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Biomedical subjects

A W Yip

Publications and source records attributed to A W Yip.

27 records · Page 2Linked to original sources
PubMed1993

Obturator hernia: a continuing diagnostic challenge.

BACKGROUND: The rare obturator hernia has a high incidence of potentially lethal complications. This report reviews this condition and stresses the dangers of unrecognized obturator hernia. METHODS: Thirteen patients with 14 obturator hernias were seen during a 5-year period. All the patients were emaciated and elderly, and 12 were women. They all had clinical features of small bowel obstruction. The classic Howship-Romberg sign was present in only three patients. The diagnosis was made before surgery in five patients. RESULTS: All hernial sacs contained small bowel. Ileum were present in 11 instances. Richter-type hernia was present in 10 cases. Bowel resection for gangrenous loop was required in seven instances. Apart from associated poor medical conditions, delay in presentation and operation also contributed to the high morbidity and mortality rates. Five patients (38.5%) had postoperative complications, and two patients (15.4%) died of chest infections. CONCLUSIONS: The need for awareness of the condition is stressed and the diagnosis of obturator hernia should be strongly suspected in a thin, elderly woman who has small bowel obstruction and no previous abdominal surgery.

Aged↗
PubMed1992

Mirizzi syndrome with cholecystocholedochal fistula: preoperative diagnosis and management.

Gallstone obstruction of the cystic duct with resulting repeated attacks of inflammation and pressure necrosis leads to the formation of cholecystocholedochal fistulas (Mirizzi syndrome type II). Obstructive jaundice and cholangitis are the common presentations of the condition. These fistulas are often not recognized before operation and constitute a high risk of damage to the common duct during a formal cholecystectomy. A high index of suspicion is required to diagnose the condition. We report five patients with cholecystocholedochal fistulas diagnosed by endoscopic retrograde cholangiography that delineated the fistula and the obstructing stone. The plan of management was formulated before surgery, and persistent attempt to dissect the Calot's triangle was avoided. In three patients the common duct defect was closed with the use of a gallbladder flap. Hepaticojejunostomy was required for the two difficult cases with large common duct defects and inflamed tissue.

Aged↗
PubMed1991

Plea for selective operative cholangiography.

A prospective study was carried out to evaluate the use of routine operative cholangiography in 382 patients undergoing elective cholecystectomy. Operative cholangiography was performed in 356 patients. In each patient, the presence or absence of clinical and operative indications for common duct exploration was correlated with the result of the operative cholangiography. In 114 patients (32%) there were one or more indications for exploration and only 34 patients showed positive cholangiographic findings and were explored. Ductal stones were found in 25 patients and nine patients had negative explorations. In the remaining 242 patients who had no indication for common duct exploration, normal cholangiogram was obtained in 234 patients and eight had false positive cholangiograms and were explored unnecessarily. No unsuspected common duct stones were detected in the whole series. Based on these results, a plea is made for selective operative cholangiography.

Cholangiography↗
PubMed1990

A new semiquantitative culture method for early detection of surgical incisional wound infection.

A semiquantitative culture technique for early detection of surgical wound infection was done by rolling a segment of a plastic intravenous catheter across a blood agar plate after insertion into the most inflamed part of the wound on postoperative day 3. Patients were monitored daily for purulent discharge until healing. Of the 53 wounds studied, 44 (83%) had no growth or low-density superficial colonization on the blood agar (generally less than 15 colony-forming units and within the upper 1.5 cm of the catheter). None of these 44 wounds was subsequently infected; therefore, these colonies represented colonization. Of the 9 wounds (17%) that yielded greater than 15 colony-forming units and a diffuse subcutaneous pattern (colonies below the upper 1.5 cm of the catheter), all developed purulent discharge with a positive culture of the same organisms found by semiquantitative culture. This result differed significantly (P less than .01) from the 44 wounds without subsequent infection. This semiquantitative technique has the potential to distinguish infection from colonization and may be useful in diagnosing surgical wound infection.

Bacteria↗
PubMed1990

Mesenteric hernias through defects of the mesosigmoid.

Internal herniation through defects in the gastrointestinal mesentery is extremely rare. Two patients with small bowel herniation involving the sigmoid mesocolon are reported. The condition has a high incidence of strangulation, with rapid onset of gangrene of the bowel. The mortality is high and the role of early surgical intervention is stressed.

Adolescent↗
PubMed1989

Incidence and significance of pneumoperitoneum after inguinal herniorrhaphy.

Previous studies have shown pneumoperitoneum either to be extremely rare or to not occur after inguinal herniorrhaphy, and that its presence signifies a serious intra-abdominal complication. A prospective study has been carried out to consider the incidence and significance of pneumoperitoneum after herniorrhaphy for indirect inguinal hernias. In a 1-year period, 100 patients were studied. Pneumoperitoneum was detected in six patients. In five patients, the amount of free gas was minimal and was reabsorbed after 48 h. The pneumoperitoneum was large and of increasing amount in one patient. Faecal fistula developed 7 days after operation due to an injury from the hernial repair to the sigmoid colon. The result of this study suggested that detectable pneumoperitoneum of small amount may be present after inguinal herniorrhaphy and, if it persists for longer than 48 h, the presence of a perforated viscus should be considered.

Hernia, Inguinal↗