Laparoscopic cholecystectomy after open cholecystostomy for gallbladder empyema: a case report

The case of a patient with gallbladder empyema initially drained through a minilaparotomy procedure under local anesthesia with a tube cholecystostomy is reported in this paper. Eight weeks later, the patient underwent an elective interval laparoscopic cholecystectomy. At laparoscopy, the gallbladder and the cholecystostomy tube were dissected free from the abdominal wall and the greater omentum, which was attached to the gallbladder. The tube was removed from the gallbladder fundus, and the operation was completed laparoscopically without any major problems.     

Floating gallbladder strangulation caused by the lesser omentum: report of a case

Strangulation of the gallbladder by the omentum is extremely rare. We report what to our knowledge is only the second documented case of strangulation of a floating gallbladder by the lesser omentum. A 61-year-old Japanese woman presented to a local hospital after the sudden onset right upper quadrant pain. Her clinical features suggested a gallbladder volvulus, and the patient was referred to our hospital for investigation and treatment. Ultrasonography and computed tomography showed no cholecystolithiasis, but the fundus and body of the gallbladder were markedly swollen without wall thickening, whereas the neck of the gallbladder was normal. A narrowed, twisted area was seen between the body and neck of the gallbladder. Based on these findings, gallbladder volvulus was diagnosed and she underwent emergency laparoscopic cholecystectomy. The fundus and body of the gallbladder were grossly necrotic. The narrowest part of the gallbladder was tightly strangulated by the lesser omentum, but the gallbladder neck was normal. Histopathologic examination of the resected gallbladder showed ischemic changes in the wall of the fundus and body. This case highlights that the clinical features and imaging findings of a gallbladder strangulated by the lesser omentum are similar to those of gallbladder volvulus and that a positive outcome is dependent on a correct diagnosis and prompt surgical management.     

Reconstruction of sternal and abdominal wall defects in a case of desmoid tumor.

A case of desmoid tumor of the anterior chest and abdominal wall is presented. The entire body of the sternum along with the upper abdominal wall and inner parts of both breasts was resected. The resulting defect over the pericardium and abdomen was reconstructed by the omentum and Marlex mesh. The large skin defect was covered by bilateral thoracoabdominal tube pedicles. The patient had a stable chest wall with uncompromised respiratory function 1 week after the operation. Prevention of local recurrences of desmoid tumors requires wide excision of the involved soft tissues and bony structures. The principles of wide resection of soft tissue tumors, reconstruction of the anterior chest and abdominal wall defects, and planning the skin coverage over the resulting defect are discussed.     

腹壁巨大缺损的修复重建

目的探讨带蒂大网膜加聚丙烯网片修复手术切除致腹壁巨大缺损的临床效果。方法1994年～2004年,采用带蒂大网膜加聚丙烯网片修复12例因腹壁肿瘤切除致腹壁巨大缺损的患者,缺损范围10cm×7cm～25cm×17cm。结果12例患者术后伤口均I期愈合。获随访1～5年,无肿瘤复发,无腹壁切口疝、肠粘连、肠梗阻和肠瘘等并发症发生。结论带蒂大网膜代替腹膜加聚丙烯网片修复腹壁缺损的方法疗效可靠,副作用少。     

减重手术—袖状胃切除术

距幽门2 cm开始紧贴胃大弯壁用超声刀离断大网膜，同时充分游离胃后壁与胰腺之间粘连，直至胃底，显露出左侧膈肌脚及食道左侧。经口置入36 F粗胃管，沿胃小弯直至到达胃窦处，距幽门4～6 cm开始用成钉高度较高的内镜下直线切割闭合器进行袖状胃裁剪，然后换用为钉腿高度较低的内镜下直线闭合器切割，切割线距离胃管边缘1 cm，在胃底部离食道左侧缘1～2 cm处离断胃底。用倒刺缝合线连续浆肌层缝合加固胃切缘，可将大网膜一并缝合在胃切缘。移除胃管，清理腹腔，扩大主操作孔，取出切除的胃组织，在左侧膈肌脚放置引流管，用不可吸收线全层缝合10 mm及12 mm戳卡孔。     

Clostridial myonecrosis of the abdominal wall. Resection and prosthetic replacement

A case of extensive clostridial myonecrosis of the anterior abdominal wall is described in an elderly patient after anterior resection of the sigmoid colon. After extensive resection of the abdominal wall, the defect was bridged by omentum and reinforced with Marlex mesh. Mesh skin grafts were applied to the granulation tissue which formed rapidly from the underlying omentum. This prosthetic abdominal wall proved to be durable despite subsequent reoperation for recurrent carcinoma.     

