1.Intraoperative cholangiography during Laparoscopic cholecystectomy in the GrandMed Hospital
Bulgan Ch ; Batkhuu A ; Enkhbayar D ; Altankhuyag B ; Saruul E ; Mishigdorj L
Journal of Surgery 2016;19(1):19-22
Introduction: In gallstone diseases,
common bile duct stones and thickened bile
could cause hepatitis or other difficulties.
Therefore intraoperative cholangiography is
helpful in many operations besides detecting
and diagnosing the gallstones in common
bile duct.
Materials and Methods: Out of 266
patients who had undergone Laparoscopic
Cholecystectomy surgery in GrandMed
Hospital, 14 patients were found to have
jaundice and cholestasis after undergoing
laboratory and radiology tests.
Results: These 14 patients have all
undergone IOC. 7 out of 14 patients were
found to have positive cholangiogram and
the other 7 - negative. Biliary tract tumor
and anatomic anomalies were not identified
among these patients.
Conclusion: Making analysis using
only laboratory data is not adequate for
directly detecting choledocholithiasis. IOC
not only shows bile tract obstruction and
determines cholestasis causes, but it also
identifies the anatomy biliary tract, which
is a procedure that facilitates dissection.
Therefore IOCcan prevent the most serious
complication of laparoscopic cholecystectomy
- common bile duct injury. The sensitivity
of IOC ensures the gathering of important
information on time, so suggest to use it for
every suspicious case.
2. Intraoperative cholangiography during Laparoscopic cholecystectomy in the GrandMed Hospital
Bulgan CH ; Batkhuu A ; Enkhbayar D ; Altankhuyag B ; Saruul E ; Mishigdorj L
Journal of Surgery 2016;19(1):19-22
Introduction: In gallstone diseases,common bile duct stones and thickened bilecould cause hepatitis or other difficulties.Therefore intraoperative cholangiography ishelpful in many operations besides detectingand diagnosing the gallstones in commonbile duct.Materials and Methods: Out of 266patients who had undergone LaparoscopicCholecystectomy surgery in GrandMedHospital, 14 patients were found to havejaundice and cholestasis after undergoinglaboratory and radiology tests.Results: These 14 patients have allundergone IOC. 7 out of 14 patients werefound to have positive cholangiogram andthe other 7 - negative. Biliary tract tumorand anatomic anomalies were not identifiedamong these patients.Conclusion: Making analysis usingonly laboratory data is not adequate fordirectly detecting choledocholithiasis. IOCnot only shows bile tract obstruction anddetermines cholestasis causes, but it alsoidentifies the anatomy biliary tract, whichis a procedure that facilitates dissection.Therefore IOCcan prevent the most seriouscomplication of laparoscopic cholecystectomy- common bile duct injury. The sensitivityof IOC ensures the gathering of importantinformation on time, so suggest to use it forevery suspicious case.
3. RARE CASE OF RIGHT SIDED TRAUMATIC DIAPHRAGMATIC HERNIA IN GRAND MED HOSPITAL
Mishigdorj L ; Enkhbayar D ; Altankhuyag B ; Bulgan CH
Journal of Surgery 2016;19(1):74-76
Summery For TDHDiaphragmatic rupture is a lifethreateningcondition. Diaphragmaticinjuries are quite uncommon and oftenresult from either blunt or penetratingtrauma. Diaphragmatic ruptures are usuallyassociated with abdominal trauma however,it can occur in isolation. Acute traumaticrupture of the diaphragm may go unnoticedand there is often a delay between the injuryand the diagnosis. A comprehensive literaturesearch was performed using the terms“delayed presentation of post traumaticdiaphragmatic rupture” and “delayeddiaphragmatic rupture”. The diagnosticand management challenges encounteredare discussed, together with strategies fordealing with them.In our hospital, we had one patientwho has been diagnosed as a TDH. Wewerefocused on mechanism of injury,duration, presentation and site of injury,visceral herniation, investigations anddifferent approaches for repair. We intendto do a laparoscopic repair, but it diagnosedas a TDH so we did open Laparotomy.
4.Time Depending Changes of Acute Cholecystitis
Buyanbat Ts ; Bat-Orshikh Kh ; Nasantuya N ; Altankhuyag M ; Byambasuren GL ; Tsetsgee L ; Altantuya B ; TSerenlham SH
MONGOLIAN MEDICAL SCIENCES 2010;151(1):2-4
BACKGROUND: Acute cholecystitis is defi ned mostly as bacteria from intestinal infl ammation to gallbladder. Sometimes the inflammation can occur when bacteria and viral can fl ow by blood and lymphus. Acute cholecystitis is leading the second place of acute abdomen. (1.2.3.7.8). The acute cholecystitis complication is not decreasing(4.5.6). The mortality is 0.5-0.8%(2.4.5.9). The acute cholecystitis is comparing with cholelith. Foreign scientists are recommending that fi rst 24-48 hours to treat by drugs, and after that if infl ammation is not healing to do cholecystectomy. In our country the acute cholecystitis is taking the place after acute abdomen and appendicitis. And also, acute cholecystitis morbidity is not decreasing and indication of cholecystectomy is not decided yet.
OBJECTIVE: The main purpose of this survey is to study changing of acute cholecystitis depending on time Materials and Methods We studied 58 patients who had cholecystectomy in Surgical Department of The Central Clinical Hospital for State Special Clerks between 2005 and 2008. The result analyzed by SPSS-15.0 Program.
