scholarly journals Postoperative Delayed Duodenum Perforation following Elective Laparoscopic Cholecystectomy

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Kong Jing ◽  
Wu Shuo-Dong
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Rare Complication ◽  
Subtotal Gastrectomy ◽  
Needle Aspiration ◽  
Catheter Drainage ◽  
Billroth Ii ◽  
The Past ◽  
Complications Of Laparoscopic Cholecystectomy ◽  
Elective Laparoscopic Cholecystectomy

Background. Duodenum injury is extremely rare complication of laparoscopic cholecystectomy with potentially fatal consequences.Methods. Over the past 13-year period, 3000 laparoscopic cholecystectomies were performed in our institution. Duodenum injury only occurred in one patient recently who had undergone gastrectomy owing to duodenal diverticulum. The diagnosis and management of this rare complication of laparoscopic cholecystectomy are described, and the literature is reviewed.Results. We present this case of duodenum injury on the fourth postoperative day after selective laparoscopic cholecystectomy was treated successfully by percutaneous needle aspiration and catheter drainage. The hospital stay was 26 days. No abscess recurred during the follow-up period.Conclusion. Duodenum injuries are extremely rare complications of laparoscopic cholecystectomy with potentially fatal consequences if not promptly recognized and treated. Sonographically guided percutaneous needle aspiration and catheter drainage can be used to treat the intraperitoneal abscess. Billroth II subtotal gastrectomy and gastrojejunostomy were beneficial for the treatment.

Moy.02Using aboutmyop.org as an alternative method for post-operative follow-up after elective laparoscopic cholecystectomy – a feasibility study

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Prita Daliya ◽  
Jody Carvell ◽  
Judith Rozentals ◽  
Maria Ubhi ◽  
Dileep Lobo ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Feasibility Study ◽  
Controlled Trial ◽  
Digital Data ◽  
National Guidelines ◽  
Patient Acceptability ◽  
Safe Alternative ◽  
Operative Care ◽  
Elective Laparoscopic Cholecystectomy

Abstract Introduction The majority of institutions no longer offer routine post-operative follow-up after elective laparoscopic cholecystectomy. National guidelines however recommend the use of post-operative hotlines or planned telephone follow-up for day-case procedures. At a time when NHS resources are limited, a digital solution may provide a safe alternative to telephone or physical follow-up. Our aim was to identify if digital follow-up with aboutmyop.org; a digital data-sharing platform, was equivalent to telephone follow-up. Method Study participants were invited to use aboutmyop.org before and after surgery. Patients were given free choice on whether they opted to use post-operative digital follow-up or routine post-operative care (no follow-up or telephone follow-up). In addition to follow-up compliance, the outcomes measured included 30-day post-operative complications, readmission, and re-operation. Results Of 597 laparoscopic cholecystectomy patients who were offered follow-up, 16.4% opted for digital follow-up, and 33.3% phone follow-up. Over 5 times as many patients who opted for telephone follow-up missed their appointment when compared to those who chose digital follow-up (5.6% vs. 30.9%, p < 0.001). Digital follow-up had a high sensitivity (68.2%-100%) and specificity (100%) for identifying complications at 30-days post-operatively and was completed significantly earlier than phone follow-up (median 6 days vs. 13.5 days, p = 0.001) with high patient acceptability. Conclusion This feasibility study demonstrates that digital follow-up utilising the aboutmyop.org platform is an acceptable alternative modality to telephone follow-up in elective laparoscopic cholecystectomy patients. Future work should aim to compare matched cohorts of patients undergoing digital follow-up, telephone follow-up, and no follow-up as a randomised controlled trial.

scholarly journals Management of a pseudo-aneurysm in the hepatic artery after a laparoscopic cholecystectomy

2016 ◽  
Vol 98 (7) ◽  
pp. 456-460 ◽  
Author(s):  
MP Senthilkumar ◽  
N Battula ◽  
MTPR Perera ◽  
R Marudanayagam ◽  
J Isaac ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Laparoscopic Cholecystectomy ◽  
Hepatic Artery ◽  
Computed Tomography Angiography ◽  
Rare Complication ◽  
Artery Pseudoaneurysm ◽  
Pseudo Aneurysm ◽  
High Index Of Suspicion ◽  
Time Of Presentation

