Laparoscopic cholecystectomy in the dog

Cholecystectomy is a procedure used to rectify severe gallbladder disease that is not amenable to medical management. It is most commonly performed in dogs with gallbladder mucocoele, a condition affecting mainly small breeds such as the Border Terrier, Cocker Spaniel and Shetland Sheepdog. Traditionally, this has been done by open laparotomy but, in the human field, where cholecystectomy is a common and routine procedure, laparoscopic cholecystectomy has almost completely superseded open laparotomy, as it has been shown to be safer and have lower rates of morbidity. This article describes a technique for laparoscopic cholecystectomy in the dog as a suitable alternative to open laparotomy.

Vesico-cervical fistula following normal vaginal delivery: case report and management overview

Vesico-uterine fistula is an uncommon pathological communication developing between the uterus or cervix and the urinary bladder especially in traumatic caesarean sections. We presented a case of vesico-cervical fistula who presented after 18 years of occurrence of fistula and successful repair. Clinical diagnosis may be delayed due to varied presentations and evaluation may require more than one modality of investigation. The choice of treatment surgical or conservative management depends on the location size and number of the fistula. Surgical outcomes of open laparotomy, laparoscopic and robotic surgery have been successful. Obstetric outcomes of post repair patients have had successful pregnancies.

Etiology and surgical management of pediatric acute colon perforation beyond the neonatal stage

Purpose Acute colon perforation is a pediatric surgical emergency. We aimed to analyze the different etiologies and clinical characteristics of acute non-traumatic colon perforation beyond the neonatal period and to identify surgical management and outcomes. Methods This retrospective study included 18 patients admitted with acute colon perforation and who received surgical treatment. Results Age of patients ranged between 1 month and 15 years. Five patients swallowed foreign objects (two swallowed magnets), two had colon perforation secondary to a malignant tumor (both colorectal adenocarcinoma) and two were iatrogenic (one prior colonoscopy, one air enema for intussusception). There was one perforation due to chemotherapy and Amyand’s hernia respectively. The remaining seven patients had unknown etiologies; five of them were diagnosed with colitis. Fifteen (83.3 %) patients underwent open laparotomy, among which four attempted laparoscopy first. Three (16.7 %) patients underwent laparoscopic surgery. Fourteen (77.8 %) patients received simple suture repairs and four (22.2 %) received colonic resections and anastomosis. Four (22.2 %) patients received a protective diverting colostomy and three (16.7 %) received an ileostomy. Conclusions There is a wide range of etiology besides necrotizing enterocolitis and trauma, but a significant portion of children present with unknown etiology. Type of surgery elected should be dependent on the patient’s etiology, disease severity and experience of surgeons.

C-reactive Protein as a Quantitative Biomarker in Female Dogs Undergoing Laparoscopic and Open Elective Ovariectomy

Background: Injury or inflammation to the animal body resulted in the initiation of the acute-phase response (APR). Many plasma proteins increase in concentration in response to inflammatory stimuli, but C- reactive protein is considered as the most suitable markers due to their rapid and substantial increase in concentration and short half-lives. The CRP response varied according to the degree of surgical trauma on 3-standardized levels indicating CRP as an inflammatory activity indicator and monitoring markers. The aim of this study was to assess CRP concentrations in female dogs undergoing laparoscopic and open elective ovariectomy. Methods: The studies were conducted on twenty clinically healthy, adult, female dogs under elective spaying. Twenty healthy bitches were randomly assigned into four groups (A, B, C and D) consisting of five animals in each group. The studies were conducted in two phases (I and II).In phase I ovariectomy had been performed in animals of groups A and B with laparoscopy whereas, in phase II ovariectomy in animals of groups C and D were done by open laparotomy. Result: The pre-treatment CRP values did not show any significant change whereas post treatment values of group B were significantly lower as compared to groups D and C. On day 4th, group D values were significantly higher than groups C, B and A. Group C values were also significantly higher than group B. The highest value in group D might be due to more surgical manipulations and post-operative infection at surgical site in the animals under this group.