In-situ-Aortenrekonstruktion bei sekundärer aortoenterischer Fistel

A 52-year-old male patient developed a secondary aorto-enteric fistula 33 months after implantation of an infrarenal Dacron tube graft. The correct preoperative diagnosis was established by endoscopy and abdominal computed tomography. After removal of all infected prosthetic material, the intestinal wall was repaired, followed by in situ replacement of a new graft, which was covered by the major omentum. In this report we discuss diagnostic procedures and surgical management of aorto-enteric fistulae, especially in situ replacement and extra-anatomic revascularization.     

Spontaneous Abscesses of the Abdominal Wall,Omentum and Abdominal Cavity Caused by Group G Streptococci: A Case Report

We report the first case, to our knowledge, of spontaneous abscess of the abdominal wall, omentum and abdominal cavity caused by group G streptococci. A 52-year-old diabetic woman presented with abdominal tenderness and weight loss that had persisted for a few weeks. CT scan showed several abscesses of the abdominal wall, omentum and abdominal cavity. The abscesses were drained laparoscopically and antibiotics were given postoperatively. Biopsies and cultures showed group G streptococci. The patient recovered without any complication and left our hospital on the 17^th postoperative day.     

Duodenal obstruction related to benign biliary tract disease.

Duodenal obstruction in six patients was related to biliary tract disease and previous abdominal surgery. Causes of obstruction were adhesions to the inflamed gallbladder, adhesions to the gallbladder bed after cholecystectomy, intramural hematoma after transduodenal exploration of the common bile duct and severe pancreatitis after common bile duct exploration. Measures that may possibly prevent duodenal obstruction include early recognition and treatment of cholelithiasis, positioning of omentum between duodenum and gallbladder bed after cholecystectomy, avoidance of transduodenal exploration where possible and careful duodenal closure if necessary, avoidance of forceful dilation during common bile duct exploration, and a decrease in the number of negative explorations by increased use of cystic duct cholangiography     

巨大腹壁疝修补术中应用主动减容手术对腹腔内高压及预后的影响

目的巨大腹壁疝修补术中应用主动减容手术对腹腔内高压及预后的影响。 方法回顾性分析2015年1月至2017年8月，广元市中心医院就诊的40例巨大腹壁疝患者临床资料，患者均行巨大腹壁疝修补术联合主动减容手术。记录围术期及术后恢复相关指标、并发症及疝复发情况，并比较手术前后膀胱内压力变化。 结果所有患者均顺利完成手术，切除肠管长度（243.34±33.40）cm，拆线后手术切口均达到一级愈合。术后总并发症发生率为30.00%，随访9～12个月，疝复发率为5.13%。与术前比较，术后膀胱内压力明显降低[（11.19±1.84）cm H₂O vs（19.78±2.32）cm H₂O，P<0.05]。 结论巨大腹壁疝修补术联合主动减容手术切除部分网膜/肠管等脏器，可明显降低患者腹腔内高压，改善患者预后。     

Extraperitonisation with polypropylene net in plastic surgery of ventral hernia

Polypropylene net was used in 82 patients for treatment of hernia of anterior abdominal wall. Greater omentum and peritoneum were used for isolation of the net from intestinal loops. 60 patients were followed up from 1 to 5 years. Recurrences of hernia were not revealed. It is concluded that greater omentum provides good extraperitonisation of transplant from intestinal loop and prevents complications due to contact of net with abdominal organs.     

