Perforated peptic ulcer (PPU) is developed in 2%-10 % of peptic ulcer. The essential treatment is emergent surgical repair. Usually, the surgical repair with or without an omental patch is performed by laparotomy. The laparoscopic emergency surgery (LES) for PPU is increasingly being preferred with the innovation of laparoscopic devices and procedures and increase of surgeon’s expertise and experiences. Generally, a laparoscopic approach is recommended in stable patient. And, in selected patient with instability, a laparoscopic approach may be adopted. The patient selection criteria is recommended in hemodynamic stability, surgeon’s skills, cardiovascular or pulmonary comorbidity and Boey score. These LES rate differences for PPU are resulted that the variability in the healthcare infrastructure and patient-related factors between countries. The surgeon’s decision about LES for PPU is affected by various factors. Even surgeon’s fatigue, physical strength, stressful feelings and poor emotional mood may be one of factors. According to published literature, the practical LES performance is affected by various limiting factors. Although guideline about laparoscopic emergency knotless suture repair for PPU is absent, the 4 retrospective studies about LES for PPU between knotless and interrupted suture repair revealed that the laparoscopic knotless suture repair using barbed suture material is alternative, feasible, safe, simple and non-inferior method. However, the recommendation evidence about single port LES for PPU is unclear.

Bladder injury is uncommon in blunt abdominal trauma. The injury can be life-threatening if not treated properly. Thus, timely and accurate diagnosis is critical. Traumatic intraperitoneal bladder rupture (TIBR) can be managed laparoscopically in patients who are hemodynamically stable. In this case series, we present 3 patients who underwent laparoscopic repair of TIBR performed by a single surgeon. In addition, we address useful technical tips that would facilitate the generalized use of laparoscopy for treating TIBR.

Citations

• Bladder trauma: a guideline of the guidelines
  Deshin Reddy, Abdullah E. Laher, Maeyane Moeng, Ahmed Adam
  BJU International.2024; 133(4): 365.     CrossRef

Acute mesenteric ischemia is a state in which intestinal infarction can be caused by a sudden decrease in blood flow. A 68-year-old man was transferred to Hanyang University Guri hospital with abdominal pain. A computed tomography scan performed before the transfer showed no abnormal findings. Examination and evaluation revealed abnormal electrocardiogram findings and increased troponin I. Although emergency coronary angiography was normal, the patient continued to complain of severe abdominal pain. A computed tomography scan showed occlusion of the superior mesenteric artery. Percutaneous aspiration embolectomy was successfully performed prior to surgery, and subsequent laparoscopic exploration revealed an area of bowel necrosis which was then resected. The length of the small intestine remaining after resection measured 1.6 m. On postoperative Day 6, the patient began a soft food diet and was prescribed medication after being diagnosed with atrial fibrillation. He was discharged on the 13th postoperative day without postoperative complications.

Rapunzel syndrome is a very rare condition. The trichobezoar, in cases of Rapunzel syndrome, extend from the stomach into the duodenum and small bowel. Trichobezoars are usually encountered in young women with psychiatric problems, such as trichotillomania, trichophagia, or mental retardation and pica. Large trichobezoars, which are associated with Rapunzel syndrome, are removed during open surgery which requires large incisions. This Case Report describes 2 girls who had Rapunzel syndrome where the trichobezoars reached the jejunum and laparoscopic surgery was successful in the removal of the trichobezoars. Laparoscopic removal of a trichobezoar can be considered as a treatment option for children with Rapunzel syndrome.

Citations

• Endoscopic Treatment of Gastric Bezoars: A Report of Three Cases
  Younghee Choe, Joon Sung Kim, Byung-Wook Kim
  The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2024; 24(3): 286.     CrossRef

A 51-year-old female underwent recurrent open incisional hernia repair with retrorectus mesh placement. Early in the post-operative course, she developed a hernia reoccurrence secondary to breakdown of the staple line, at the level of the posterior rectus sheath, resulting in a small bowel obstruction. This hernia could not be felt upon physical examination but was detected by imaging. The patient was promptly taken to the operating room for laparoscopic reduction of the incarcerated loop of small intestine, along with laparoscopic repair of the posterior rectus sheath defect. It is critical for surgeons to recognize the possibility of a staple line breakdown at the level of posterior rectus sheath early on in the diagnosis which would prompt urgent surgical intervention in the setting of a bowel obstruction.

Citations

• Strangulated interstitial interparietal hernia following lower segment caesarean section: a case report
  Celine Garrett, Ruwanthi Wijayawardana, David L Morris
  Journal of Surgical Case Reports.2023;[Epub]     CrossRef

Purpose:

Open adhesiolysis has been the favored approach regarding surgical management of intestinal obstruction. Following the development of laparoscopic devices and necessary surgical techniques, laparoscopic treatment of intestinal obstruction and adhesion has been tried in highly selected cases. Our study was designed to investigate laparoscopic adhesiolysis to treat intestinal obstruction.

Methods:

The clinicopathologic data and surgical outcomes of 14 patients who underwent emergency laparoscopy between January 2007 and April 2015 were retrospectively reviewed.

Results:

Five patients had a history of abdominal surgery, and twelve patients had adhesive intestinal obstruction. The causes of adhesive intestinal obstruction included tuberculous peritonitis, periappendiceal abscess, serosal fibrosis and chronic inflammation of intestine, gastric volvulus by fibrotic band. Two patients had non-adhesive intestinal obstruction, caused by intussusception and small bowel ulcer with stricture. The mean surgical time was 98.5 minutes, with mean blood loss of 35 ml. One case was converted to open surgery (7.1%). The mean postoperative hospital stay was 6.5 days. The mean time to oral intake was 3.4 days. There were no postoperative complications or deaths.

Conclusion:

When the patients are selected carefully in accordance with the guidelines, in our experience laparoscopic adhesiolysis is safe and feasible.