Introduction Symptomatic hepatic-artery pseudoaneurysm (HAP) after bile-duct injury (BDI) is a rare complication with a varied (but clinically urgent) presentation. Methods A prospectively maintained database of all patients with BDI at laparoscopic cholecystectomy (LC) referred to a tertiary specialist hepatobiliary centre between 1992 and 2011 was searched systematically to identify patients with a symptomatic HAP. Care and outcome of these patients was studied. Results Eight (6 men) of 236 patients with BDI (3.4%) with a median age of 65 (range: 54?6) years presented with symptomatic HAP. Median time of presentation of the HAP from the index LC was 31 (range: 13?16) days. Bleeding was the dominant presentation in 7 patients. One patient presented late (>2 years) with abdominal pain alone. Computed tomography angiography was the most useful investigation. Angioembolisation was successful in 7 patients. One patient died, and another patient developed liver infarction. Three patients (38%) developed biliary strictures after embolisation. Seven patients are alive and well at a median follow-up of 66 months. Conclusions Presentation of HAP is often delayed. A high index of suspicion is necessary for the diagnosis. Computed tomography angiography is the first-line investigation and selective angioembolisation can yield successful outcomes.

scholarly journals Meatal ulcer: very rare complication of Foley catheterization

2017 ◽  
Vol 4 (4) ◽  
pp. 1505
Author(s):  
Vipul D. Yagnik
Keyword(s):  
Rare Complication ◽  
Subtotal Gastrectomy ◽  
Blood Chemistry ◽  
Stomach Wall ◽  
Aseptic Technique ◽  
Urethral Catheterization ◽  
Exophytic Tumor ◽  
Surgical History ◽  
Trained Staff

A 65 year old gentleman was admitted with the diagnosis of exophytic tumor arising from the stomach wall. His vitals were normal. Patient was poorly built and poorly nourished with BMI of blood chemistry, ECG, and ECHO was normal. His past medical and surgical history was not significant. Urethral catheterization was performed pre-operative with strict aseptic technique. Patient underwent   laparotomy with subtotal gastrectomy and gastrojejunostomy. Catheter care was done regularly by trained staff. Catheter was removed on third post operative day. After removal of catheter, Patient had a difficulty in passing   urine. On examination, single meatal ulcer was noted (Figure 1). Post –operative course was unremarkable. Patient is in follow up since last six month without any problem.

scholarly journals Management of afferent loop syndrome after Roux-en-Y subtotal gastrectomy and choledocolithiasis with recurrent cholangitis

2020 ◽  
Vol 13 (1) ◽  
pp. e232498
Author(s):  
Fernando Azevedo ◽  
Carolina Canhoto ◽  
José Guilherme Tralhão ◽  
Hélder Carvalho
Keyword(s):  
Bile Flow ◽  
Rare Complication ◽  
Acute Cholangitis ◽  
Subtotal Gastrectomy ◽  
Bacterial Overgrowth ◽  
Billroth Ii ◽  
Afferent Loop ◽  
Afferent Loop Syndrome ◽  
Biliary Stasis ◽  
Multiple Episodes

Afferent loop syndrome is a rare complication after gastrectomy with Billroth II or Roux-en-Y reconstruction, caused by an obstruction in the proximal loop. The biliary stasis and bacterial overgrowth secondary to this obstruction can lead to repeated episodes of acute cholangitis. We present the case of a male patient who had previously undergone gastrectomy with Roux-en-Y reconstruction and later experienced multiple episodes of acute cholangitis secondary to choledocolithiasis. He underwent an open exploration of the bile ducts with choledocolitotomy, but the events of cholangitis persisted. Further investigation permitted to identify a dilation of the biliary loop of the Roux-en-Y anastomosis, suggesting enterobiliary reflux as the cause of recurrent acute cholangitis. Therefore, a bowel enterectomy and new jejunojejunostomy were undertaken, and normal biliary flow was re-established. The surgical treatment is mandatory in benign causes, leading to the resolution of the obstruction and subsequent normalisation of bile flow.

scholarly journals Severe Intraoperative Bradycardia during Laparoscopic Cholecystectomy due to Rapid Peritoneal Insufflation

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Mohammed Heyba ◽  
Ahmed Khalil ◽  
Yasser Elkenany
Keyword(s):  
Cardiac Arrest ◽  
Laparoscopic Cholecystectomy ◽  
Flow Rate ◽  
Low Flow ◽  
Postanesthesia Care Unit ◽  
Surgical Team ◽  
Severe Bradycardia ◽  
Elective Laparoscopic Cholecystectomy ◽  
Surgical Operations