Closed marsupialization and delayed marsupialization in the treatment of severe pancreatitis

The timing for surgical intervention and the type of operation in the treatment of severe pancreatitis are still controversial. In this study, we used closed marsupialization in which early operation was preferable and after decompression of the pancreas and necrosectomy, both edges of the opened greater omentum were sutured respectively to the upper and lower peritoneal borders of the transverse abdominal incision, forming a marsupium separating the greater and lesser abdominal cavities from each other. The abdominal incision was then sutured to close the opening of the marsupium. Should clinical features or CT, BUS scan have indicated the existence of pancreatic abscess a week or longer after the exploration, stiches of the abdominal wall incision were removed. The marsupium was easily reentered and necrotic tissue removed. As the omentum edges were adhered to the abdominal wall incision separating the greater and lesser abdominal cavities, reoperation was safe. The incision was then kept open (delayed marsupialization). The theoretical basis of the operation and satisfactory clinical results are discussed.     

Abdominal Wall Hernia during Laparoscopic Gastric Bypass: A Serious Consideration

Morbidly obese patients are predisposed to developing abdominal wall hernias with the potential complication of small bowel obstruction.We report a patient who developed an obstructed paraumbilical hernia a few days after laparoscopic gastric bypass and died of aspiration pneumonia after re-laparoscopy. The controversy regarding the optimal time and method of repair of abdominal wall hernias in patients undergoing laparoscopic gastric bypass is discussed with emphasis placed on either a simultaneous repair or to split the omentum to one side leaving incarcerated omentum that is plugging the hernia defect in place for a delayed repair.     

腹腔引流管拔管相关并发症的处理及预防

目的 探讨腹部手术后腹腔引流管拔管相关并发症出现的原因、处理方法及预防措施。方法回顾性分析2015年10月至2020年10月期间嘉兴市中医医院普外科1 189例行腹部手术并放置腹腔引流管患者的临床资料。结果 1 189例腹部手术中28例出现腹腔引流管拔管相关并发症,主要包括困难性拔管5例,腹腔出血5例,引流管断裂3例,T管固定线脱落胆漏2例,皮肤瘘管形成3例及大网膜疝10例。困难性拔管经反复尝试均顺利拔出;腹腔出血经再次手术止血治疗痊愈;引流管断裂经再次手术取出残端;胆漏患者行腹腔穿刺引流保守治疗后康复;皮肤瘘管病程长,治愈缓慢;大网膜疝患者部分可轻轻回纳即可,若合并出血可结扎止血后回纳腹腔;各并发症经处理均取得良好临床效果。结论 腹腔引流管拔管并发症在临床上时有发生,一旦出现需及时处理。临床医师需加强防范意识,实施有效的预防措施,尽量减少引流管拔管相关并发症。     

Intraperitoneal granulomatous foreign body reaction after accidental perforation of the abdominal wall. Case report

After an accidental perforation by a wooden stake of the abdominal wall and distal ileum a 28-year-old man developed an aggressive granulomatous foreign body reaction of the greater omentum with high fever and abdominal pain. The patient was cured by omental resection and prednisone treatment.     

Port site recurrence of unexpected gallbladder carcinoma after a laparoscopic cholecystectomy: Report of a case

Unexpected gallbladder carcinoma was identified in a 71-year-old woman after she underwent a laparoscopic cholecystectomy (LC) for symptomatic cholelithiasis. A subsequent laparotomy for a resection of the liver bed and a dissection of the lymph nodes around the hepatoduodenal ligament was done. Two and a half years later, the patient developed subcutaneous metastasis at the epigastric trocar site through which the gallbladder was removed. A third operation was thus performed, revealing no evidence of peritoneal dissemination, liver metastasis, or lymph node metastasis, and the abdominal wall mass was resected. The histological findings confirmed the diagnosis of metastatic carcinoma of the gallbladder. We recommend that when planning LC, the possibility of malignancy should thus be kept in mind. However, if there is any sign which does not completely exclude malignancy, such as a contracture or wall thickness of the gallbladder, LC should be performed by the abdominal wall lifting method and using a protective bag for the removal of the gallbladder.     

