Jm Plummer

Laparoscopic cholecystectomy for chronic cholecystitis in Jamaican patients with sickle cell disease: preliminary experience

Laparoscopic cholecystectomy, with its advantages of reduced postoperative pain and shorter hospitalization is the accepted standard of care for patients with symptomatic cholelithiasis. A retrospective study was done to assess the outcome of laparoscopic cholecystectomy in patients with sickle cell disease, a group known for its high postoperative morbidity. The study sample comprised of patients seen at the University Hospital of the West Indies during the period 1999 to 2004. Twelve patients were females and four were males. Their mean age was 28.5 years (range 13-43 years). Fifteen underwent elective cholecystectomy for recurrent episodes of cholecystitis while one patient required an emergency procedure. All patients underwent endoscopic retrograde cholangiopancreatography, which successfully removed common bile duct stones which were present in 25% of the cases. There were four conversions to open cholecystectomy as a result of obscure anatomy due to scarring and adhesions. The duration of surgery ranged from 70-150 minutes. Six patients developed postoperative complications, four of whom had acute chest syndrome. This resulted in death in one patient. The mean postoperative hospitalization period was 5.5 days. This report indicates that patients with sickle cell disease remain a high risk group with the potential for significant morbidity even when subjected to minimal access surgery.

Extramedullary plasmacytoma of the pancreas as an uncommon cause of obstructive jaundice: a case report

IntroductionThough uncommon, extramedullary plasmacytoma of the pancreas should be considered in the differential diagnosis of obstructive jaundice and pancreatic neoplasms. This report highlights a case of obstructive jaundice in a 46-year-old West Indian man that resulted from an extramedullary plasmacytoma.Case presentationA 46-year-old West Indian man presented to our hospital with evidence of a significant upper gastrointestinal bleed. He gave a recent history of jaundice, constitutional symptoms and back pain. Ultrasonography revealed a mass in the head of the pancreas with resultant common bile duct dilatation. The patient required urgent surgical intervention for ongoing bleeding at which time a biopsy of the pancreas was taken. Histological analysis revealed a plasmacytoma of the pancreas. A blood film showing rouleaux formation and a skeletal survey demonstrating multiple lytic lesions confirmed multiple myeloma. Before further evaluation or treatment was carried out, the patient defaulted from follow-up and died from his illness seven months later.ConclusionThis case represents an example of multiple myeloma with visceral involvement, brought to clinical attention through involvement of the pancreas. The report serves to reaffirm knowledge of the various presentations, the optimal diagnostic tools and the current proposed treatment strategies for extramedullary plasmacytomas of the pancreas.

Dengue fever mimicking acute appendicitis: A case report

INTRODUCTION Dengue fever is an acute viral disease, which usually presents as a mild febrile illness. Patients with severe disease present with dengue haemorrhagic fever or dengue toxic shock syndrome. Rarely, it presents with abdominal symptoms mimicking acute appendicitis. We present a case of a male patient presenting with right iliac fossa pain and suspected acute appendicitis that was later diagnosed with dengue fever following a negative appendicectomy. PRESENTATION OF CASE A 13-year old male patient presented with fever, localized right-sided abdominal pain and vomiting. Abdominal ultrasound was not helpful and appendicectomy was performed due to worsening abdominal signs and an elevated temperature. A normal appendix with enlarged mesenteric nodes was found at surgery. Complete blood count showed thrombocytopenia with leucopenia. Dengue fever was now suspected and confirmed by IgM enzyme-linked immunosorbent assay against dengue virus. DISCUSSION This unusual presentation of dengue fever mimicking acute appendicitis should be suspected during viral outbreaks and in patients with atypical symptoms and cytopenias on blood evaluation in order to prevent unnecessary surgery. CONCLUSION This case highlights the occurrence of abdominal symptoms and complications that may accompany dengue fever. Early recognition of dengue fever mimicking acute appendicitis will avoid non-therapeutic operation and the diagnosis may be aided by blood investigations indicating a leucopenia, which is uncommon in patients with suppurative acute appendicitis.

