Medical Journal of The Islamic Republic of Iran (MJIRI)

 Abstract

 Background: The cosmetic result of the surgical scar has long been considered by surgeons as an important factor for patient satisfaction. On the other hand, there has been an old teaching that perfect closure of contaminated wounds increases the rate of infection. We decided to look into this matter and see if this is a fact or a myth.

 Methods: In this prospective randomized study conducted on 200 patients with suppurative or gangrenous appendicitis, we closed the wounds with a cosmetic subcuticular suture of 4/0 nylon in 100 patients and in the other 100 patients the wound was approximated loosely with a few stitches of 3/0 nylon in vertical mattress fashion during a 14-month period.

 Results: There was no significant difference in the rate of wound infection between these two groups.

 Conclusions: This study shows that perfect closure of the wound with subcuticular closure, which gives a very good cosmetic result in comparison with traditional loose closure, does not increase the rate of wound infection.

 Abstract

 Acute inflammation of the gallbladder can occur without gallstones. Acalculous cholecystitis typically develops in critically ill patients in the intensive care unit. Patients on parenteral nutrition, with extensive burns, sepsis, major operations, multiple organ trauma or prolonged illness with multiple organ system failure are at risk for developing acalculous cholecystitis. The association of acalculous cholecystitis with Mirizzi syndrome is very unusual. Mirrizzi syndrome, which is an unusual cause of obstructive jaundice, is most commonly caused by a stone impacted in Hartmann’s pouch, exerting pressure over the common bile duct (CBD) with subsequent erosion into the CBD. The case we are presenting is a case of Mirrizi syndrome type-1 due to acalculous cholecystitis in a 13- year-old girl that presented with intermittent jaundice and RUQ abdominal pain and fever. Intraoperative finding showed Mirizzi syndrome type- 1 without gallstones. The cause of jaundice was only pressure of the gallbladder on the CBD and cholecystectomy with intraoperative cholangiography was performed. At post operative follow-up, the patient became anicteric and all symptoms and signs disappeared.