Department of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA (Drs McCormack and Bowne).

ABSTRACT

Introduction: Wandering spleen is a rare condition in which the spleen lacks or has extreme laxity of associated ligaments, enabling it to float freely throughout the abdomen. This condition most commonly presents as splenic ischemia secondary to torsion of the vascular pedicle and is most commonly treated with splenectomy over splenic salvage.

Case Description: We present the case of a 34-year-old woman with wandering spleen who underwent a technique for laparoscopic splenopexy in which a fibrin sealant is applied between the splenic capsule and lateral abdominal wall for splenic fixation.

Conclusion: This technique can be performed by surgeons trained in basic laparoscopy and may be used to increase splenic salvage.

Key Words: Splenopexy, Wandering spleen.

The post Technique of Splenopexy for Wandering Spleen 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.

Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, PA, USA (Dr. Pereira). Division of Minimally Invasive Surgery, Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, PA, USA (Drs. Grias, Della Badia).

ABSTRACT

Introduction: Perforation of the uterus or fallopian tube during microinsert placement, with subsequent migration of the microinsert into the abdominopelvic cavity, is a known complication.

Case Description: A 38-year-old woman underwent hysteroscopic tubal sterilization with Essure microinserts (Conceptus, Mountain View, California). She returned 4 months later for hysterosalpingography, during which only part of the right microinsert was identified in the right cornu of the uterus. The remaining part of the microinsert was suspected to be in the pelvic cavity. Laparoscopy showed one fragment of the right microinsert projecting from the right cornu; the remaining fragment was incorporated into the serosa of the distal ileum. After an intraoperative consultation with the colorectal surgery team, both fragments of the microinsert were left as is, and tubal fulguration for sterilization was performed.

Discussion: Although perforated microinserts can cause small-bowel obstruction or perforation, our case highlights the asymptomatic incorporation of a microinsert into the serosa of the distal ileum.

Key Words: Essure, Hysteroscopy, Complications, Small bowel, Migration.

The post Asymptomatic Serosalized Essure Microinsert in the Distal Ileum first appeared on JSLS.