Familial Mediterranean fever (FMF) also known as hereditary polyserositis, is an inherited disorder commonly found in Armenians, Turks, Arabs, Balkans, and Jews originating from North African countries. The diagnosis of FMF is based on clinical findings and family history, as no specific diagnostic test is yet available. One of its main clinical features is recurrent acute episodes of peritonitis. During such an episode, physical examination and laboratory findings may be similar to those for acute appendicitis. Therefore up to two-thirds of FMF patients undergo emergency appendectomy, with the appendix being normal in most cases. As laparoscopic appendectomy has proved to be safe and advantageous, and to prevent misdiagnosis and unnecessary emergency surgery, we performed elective laparoscopic appendectomy in 13 FMF patients ranging in age from 8 to 32 years. They had been suffering from the disease for 1 to 12 years (mean 3.8) and had had an average of 3.5 yearly episodes of FMF peritonitis. All procedures were concluded by laparoscopy without conversion to open surgery. The average postoperative hospital stay was 3.07 days. The only complication was superficial wound infection in one patient (7.6%), and the mean time to regain full normal activity was 8.5 days. We conclude that elective laparoscopic appendectomy in FMF patients is safe. It helps to exclude appendicitis as a cause for peritonitis in these patients and may prevent unnecessary emergency surgery.

Adolescent↗

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Anterior approach for removal of spinal angiolipoma. A case report.

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Hemangioma↗

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Nonoperative management of blunt splenic trauma in adults.

Forty-five adult patients with traumatic splenic injuries were treated during a 6-year period between 1980-1986 at Hadassah Hospital. The diagnosis was confirmed by splenic scintigraphy with 99mTc Tin-colloid. Fifteen patients (33%) who were stable on admission or after initial resuscitation were treated non-operatively and selected for this study. Treatment consisted of careful hemodynamic monitoring, strict bed rest, nasogastric suction, and i.v. fluids. In no case was emergency laparotomy necessary for deterioration of clinical condition or late complications. Splenic scans were repeated in 11 of the patients to assess resolution. In six of the patients, minimal residual defects were detected with no further complications. It is concluded that nonoperative treatment of splenic injuries in carefully selected patients is both safe and effective.

Adolescent↗