gastric outlet obstruction by a gallstone (bouveret's syndrome)
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Case reports: Online First
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Laparoscopic resection of a proximal splenicartery aneurysm
M. Adham,1 P. Blanc,1 P. Douek,2 L. Henri,3 C. Ducerf,1
J. Baulieux11Department of General and Gastrointestinal Surgery and LiverTransplantation, Croix Rousse Hospital, 103, Gde rue de la CroixRousse, 69317 Lyon, France2Department of Radiology, Croix Rousse Hospital, 103, Gde rue de laCroix Rousse, 69317 Lyon, France3Department of Radiology, Edouard Herriot Hospital, Lyon, FranceReceived: 10 August 1999; Accepted: 15 September 1999; Onlinepublication: 9 March 2000DOI: 10.1007/s004640010051AbstractThe usual treatment for splenic artery aneurysm is resectionunder laparotomy. In recent years, the laparoscopic ap-proach has consisted of ligation without resection. Morerecently, laparoscopic resection was reported by the Cleve-land Clinic. In this paper, we describe the technique used inthe laparoscopic resection of our first case of laparoscopicresection of splenic artery aneurysm (SAA). The patient wasa young woman with a 12-mm SAA discovered on system-atic abdominal ultrasound. The laparoscopic procedure wasdone successfully, and the aneurysm was resected using anultrasonic dissector. The postoperative course was unevent-ful, and the patient was discharged on the 3rd postoperativeday. Pathological examination revealed the atheroscleroticorigin of the aneurysm. The patient is doing well 12 monthsafter surgery, with normal splanchnic Doppler ultrasound.This procedure offers a one-step definitive cure via a mini-mally invasive surgical procedure.Correspondence to:M. Adham—Email: [email protected]
Gastric outlet obstruction by a gallstone(Bouveret’s syndrome)
F. Ezberci,1 H. Kargi,2 A. Ergin3
1Department of Surgery, University of Kahramanmaras Sutcu Imam,Faculty of Medicine, Kahramanmaras, Turkey2Department of Surgery, Kahramanmaras State Hospital,Kahramanmaras, Turkey3Department of Gastroenterology, Kahramanmaras State Hospital,Kahramanmaras, TurkeyReceived: 12 May 1999; Accepted: 12 August 1999DOI: 10.1007/s004640000050AbstractGastric outlet obstruction caused by a gallstone in the du-odenum or pylorus (Bouveret’s syndrome) is a very rare
complication of gallstone disease. Presenting symptoms in-clude epigastric pain, nausea, and vomiting. Preoperativediagnosis is not easy. Oral endoscopy is one of the diag-nostic procedures. We present a case in which the diagnosiswas made by endoscopic examination. Multiple attempts atendoscopic extraction of the gallstone from the duodenumwere unsuccessful. A one-stage surgical procedure consist-ing of the removal of the impacted stone, fistula repair, andcholecystectomy was performed in this case. The postop-erative course was uneventful.Keywords: Bouveret’s syndrome — Cholelithiasis — Duo-denal obstruction — Gallstone ileus — Gastric outlet ob-structionCorrespondence to:F. Ezberci—Email: [email protected]
Overcoming Wallstent malposition in thetreatment of rectosigmoid obstruction
A. J. Pikarsky,1 J. E. Efron,1 E. G. Weiss,1 P. Eisenberg,2
J. J. Nogueras,1 S. D. Wexner11Department of Colorectal Surgery, Cleveland Clinic Florida, 3000 WestCypress Creek Road, Fort Lauderdale, FL 33309, USA2Department of Radiology, Cleveland Clinic Florida, 3000 West CypressCreek Road, Fort Lauderdale, FL 33309, USAReceived: 14 July 1999; Accepted: 24 September 1999; Onlinepublication: 9 March 2000DOI: 10.1007/s004640010048AbstractIn recent years, the use of transanal stenting of malignantcolonic strictures for the palliation of obstructive symptomshas increased. Due to the rectosigmoid angle, stenting sig-moid tumors is more troublesome than rectal lesions, but thedifficulty may be overcome by using a two-team approach.The radiologist assists the endoscopist with the use of fluo-roscopy to ensure proper positioning of both the colono-scope and the stent. The most common complication is stentmigration, but stent obstruction and colonic perforation mayalso occur. We treated a woman suffering from metastaticgastric cancer with peritoneal metastases by creating a 12-cm stricture in the sigmoid colon. Two adjoining Wallstentswere required to bridge the obstruction. Following migra-tion of the proximal stent, a third stent was introduced tobridge the previous two stents with satisfactory outcome.Keywords: Cancer — Colon — Palliation — Sigmoid stric-ture — Wallstent
© Springer-Verlag New York Inc. 2000Surg Endosc (2000) 14: 372–374
Laparoscopic diagnosis of gallbladderagenesis
