Ram Avrahami

Femorofemoral bypass, even in pregnancy--a case report.

A 29-year-old pregnant woman sustained blunt, left lower abdominal trauma, with hip and pelvic fractures, and progressive dissection of an intimal flap in the left iliac artery, which manifested two days later as profound ischemia of the left leg. The patient underwent distal thromboembolectomy, fasciotomies and revascularization of the leg by femorofemoral polytetrafluoroethylene bypass. The patient recovered completely and gave normal birth three months later to a healthy child. Four years after the operation she gave uneventful birth to another child. Various considerations pertinent to this complex traumatic-vascular-gestational state are discussed.

Role of Gastrografin in the Management of Small Bowel Obstruction: A Study of 355 Cases

The effect of Gastrografin on the management of small bowel obstruction was evaluated retrospectively. A total of 355 patients with small bowel obstruction (excluding those with abdominal wall hernia)

Anemia, Coagulopathy, and Acute Leg Ischemia: Unusual Complications of a Persistent Sciatic Artery Aneurysm A Case Report

In the event of a developmental abnormality of the vascular system of the lower limb in which the femoral system fails to develop or the axial artery fails to involute, the main vascular supply to the leg will be through a persistent sciatic artery (PSA). With an incidence of less than 0.04%, PSA can be asymptomatic, but in about half the cases an aneurysmal dilatation can ensue, and its symptomatology may include a painful gluteal mass. Cases have been reported of coagulopathy, anemia, or acute ischemia complicating PSA aneurysm. The case presented here is a clinical constellation of all three compo nents appearing together in a patient who had long been investigated for anemia and had been operated on for a bleeding duodenal ulcer (as a consequence of coagulopathy) in a different center. At hospitalization, the gluteal mass was noted on examination, and angiography showed a huge PSA aneurysm. The clinical presentation and management of this case are discussed in light of the current literature.

Incarcerated Hernia: Are You Sure, Doctor?

Groin and abdominal wall hernias constitute a frequent condition and contribute substantially to both elective and emergency surgery. Incarcerated hernias, given their dangerous potential, are usually

Incidental Cholecystectomy Does Not Increase the Risk of Surgery for Gastrointestinal Malignancy

From 1975 to 1994, 291 incidental cholecystectomies were performed in our department, 143 of them during surgery for gastrointestinal tumors. The number of incidental cholecystectomies has increased gradually each year, mainly after preoperative sonographic screening of the gallbladder became routine in our department. We have found that mortality, morbidity and duration of surgery were not significantly influenced by the addition of incidental cholecystectomy. The risk of the gallbladder becoming symptomatic during the expected survival of the patients who were operated upon for gastrointestinal tumors is higher than the added risk, morbidity or mortality as well as additional cost of incidental cholecystectomy. Therefore, the authors recommend the performance of incidental cholecystectomy during elective laparotomies for gastrointestinal tumors.

Gallstone Disease in Pregnancy: Mere Coincidence or Physiologic Response?

Albeit there have been numerous reports, but it has still not been completely clarified what the exact role (if any) of pregnancy is in the development of gallstone disease, or its influence in previo

Cecal Diverticulitis: The Challenge Goes on

Diverticula are more common in the left colon and isolated right-sided diver-ticulum of the colon with perforation is a rare entity. Right sided diverticulitis of the colon is diagnosed in patients ap

Carcinoma of the Gallbladder: Diagnosis, Treatment, Prognosis

Despite modern imaging techniques, the majority of gallbladder cancers are recognized at the time of laparotomy, when curative procedures are rarely possible. Predisposing factors include old age, female sex and cholelithiasis. Abdominal pain, vomiting, anorexia, weight loss and jaundice are the most prevalent signs and symptoms. The nonspecific clinical picture combined with low sonographic diagnostic value make preoperative diagnosis unlikely. The very low survival rates, with or without surgery, dictate a more palliative approach. Palliation includes primarily the relief of pain, jaundice and intestinal obstruction. Between 1987 and 1992, we have treated 21 patients with gallbladder carcinoma. The following paper reviews these cases in light of the current literature.