SURGICAL TREATMENT OF PRIMARY INTRA-ABDOMINAL COMPLICATIONS: ABSCESSES AND INFILTRATES

Purpose of the work. improving the results of surgical treatment of patients with primary intra-abdominal infiltrates and abscesses. Material and methods. From 2006 to 2019, 191 patients with primary intra-abdominal infiltrates and abscesses were treated. The patients' age ranged from 16 to 85 years. There were 96 male patients (50.26%), 95 female patients (49.74%). Results. The patients were divided into 3 subgroups depending on the underlying disease. The first group included 74 (38.74%) patients with destructive appendicitis, of which 39 (20.42%) were in the control group, and 35 (18.32%) were studied. The second group included 48 (25.13%) patients suffering from perforated gastric ulcer and 12 duodenal ulcer, of which the control group was 26 (13.61%), and the studied group was 22 (11.52%). The third group included 69 (36.13%) patients with cholecystitis, of which 37 (19.37%) were in the control group, and 32 (16.76%) were studied. All patients were operated on. Conclusions. Surgical treatment is individualized depending on the disease, so with destructive appendicitis from 74 (38.74%) laparotomic in 42 (21.99%), laparoscopic in 32 (16.75%), and in 12 (6.28%) with conversion; perforated gastric ulcer and 12 duodenal ulcer in 48 (25.13%) open laparotomy; with cholecystitis from 69 (36.13%) in 48 (25.13%) laparotomic and in 21 (11.00%) laparoscopically. The use of water-jet technologies in 64 (33.51%) patients made it possible to minimize damage to the serous membrane and cleanse the peritoneum from acquired formations.

Traumatic damage to the liver capsule: an unusual cause of small bowel obstruction

A 61-year-old man presented to the emergency department with severe abdominal pain. Three months prior to presentation, he had sustained blunt trauma to his right side while cycling, but had not sought medical attention. On admission, a CT scan showed small bowel obstruction (SBO) and he underwent an emergency open laparotomy. Intraoperatively, a subcapsular liver haematoma was identified, with incarcerated, necrotic small bowel within the liver capsule. The patient underwent deroofing of the haematoma with an omental patch and a small bowel resection with primary anastomosis. We believe this is the first reported case of SBO secondary to small bowel herniation into the liver capsule following trauma.

Giant bilateral adrenal lipoma in a patient with congenital adrenal hyperplasia

Summary Apart from adrenal myelolipomas, adrenal lipomatous tumors are rare and only seldom described in the literature. We present the case of a 50-year-old man, with a classical form of congenital adrenal hyperplasia (CAH), which was well treated with prednisolone and fludrocortisone. The patient presented with pollakisuria and shortness of breath while bending over. On MRI, fat-equivalent masses were found in the abdomen (14 × 19 × 11 cm on the right side and 10 × 11 × 6 cm on the left side). The right adrenal mass was resected during open laparotomy and the pathohistological examination revealed the diagnosis of an adrenal lipoma. Symptoms were subdued totally postoperatively. This is the first report of a bilateral adrenal lipoma in a patient with CAH that we are aware of. Learning points Macronodular hyperplasia is common in patients with congenital adrenal hyperplasia (CAH). Solitary adrenal tumors appear in approximately 10% of adult CAH patients and are often benign myelolipomas. The Endocrine Society Clinical Practice Guideline does not recommend routine adrenal imaging in adult CAH patients. Adrenal imaging should be performed in CAH patients with clinical signs for an adrenal or abdominal mass. Adrenal lipoma is rare and histopathological examinations should rule out a differentiated liposarcoma.

La malrotazione intestinale: cosa deve sapere il pediatra

Intestinal malrotation includes anomalies of intestinal rotation and fixation occurred during embryogenesis. It may present with acute or chronic-intermittent symptoms or remain asymptomatic. There are several methods to identify a defect of intestinal rotation, however an upper gastrointestinal series remains the method of choice in non-acute cases. Surgical correction is performed by open laparotomy, while the laparoscopic approach is reserved only to selected cases. This article suggests an evaluation of children with suspected intestinal malrotation and gives information about its management and complications to paediatricians.