Abdominal wall abscess following laparoscopic cholecystectomy: an unusual late complication of lost gallstones

Laparoscopic cholecystectomy (LC) is associated with a significant risk of gallbladder perforation with spillage of bile and stones into the peritoneal cavity. The retrieval of the spilled stones is not always possible by laparoscopic technique. Majority of these cases do not have any problem in future but sometimes the lost stones lead to serious complications. The authors present a case of lost gallstones, which resulted into an abdominal wall abscess and discharging sinus 9 years after LC. This late presentation is among the very few reports after LC. Risk factors for gallbladder perforation, various techniques to avoid spillage of stones, possible complications and their management is discussed.     

Long-term survivor of brain metastases from malignant melanoma

Malignant melanoma is notorious for distant metastases. Median survival for stage IV melanoma is 6-10 months and 5 year survival is less than 5%. Median survival for melanoma with brain metastases is even lower i.e. 2 to 9 months. Here a case is reported who was treated for melanoma of sole of left foot with ipsilateral inguinal adenopathy and brain metastases in 2001 and is still surviving disease-free after a lapse of 8 years.     

Gastric Plication Can Reduce Slippage Rate After Laparoscopic Gastric Banding

Background:

Laparoscopic insertion of a gastric band for weight reduction is increasingly performed in obese and morbidly obese patients. Complication rates after gastric band insertion are reduced by using certain techniques.

Patients and Methods:

This was a prospective study of all patients who underwent laparoscopic adjustable gastric band (LAGB) insertion at our unit. This procedure is performed through the classical 4-port technique and the use of a liver retractor. The pars flaccida method is performed in all patients, and the gold finger, a malleable instrument, is used to guide the band through the retroesophageal window in patients with difficult anatomy. Band slippage is avoided by using 2 types of gastric plication, depending on the anatomical characteristics of the stomach. Outcomes and morbidity are recorded, and patients are followed up in outpatient clinics.

Results:

Laparoscopic adjustable gastric band (LAGB) insertion was performed in 464 patients. A single consultant surgeon performed all procedures over a 2-year period. From August 2005 through August 2007, 380 (81.89%) women and 84 (18.10%) men were included in this study. The mean age was 41 years (range, 21 to 62). The mean body mass index was 43 (range, 35 to 62). Morbidity included dysphagia, epigastric pain, port displacement, port infection, erosion, and acute respiratory distress. Only one (0.21%) case of band slippage was reported. The mean follow-up was 26 months (range, 18 to 42).

Conclusion:

Laparoscopic gastric plication adds greater security and provides optimum gastric band placement. It is an effective method to reduce slippage after gastric band insertion.     

Anterior dislocation of hip with ipsilateral femoral neck and head fracture

A 70-year-old male patient presented to our emergency department with trauma left hip following a fall. Physical examination revealed external rotation, slight flexion, adduction, and shortening of the affected limb. There was a palpable fullness in the groin. Radiographic examination revealed fracture neck of femur with femoral head dislocated anteriorly and lying in the obturator foramen. There was an associated femoral head fracture with a fragment of it in the acetabulum. Although this sort of injury has been reported once, the difference in our case lies in the age of the patient; the injury complex was caused by a less severe trauma and a unique mechanism of injury. Also a modification of Brumback classification is proposed to include such fractures more specifically in order to allow comparative analysis in such rare injuries as more and more such case reports are added to literature.     

Hysteroscopic endometrial ablation using the Hydro ThermAblator in an outpatient hysteroscopy clinic: feasibility and acceptability

STUDY OBJECTIVE: To assess the feasibility and patient acceptability of global endometrial ablation using the Hydro ThermAblator (HTA) in an outpatient hysteroscopy clinic setting under local anaesthesia. DESIGN: A prospective cohort study (Canadian Task Force classification II-2). SETTING: University hospital in the United Kingdom. PATIENTS: Forty patients with medication-resistant menorrhagia. INTERVENTION: Oral mefenamic acid was administered 8 hours before the procedure. A combined cervical/paracervical block using lignocaine 1% adrenaline 1:200,000 was used before hysteroscopic endometrial ablation using the HTA device. MEASUREMENTS AND MAIN RESULTS: A successful procedure was defined as a completed HTA treatment cycle. Failure was defined as premature termination or inability to carry out the HTA procedure after scheduling the patient. Pain scores were estimated at three stages during and after the procedure using a visual-analog scale. A questionnaire was used before discharge to assess acceptability. Forty patients were successfully treated. The median pain score during the ablation was 6.4 (range 4.0-8.9). Eighty-eight percent of patients found the procedure acceptable. No serious complications occurred. All patients were discharged home within 2 hours of the procedure. CONCLUSION: Selected patients suffering from menorrhagia may be treated with the HTA device using local anesthesia in an outpatient setting.