating or nausea between the 2 groups. Frequent heartburn was a symptom in 19.3 per cent of patients following LC as compared to 3.2 per cent of control patients (p = 0.004, chi-squared 9.39, 1 d.f.). Furthermore 11.3 per cent of post-operative patients complained of dysphagia versus 6.4 per cent of the control group (p = 0.08, chi-squared 1.245, 1 d.f.). One hundred and twenty (57.1 per cent) patients judged their operation to be a complete success, while 9 (4.3 per cent) were dissatisfied. Five of the latter group cited frequent heartburn as the cause of their dissatisfaction. We conclude that abdominal pain, bloating and nausea occur as frequently in the general population as in patients following LC. Patients are more likely to suffer from heartburn and dysphagia following LC than a normal population supporting a link between cholecystectomy and lower oesophageal dysfunction.
Perianal hidradenoma papilliferum occurring in a male: a case report.
Loane J. Kealy WF. Mulcahy G.
Department of Pathology, Cork University Hospital, Ireland.
Hidradenoma papilliferum is a rare apocrine gland tumour, described only once previously in a male. We present the second such case.
Helicobacter pylori does not play a role in the aetiology of acute appendicitis.
Fanning NF. Horgan PG. Tanner WA. Keane FB.
Department of Surgery, Meath Hospital, Dublin.
The aetiology of acute appendicitis remains uncertain. H. pylori is viable outside the gastroduodenum, however its pathological role outside this area has not been fully investigated. Ten consecutive patients with a histological diagnosis of acute appendicitis were investigated for H. pylori status by serology, and by culture, histology, and polymerase chain reaction (PCR) analysis of the appendiceal specimens. One patient had positive serology for H. pylori, however PCR analysis was negative. Culture failed to reveal H. pylori colonies. Histology in 5 cases did reveal organisms with a morphological appearance of H. pylori, but PCR analysis confirmed that H. pylori was not present. Using a variety of methods, with PCR acting as the 'gold standard', we have shown that H. pylori is not associated with acute appendicitis.
Colonic pseudo-obstruction following acute pancreatitis.
Teh SH. O'Riordain DS. O'Connell PR.
Department of Surgery, Mater Misericordiae Hospital, Dublin.
The purpose of this case presentation is to illustrate the rate association between acute pancreatitis and colonic pseudo-obstruction and to highlight the difficulties of assessing intestinal motility in a defunctioned segment of bowel prior to closure of a defunctioning stoma.