RESULT AND DISCUSSION: The patients who was studied were 14 men (24.14%) and 44 women (75.86%). For the clinical symptoms of acute cholecystitis, the result has been occurred as following: the epigastria pain is 17 (29.31±5.9), around the right rib arch is 49 (84.48±4.7), the pain spread of the right shoulder blade is 20 (34.48±6.2), and the pain spread of the right shoulder is 33 (56.89±6.5), to have a fever 6 (10.34±3.0), vomit 10 (17.24±4.9), diarrhea 7 (12.06±4.2), thirsty 16 (27.58±5.8). The pain around right rib arch, pain spread right arm and shoulder, and thirsty are the clinical features that close to the features of scientist’s Alperovich B.I., Soloviev M.M., Saveliev V.S. Acute cholecystitis depending on time 0-24 hours catarrhal 5, phlegmonous 2, necrosis 1, 24-48 hours phlegmonous 4, necrosis 10, necrosis hole 2, 48-72 hours phlegmonous 10, necrosis 8, necrosis hole 3, above 72 hours phlegmonous 2, necrosis 5, necrosis hole 6. Acute cholecystitis starts above 24 hours.
CONCLUSION: 1. The acute cholecystitis has been occurred 14 for men and 44 for women. Ate the age of 30-39. These cases were determined more then 31 percent.
2. For the clinical symptoms of acute cholesystitis, the result has been occurred as following:
- the epigastria pain is 17, (29.31±5.9)
- around the right rib arch is 49 (84.48±4.7)
- the pain spread of the right shoulder blade is 20 (34.48±6.2), and
- the pain spread of the right shoulder is 33 (56.89±6.5).
3. Under the period study of the acute cholecystitis, the pus, necrosis and perforation cases have been excessively occurred specially at 48-72 hours.
4. Under the comparison study between the acute cholecystitis and its period, the acute wall cholecystitis changes have been occurred specially at 24-48 hours.
5.Improving diagnosis of alcohol-induced acute necrotizing pancreatitis
Erdenebold D ; Baasanjav N ; Batbold B ; Puntsag Ch ; Ganbaatar M ; Altankhuyag S
Mongolian Medical Sciences 2021;195(1):25-30
Introduction:
About 20-30% of patients with acute pancreatitis have a severe disease and mortality rate among
inpatients were 15%. There are many causes of acute pancreatitis (AP), but most common cause of
AP is an alcohol. According to some studies in our country, alcohol is the number one cause of acute
pancreatitis and the mortality rate is 15.3%. Very important for prognosis of disease optimal choice
of treatment tactics, detection of infectious evidence of necrotizing pancreatitis. Therefore, based on
the above, there is an urgent need to conduct research to address important issues and to improve
the diagnosis and treatment of acute alcohol-induced pancreatic necrosis.
Goal:
Determine the importance of early diagnostic assessment of alcohol induced severe acute necrotizing
pancreatitis.
Materials and Methods:
Research model and research method. We conducted our research using an observational research
model and a factual research method.Sampling of research materials will be carried out by targeted
sampling. From November 1, 2008 to January 1, 2020, 122 patients who were hospitalized with
alcohol-inducedAP were selected and archival documents or medical histories were selected.
Statistical analysis was performed using averages and regression analysis methods to calculate the
laboratory parameters in the analysis related to the new evaluation system.
Results:
The minimum age of patients with ANP was 25 and the maximum was 71, with the majority (87.4%)
aged 26 to 60 years. When the Person Correlation method calculates the relationship between
alcohol consumption and mortality, it is assumed that the weaker the correlation, the higher the
amount of alcohol consumed, the lower the cure and the higher the mortality. Of the 31 deaths
reported in the study, 24 (77.4%) were hospitalized more than 72 hours after the onset of the disease.
Late hospitalization and late treatment of patients with acute necrotizing pancreatitis (ANP) disease
have been shown to adversely affect the prognosis of the disease. In our study, all parameters were
significant, but procalcitonin, serum amylase, serum lipase, serum LDG8 C-reactive protein, serum
glucose was found to be higher than the value specified in the evaluation system for the variable (in determining pancreatic necrosis). АNOVA analysis test showed that white blood cells, procalcitonin,
serum amilza, serum lipaza, serumglucose, serum LDG, C-reactive protein were higher than those
specified in the evaluation system, and that the level of significance for the variable (indicating a
severe pancreatitis or poor prognosis) was higher than other test results (P <0.01). According to
the new evaluation system, 12 out of 122 patients were classified as A class or 0-3, 69 (56.5%)
patients were class B or 4-6, and 41 (33.6%) patients were class C or >7 points. Of the total cases,
90.1% were rated as severe form of ANP and pancreatic necrosis by the classification system we
developed. When we assessed the prognosis with the new assessment system, we found that 100
percent of patients in category A were cured, 89.8 percent of patients in category B were cured, and
41.5 percent of patients in category C were cured and 58.5 percent died. Statistical calculations using
the correlation analysis method for the correlation between the score and the cure of the evaluation
system shows negative correlation (P <0.01) other words, the higher the score of the evaluation
system, the lower the cure rate and the higher the mortality rate.
Conclusion
In Mongolia, relatively young men suffer from alcohol-induced pancreatitis.Factors contributing to the
development of necrosis in acute pancreatitis include alcohol abuse, prolonged alcohol use, delayed
hospitalization, and delayed treatment.In our study, following clinical signs and laboratory findings are
effective in distinguishing severe forms of acute necrotizing pancreatitis, early diagnosis, assessment
of prognosis. Laboratorytests include: increase in white blood cells, procalcitonin, serum amylase,
serum LDH, serum lipase, C-reactive protein and a decrease in hematocrit, serum calcium.