1,721,001 research outputs found
LAPAROSCOPIA PER DIVERTICOLITE HINCHEY II “NON RESPONDER”: SIGMOIDECTOMIA O LAVAGGIO PERITONEALE?
No full textObiettivi: In letteratura, non esiste un chiaro consenso riguardo al ruolo del lavaggio e drenaggio laparoscopico (LDL) rispetto alla sigmoidectomia laparoscopica (SL) nelle diverticoliti acute complicate di grado II Hinchey “non responder” al trattamento conservativo in quanto non drenabili per via percutanea nè controllabili con sola terapia antibiotica. Lo scopo di questo studio è confrontare i pazienti sottoposti a queste due procedure chirurgiche ed analizzare i risultati postoperatori.
Materiali e metodi: Abbiamo considerato nel periodo 2013-2016, 9 pazienti (Gruppo A) sottoposti a SL e 7 pazienti (Gruppo B) a LDL per diverticolite acuta di grado Hinchey II “non responder”.I seguenti parametri sono stati analizzati e comparati: età media, BMI, Mannheim Peritonitis Index (MPI), ASA Score, tempo medio operatorio, durata media della degenza post-operatoria, morbilità, tasso di re-intervento e mortalità. Il t-test di Student e il test corretto di Fisher sono stati utilizzati per l’analisi statistica. Il p <0,05 è stato considerato signi"cativo.
Risultati: Il gruppo A e il gruppo B non sono risultati significativamente differenti per età media (62 vs 60 anni; p =
0.80), BMI (25,82 vs 28,86 kg/m2; p = 0.31), MPI (9,66 vs 14,00; p = 0.26) ed ASA score (2,37 vs 2; p = 0.60). Anche il tasso di complicanze (11% vs 57%; p = 0.10), il tasso di re-intervento (0 vs 28%; p = 0,18) e la durata media della degenza post-operatoria (8 vs 13 gg, p = 0.09) non sono risultati signi"cativamente dissimili tra i due gruppi. In effetti, 2 pazienti inizialmente sottoposti a LDL hanno successivamente necessitato di SL per insuf"ciente
controllo dell’infezione. Il tempo operatorio medio è risultato signi"cativamente più lungo nel gruppo A (195 min vs 64 min; p < 0.05). Nessun decesso è stato identi"cato nei due gruppi.
Conclusioni: Sebbene retrospettivo e con una popolazione limitata, questo studio dimostra che l’ LDL può avere un ruolo nel trattamento delle diverticoliti acute di grado II Hinchey “non responder”. Questa procedura, in casi selezionati, può rappresentare un opzione ef"cace e sicura nel trattamento dell’infezione addominale diverticolare. L’eventuale insuccesso del LDL non pregiudica la possibilità di ricorrere successivamente ad
un intervento resettivo
Indocyanine Green (ICG) for the assessment of splenic perfusion during laparoscopic splenic artery aneurysmectomy. A case report
No full textCase report: We describe the case of a 54-year-old man with a 20mm splenic aneurysm, who underwent laparoscopic aneurysmectomy, without splenic removal. The residual splenic blood supply was assessed by using indocyanine green i.v. administration. Clinical findings: The patient presented at ED with abdominal pain, syncopal episode, and tachycardia. A CT scan with contrast showed hemoperitoneum with a 20mm splenic aneurysm, which was located at the bifurcation of the splenic and left gastroepiploic artery. Treatment and Outcome Laparoscopic surgery was then warranted. Abdominal exploration revealed a serohemorrhagic collection without active source of bleeding. After opening the gastro-colic ligament and obtaining vascular control of the splenic artery, the aneurysm was clipped and resected. No macroscopic modifications occurred to the spleen. This finding was confirmed by intravenous administration of indocyanine green. The operating time was 265 minutes. During the postoperative course, a grade A pancreatic fistula occurred. The patient was discharged on postoperative day seventh. Clinical relevance: The management of true splenic artery aneurysms should be patient-tailored, considering the location of the aneurysm, operative risks and the patient's age, life expectancy and clinical status. The use of ICG in splenic surgery helps delineate the splenic parenchyma and evaluate residual splenic vascularization. Key words: Indocyanine Green, Laparoscopy, Mini-invasive Surgery, Splenic Artery Aneurysm
Laparoscopic resection of multiple aneurysms of the gastroepiploic arterial arcade
No full textGastroepiploic arterial aneurysms (GEAA) represent a very rare disorder [1, 2]. The risk of GEAA rupture is high, and it is associated with a high mortality rate [3]. GEAAs are usually identified following rupture or are incidentally diagnosed. In emergency, an open surgical approach to treat GEAAs has been most frequently reported [4]. Alternatively, if the patient is hemodynamically stable, an angiography and embolization can be attempted. Herein we report the case of a patient presenting with two fissurated GEAAs that were successfully excised laparoscopically after failure of the endovascular approach
An unusual case of repeated splenectomy: traumatic rupture of an accessory spleen in a previously splenectomized patient
No full textThe traumatic rupture of an accessory spleen is a very rare condition and only few cases have been reported in the literature. We describe the case of a 51-year-old man undergone splenectomy for trauma several years before, who developed hemoperitoneum due to a laceration of a voluminous accessory spleen, following an accidental two-meter fall. As a conservative management of the injury was not possible, an accessory splenectomy was then required. Thus, a briefly review of the literature about this uncommon topic was perfomed
Acute abdomen caused by greater omentum torsion: A case report and review of the literature. Omentum majus torsiyonunun neden olduğu akut batın: Olgu raporu ve literatürün gözden geçirilmesi
No full textTorsion of the greater omentum is a rare cause of acute abdomen. Based on etiopathogenesis, it can be classified as primary or secondary. However, regardless of the cause, segmentary or diffuse omental necrosis will follow. Preoperative diagnosis is not easy, though abdominal ultrasound and computed tomography (CT) scans may show peculiar features suggestive of omental torsion. Laparoscopic resection of the affected omentum is the treatment of choice. Presently reported was a case of primary omental torsion, in addition to a comprehensive literature review
Perfore apandisitte pulmoner sekestrasyonun neden olduğu hemoptizi: Seyrek görülen bir olgunun raporu
No full textPulmonary sequestration is a rare and usually asymptomatic congenital anomaly. Optimal management of this condition is still a subject of debate, including superiority of surgical resection or angiographic embolization of the aberrant arterial vessel. Presently described is rare case of a 51-year-old male who presented with hemoptysis related to pulmonary sequestration associated with acute right lower quadrant abdominal pain caused by perforated appendicitis
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