Pelvic Abscess after Cesarean Section Treated with Laparoscopic Drainage

Cesarean section (CS), the rate of which is increasing worldwide, may be associated with complications. Although pelvic abscess after CS is rare, it is difficult to treat. We herein report two cases of pelvic abscess treated laparoscopically after CS. The abscesses of the patients were located in the pouch of Douglas and the uterine scar after CS, respectively. Several days after CS, the patients presented with lower abdominal pain and fever. Laparoscopic drainage was performed because imaging revealed a pelvic abscess that was not amenable to drainage through interventional radiology. The patients recovered from infection and were discharged four days after drainage.

Early gastrogastric fistula after Roux-en-Y gastric bypass: successful fistula treatment with self-expandable endoscopic stent

A 25-year-old patient underwent laparoscopic Roux-en-Y gastric bypass surgery with an initially uneventful postoperative course. Two weeks postoperatively, the patient presented with acute abdominal pain. CT scan revealed a gastrogastric fistula from the gastric pouch to the gastric remnant. Laparoscopic drainage was performed, and intraoperative endoscopy confirmed a large gastrogastric fistula. Due to intense adhesions between pouch and remnant, a closure by suture of the fistula was not possible. The fistula was initially treated with a fully covered metal stent. After multiple stent migrations despite clip attachment to the mucosa, the stent was changed to a partially covered metal stent. Fistula healing progress was documented every 2 weeks. After 10 weeks of stent treatment, fistula closure was accomplished.In conclusion, early fistula from the gastric pouch to the gastric remnant is a rare complication and can be managed with endoscopic stent placement.

Post –Operative Bilateral Renal Sub capsular Hematoma, Successfully Treated with Laparoscopic Drainage – A Case Presentation

Page kidney is a rare phenomenon which present as uncontrolled hypertension and hypertensive emergencies. Here we bring to notice a case presenting with anuria and rapid progressive renal failure. We have also tried to focus on the use of imaging for diagnosis and benefits of prompt and effective therapy causing complete recovery of the kidneys.

Minimally invasive management of traumatic biliary fistula in the setting of gastric bypass

The current management of persistent biliary fistula includes biliary stenting and peritoneal drainage. Endoscopic retrograde cholangiopancreatography (ERCP) is preferred over percutaneous techniques and surgery. However, in patients with modified gastric anatomy, ERCP may not be feasible without added morbidity. We describe a 37-year-old woman with traumatic biliary fistula, large volume choleperitonitis and abdominal compartment syndrome following a motor vehicle collision who was treated with laparoscopic drainage, lavage and biliary drain placement via percutaneous transhepatic cholangiography.

Spontaneous Free Peritoneal Perforation of an Infected Pancreatic Fluid Collection Managed with Laparoscopic Drainage and Necrosectomy

Introduction. Free peritoneal perforation of pancreatic fluid collections is extremely rare and only few case reports exist in the literature. Many of these patients undergo emergency exploratory laparotomy due to sepsis and haemodynamic instability requiring sepsis control. The use of laparoscopic techniques in this circumstance is limited by the haemodynamic stability of the patient and the technical challenges. But effective laparoscopic management is associated with less morbidity to the patient. Case Presentation. A 28-year-old patient presented with worsening generalized abdominal pain with increased inflammatory markers. She required persistent inotropic support despite adequate fluid resuscitation. She had transient acute renal impairment and acute respiratory distress, which improved with noninvasive support. CECT (contrast-enhanced computed tomography) showed an infected pancreatic fluid collection with peritoneal free fluid. Aspiration of pelvic collection showed purulent fluid. Based on these clinical and imaging findings, she was diagnosed with a free peritoneal perforation of an infected pancreatic fluid collection. She underwent a laparoscopic drainage and necrosectomy of the infected pancreatic collection and peritoneal washout. She had a gradual recovery. All inotropes were omitted on the second day following surgery. She was sent to the ward from the ICU (intensive care unit) on the 4th postoperative day. Conclusion. The laparoscopic approach is a viable option in managing ruptured pancreatic fluid collections when patient and technical factors are supportive. It reduces surgical morbidity, thereby reducing the overall strain on physiological reserves. When opted for laparoscopic drainage, the procedure must be guided by imaging findings. Multidisciplinary participation is critical in the overall management.

Laparoscopic management of liver abscess: a viable alternative in USG guided percutaneous drainage failure cases

Background: Liver abscesses are conventionally treated by ultrasonography (USG) guided percutaneous aspiration or drainage under antibiotic cover. We performed laparoscopic liver abscess drainage successfully in patients where medical management and percutaneous drainage had proven inadequate.Methods: Cases were received either from outpatient department (OPD) or were transferred from medical wards. Patients were first treated conservatively and percutaneous aspiration was attempted. Patients not responding to these treatment modalities were considered for diagnostic laparoscopy with drainage of abscess cavity and placement of 28 Fr drain under vision.Results: 20 patients with large liver abscess were treated successfully by laparoscopic drainage. Mean age in the study was 47 years (range 19-70 years) and average hospital stay was 5 days (range 4-12 days). Major postoperative morbidity or deaths were not registered. Patients with ruptured liver abscess, deep seated abscess cavity and medically unfit patients were excluded from the study.Conclusions: Laparoscopic drainage of liver abscesses, in combination with systemic antibiotics is a safe and viable alternative in all patients who require surgical drainage. It helps in the early return of gastrointestinal function and resumption of normal activities also potentially achieving better abscess drainage.

Laparoscopic drainage of an ovarian haematoma in a Martina Franca jenny (Equus asinus)

An 11-year-old Martina Franca jenny (Equus Asinus), involved in a breed recovery programme organised by the Puglia Region, was referred to the University’s Veterinary Teaching Hospital for a mass formation detected on the surface of the right ovary. The subject had regular oestrous cycles, but gestation loss was reported in the anamnesis. The ovarian mass was monitored by transrectal palpation and ultrasonography. In the differential diagnosis, an ovarian haematoma, a haemorrhagic anovulatory follicle and a granulosa cell tumour were hypothesised; a surgical resolution with laparoscopic access was chosen. During surgery, about 750 ml of haemorrhagic fluid was drained, confirming the suspect of the ovarian haematoma. After resolution, the jenny was inseminated, eventually giving birth to a live and viable foal. Usually, an ovarian haematoma spontaneously regresses, but, in this report, the lesion remained stable for more than two months, leading to the decision of the surgical resolution. Furthermore, to the authors’ knowledge, this lesion has never been reported in donkeys.