 | WORM EXTRACTION FROM BILE DUCTS A 30 YEAR WOMEN WITH INTRACTABLE BILIARY COLIC CASE REPORT: This 30 year women developed severe pain right upper quadrant for last 10 days. She sought many consultations and was given intravenous analgesics both (nonnarcortic and narcotic). Pain did not subside and she sought my consultation. Examination revealed her to be in agony with severe upper abdominal pain. General physical examination was otherwise unremarkable. Abdominal examination revealed mild tenderness in right hypochondrium with doubtful Murphy's sign. Urgent abdominal ultrasound showed a linear structure in bile ducts making slow writhing movements. The structure had an anechoic tube (alimentary canal) inside suggestive of a large Ascarid. Urgent ERCP was performed and bile duct and pancreatic duct cannulated selectively. Pancreatic duct was normal. Bile ducts contained a long linear filling defect extending from lower end of common bile duct to right intrahepatic duct (see image gallery for ERCP plate). A basket was introduced in the duct (see video clip) and the linear structure was engaged with soft closure and extracted out of the bile duct. Accompanying the basket was a 25 cm thick highly motile Ascarid. To recover the worm, endoscope was withdrawn along with the basket and the friendly catch. While the endoscope was being withdrawn and the basket was in the duodenum with the worm out of bile duct, patient indicated of relief of abdominal pain. A relook cholangiogram showed no more structures in the duct. She was given antihelmintic therapy and passed hundreds of worms with the feces. The worms recovered form stools were both male and female population and varied in length and size. However the lone worm recovered form bile ducts was the longest and the thickest male worm. The phenomenal behavior of this ubiquitous infection remains unexplained. (Source Records from Dr. Khuroo's Medical Clinic. Review prepared by Mehnaaz Sultan Khuroo Host website www.drkhuroo.org , E-mail: mkhuroo@yahoo.com ). |
 | Expanded Recall/Market Withdrawal of Hernia Repair Patch Davol, Inc. is expanding its earlier recall of the Composix Kugel Patch, which is used to repair ventral hernias that can appear at the site of a prior surgical incision. The recalled patches have a "memory recoil ring" that allows the patch to be folded for insertion and then once in place, to spring open and lay flat. The problem is that this ring can break, and if that happens, it can cause a bowel perforation or chronic intestinal fistula. Davol is now notifying health care professionals about an expanded recall and market withdrawal of additional patches that have a similar design. These actions affect Large Oval and Large Circle patches that have this design. Health care providers who have patches from the recalled lots should stop using them immediately. Here's what the company recommends for managing patients who have already received one of the recalled devices: • First, identify these patients. Advise them about the recall and tell them to seek attention immediately if they experience symptoms that could be associated with ring breakage such as unexplained or persistent abdominal pain, fever, tenderness at the implant site or other unusual symptoms. • Examine symptomatic patients for conditions that could be associated with ring breakage. These include bowel obstruction, perforation or fistula, abdominal wall pain or infection, palpable abdominal wall mass, or migration or movement of the ring. • Evaluate the patient's condition based on clinical signs and symptoms and clinical judgment. • And finally, report any problems to the company. Note that Davol has redesigned this product to correct the problem. These newer patches are not being recalled. They are identifiable by a label that says "redesigned for improved ring integrity." |
 | Composix Kugel Mesh Hernia Patch Composix Kugel Mesh Patch recalled due to defective memory recoil ring that can break under stress. It may be linked to bowel rupture or chronic intestinal fistulae. Symptoms: unexplained/persistant abdominal pain, fever & tenderness at surgery site. |
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