University of Toledo College of Medicine, Toledo, OH, USA (all authors). Department of Urology, University of Toledo Medical Center, Toledo, OH, USA (Dr. Jain).

ABSTRACT

Introduction: Weck Hem-o-Lok (Teleflex Medical, Research Triangle Park, North Carolina) clips are frequently used to achieve hemostasis of the lateral prostatic pedicles during radical prostatectomy. Rarely, these clips can detach and migrate into the bladder wall, leading to postoperative urinary tract complications. Hem-o-Lok clip migration into the bladder is a rare complication of laparoscopic radical prostatectomy that has been reported within 1 year postsurgery.

Case Report: We report the case of a 61-year-old white man who presented with urinary stress incontinence, acute urinary retention, and a history of recurrent urinary tract infections more than 2 years after salvage robot-assisted laparoscopic radical prostatectomy for recurrent prostate cancer that was unsuccessfully treated with brachytherapy. As part of his diagnostic workup, cystoscopy demonstrated an open bladder neck with no evidence of contracture and the presence of a calcification near the vesicourethral anastomosis. Unroofing these calcifications via laser lithotripsy revealed two eroded Hem-o-Lok clips, which were subsequently removed from the bladder wall.

Conclusion: Salvage prostatectomy after radiotherapy as the primary treatment for prostate cancer may increase the window of time in which intravesical clip migration can occur because of delayed wound healing at the vesicourethral anastomosis. Furthermore, clip migration can present with signs of urinary tract dysfunction in the absence of bladder neck contracture and beyond the time frame initially expected.

Key Words: Prostatic neoplasms, Prostatectomy, Laparoscopy, Urinary incontinence, Postoperative complications.

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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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