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Case reports: Online First

Surg Endosc (2001) 15: 1359–1361 © Springer-Verlag New York Inc. 2000

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Laparoscopic repair of Bochdalek’s hernia quent CT (intravenous contrast scan) revealed a 4.6 × 3.5
with gastric volvulus cm mass with neither extraluminal infiltration nor enlarged
lymph nodes. The patient underwent successful laparoscop-
ic-assisted resection of the leiomyoma and enjoyed an un-
G. Carreño, R. Sánchez, R. A. Alonso, M. A. Galarraga,
eventful postoperative recovery. Subsequent histopathology
C. Moriyón, A. Magarzo, F. Bouzón, Z. Makdissi,
confirmed the diagnosis. The diagnosis of small bowel leio-
R. A. Obregón
Department of General Surgery, Hospital de Cabueñes, 33394 myoma is generally difficult because the conventional ra-
Cabueñes—Gijón, Asturias, Spain diographic methods are unhelpful. These tumors are there-
Received: 4 May 2000/Accepted in final form: 15 June 2000/Online fore best detected preoperatively with superior mesenteric
publication: 16 August 2001 angiography. Repeat of the noninvasive tests is strongly
DOI: 10.1007/s004640040028
indicated if they are initially negative. Once discovered,
Abstract small bowel leiomyoma should be resected to avoid cata-
Bochdalek’s hernia is the most common congenital dia- strophic complications. Thereafter, it has an excellent prog-
phragmatic hernia in newborns, but it is an uncommon clini- nosis. In this context, minimal-access surgery is a safe and
cal feature in adults. In most cases, there are no symptoms approachable method to deal with such a problem.
or only minor gastrointestinal problems. Rarely, it may Key words: Laparoscopic-assisted resection — Gastroin-
manifest as an acute abdomen due to viscus strangulation, testinal hemorrhage — Jejunal leiomyoma
requiring emergency surgery. We report the case of a 52- Correspondence to: M. A. Abbas—E-mail: mustafa_abbas@
year-old man with herniation of the colon and a volvulated hotmail.com
stomach through a Bochdalek’s hernia. The patient was op-
erated on via a laparoscopic approach and had an unevent-
ful recovery. We recommend the laparoscopic approach as
an alternative to open surgery in cases of noncomplicated Radiological treatment of retained bile duct
Bochdalek’s hernia. stones following recent surgery using glucagons
Key words: Bochdalek’s hernia — Diaphragmatic hernia
— Hernia S. Mahmud,1 I. McGlinchey,2 H. Kasem,1 A. H. M. Nassar1
1
Correspondence to: G. Carreño Villarreal—E-mail: guisilvi@ Department of Surgery, Vale of Leven District General Hospital,
teleline.es Alexandria, Dunbartonshire, Scotland, 683 OUA, UK
2
Department of Radiology, Vale of Leven Hospital, Alexandria,
Dunbartonshire, Scottland, G83 OUA, UK
Received: 1 February 2001/Accepted in final form: 22 March
Laparoscopic-assisted resection of bleeding 2001/Online publication: 4 September 2001
DOI: 10.1007/s00464-001-4207-9
jejunal leiomyoma Abstract
Background: Retained common bile duct (CBD) stones
M. A. Abbas, M. Al-Kandari, F. M. Dashti pose an occasional problem following ductal exploration, in
Department of Surgery, Farwania Hospital, State of Kuwait
Received: 29 March 20001/Accepted in final form: 5 April 2001/Online
spite of completion cholangiography or choledochoscopy.
publication: 4 September 2001 We present a method for treating retained stones in the
DOI: 10.1007/s00464-001-4210-1 Radiology Department by biliary lavage via a transcystic
Abstract tube (TCT) or a T-tube, after intravenous administration of
Laparoscopic-assisted resection has shown remarkable im- glucagon.
provements in the treatment of small bowel diseases, nota- Methods: A TCT or T-tube is inserted following CBD ex-
bly the leiomyomas. This case report documents the suc- ploration for multiple intrahepatic stones or when stones are
cessful removal of a bleeding jejunal leiomyoma with the fragmented to facilitate removal or flushing into the duode-
aid of laparoscopy. A 51-year-old man was admitted to the num. A tube cholangiogram is performed on the 1st post-
hospital twice within 3 months with melena. On the first operative day. If any retained stones are encountered, 1 mg
admission, upper and lower gastrointestinal endoscopy were glucagon is administered intravenously and saline irrigation
negative, and small bowel enema was inconclusive. On the through the tube is done under fluoroscopic control, allow-
second admission, Technetium-99 Red Blood Cells (Tm-99 ing the stone to pass to the duodenum. The cholangiogram
RBC) scan showed dye extravasation (interpreted as from is repeated 10–14 days later, before removing the tube.
the left colon). Subsequent colonoscopy was normal, as was Results: In case 1, transcystic CBD exploration was per-
a barium enema. An elective superior mesenteric angiogra- formed. Two stones were crushed and flushed into the du-
phy revealed a benign-looking jejunal leiomyoma. Subse- odenum. TCT cholangiography the following day. showed a