Mucinous cystadenoma of the appendix presenting with an elevated carcinoembryonic antigen (CEA): Report of two cases and review of the literature

INTRODUCTION Despite the fact the mucocoele of the appendix is a rare entity it has been the subject of much interest in the literature. The term mucocoele refers to cystic dilatation of the appendix filled with mucin resulting from proximal obstruction of the appendix lumen. PRESENTATION OF CASE We report two patients presenting with mucinous cystadenoma of the appendix with elevation of serum carcinoembryonic antigen (CEA), which has rarely been reported. Both patients had mild symptoms and a normal colonoscopy preoperatively. The diagnosis was not suspected in one patient prior to surgery. The elevated CEA prompted additional diagnostic radiologic investigations including ultrasonography, and computed tomography scans. The patients had uneventful appendicectomies with subsequent normalization of their CEA levels. DISCUSSION Mucinous cystadenoma of the appendix is a rare pathological entity characterized by a dilated mucous filled appendix. The presence of an elevated CEA associated with the presence of this entity is a rare presentation. CONCLUSION Because the diagnosis is rarely suspected prior to surgery patients with an enlarged appendix with associated elevated CEA levels should have careful investigations to exclude malignancy.

Emergency subtotal colectomy for lower gastrointestinal haemorrhage: over-utilised or under-estimated?

Introduction:  A minority of patients with unlocalised massive lower gastrointestinal bleeding (LGIB) will require treatment with emergency subtotal colectomy (STC).

Solid-pseudopapillary tumour of the pancreas as a rare cause of gastric outlet obstruction: a case report

The presence of a large bulky pancreatic tumour in a young female should raise suspicions of the diagnosis of solid-pseduopapillary tumour of the pancreas.This rare tumour has the characteristics of a low-grade malignancy with indolent behaviour. Most patients present with vague non-specific abdominal pain resulting in delayed diagnosis. The light microscopic features show solid areas alternating with pseudopapillary formations. Metastases are frequently amenable to resection.Favourable prognosis with long-term survival has been shown even in patients with metastatic disease. Herein we present the case of a 21 year-old female patient of Afro-Caribbean extract who presented with gastric outlet obstruction from a large pancreatic tumour.

Surgical Care in Jamaica in the Laparoendoscopic Era: Challenges and Future Prospects for Developing Nations

In an era of technology-dependent surgery, Jamaica and other developing countries must deal with the wide disparity between their surgical practices and those of developed nations. Although there is still a place for the well-trained surgeon, the current emphasis in developed nations is less on the individual surgeon and more on the surgery team and system, with increasing costs despite diminishing government support. At the University of the West Indies, we are challenged to continue providing appropriate service and training for the Caribbean region, but we hope that a combination of fellowship-trained team leaders and partnerships with resource-rich institutions will enable us to meet this challenge and to meet the health care needs of our populace.

Adult Hirschsprung's disease in Jamaica: operative treatment and outcome

Aim  This study reviewed the operative management and outcome of patients with adult Hirschsprung’s disease treated at the University Hospital of the West Indies, Mona, Jamaica.

Popliteal artery transection associated with blunt knee injury: controversies in management--a case report

From: Department of Surgery, Radiology, Anaesthesia and Intensive Care,The University of the West Indies, Kingston 7, Jamaica, West Indies.Correspondence: Dr JM Plummer, Department of Surgery, Radiology,Anaesthesia and Intensive Care, The University of the West Indies, Kingston7, Jamaica, West Indies. Fax: (876) 970-4302, e-mail: surradic@uwimona.edu.jm.

Clinicopathologic profile of gastric carcinomas at the University Hospital of the West Indies

The objective of this study was to examine the clinicopathologic features of gastric cancer seen at the University Hospital of the West Indies (UHWI) and to compare the findings with other studies. A retrospective study was conducted using data obtained from the surgical pathology reports of all gastrectomies and gastric biopsies during the period January 1993 and December 2002. Additional cases were identified from the Department of Surgerys audit database. Demographic, clinical and pathological features were analyzed. Two hundred and sixteen patients were identified, 126 males and 90 females. One hundred and thirty-six underwent biopsy procedures but no definitive surgery aimed at cancer eradication, while 70 had gastrectomy. The peak age prevalence in both males and females was the 70-79-year age group. While the antrum was the commonest site, there was an overall increase in tumours of the gastro-oesophageal junction and tumours of the entire stomach in the latter five-year period of the review especially in the 50-59-year age group. Epigastric pain and constitutional symptoms were the common presenting features, and the most common gross tumour characteristic was an ulcerating mass, while histologically, the intestinal variety was most common. Lymph node metastases were common. Helicobacter pylori (Hpylori) were present in 16.7% while chronic multifocal atrophic gastritis was present in 40%. This study indicates that the gastric cancer pattern is typical of developing countries. However, the low prevalence of H pylori in the resected specimens may indicate the importance of other risk factors for gastric cancer development in this population. This warrants further study.