Laparoscopy is becoming increasingly popular in gynecological and general surgical operations. There are complications that are inherent to the laparoscopy techniques; amongst them is intraoperative vagal-mediated bradycardia that results from peritoneal stretching. This can occur due to high flow rate of gas during peritoneal insufflation, a practice still happening nowadays. We report a case of a middle-aged hypertensive patient who was undergoing elective laparoscopic cholecystectomy. The patient was assessed more than once preoperatively by the anesthesia team for blood pressure optimization. The patient underwent general anesthesia and developed severe bradycardia immediately after peritoneal insufflation. The management started immediately by stopping the insufflation and deflating the abdomen. Afterwards, atropine was administered intravenously, and CPR was started preemptively according to the ACLS protocol to prevent the patient from progressing into cardiac arrest. She responded to the management and became vitally stable within one minute. After confirming that there was no cardiac or metabolic insult through rapid blood investigations and agreeing that the cause of bradycardia was the rapid insufflation, the surgical team proceeded with the surgery in the same setting using low flow rate of CO2 to achieve pneumoperitoneum. There were no complications in the second time and the operation was completed smoothly. The patient was extubated and shifted to the postanesthesia care unit to monitor her condition. The patient was stable and conscious and later shifted to the wards and discharged on routine follow-up after confirming that there were no complications in the postoperative follow-up. Therefore, it is important to monitor the flow rate of CO2 during peritoneal insufflation in laparoscopic surgery as rapid peritoneal stretch can cause severe bradycardia that might progress into cardiac arrest, especially in hypertensive patients. It is also important for the anesthetist to be vigilant and ready to manage such cases.

scholarly journals Treatment of a huge biloma complicating curative radiofrequency ablation of hepatocellular carcinoma: a case report

2019 ◽  
Vol 47 (10) ◽  
pp. 5337-5342
Author(s):  
Haochen Wang ◽  
Ziguang Yan ◽  
Jian Wang ◽  
Yinghua Zou
Keyword(s):  
Hepatocellular Carcinoma ◽  
Radiofrequency Ablation ◽  
Rare Complication ◽  
Percutaneous Catheter Drainage ◽  
Catheter Drainage ◽  
Endoscopic Retrograde ◽  
Plastic Stent ◽  
Percutaneous Catheter ◽  
The Common

Development of a huge intrahepatic biloma after radiofrequency ablation (RFA) is a rare complication. We report a patient with hepatocellular carcinoma (HCC) who had been treated by RFA and was complicated by a huge biloma. The biloma was cured by percutaneous catheter drainage and endoscopic retrograde cholangiopancreatography. A plastic stent was placed from the duodenal ampulla to the common bile duct to lower the pressure. The catheter and the stent were removed within 1 month after the biloma had disappeared. There was no recurrence of the biloma and HCC lesions with a follow-up time of 2 years. The present case is one of the best reported outcomes after development of a huge biloma.

scholarly journals Elective day-case laparoscopic cholecystectomy: a formal assessment of the need for outpatient follow-up

2013 ◽  
Vol 95 (8) ◽  
pp. e10-e14 ◽  
Author(s):  
GI van Boxel ◽  
M Hart ◽  
A Kiszely ◽  
S Appleton
Keyword(s):  
Patient Satisfaction ◽  
Laparoscopic Cholecystectomy ◽  
Significant Proportion ◽  
Day Case ◽  
Residual Symptoms ◽  
Symptom Resolution ◽  
Case Surgery ◽  
Elective Laparoscopic Cholecystectomy ◽  
Patients Experience

Introduction Elective laparoscopic cholecystectomy (LC) is performed routinely as day-case surgery. Most hospital trusts have a policy of no routine postoperative outpatient follow-up although there are no formal guidelines on this. The aim of this retrospective study was to identify the incidence of complications, the degree of symptom resolution and patient satisfaction with a view to formally appraising the need for outpatient follow-up. Methods Patients who underwent LC in the period between February 2011 and June 2012 were contacted retrospectively by telephone. A standardised questionnaire was used to ascertain the incidence of surgical site infection (SSI), other complications, symptom resolution and patient satisfaction. Results A total of 211 responses were collected. The rate of SSI was 7.6% (n=16), with the only specific risk factor being smoking (p=0.027). All other complications had a combined incidence of 7% (n=15). There was complete resolution of symptoms in 64% of patients. Of the 36% of patients with residual symptoms, 45% described abdominal discomfort or pain, 41% described reflux symptoms and 14% complained of diarrhoea. Patient satisfaction was very high (96%), yet 33% of patients visited their general practitioner postoperatively in relation to their surgery. Conclusions Patients are highly satisfied with elective day-case LC. However, SSI is not uncommon, occurring in 1 in 13 patients. Although the majority of patients experience complete symptom resolution, a significant proportion do not. In our experience, routine outpatient follow-up is not required. Nevertheless, the lack of formal follow-up may prove a missed learning opportunity, potentially resulting in inappropriate patient selection for surgery.

scholarly journals Management of complex hepatic abscess by percutaneous catheter drainage: a case report

2020 ◽  
Vol 7 (8) ◽  
pp. 2799
Author(s):  
Prashant Pareek ◽  
Priyanka Pareek ◽  
Pratish Kumar Singh
Keyword(s):  
Hepatic Abscess ◽  
Needle Aspiration ◽  
Percutaneous Catheter Drainage ◽  
Surgical Drainage ◽  
Catheter Drainage ◽  
Percutaneous Catheter ◽  
Liver Abscesses ◽  
The Right ◽  
Antibiotic Coverage