Abad Abstract The Da Vinci robot device represents the latest advance in laparoendoscopic surgery. c/ Barranco de la Ballena s/n. 35020 Las Palmas de Gran Canaria.gla. J. c/ Barranco de la Ballena s/n. This is associated yahoo. moperitoneum — Hemodynamics — Acid-base balance Conclusion: The current standard treatment for retained Correspondence to: D. Terzic. With the aid of a cardiopulmonary by- 1 Department of Anesthesiology. The patient could not be weaned 2 Department of General and Vascular Surgery. Spain Received: 16 December 1999/Accepted in final form: 18 January Totally endoscopic Nissen fundoplication with 2001/Online publication: 4 September 2001 a robotic system in a child DOI: 10. causing a brief mild episode of results. no significant changes were observed in PH. Therefore. Spain clinmed. laparoscopic choledochotomy was per. Gutt. Germany molecular-weight heparin in selected cases of laparoscopic 3 Department of General and Vascular Surgery.1007/s00464-001-0038-y Abstract Hemodynamics. Germany cholecystectomy. Alonso3 essary. which included a 172-min Received: 31 July 2000/Accepted in final form: 31 August 2000/Online period of intraperitoneal insufflation of carbon dioxide publication: 4 September 2001 (CO2). the potential risks of robot-assisted surgery have not pain. Intensive Care Medicine. This new technique is a simple and safe alternative for retained CBD stones. most of which as small stones or fragments. despite our encouraging first passing into the duodenum. Pneumatosis cystoides intestinalis (PCI) is an uncommon perature was maintained with an external warming blanket. Meininger—E-mail: dirk_meininger@ stones is endoscopic sphincterotomy. In case 2. To our complication of celiac disease knowledge. Pulmonary thromboembolism was dem- D. 35020 Las Palmas de Gran Correspondence to: A. J. However. Spain 2 Department of Intensive Care. mitted to this type of procedure require intensive and even choscopy was satisfactory. Holzinger. which was cleared with the Key words: Robotics — Nissen fundoplication — Pneu- help of glucagon. In addition to standard monitoring. Westphal1 firmed at surgery. . c/ Barranco de la Ballena s/n.1360 5–6-mm fragment causing complete obstruction. D-60590 Frankfurt. Cáceres.3 onstrated by transthoracic echocardiogram and later con- K. this operative day 6. Hospital Universitario de Gran Canaria Dr. Because glucagon causes intense relaxation of Fatal pulmonary thromboembolism after the sphincter of Oddi. 1 Department of Cardiovascular Surgery. and A 67-year-old woman presented with severe cardiopulmo- anesthetic management nary insufficiency 17 days after an uneventful laparoscopic cholecystectomy. Robot-assisted techniques have the poten. this is the first such case to be reported.2 A. Klaiber Department of Surgery. Hospital Universitario de Gran Canaria Gallbladder Dr. gas exchange. Theodor-Stern-Kai 7. heart rate.uk 3 Department of Pathology. fied a small stone in the CBD. Received: 1 August 2001/Accepted in final form: 25 January Key words: Laparoscopic cholecystectomy — Pulmonary 2001/Online publication: 4 September 2001 embolism — Thromboembolism — Thrombectomy DOI: 10. patients sub- formed to remove seven large stones.Nassar@ Canaria. Switzerland short intervals. and mivacurium for continuous trointestinal tract. CH-3270 Aarberg. Spital Aarberg. C. remifentanil. the stone was observed doscopic surgery. 35020 Las Palmas de bile duct exploration — Retained stones — Glucagon — Gran Canaria. Goethe University Hospital Center. Germany artery was accomplished. Negrı́n. Nassar—E-mail: A. Theodor-Stern-Kai 7.1 C. mortality. Following tial to significantly improve the performance of laparoen- the use of glucagon and irrigation. arterial DOI: 10. N. During surgery. type of coincidence has been described in seven prior cases. Heller. W. and Pain pass.com with morbidity. Completion choledo. We report a case where PCI developed in skin closure. Goethe University Hospital Center. fore recommend antithromboembolism therapy with low- D-60590 Frankfurt. W. or mean arterial pressure.1007/s00464-001-4200-3 Correspondence to: C. T-tube cholangiography identi. PCI has been associated with several muscle relaxation allowed extubation immediately after clinical settings. Theodor-Stern-Kai 7. J. a thrombectomy of the right atrium and the pulmonary Control. H. Abad. invasive monitoring. M. Ch. we used invasive blood The role of diagnostic laparoscopy pressure monitoring during the 282-min period of general anesthesia. Division of Pediatric off cardiopulmonary bypass and ultimately died.1007/s004640042008 oxygen pressure (PaO2). J. W. Hospital Universitario de Gran Key words: Laparoscopic cholecystectomy — Common Canaria Dr. We there- Surgery. Arterial blood gas samples were analyzed at A. and significant additional cost.ac. The girl was discharged from hospital on post. Goethe University Hospital Center. the procedure should not take much laparoscopic cholecystectomy longer than a routine tube cholangiogram. Body tem. Negrı́n. We report the case of an endo- scopic Nissen fundoplication performed with the aid of a Pneumatosis cystoides intestinalis as a telemanipulation robot system in a 10-year-old girl.2 C. F. D-60590 Frankfurt. Meininger. Negrı́n. arterial carbon dioxide pressure Abstract (PaCO2).1 J. a patient with known celiac disease. yet been definitively established.1 K. The safety of glucagon makes it possible to repeat the procedure if nec. To our knowledge. Byhahn. but important condition characterized by the presence of Total intravenous anesthesia with continously administered gas-filled cysts in the submucosa and subserosa of the gas- propofol.

