XIPHOPAGUS CONJOINED TWINS: PREOPERATIVE EVALUATION AND SURGICAL MANAGEMENT.
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Biomedical subjects
Publications and source records attributed to M M WOOLLEY.
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If a diagnosis of traumatic pancreatitis is made and the patient does not improve clinically during the first 24 hours, transection of the pancreas should be suspected. If this is found to be the case at operation, the distal pancreas should be resected and the proximal end of the pancreas closed carefully with interrupted mattress suture of non-absorbable suture material. Particularly, the pancreatic duct should be ligated to prevent the formation of an external fistula. Any attempt at reapproximation of the transected pancreas will invariably result in an external pancreatic fistula if the patient survives the immediate postoperative period.
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THE DECISION FOR SPLENECTOMY MUST BE BASED ON A KNOWLEDGE OF THE THREE FUNCTIONS OF THE SPLEEN: Hematopoiesis (usually ceasing during fetal life but sometimes resuming when bone marrow function fails); filtration of abnormal and senescent cells and control of bone marrow activity, most probably humoral. When bone marrow function fails, splenectomy is contraindicated since splenic hematopoiesis becomes a vital function. On the other hand, when a large proportion of erythrocytes are abnormally shaped (spherocytes), although otherwise adequate, the spleen may trap these cells in its filter and destroy large numbers. Splenectomy is beneficial in almost every case of congenital spherocytosis, but in only half the cases of the acquired defect. In panhematocytopenia, thrombocytopenia and neutropenia, all apparently due to depression of hematopoiesis by endocrine or other action of the spleen, splenectomy may be beneficial if medical therapy fails.A SURGEON UNDERTAKING SPLENECTOMY SHOULD RECOGNIZE TWO SPECIAL PROBLEMS: (1) The presence of accessory spleens, which if not removed may negate the effects of the operation, and (2) the apparently high rate of infection in infants and children who have undergone splenectomy.
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From 2 per cent to 5 per cent of all indirect inguinal hernias are of the sliding variety. (Sliding hernias are those in which part of the wall of the sac is formed by a viscus.) The proportion of sliding hernias is even higher in the aged. Hernias of this kind are found almost exclusively in males and usually on the left side. Preoperative diagnosis is not essential if the surgeon can recognize the lesion at operation and knows how to repair it properly. The LaRoque technique in which the peritoneal cavity is entered above the internal ring allows accurate definition of the pathological anatomy and effective repair of the hernia. It should be used in all true sliding indirect inguinal hernias.
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