Santa Barbara Cottage Hospital, Santa Barbara, California, USA (Drs Loseth, Johnson, and Sharma)

ABSTRACT

Colonoscopy is a routine procedure to screen for colorectal cancer. Splenic injury is an extremely rare but potentially fatal complication. We present a case of a 74-year-old woman on edoxaban who underwent a screening colonoscopy at a nearby outpatient surgery center. While in the recovery room, she experienced abdominal pain, hypotension, and episodes of syncope, arriving to our Emergency Department approximately 10 hours after the colonoscopy. She presented to the Emergency Department with a distended abdomen, hypotensive, and with significant abdominal pain. Abdominal computed tomography scan showed significant hemoperitoneum around the bilateral paracolic gutters, spleen, and gastric fundus. She underwent emergent midline laparotomy with evacuation of 1.5 L of hemoperitoneum with ongoing bleeding from her deseroalized spleen, suggesting traction injury from colonoscopy. In patients with abdominal pain, hypotension, and low hemoglobin postcolonoscopy, splenic injury should be considered in order to recognize early and manage appropriately.

Key Words: Abdominal pain; Splenic injury; Colonoscopy; Spleen; Anticoagulant; Complication

The post Splenic Injury After Colonoscopy first appeared on JSLS.

Department of Surgery, Harlem Hospital Center, Columbia University, New York, New York, USA (Drs Khan, Saeed, Razdan, Ahmed, and Suman).
Department of Pathology, Harlem Hospital Center, Columbia University, New York, New York, USA (Dr Landa).
Department of Internal Medicine, Richmond University Medical Center, Staten Island, New York, USA (Dr Iqbal).

ABSTRACT

Introduction: Appendectomy is one of the most commonly performed surgical procedures in the world. Over time, complications associated with appendectomy have declined. Stump appendicitis is one of the rare delayed complications of appendectomy. It involves infection of the residual appendix tissue that can occur after a patient has undergone appendectomy in which the stump was left behind. Patients present with abdominal pain associated with nausea and vomiting. Computed tomography scanning of the abdomen is diagnostic.

Case Description: We report the case of a 21-year-old man with stump appendicitis status post laparoscopic appen- dectomy at another hospital, which was successfully treated with laparoscopic completion appendectomy.

Key Words: Stump appendicitis, Laparoscopic appendectomy, Residual appendix, Abdominal pain, Completion appendectomy.

The post Stump Appendicitis Status Post Laparoscopic Appendectomy first appeared on JSLS.

Department of General Surgery, Horizon Health Paris Clinic, Paris, IL (Dr Li), Department of General Surgery, Cleveland Clinic Florida, Weston, FL (Drs Lo Menzo, Szomstein, and Rosenthal)

ABSTRACT

Introduction: Gallbladder volvulus is rare, but delay in diagnosis and surgical intervention can lead to significant morbidity and mortality.

Case Description: An older woman presented with abdominal pain and was diagnosed with acute cholecystitis. During surgery, she was found to have 360-degree counterclockwise torsion of the gallbladder with ischemia. Laparoscopic cholecystectomy was performed without complications.

Conclusion: In the proper clinical setting, there is no need to explore extra studies for a preoperative confirmatory diagnosis, which may delay surgical intervention. Good prognosis is expected after prompt cholecystectomy.

Key Words: Gallbladder volvulus, Abdominal pain, Acute cholecystitis, Laparoscopic cholecystectomy.

The post Gallbladder Volvulus: Case Report and Review of the Literature first appeared on JSLS.

Department of Surgery, Harlem Hospital Center, Columbia University, New York, New York, USA (all authors).

ABSTRACT

Introduction: Gastric bypass is a commonly performed surgery for morbid obesity. Duodenal ulcer perforation after laparoscopic Roux-en-Y gastric bypass is a rare occurrence, with approximately 25 cases reported in the literature. The diagnosis of a perforated duodenal ulcer after gastric bypass can present a challenge. Most peptic ulcers after gastric bypass surgery occur in the Roux limb as marginal ulcers with the symptom of acute epigastric pain. Ulceration and then subsequent perforation in the secretory limb can also present with acute abdominal pain, with or without free air in the peritoneal cavity on imaging studies.

Case Description:We report 2 rare cases of laparoscopic repair of a perforated duodenal ulcer after gastric bypass surgery, treated laparoscopically with a Graham patch.

Conclusions: Diagnostic laparoscopy is recommended for post–Roux-en-Y gastric bypass patients presenting with acute abdominal symptoms, to rule out internal hernias and other rare life-threatening diseases, such as perforated duodenal ulcer. Surgeons should be aware of this entity and be certain to rule it out. If found during exploration, the duodenal ulcer can be repaired with a laparoscopic Graham patch.

Key Words: Abdominal pain, Graham patch repair, Laparoscopic gastric bypass, Perforated duodenal ulcer.

The post Role of Laparoscopy for the Diagnosis and Treatment of Perforated Duodenal Ulcers After Gastric Bypass Surgery first appeared on JSLS.

Easton Hospital, Department of Surgery, Drexel University College of Medicine, Easton, Pennsylvania, USA (all authors).

ABSTRACT

Introduction: Lipomas of the intestinal tract are rare, but they present as the third most common cause of intestinal neoplasms. Most intestinal lipomas are asymptomatic. However, they may present with bleeding, obstruction, intussusception, or abdominal pain. Spontaneous expulsion of an intestinal lipoma is extremely rare and has never been reported in the postoperative period.

Case Description: We present the case of a 53-year-old male patient who underwent laparoscopic roux-en-Y gastric bypass. On postoperative day 4, the patient had a myocardial infarction and persistent abdominal discomfort. The spontaneous expulsion of an intestinal lipoma was observed on postoperative day 5, after which the patient instantly felt relief. In this case report, we provide a comprehensive literature review of intestinal lipomas, with their complications and management.

Discussion: Only a few spontaneous expulsions of intestinal lipomas have been described in the literature. This is the first reported case of a spontaneous expulsion in the immediate postoperative period or after a myocardial infarction. Intestinal lipomas may cause a variety of complications, including bleeding, obstruction, and intussusception. The likelihood of complications increases with size. The criteria for resection remain controversial, and a variety of technical methods have been described. Spontaneous rectal expulsion of giant intestinal lipomas without surgical or endoscopic manipulation is possible.

Conclusion: Intestinal lipomas are rare and either are asymptomatic or present with unspecific symptoms. A consensus on the clinical management of intestinal lipomas has not been established. Besides open surgery, laparoscopic and endoscopic treatment options are emerging.

Key Words: Lipoma, Laparoscopy, Postoperative complications, Intestinal diseases, Abdominal pain.

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The post Expulsion of Giant Intestinal Lipoma After Laparoscopic Roux-en-Y Gastric Bypass first appeared on JSLS.