Tracheostomy in pediatric intensive care. Analysis of 5-year-experience and review of literature.

resulting into the parallel or spiral type. In the parallel type, the 2 ducts are usually joined with fibrous tissue which might express great difficulty in their exposure and separation during cholecystectomy. The ratio of the spiral type of junction was slightly lower than that found in America (8%), but markedly lower than that reported in Britain which equaled to 25%. The liver seemed to be enlarged in 22% of the cases. This might be attributed to mild or recurrent attacks of malaria, infective hepatitis or typhoid, which are common endemic tropical diseases in Khartoum, Sudan. Furthermore, the gall bladder also seemed to be enlarged in a relatively similar ratio to that of the liver. Whether this enlargement is a genetic predisposition, secondary to stretch by the enlarged livers or mere casual coincidence, needs further interpretation. The common hepatic ducts were not found in 3% of the cases. Uncommonly, 3 hepatic ducts were found in 4 subjects amounting to 2% of the cases. The bile duct was found to open separately in the duodenal wall or inside its lumen in 13.5% of the cases. This ratio was relatively lower than those reported by early workers. This might be due to a difficulty in manual palpation of the common bile ducts during surgery. Generally, the incidence of anatomical variations of the extra biliary ducts among Sudanese citizens in Khartoum, Sudan, was relatively similar to those found elsewhere. In comparison to the anatomic variations of the extra biliary ducts among Sudanese citizens in Khartoum, Sudan, to those found elsewhere, the incidences of the spiral type of junction between the cystic duct and the common hepatic duct and the separate opening of the common bile duct into the duodenum showed relatively lower ratios. Absence of the common hepatic ducts registered a brisk value. Three bile ducts were found in 2% of the cases. The incidence of the anatomic variations of the extra biliary ducts among Sudanese citizens in Khartoum, Sudan, is relatively similar to those found elsewhere.