Abdominal wall sinus due to impacting gallstone during laparoscopic cholecystectomy: an unusual complication

During laparoscopic cholecystectomy, perforation of the gallbladder can occurs in < or = 20% of cases, while gallstone spillage occurs in < or = 6% of cases. In most cases, there are no consequences. Gallstones can be lost in the abdominal wall as well as the abdomen during extraction of the gallbladder. The fate of such lost gallstones, which can lead to the formation of an abscess, an abdominal wall mass, or a persistent sinus, has not been studied adequately. Herein we report the case of a persistent sinus of the abdominal wall after an emergent laparoscopic cholecystectomy in an 82-year-old woman with gangrenous cholecystitis and perforation of the friable wall in association with an empyema of the gallbladder. The culture of the obtained pus was positive for Escherichia coli. After a small leak of dirty fluid from the wound of the epigastric port site of 4 months' duration, surgical exploration under local anesthesia revealed that the sinus was caused by spilled gallstones impacting into the abdominal wall between the posterior sheath and left rectus abdominalis muscle. The removal of the stones resulted in complete healing. Long-term complications after laparoscopic cholecystectomy involving the abdominal wall are rare but important possible consequences that could be avoided.     

Congenital epigastric evisceration: a case report

A rare case of abdominal wall defect at the epigastric midline is presented. This newborn boy had only the greater omentum eviscerated, and no other abnormalities could be detected. This case does not seem to relate to the abdominal wall defects reported so far in the literature. This singular case contributes to enlarge the spectrum of congenital defects of the abdominal wall.     

Dual mesh repair for a large diaphragmatic hernia defect: An unusual case report

IntroductionDiaphragmatic hernia secondary to traumatic rupture is a rare entity which can occur after stab wound injuries or blunt abdominal traumas. We aimed to report successfully management of dual mesh repair for a large diaphragmatic defect.Case reportA 66-year-old male was admitted with a right sided diaphragmatic hernia which occurred ten years ago due to a traffic accident. He had abdominal pain with worsened breath. Chest X-ray showed an elevated right diaphragm. Further, thoraco-abdominal computerized tomography detected herniation a part of the liver, gallbladder, stomach, and omentum to the right hemi-thorax. It was decided to diaphragmatic hernia repair. After an extended right subcostal laparotomy, a giant right sided diaphragmatic defect measuring 25 × 15 cm was found in which the liver, gallbladder, stomach and omentum were herniated. The abdominal organs were reducted to their normal anatomic position and a dual mesh graft was laid to close the diaphragmatic defect. Patients’ postoperative course was uneventful.DiscussionDiaphragmatic hernia secondary to trauma is more common on the left side of the diaphragm (left/right = 3/1). A right sided diaphragmatic hernia including liver, stomach, gallbladder and omentum is extremely rare. The main treatment of diaphragmatic hernias is primary repair after reduction of the herniated organs to their anatomical position. However, in the existence of a large hernia defect where primary repair is not possible, a dual mesh should be considered.ConclusionA dual mesh repair can be used successfully in extensive large diaphragmatic hernia defects when primary closure could not be achieved.     

Gallbladder duplication successfully removed laparoscopically using endoscopic nasobiliary tube

Laparoscopic cholecystectomy is sometimes difficult due to complicated biliary anatomy including gallbladder duplication, a rare anomaly of the biliary tract. We report a case of duplicated gallbladder successfully removed under laparoscopy using endoscopic nasobiliary (ENB) tube cholangiography. A 61-year-old Japanese woman presented us with right upper abdominal pain. Ultrasonography revealed two cystic structures lying in the gallbladder fossa, and the upper one contained multiple stones. Endoscopic retrograde cholangiography showed two gallbladders, each of which has a cystic duct draining into the common bile duct separately. Laparoscopic cholecystectomy was planned under the preoperative diagnosis of double gallbladder with gallstones in the accessory gallbladder. The ENB tube was inserted just before the operation. Laparoscopic removal of the double gallbladder was successfully done using the ENB tube to identify the biliary tree anatomy and to close the stump of the cystic duct. In this communication, we would like to stress the usefulness of the ENB tube at the time of laparoscopic biliary surgery in patients with biliary anomalies including gallbladder duplication.