No abstract

No abstract

Background/Aim:History of ascariasis is known to stretch back many centuries. One quarter of the world's population is known to be infected by ascariasis. It is endemic in various parts of the Indian subcontinent and the gangetic plain of West Bengal is one of them. We aimed to study the various types of clinical presentations, complications and different diagnostic tools and to assess various options for the management of biliary ascariasis.Materials and Methods:Forty-two cases of hepatobiliary ascariasis were studied over a period of 3 years. All the patients were adults aged between 20 and 50 years and all but two were admitted with acute upper abdominal pain.Results:In this study, biliary ascariasis was found to be more common in females, 73.8% (31 patients). The most common presentation was upper abdominal pain in 95.2% of the patients (40 patients). Complications observed were obstructive jaundice in 28.56% (12 patients), cholangitis in 16.7% (seven patients), acute pancreatitis in 2.4% (one patient) and hepatic abscess in 2.4% (one patient). History of worm emesis was present in 38.1% (16 patients). History of previous cholecystectomy was present in 16.7% (seven patients) and endoscopic sphincterotomy in 4.8% (two patients). Ultrasound was the diagnostic tool of choice with 100% results. Conservative management was successful in 83.3% (35 patients). During follow-up, worm reinvasion of the biliary system occurred in 7.1% (three patients).Conclusion:In endemic countries, ascariasis should be suspected in patients with biliary disease, especially if a cholecystectomy or sphincterotomy has been performed in the past. Most of the patients respond to conservative management.

The ileosigmoid knot is a rare surgical emergency. It is an unusual type of bowel obstruction in which the ileum usually wraps around the base of the sigmoid colon and forms a pseudoknot. It is usually associated with difficult preoperative diagnosis and poor surgical outcome. To analyze the clinical presentations, operative findings, management, postoperative complications and outcome of patients with ileosigmoid knotting. A retrospective analysis of nine cases of ileosigmoid knotting over a 6-year period from July 2005 to May 2011. Ileosigmoid knotting was common in males in the fifth decade. Mean duration of symptoms prior to admission was 42.67 h. Both the ileum and the sigmoid colon were gangrenous in all the patients. Mortality was 22.22 %. The mean duration of hospital stay was 13.67 days. To conclude, ileosigmoid knotting, though a rare cause of intestinal obstruction, carries a significant risk of mortality. In our study, ileostomy along with colorectal anastomosis seemed to be a better and safer alternative than primary repair in the management of ileosigmoid knotting. Awareness of this condition among surgeons will help to reduce the morbidity and mortality associated with this unusual form of intestinal obstruction.