Biography
Abstract
Background. Carcinoid tumors are rare but considered to be one of the commonest tumors in the appendix. Their incidence has been shown to vary in different studies. Aimes, Setting & Design. This seminal study was carried out to determine the incidence and clinico-pathological profile of appendiceal carcinoids in a cohort of patients undergoing emer¬gency appendicectomies for clinically suspected acute appendicitis in Emirate of Sharjah. Materials and methods. The study included the retrospective data of 964 patients operated for clinically suspected appendicitis, the resected specimens of whom were received in the Pathology laboratory of Al-Qasmi hospital Sharjah from January 2010 to December 2010. Results. Out of the 964 patients 9 (0.93%) were found to have appendiceal carcinoids. The mean age was 28.7 years with a male to female ratio of 2:1. Eight tumors were located near the tip of appendix with mean diameter of 3.3 mm. All tumors were found to be positive for chromogranin A, synaptophysin and neuron-specific enolase on immunohistochemistry (IHC). None of the patient’s had recurrence or any reportable complications in the short follow up period (12-26 months). Conclusions. Our study found higher incidence of appendiceal carcinoids in pa¬tients undergoing emergency appendectomy for acute appendici¬tis in Emirate of Sharjah compared to two previous studies from the same geographical region. Moreover, tumors were found more commonly in young males in contrary to previous studies and all the tumors were positive for common neuroendocrine markers.
Biography
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is widely performed as an initial surgical treatment for patients with acute cholecystitis complicated by hyperbilirubinemia. This procedure carries a significant risk of complications, and needs to be performed by a highly experienced professional. The objective of our study was to evaluate effectiveness of less dangerous, in our view, surgical approach to this clinical problem. First, we performed laparoscopic cholecystectomy on two hundred and forty-eight patients with acute cholecystitis complicated by hyperbilirubinemia followed by T-tube cholangiography on third postoperative day (1996-2009). Signs of compression of Common Bile Duct (CBD) by inflamed and swollen ligaments were seen intraoperatively in 68 patients (67.8%). Gallstones under 1 cm and CBD around 1 cm were found in 44 patients (17.7%). Gallstones over 1 cm and CBD of 1.5 cm were found in 11 patients (4.4%). In cases where gallstones were found, they were removed by ERCP (less than 1 cm) or by classic methods (greater than 1 cm). If no biliary obstruction were seen, drainage was removed in the following two days. Other causes of hyperbilirubinemia (pancreatitis, strictures, etc.) were found in 25 patients (10%). Only two of them required surgical attention. T-tube cholangiography, performed on third day after cholecystectomy, showed that 184 patients (74.1%) had no biliary flow obstruction and normal bilirubin levels; as a result ERCP was not indicated. Taking this into account, we recommend first to perform cholecystectomy, with placement of external drainage and perform T-tube cholangiography on the third postoperative day, followed by ERCP if indicated.