L. Sarli, V. Violi, S. GobbiInstitute of General Surgery and Surgical Therapy, Parma UniversitySchool of Medicine, Via Gramsci 14, 43100 Parma, ItalyReceived: 2 July 1999; Accepted: 15 September 1999; Onlinepublication: 23 February 2000DOI: 10.1007/s004640000054AbstractIn this article, we report two cases of gallbladder agenesisthat were incorrectly diagnosed as cholelithiasis on preop-erative sonography. In the first case, the diagnosis was madeby laparoscopic surgery and confirmed by postoperative CTscan. The second case was confirmed by laparoscopic ab-dominal examination and by laparoscopic sonography. Bothpatients had undergone preoperative IV cholangiography.Preoperative cholangiography and laparoscopic explorationcompleted by laparoscopic sonography should be consid-ered adequate modalities for the diagnosis of gallbladderagenesis, without the need for laparotomy and thoroughpostoperative workup.Keywords: Diagnostic laparoscopy — Gallbladder agen-esis — Gallstones — Laparoscopy — UltrasoundCorrespondence to:L. Sarli—Email: [email protected]
Successful management of para-aorticlymphocyst with laparoscopic fenestration
L. Sarli,1 P. Cortellini,2 C. Pavlidis,1 M. Simonazzi,2
N. Sebastio21Institute of Surgery and Surgical Therapy, Parma University School ofMedicine, Azienda Ospedale, Via Gramsci no. 14, 43100 Parma, Italy2Department of Urology, Parma Hospital, Parma, ItalyReceived: 30 July 1999; Accepted: 15 September 1999; Onlinepublication: 23 February 2000DOI: 10.1007/s004640000053AbstractPara-aortic lymphocyst occasionally follows retroperitonealpara-aortic node dissection for neoplastic diseases. We pre-sent a case in which the leakage of chylous fluid and then apara-aortic lymphocyst followed right nephrectomy andpara-aortic node dissection for kidney cancer. Our methodof treatment utilized conservative management of chylousascites and laparoscopic internal drainage of the retroperi-toneal lymphocyst.Keywords: Cancer — Kidney — Laparoscopic fenestration— Para-aortic lymphocyst — Retroperitoneal lymphade-nectomy — Surgical complicationsCorrespondence to:L. Sarli—Email: [email protected]
Intraoperative Doppler color flow imagingcombined with regulation of arterial inflowduring surgery for intrahepatic arterioportalfistula
K. Inoue,1 M. Makuuchi,1 T. Takayama,1 G. Torzilli,1
Y. Sugawara,1 Y. Bandai,1 K. Shimoji21Hepatobiliary Pancreatic Surgery Division, Artificial Organ andTransplantation Division, Department of Surgery, Graduate School ofMedicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo,113-8655, Japan2Third Department of Internal Medicine, Saitama Medical School,Saitama, JapanReceived: 30 July 1999; Accepted: 12 August 1999; Online publication:23 February 2000DOI: 10.1007/s004640000049AbstractLarge fistulas associated with impaired liver functionshould be treated by direct obliteration or removal of theshunt orifice. In a large shunt with the portal branch lying onthe arterial branch, identification of the exact site of thefistula can be a challenge. We report a case of impaired liverfunction due to a large intrahepatic arterioportal fistula. Thesite of the shunt orifice could not be located accurately bypreoperative imaging. However, intraoperative color Dopp-ler ultrasonography and the simple regulation of arterialinflow clearly demonstrated the shunt orifice. This originaltechnique has allowed the precise definition of the problemand has optimized the surgical treatment for this criticalcondition. Consequently, it should be considered a new op-tion for the definition and management of large intrahepaticarterioportal fistulas.Keywords: Angiography — Computed tomography — In-trahepatic arterioportal fistula — Intraoperative ultrasonog-raphy — Liver failure — Liver surgeryCorrespondence to:M. Makuuchi—Email: [email protected]
Is the loss of gallstones during laparoscopiccholecystectomy an underestimatedcomplication?
S. Gerlinzani, M. Tos, R. Gornati, B. Molteni,D. Poliziani, A. M. TaschieriDivisione di Chirurgia Generale II, Universita` degli Studi di Milano,Ospedale Luigi Sacco, Cattedra di Chirurgia Generale,Via G.B. Grassi 74, 20157 Milan, ItalyReceived: 22 July 1999; Accepted: 12 August 1999; Online publication:23 February 2000DOI: 10.1007/s004640000047AbstractLaparoscopic cholecystectomy entails an increased risk ofgallbladder rupture and consequent loss of stones in theabdominal cavity. Herein we report the case of a 51-year-old male patient, who underwent laparoscopic cholecystec-tomy 2 years before presentation to our hospital. He hadexperienced tension sensation and epigastric pain since 4months postoperatively. A well-defined epigastric mass,
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which was hard and painful on palpation, was detected andlater confirmed by ultrasonography and CT scan. Explor-ative laparotomy revealed a mass in the area of the gastro-colic ligament, resulting from biliary gallstones in conjunc-tion with a perimetral inflammatory reaction. A review ofthe literature showed that the incidence of gallbladder le-sions during laparoscopy is 13–40%. In order to prevent thiscomplication, meticulous isolation of the gallbladder,proper dissection of the cystic duct and artery, and careful
extraction through the umbilical access are required. Liga-tion after the rupture or use of an endo-bag may be helpful.The loss of gallstones and their retention in the abdominalcavity should be noted in the description of the surgicalprocedure.Keywords: Biliary gallstones — Gallbladder rupture —Laparoscopic cholecystectomyCorrespondence to:S. Gerlinzani—Email: [email protected]
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