Liver abscesses are a commonly encountered pathology in the tropical setting. Most commonly these are secondary to amoebic infestation. Majority of liver abscesses present with abdominal pain confined to the right hypochondrium. Smaller abscesses are easily dealt with by needle aspiration or catheter drainage under image guidance. Larger and complex abscesses are commonly dealt with by surgical drainage. We deal here with a case of complex liver abscesses which even had perforated into the pleural cavity. Keeping a close watch on the patient’s general condition which was satisfactory, we did not rush into a major surgical procedure. Wide antibiotic coverage and pulmonary care were initiated. Two pig-tail catheters were placed in separate abscesses and metronidazole irrigation periodically done. The daily drain output gradually reduced and we could successfully remove the two catheters at an interval. The patient made a good recovery and continues to do well on follow-up. We see in this case that even large and multiple abscesses if meticulously managed, surgical drainage can be avoided and catheter drainage provides satisfactory results. Good antibiotic coverage must continue in the follow-up period too.

scholarly journals Cytologic features of primary monophasic synovial sarcoma of the thyroid gland

CytoJournal ◽  
2017 ◽  
Vol 14 ◽  
pp. 24 ◽  
Author(s):  
Chang-Soo Park ◽  
Young Kim ◽  
Eun-Hui Jeong ◽  
Nah-Ihm Kim ◽  
Yoo-Duk Choi
Keyword(s):  
Thyroid Gland ◽  
Synovial Sarcoma ◽  
Soft Tissue Tumor ◽  
Molecular Genetic ◽  
Needle Aspiration ◽  
Molecular Genetic Study ◽  
Fine Needle ◽  
The Past ◽  
Neck Area

Synovial sarcoma (SS) is a rare soft tissue tumor, commonly arising in para-articular areas of extremities, but can also present in the head and neck area. However, primary SS of the thyroid gland is an extremely rare tumor which has been reported only five times in previous English literatures. This report presents fine needle aspiration (FNA) cytology of primary monophasic SS of the thyroid gland. A 47-year- old woman incidentally detected thyroid nodule in the isthmus of right thyroid gland on an ultrasonography by regular health check-up. Because the possibility of malignancy could not be ruled out, FNA and surgical resection were performed. The cytological, histopathological, immunohistochemical, and molecular genetic study of SYT-SSX transcript were discussed. For the past 3 years of follow-up after surgery, no recurrence or metastasis has been identified.

scholarly journals COMPARATIVE STUDY OF FENTANYL, TRAMADOL AND NALBUPHINE IN ATTENUATION OF HAEMODYNAMIC RESPONSES IN LAPAROSCOPIC CHOLECYSTECTOMY

2021 ◽  
Vol 9 (02) ◽  
pp. 883-892
Author(s):  
Hp Singh ◽  
◽  
Naveen Kumar Jindal ◽  
Jaspreet Singh ◽  
◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Sedation Score ◽  
P Value ◽  
Randomised Study ◽  
The Past ◽  
Opioid Drugs ◽  
Elective Laparoscopic Cholecystectomy ◽  
Group B ◽  
Induction Of Anaesthesia ◽  
Made In

Background:-Numerous attempts have been made in the past to attenuate the haemodynamic responses occurring during laparoscopic cholecystectomy. The present study compared the effect of three opioids namely TRAMADOL, Fentanyl and Nalbuphine in obtundation of haemodynamic responses in laparoscopic cholecystectomy in terms of Heart rate, BP (SBP, DBP and MAP) and secondary aim was to calculate duration of analgesia and sedation score. Materials And Methods:-This was a randomised study comparing three opioid drugs- nalbuphine, fentanyl and TRAMADOL. It was carried out on 75 patients of either sex aged 18 - 60 years scheduled for elective laparoscopic cholecystectomy under GA. Subjects were enrolled into three groups- Group B (n= 25) patients received inj. TRAMADOL 2 mcg/kg IV, Group F (n= 25) received inj. Fentanyl 2 mcg/kg IV and Group N (n= 25) patients received inj. Nalbuphine 0.2 mg/kg 5 minutes before the induction. Result:-At the time of extubation, mean MAP in Group B, F and N was 99.88, 95.32 and 97.24 respectively. This difference is highly significant when compared statistically (p value is 0.005). Conclusion:-With this study, we conclude that the administration of intravenous fentanyl and nalbuphine five minutes prior to induction of anaesthesia helps in better obtundation of haemodynamic responses to laparoscopic cholecystectomy than TRAMADOL.

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