CRSLS : MIS case reports from SLS最新文献

Introduction: Infection with COVID-19 may lead to extrapulmonary pathologies secondary to the systemic inflammatory effects of the virus.

Case description: This case report discusses a 55-year-old female patient who presented with small bowel obstruction (SBO) several months after resolution of a COVID-19 infection. The patient was surgically treated with a small bowel resection, and eventually made a full recovery.

Discussion: The pathophysiology of COVID-19-induced SBO can be explained by the prolonged inflammation and coagulation activation in the bowel's vasculature system. Under these circumstances, microthrombosis occurs in the bowel's microvasculature; the affected intestinal tissue becomes ischemic and infarcted. The damaged bowel is eventually replaced with fibrotic scar tissue, thus promoting bowel stricture and subsequent obstruction.

Conclusion: COVID-19 can be responsible for both acute and chronic embolic and thrombotic events in the mesenteric vasculature, which acts as a risk factor in the manifestation of SBO.

Introduction: Mayer-Rokitansky-Kuster-Hauser syndrome or vaginal agenesis, is the rare congenital absence of the vagina with varying degree of hypoplasia of the Mullerian duct system and uterine development. One of the reconstructive surgical options for a vaginoplasty involves the usage of the large bowel.

Case description: We report two cases of patients who have had a sigmoid neovaginoplasty presenting many years later with postmenopausal bleeding.

Discussion: The authors describe the evaluation that can be performed by the gynecologist and gastroenterologist to initiate the work-up for this rare presentation.

Von Meyenburg complexes are benign bile duct hamartomas that arise as cystic nodules of the liver. Von Meyenburg complexes are often asymptomatic and thus typically discovered incidentally on imaging or autopsy. They can also be encountered at the time of surgery where they often appear as scattered white liver lesions concerning for malignancy. Here, we present a case in which white hepatic nodules were found incidentally during laparoscopic cholecystectomy in a 36 -year-old female. Pathologic analysis confirmed the diagnosis of von Meyenburg complexes. The operating surgeon proceeded with laparoscopic cholecystectomy without complication. We report this case to encourage awareness of this benign entity. The finding of scattered hepatic lesions found intra-operatively can create concern for metastatic neoplastic processes. An awareness of von Meyenburg complexes and their gross appearance can better guide surgeons' intraoperative decision-making when encountering these characteristic hepatic lesions.

Introduction: Left sided gallbladder (sinistroposition) is a well described congenital abnormality that can pose an unexpected challenge for the surgeon, especially regarding port placement for safe and effective dissection.

Case description: In this case, a 36 -year-old woman with biliary colic was taken to the operating room for elective cholecystectomy and found, after port placement, to have sinistroposition of the gallbladder. The operation was completed with relative ease using our typical port placement of a 5 mm port at Palmer's point, a 12 mm port at the umbilicus; and two additional 5 mm ports, one in the right midclavicular line, and one in the right anterior axillary line.

Discussion: Multiple port placements for safe and effective dissection of a left sided gallbladder have been discussed. Identification of sinistropic gallbladder often occurs after ports are already placed in position for right sided cholecystectomy. In this case, our typical port placement where the operating surgeon's right-hand port is located at Palmer's point provided excellent positioning for dissection. No alterations to the surgeon's left-hand port or the assistant port were necessary. The dissection was able to be completed from familiar angles, so dissection and identification of anatomy was performed with relative ease. This is important as sinistroposition can at times lead to abnormalities of the biliary tree, though none were noted in this case.

A 62-year-old male with history and endoscopic findings consistent with gastroesophageal reflux underwent elective laparoscopic fundoplication. He developed severe abdominal pain four days postoperatively, and computed tomography (CT) angiogram of the abdomen demonstrated occlusion of the superior mesenteric artery due to dissection. The patient was administered intravenous heparin following vascular surgical advice, resulting in resolution of the pain within an hour and no subsequent complications. Laparoscopy-associated mesenteric vascular events are rare but associated with very high morbidity and mortality. Mesenteric arterial occlusion is most frequently reported following laparoscopic cholecystectomy but may occur following many common laparoscopic procedures. Presentation generally occurs hours to days following the procedure, with severe abdominal pain out of proportion with physical signs. If left unrecognized, patients progress to bowel and visceral ischemia, necrosis, and multiorgan failure. Mechanisms postulated to cause these mesenteric vascular events involve changes in splanchnic blood flow, reduced cardiac output and systemic venous return, and hypercapnia related to carbon dioxide insufflation. Diagnosis may be made promptly with CT angiography, and potentially treated with intravenous heparin alone, avoiding a laparotomy or bowel resection. This is the first reported case of successful anticoagulation causing resolution of the occlusion sufficient to avoid reoperation or bowel resection. Once identified, this condition should be treated in liaison with vascular surgery colleagues, which may require anticoagulation, endovascular, or open intervention.

