Shalom Watemberg

Gangrenous Cholecystitis: Seventeen Years of Experience

Background: Gangrenous cholecystitis is a potentially lethal disease. We evaluated the magnitude of this complication from the aspect of pre- and postoperative findings and examined

Surgery for Acute Cholecystitis in the Elderly (> 80 Years)

In the last 15 years we operated on 618 patients for acute cholecystitis, of whom 60 were 80 years of age or more. Most of the ever-increasing number of patients within the hospital population who suf

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.