Laparoscopic management of bile peritonitis after liver biopsy.

Bile peritonitis is an infrequent complication of liver biopsy and is usually treated by supportive care or laparotomy. Fever, peritoneal signs, and hemoconcentration developed in a 56-year-old man 7 hr after biopsy. At laparoscopy, a large amount of cloudy, bilious fluid was aspirated using a suction-irrigation device. No liver injury or bile leak was seen. The patient gradually improved and, although he required percutaneous drainage of the subhepatic bile collection, did well. This case illustrates the new use of laparoscopy to manage bile peritonitis after liver biopsy. Compared with conventional laparotomy, this procedure has the advantages of lower intraoperative risk, shorter recovery time, and superior visualization of peritoneal contents.     

Laparoscopic management of chemical peritonitis caused by dermoid cyst spillage

Background:

Dermoid cyst is the most frequent benign ovarian tumor. Spillage of cyst contents during surgery is common and can rarely lead to chemical peritonitis.

Case Report:

A patient presented 3 days after attempted laparoscopic removal of bilateral dermoid cysts. On examination, she had a low-grade fever, rebound tenderness with guarding, and a markedly elevated white blood cell count. A decision was made to proceed with laparoscopy with the presumptive diagnosis of chemical peritonitis. Laparoscopic findings included residual dermoid cyst contents and extensive filmy adhesions of the bowel and omentum to the peritoneal surface. The chemical peritonitis resolved after laparoscopic removal of residual dermoid cyst content including bilateral salpingo-oophorectomy and copious irrigation.

Conclusion:

Early recognition and prompt treatment by repeat laparoscopic surgery with removal of the remaining cyst contents and peritoneal lavage can be a successful method for treating chemical peritonitis.     

Laparoscopic diagnosis and management of malignant ascites

Malignancy is the second most common cause of ascites. Tissue diagnosis is often difficult because the cytology of ascitic fluid is positive in only 57% of cases. Peritoneovenous shunting is often used as palliation in such patients and has proven superior to nonoperative management for some patients. We present three cases of malignant ascites with negative cytologies managed by using laparoscopic biopsies to confirm intraperitoneal cancer and assist in the placement of a peritoneovenous shunt. Results suggest that exploratory laparoscopy and shunt placement is a valuable procedure in these patients with a limited life expectancy and is preferable to open laparotomy.     

Laparoscopic diagnosis and management of perinephric adipose-containing lesions

We describe two patients in whom imaging and percutaneous biopsy of perinephric masses were insufficient for diagnosis. Laparoscopic biopsy permitted the diagnosis of fibrosis with chronic inflammation in one case and liposarcoma in the other.     

Laparoscopic diagnosis and management of transverse testicular ectopia

Transverse testicular ectopia (TTE) is a rare genitourinary anomaly. We report a case of TTE in a 14-year-old boy diagnosed and managed laparoscopically. The clinical features and etiology of this rare testicular anomaly are reviewed.     

艾滋病并发原发性细菌性腹膜炎5例诊疗分析

艾滋病(AIDS)是由于感染了艾滋病病毒(HIV)而造成 以免疫系统损害和感染为主要特征的一组综合征，其容易 并发细菌、病毒、真菌、结核菌感染。本文着重讨论5例 AIDS 病例并发原发性细菌性腹膜炎诊断和治疗。     

Laparoscopic treatment of biliary peritonitis following nonoperative management of blunt liver trauma

Introduction  

Nonoperative management (NOM) of hemodynamically stable patients with blunt hepatic injuries is considered the current standard of care. However, it is associated with several in-hospital complications. In selected cases laparoscopy could be proposed as diagnostic and therapeutic means.     

Pseudomonas aeruginosa as a primary pathogen in children with bacterial peritonitis

This prospective study compared the efficacy of sulbactam/ampicillin and clindamycin/gentamicin in the treatment of children with bacterial peritonitis. Of the 29 children enrolled, 17 were evaluable; eight received sulbactam/ampicillin/gentamicin and nine clindamycin/gentamicin. Sixteen patients were previously healthy children with appendicitis. An average of 3.6 bacterial species were recovered from the peritoneal fluid of each patient. E coli and B fragilis were the most common aerobic and anaerobic isolates, recovered from 15 and ten patients, respectively. Pseudomonas aeruginosa was recovered from seven of 17 children; the three children with P aeruginosa infections randomized to the sulbactam/ampicillin group received gentamicin in addition to the investigational agents throughout the treatment course. Although the study groups were small, there was no difference in age, sex, number of pathogens per patient, duration of hospitalization, toxicity, or treatment failures between the two treatment groups or between children infected with P aeruginosa and controls. As a result of the high prevalence of P aeruginosa in the peritoneal exudate of otherwise healthy children with appendicitis, initial antimicrobial therapy in this patient population should include agents effective against this organism.     

Laparoscopic diagnosis and management of a novel inguino-pelvic hernia

Inguinal hernias can typically be diagnosed with a proper history and thorough physical exam. However, patients with chronic groin pain, normal physical exam and no radiologic findings present a diagnostic/therapeutic dilemma [1]. We present a case of a female patient with obscure chronic groin pain. Upon laparoscopic exploration, she was found to have a hernia in a previously non-described location. Reduction of a chronically incarcerated preperitoneal fat and subsequent repair using traditional transabdominal preperitoneal repair resulted in a complete resolution of her pain.     