Introduction: Diastasis recti abdominis usually occurs during pregnancy and delivery in young women with no surgical history, and can induce a severely negative body image, urogynecological symptoms, and musculoskeletal pain. However, the optimal surgical procedure for diastasis recti abdominis is undetermined, and minimally invasive surgery has not been adopted. Additionally, open repair causes scarring that is unlikely to improve negative body image and may even worsen it. We present a case of diastasis recti abdominis surgically treated using an extended-view totally extraperitoneal approach, Rives-Stoppa technique, and transversus abdominis release procedure.

Case description: The patient was a 29-year-old woman who delivered transvaginally two weeks before presenting with bulging of the abdominal wall. Computed tomography revealed separation of the rectus. A three-month course of conservative therapy comprising exercises to strengthen the transversus abdominis was ineffective, and the patient had newly developed abdominal pain. Therefore, we performed surgical repair using the Rives-Stoppa technique and transversus abdominis release via the extended-view totally extraperitoneal approach. The postoperative course was uneventful, with no recurrence. This procedure may be superior to other methods in terms of cosmetic appearance, preventing infection, bowel adhesion, and recurrence.

Discussion: In the case study, the Rives-Stoppa technique and transversus abdominis release via the extended-view totally extraperitoneal approach achieved a good therapeutic outcome for diastasis recti abdominis.

Introduction: Since the advent of laparoscopy, the ideal first-port entry technique has not yet been determined. Use of the Veress needle at Palmer's point, although safe in practice under skilled physicians, is not without risk of complications.

Case description: A female patient with prior abdominal surgeries underwent a laparoscopic surgery for a nonmalignant indication. Intraoperative complications included hemodynamic instability and gross hematuria. The patient was ultimately stabilized, and imaging after the case revealed a hematoma formation around the left kidney with evidence of renal hilar injury.

Discussion: The laparoscopic surgeon must be aware that blind Veress needle entry has inherent risk for injury of retroperitoneal structures including the renal system. Particularly if hemodynamic instability is noted after abdominal entry at any site, physicians should have a low threshold for investigation, including by laparotomy if necessary.

Background: Extragonadal abdominopelvic teratomas in adults are extremely rare, and those in males are exceedingly rare. These masses are most commonly found incidentally and require surgical excision for diagnostic confirmation after a thorough workup.

Case presentation: This is a case report of a 49-year-old male who presented to a urology office with symptoms of hematuria, incidentally, found to have a pelvic mass on computed tomography urogram prompting colorectal surgical evaluation and subsequent laparoscopic complete excision. The clinical presentation, radiographic findings, and histopathological findings are described along with a literature review of extragonadal abdominopelvic mature cystic teratoma, also referred to as a sacrococcygeal teratoma.

Discussion: A broad differential diagnosis was generated for this patient with a pelvic mass after complete work-up, consisting of a dermoid or epidermoid cyst, liposarcoma, or sacrococcygeal teratoma. Radiological features can aid in the diagnostic confusion that may present in the adult patient.

Conclusion: Albeit rare in the male and adult population, sacrococcygeal teratoma is a plausible differential diagnosis for a pelvic mass. Underrepresented in the literature in regard to guidelines on management, complete surgical excision is the gold standard, with laparoscopy being a reasonable approach.

In this report, we present a 38-year-old female with acute cholecystitis, in which an aberrant right hepatic duct draining directly into the cystic duct was revealed by intraoperative cholangiography during a laparoscopic cholecystectomy. This anomaly was classified as the class V variant using the Hisatsugu classification schema, which has an incidence of 1.02%. The use of Strasberg's critical view of safety has become ubiquitous in laparoscopic cholecystectomy. Intraoperative cholangiography provides and additional layer of safety, and should be considered as a routine practice, particularly when imaging to delineate biliary anatomic aberrancies has not been performed prior to surgery.