Bouveret Syndrome in an Elderly Female

ABSTRACT Introduction: A gastric outlet obstruction secondary to a gallstone ileus is known as Bouveret syndrome. Herein we present a case of an elderly woman with an impacted gallstone in duodenum and discuss its' management. Patient description: A 96-year-old woman was admitted to our department due to a gastric outlet obstruction. Initial gastroscopy revealed a gastric bezoar. An attempt for its extraction failed. She underwent a laparotomy in which a cholecystoduodenal fi stula and a large impacted stone were found. Separation of the fi stula, including closure of the duodenum side, cholecystectomy and removal of the obstructing gallstone were performed. Additional stones were found and retrieved during common bile duct (CBD) exploration. Surgery was fi nalized by duodenoplasty, closure and T-tube drainage of the CBD. Post-operative course was prolonged and uneventful. Discussion and Conclusions: Bouveret syndrome is a rare cause of gastric outlet obstructions. In this case, unsuccessful endoscopic treatment necessitated surgery for removal of impacted gallstone in the duodenum

The SCARE Statement: Consensus-based surgical case report guidelines

AbstractIntroductionCase reports have been a long held tradition within the surgical literature. Reporting guidelines can improve transparency and reporting quality. However, recent consensus-based guidelines for case reports (CARE) are not surgically focused. Our objective was to develop surgical case report guidelines.MethodsThe CARE statement was used as the basis for a Delphi consensus. The Delphi questionnaire was administered via Google Forms and conducted using standard Delphi methodology. A multidisciplinary group of surgeons and others with expertise in the reporting of case reports were invited to participate. In round one, participants stated how each item of the CARE statement should be changed and what additional items were needed. Revised and additional items from round one were put forward into a further round, where participants voted on the extent of their agreement with each item, using a nine-point Likert scale, as proposed by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) working group.ResultsIn round one, there was a 64% (38/59) response rate. Following adjustment of the guideline with the incorporation of recommended changes, round two commenced and there was an 83% (49/59) response rate. All but one of the items were approved by the participants, with Likert scores 7–9 awarded by >70% of respondents. The final guideline consists of a 14-item checklist.ConclusionWe present the SCARE Guideline, consisting of a 14-item checklist that will improve the reporting quality of surgical case reports

The role of open abdomen in non-trauma patient : WSES Consensus Paper

The open abdomen (OA) is defined as intentional decision to leave the fascial edges of the abdomen un-approximated after laparotomy (laparostomy). The abdominal contents are potentially exposed and therefore must be protected with a temporary coverage, which is referred to as temporal abdominal closure (TAC). OA use remains widely debated with many specific details deserving detailed assessment and clarification. To date, in patients with intra-abdominal emergencies, the OA has not been formally endorsed for routine utilization; although, utilization is seemingly increasing. Therefore, the World Society of Emergency Surgery (WSES), Abdominal Compartment Society (WSACS) and the Donegal Research Academy united a worldwide group of experts in an international consensus conference to review and thereafter propose the basis for evidence-directed utilization of OA management in non-trauma emergency surgery and critically ill patients. In addition to utilization recommendations, questions with insufficient evidence urgently requiring future study were identified.Peer reviewe

The SCARE Statement: Consensus-based surgical case report guidelines

Introduction: Case reports have been a long held tradition within the surgical literature. Reporting guidelines can improve transparency and reporting quality. However, recent consensus-based guidelines for case reports (CARE) are not surgically focused. Our objective was to develop surgical case report guidelines.Methods: The CARE statement was used as the basis for a Delphi consensus. The Delphi questionnaire was administered via Google Forms and conducted using standard Delphi methodology. A multidisciplinary group of surgeons and others with expertise in the reporting of case reports were invited to participate. In round one, participants stated how each item of the CARE statement should be changed and what additional items were needed. Revised and additional items from round one were put forward into a further round, where participants voted on the extent of their agreement with each item, using a nine-point Likert scale, as proposed by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) working group.Results: In round one, there was a 64% (38/59) response rate. Following adjustment of the guideline with the incorporation of recommended changes, round two commenced and there was an 83% (49/59) response rate. All but one of the items were approved by the participants, with Likert scores 7–9 awarded by >70% of respondents. The final guideline consists of a 14-item checklist.Conclusion: We present the SCARE Guideline, consisting of a 14-item checklist that will improve the reporting quality of surgical case reports.</p