Open management of the abdomen and planned reoperations in severe bacterial peritonitis.

OBJECTIVE: To assess the results of open management of the abdomen and planned re-operations in severe bacterial peritonitis after perforation or anastomotic disruption of the digestive tract. DESIGN: Retrospective study. SETTING: University Hospital, The Netherlands. SUBJECTS: 67 consecutive patients. INTERVENTIONS: Open management of the abdomen and planned reoperations. MAIN OUTCOME MEASURES: Hospital morbidity and mortality, long-term follow-up. RESULTS: 38 patients developed multiple organ failure (MOF), but 29 needed only ventilatory and inotropic support. The mean number of re-operations was nine. 16 patients developed severe bleeding and 16 fistulas. In-hospital mortality was 42% (n = 28). Long-term morbidity, particularly the number of abdominal wall defects (n = 10), was considerable. CONCLUSION: Despite open management of the abdomen and planned re-operations, mortality of severe bacterial peritonitis still continues to be too high, and both short and long-term morbidity are appreciable. The value of open management of the abdomen and planned re-operations rests only on the clinical observation that other conventional surgical treatments of severe bacterial peritonitis often fail.     

Laparoscopic surgical management of perforative peritonitis in enteric fever: a preliminary study

Early surgery in enteric perforation is the only accepted form of treatment in modem day medicine and gives excellent results. Exploratory laparotomy continues to be the mainstay of surgical treatment and several different procedures are recommended in literature. Between January 1998 and November 2001, we have successfully managed 6 consecutive cases of enteric perforation laparoscopically with complete resolution of the disease. There were 4 males and 2 females in our study. The mean time of presentation to us was 38 hours after the perforation (range 22 hours to 63 hours). The mean age was 32 years (range 28 years to 43 years). All patients presented with free air under the diaphragm. A laparoscopic approach was carried out through a 10 mm supraumbilical port and two 5 mm additional ports in the midline infraumbilical area and the left iliac fossa area. Simple one layer closure of the perforation was carried out with 2-0 silk intracorporeally and the peritoneal cavity was washed out and adequately drained. All perforations were localised to the terminal ileum and were single in number. The mean operating time was 54 minutes-(range 42 to 75 minutes). All patients received parenteral ofloxacin and metrogyl. Postoperative recovery was uneventful in all patients and there were no major complications. All patients were discharged from hospital by the 4th postoperative day. Follow up over a period of 12 to 16 months revealed all patients to be in normal health. We strongly recommend a first line laparoscopic approach in all patients with typhoid perforation; as it is a safe and effective method of managing such cases.     

The diagnosis and management of primary lymphedema

Although the clinical features of lymphedema are often distinctive, it is essential to confirm the diagnosis with an objective test. Isotope lymphography is simple and 95% accurate for defining deficient lymph clearance. It is particularly useful for separating venous from lymphatic edema. Definition of the precise abnormality--peripheral lymphatic obliteration, proximal lymph node obstruction, or valvular incompetence--can only be made with lymphangiography. The mainstay of treatment is the reduction of edema by regular elevation and massage and external compression with elastic stockings. Pneumatic leggings are also helpful. Gross edema caused by peripheral obliteration may be reduced surgically by simple excision (Homans' operation) or complete excision and skin grafting (Charles' operation). Reflux through incompetent vessels may be prevented by vessel ligation. Obstruction by the iliac lymph nodes may be bypassed with an enteromesenteric pedicle.     

Laparoscopic diagnosis and treatment of primary torsion of the greater omentum

Clinical presentation of primary torsion of the greater omentum is nonspecific, thus rarely allowing for a preoperative diagnosis. Three patients presented with acute but nonspecific abdominal symptoms. Because ultrasonographic and radiologic findings were unclear, all patients underwent diagnostic laparoscopy. In all cases, laparoscopy enabled us to achieve the diagnosis and to perform a resection of necrotic omentum. The mean duration of the procedure was 56 minutes (range: 42 to 76). The postoperative course was uneventful and the patients were discharged on postoperative day 1 (2) and 3. The value of diagnostic laparoscopy increases when the disease can be treated laparoscopically. The laparoscopic vision allowed us to explore the whole peritoneal cavity, so achieving the diagnosis, and to place the operative trocars at the most convenient sites. The laparoscopic resection of the greater omentum is an easy task even for inexperienced laparoscopic surgeons, allowing patients to benefit from the advantages of a mini-invasive approach.     

腹腔镜在诊治原发性腹膜炎中的应用

目的:探讨腹腔镜在诊治原发性腹膜炎中的应用价值。方法:将1995年2月至2001年1月应用腹腔镜诊治的原发性腹膜炎11例与1995年以前行开腹手术的24例在手术时间、住院天数、切口感染率方面进行对照。结果:腹腔镜手术组11例的手术时间为(39.9±7.6)min,住院天数(7.9±2.9)d,切口感染率9.1％(1/11);开腹手术组24例的手术时间为(71.0±12.0)min,住院天数(14.0±3.9)d。切口感染率25.0％(6/24)。两组手术时间及住院天数差异有显著性(P<0.01),且腹腔镜组切口感染率低。结论:腹腔镜手术诊治原发性腹膜炎安全、有效、优于开腹手术。