Scientifically, Peritonsillar Abscess is a collection of pus that surrounds the tonsils. It is a painful infection that can spread between the throat’s underlying muscles and tonsil. If you don’t treat the throat condition in a timely manner, the infection would grow from being a pocket of pus to an abscess. There are several different episodes of Peritonsillar Abscess. The infection is caused by a group of micro organisms called Streptococci. The bacterium inflects the mouth and acts as the prime cause of Peritonsillar Abscess. Individuals, who were once affected by chronic tonsillitis or Peritonsillar Abscess, will have a better chance of being infected by the disease once again. Luckily, the risk of Peritonsillar Abscess is very low in young kids.
Conditions That Must Be Met In The Common Bile Duct And The Duodenum To Facilitate The Performance Of Choledochoduodenal Anastomosis With Good, Lasting Results
It is a sine qua non requirement that the common bile duct be sufficiently dilated to facilitate an ample and lasting anastomosis. The great majority of surgeons agree that the minimal diameter of the common bile duct should be two centimeters. Other surgeons require a diameter of 2. 5 cm.
It is the opinion of the author that choledochoduodenal anastomosis should not be performed if the common bile duct is less than 2 cm in diameter. On the other hand, there arc surgeons who admit that the anastomosis can be performed with success when the common bile duce presents a diameter of 1.4 or 1.5 cm.
The most common neoplastic obstructions of the bile duct are chose caused by carcinoma of the head of the pancreas carcinoma of rhe papilla carcinoma of the distal end of the common bile duct, or chronic pancreatitis with compression of che retropancrearic comrnon bile duct. The gallbladder and the common bile duct above the narrowed segment arc generally very dilated making it necessary to inject a large amount of radiopaquc material.
A pursestring suture is placed on the fundus of the gallbladder in the center of which the gallbladder is punctured with a Trocar and the thick gelatinous contents removed by electric suction. Some 60 to 80 ml of radiopaque substance are then injected through the puncture site.
The pursestring suture is tied, leaving the ends long co apply traction to the fundus of the gallbladder upward and to the right so that the shadow of the gallbladder will not become superimposed on the shadow of the common bile duct.
Calculi in the common bile duct, the common hepatic duct and the intrahcpatic ducts can he removed by the transcutaneohcpanr approach. Mazzariello, in 34 high risk patients with large calculi in the common bile duo or intraheparic ducts and zones of narrowing below these, was able to remove all the calculi without mortality and with minimal morbidity. The large calculi were fragmented with clamps and catheters with baskets designec to break up the calculi.
The procedure is performcxl with lorn anesthesia and patients do not need to be hospitalized except chose that may be seriously ill. Indications for this procedure arc very precise and care must he extreme.
It is possible 1.0 carrv om this procedure in atients with a nigh Surgical risk and in those in whom attempts to remove the calcuh through Ttube tracts or cndoscoplcally have failed.
In the great ajoriry of cases calculi of rerropancrearic common bile duct including those that arc impacted can be removed through the supruduodenal cholcdochotomv. There are, however, some rare cases in which one or more rcrropanrrcatic calculi arc so firmly adhercnr co the wall of rhc common bile duct that removal is difficult and risky ender these circumstances it is advisable to recur to the retroduodenal pancreatic approach through the pancreatic or posterior surface of the pancreas, making an incision in the common bile duce at the same sire where the calculus is impacted.
These calculi an generally large. The technical details of their removal will be given later.
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