38 a safe and accurate method to differentiate between the kg/m2) that was exaggerated by cortisone therapy. Nehoda. it is important to differentiate the benign Anichstrasse 35. Abstract tic laparoscopy.2 M. Freund. from the life-threatening form with intestinal in. months postoperatively. Anichstrasse farction and/or perforation. in which immediate surgery is 35. Weiss1 uibk. form of pneumoperitoneum. By performing diagnos.ac. University Hospital Innsbruck. Differentiating between them can be difficult. Received: 24 July 2000/Accepted in final form: 31 July 2000/Online publication: 4 September 2001 this explains the high rate of negative laparotomy.1 H. G. Klaiber—E-mail: aarchir@hitline. we recommend that gravating comorbid hypertension and hyperlipidemia. Kähler. Department of General Surgery. particularly since our pa- tient experienced a notable improvement in her quality of Adjustable gastric banding in a patient life. it proved to be with bihilar lymphadenopathy and obesity (110 kg. A-6020 Innsbruck. we were able to establish the diagnosis of The use of silicone in patients with immune-compromising PCI and exclude intestinal perforation or infarction. inflammatory reactions against the material. Although she was treated with a double dose of Key words: Pneumatosis cystoides intestinalis — Celiac cortisone (8 mg daily).1 C.3 Correspondence to: H. University Hospital Innsbruck. she had achieved an excess weight mary laparotomy. occurred in 27% of cases. Austria indicated. 3 Department of Radiology.weiss@ F. 1361 1 Since PCI often results in pneumoperitoneum through rup. G. Whenever tient underwent adjustable gastric banding because of ag- this differentiation has to be made. nopathy. Austria mandatory. We therefore believe that preexisting immune-compromising diseases are not an absolute contra- indication against gastric banding. the scars from the laparoscopy as disease — Pneumoperitoneum — Laparoscopic features well as those in the gastric region adjacent to the band Correspondence to: Ch. During this period. thus diseases is controversial because of fears that there may be permitting the patient to avoid an unnecessary laparotomy. We report the Although diagnostic laparoscopy is not routinely indicated case of a patient who suffered from cutaneous sarcoidosis as a diagnostic tool for the detection of PCI. Herein. in which no intervention is Anichstrasse 35. Labeck. The pa- benign form of PCI and the life-threatening form.1 H. Austria 2 Department of Internal Medicine. ture of the cysts. Weiss—E-mail: helmut. which. A-6020 Innsbruck. A-6020 Innsbruck. in DOI: 10.ch remained unaffected. the laparoscopic features of PCI loss of 33%. University Hospital Innsbruck. she had a relapse of scar are described and the coincidence of PCI with celiac disease sarcoidosis of the right elbow and bilateral hilar lymphade- is reviewed. BMI.1007/s004640042003 the past. Aigner.at . Six diagnostic laparoscopy be performed first rather than pri. Key words: Laparoscopic adjustable gastric banding — with sarcoidosis Gastric banding — Sarcoidosis — Autoimmune diseases — A case report Silicone — Cortisone — Obesity surgery — Bariatric sur- gery B.

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