BackgroundPancreatic cancer is generally found in the older population Pancreaticoduodenectomy seems to be the only way in resolving these resectable tumors. Allen. O Whipple was the first to describe pancreaticoduodenectomy in 1935 as a modified procedure. This article is a case series with respect to the 7-year experience of the Whipple procedure in Firoozgar Teaching Hospital.MethodsPatient surgery details were gathered from the surgical records of the operating room and their clinical records from the hospital archives. Data was analyzed with SPSS software (version 16.0.1). Those patients, whose tumor had invaded the superior mesenteric artery, had extensive portal vein involvement or distant metastasis was considered as unresectable.ResultsThe first Whipple procedure was recorded in our hospital in 2008. From 2008 till 20 March 2014, 70 cases were collected and analyzed. The mean age of cases was 58.4 years, the mean hospital stay length was 12.9 days (±6.23 days), mean operation time was 376 min (±37.3 min),. The most common presenting symptom was jaundice (78.6 %). Delayed gastric emptying was the most common post-operative complication. The most prevalent cause of reoperation was intra-abdominal abscess. Major morbidities of these patients consisted of cardiac arrhythmias (21.4%) and pneumonia (10%). Minor complications were wound infection (17.1%) and delayed gastric emptying (32.9%). The statistics revealed pancreatic anastomosis failure as 2.9% and a decrease in mortality rate from 50% during the first years of this study to 16% to 20% during the last years.ConclusionsIn this case series, the time of operation decreased during the recent years .Analysis shows a correlation between operation time and pack cell transfused during the operation, but no correlation was found between operation time and post-operation hospitalization course. It is true that hospital setting, socioeconomic level of the patients including their compliance, and the expertise of the surgeons and surgical staff can have an influence on the result of this operation, but it seems that the magnitude of the surgical stress of this procedure and the (compromised) functional reserve of this patient population can be a notable factor influencing the outcome.

The authors have declared that no conflict of interest exists.

A barium enema is a diagnostic and therapeutic procedure commonly used for colon and rectum problems. Rectal perforation with extensive intra- and/or extraperitoneal spillage of barium is a devastating complication of a barium enema that leads to a significant increase in patient mortality. Due to the low number of reported cases in recent scientific literature and the lack of experience with the management of these cases, we would like to present our treatment approach to a rare case of retroperitoneal contamination with barium, followed by its intraperitoneal involvement during a diagnostic barium enema. Our experience with long-term management of the patient and the good outcome will be depicted in this paper.

J Vahedian-Ardakani, Hydatid Cyst of the Liver Presenting as Cutaneous Abscesses. 1997; 17(2): 235-236 Hydatid disease is a parasitic infestation of humans and herbivorous animals, caused by Echinococcus granulosus. Dogs and some wild carnivores, like foxes, are definitive hosts, harboring worms in their intestines. Eggs are passed in feces and eaten by intermediate hosts, and larvae encyst in the liver, lungs and other organs. A man presented with two cutaneous abscesses in the right lower part of his chest wall. Further examination disclosed a hydatid cyst measuring 91x111 mm in diameter in the lower part of the right lobe of the liver, communicating with the cutaneous abscesses. The case is reported because of its unusual presentation. Case ReportA 40-year-old male was admitted with two reddish and tender subcutaneous masses in the right lower part of his chest wall at the posterior axillary line, which had developed slowly for one month prior to admission. He is a worker, dwelling in the rural areas of Bam, a city in Kerman province, and he had close contact with cattle and dogs. The subcutaneous masses were 8x10 and 6x7 cm in diameter, respectively, and the overlying skin was thin and inflamed ( Figure 1). They were typical abscesses just about to break through the skin. Sonography disclosed an echogenic mass with echo-free areas measuring 91x111 mm in diameter in the lower part of the right lobe of the liver. Abdominal CT scan could not be performed at this time. Plain x-rays of the chest and abdomen were unremarkable. Open surgical drainage of the abscesses was attempted; they contained thick pus, whitish wrinkled cystic structures and yellowish gelatinous material.After removing the contents of the cutaneous abscess, the floor of the abscess was explored with an index finger. No obvious communication tract was found at that time. Abscess fluid was sent for routine culture, which was negative. No Gram's stain, AFB stain, anaerobic culture or culture for mycobacterium was performed. Pathologic examination identified the cystic structures as hydatid cysts with acute inflammation. A CT scan of the liver after abscess drainage revealed a large, round mass with a calcified rim in the lower part of the right hepatic lobe, having close contact with the cutaneous abscesses (Figure 2). The CT scan was characteristic of hydatid cyst of the liver. The cyst was surgically excised; it did not contain any fluid, but was filled with hundreds of daughter cysts and large amounts of a yellowish gelatinous material, amounting to one liter overall. A communicating tract was found between the liver cyst cavity and the cutaneous abscesses. The pathology report confirmed hydatid cyst of the liver.