OB/GYN Hospitalist, Department of Obstetrics & Gynecology, Northwest Community Hospital, Arlington Heights, IL, USA (Dr. Markuly). Director, Minimally Invasive Gynecologic Surgery, Advocate Lutheran General Hospital, Park Ridge, IL, USA and Director, AAGL/SRS Fellowship in Minimally Invasive Gynecologic Surgery, Advocate Lutheran General Hospital, USA (Dr. Miller). Undergraduate, Northwestern University, Evanston, IL, USA (Szela).

ABSTRACT

Introduction: Uterine rupture is an acute obstetric emergency requiring a rapid response by a multidisciplinary team of physicians and allied health care professionals to minimize the risk of both maternal and neonatal morbidity and death. A risk factor is previous myomectomy. Robotic-assisted laparoscopic myomectomy is a technologically cutting-edge approach to a common surgical procedure, myomectomy. Pregnancy after robotic-assisted laparoscopic myomectomy has been reported in the literature.

Case Description: We report a case of spontaneous uterine rupture in a subsequent pregnancy after robotic-assisted laparoscopic myomectomy.

Discussion: With use of robotic assistance, the technique changes when compared with standard laparoscopic myomectomy. Areas of potential concern are the amount and type of energy required to excise the fibroid from the myometrial bed.

Key Words: Myomectomy, Uterine Rupture, Robotic Surgery, Laparoscopy, Spontaneous, Pregnancy.

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Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, IL, USA (all authors).

ABSTRACT

Introduction: India ink is routinely used for preoperative marking of colonic lesions to facilitate identification during laparoscopic colon surgery. It is a relatively inert dye with few reported adverse effects.

Case Description: We report a case of inadvertent extracolonic tattooing and intra-peritoneal spillage of India ink leading to adhesions and formation of a mass, which mimicked malignancy. The relevant literature is also reviewed.

Discussion: Although India ink is a safe dye for colonic tattooing and most of its complications are asymptomatic, it can occasionally lead to complications that might mimic malignancy and cause a diagnostic dilemma.

Key Words: India ink, Small bowel mass, Malignancy, Complication, Endoscopy.

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Ajit Pai, MCh, Jan P. Kaminski, MD, John J. Park, MD, Slawomir J. Marecik, MD, Leela M. Prasad, MD

Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, IL, USA (Drs. Pai, Park, Marecik, and Prasad). Department of General Surgery, UIC Metropolitan Group Hospitals Residency Program, Chicago, IL, USA (Dr. Kaminski).

ABSTRACT

Introduction: Crohn’s stricture of the ileal J pouch is an important cause of pouch failure and a difficult condition to treat endoscopically. We seek to document the successful endoscopic treatment of fibrostenotic Crohn’s strictures of the afferent limb of the ileal J pouch in a typical patient.

Case and Technique Description: Endoscopic stenting of the strictured segment was performed with a special covered esophageal wall stent, with the technique being refined over multiple episodes of stenting. Ultimately, a partially covered nitinol double-flared esophageal stent led to the optimal outcome.

Discussion: Successful pouch salvage, good quality of life, and avoidance of ileostomy for the past 7 years were achieved. Endoscopic stenting is an important technique in the armamentarium of the surgeon and gastroenterologist to effectively treat fibrostenotic Crohn’s strictures of the ileoanal pouch and can successfully avoid the need for complex abdominal procedures, pouch takedown, and permanent ileostomy.

Key Words: J pouch, Proctocolectomy restorative, Crohn’s disease, Stricture, Stents.

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