Nonoperative management of blunt splenic and liver injuries in adult polytrauma

Background: Isolated splenic or hepatic injuries are present in approximately 30% of all cases of adult abdominal trauma. Most authors quoted above have limited nonoperative management (NOM) to patients with isolated organ injury. Results of NOM following blunt hepatic and splenic trauma in patients with multiple injuries were evaluated in this study. Materials and Methods: Retrospective chart review was performed on multiple injured adults with splenic and liver injures resulting from blunt trauma. Associated injuries, clinical signs at presentation, used diagnostic tools, injury grading, transfusion requirements, morbidity and mortality were documented. Results: Medical records of 275 patients aged from 17 to 81 years with blunt splenic and liver trauma and associated injuries were analyzed. Patients with hemodynamic instability or obvious peritoneal signs were excluded from further study. Surgery was indicated in 106 patients without response or transient response for fluid challenge. 131 of 237(55%) patients were selected for NOM: 78 with splenic, 46 with liver and 7 with injuries to both. 25(19%) patients were older 55 years. The mean injury severity score was 25.2. Injury grade ranged from I-IV and the degree of hemoperitoneum was from mild to severe. 8 patients failed NOM (6%). Mean blood transfusion requirement during first 24 hours at admission was 0.3 units. Morbidity rate was 1.2%. Two patients (1.5%) died following severe head trauma. Conclusion: Nonoperative strategy is the preferred modality for the care of blunt splenic and liver injuries in the hemodynamically stable patients, irrespective of age, grade of injury, associated injuries or degree of hemoperitoneum

Laparoscopic resection of duodenal gastrointestinal stromal tumour

Only a few studies have revealed using laparoscopic technique with limited resection of gastrointestinal stromal tumour (GIST) of the duodenum. A 68-year-old man was admitted to the hospital due to upper gastrointestinal (GI) bleeding. Evaluation revealed an ulcerated, bleeding GI tumour in the second part of the duodenum. After control of bleeding during gastroduodenoscopy, he underwent a laparoscopic wedge resection of the area. During 1.5 years of follow-up, the patient is disease free, eats drinks well, and has regained weight. Surgical resection of duodenal GIST with free margins is the main treatment of this tumour. Various surgical treatment options have been reported. Laparoscopic resection of duodenal GIST is an advanced and challenging procedure requiring experience and good surgical technique. The laparoscopic limited resection of duodenal GIST is feasible and safe, reducing postoperative morbidity without compromising oncologic results

The outcome of local excision of large rectal polyps by transanal endoscopic microsurgery

Introduction: Local excision of large rectal polyps can be an alternative for radical rectal resection with total mesorectal excision. We aim to report the functional and oncological outcomes of transanal endoscopic microsurgery (TEM) for patients with large rectal polyps. Methods: All demographic and clinical data of patients who underwent TEM for rectal polyp of 5 cm or more at the Hasharon Hospital from 2005 to 2018 were retrospectively reviewed. Results: Twenty-eight patients were included. The mean age was 66 years. The mean polyp size was 6.2 cm (range: 5–8.5 cm) with a mean distance of 8.3 cm from the anal verge. Peritoneal entry during TEM was observed in five patients and additional laparoscopy after the completion of the TEM was performed in four patients. There were no major perioperative complications. Seven patients had minor complications. Final pathology revealed T1 carcinoma in five patients and T2 carcinoma in three patients. Re-TEM was performed in one patient with involved margins with adenoma. After a median follow-up of 64 months, one patient had local recurrence. Conclusion: TEM is an acceptable technique for the treatment of large polyps with minor complications and a reasonable recurrence rate. TEM may be considered regardless of the size of the rectal polyp

Nonoperative management of blunt splenic and liver injuries in adult polytrauma

Background: Isolated splenic or hepatic injuries are present in approximately 30% of all cases of adult abdominal trauma. Most authors quoted above have limited nonoperative management (NOM) to patients with isolated organ injury. Results of NOM following blunt hepatic and splenic trauma in patients with multiple injuries were evaluated in this study. Materials and Methods: Retrospective chart review was performed on multiple injured adults with splenic and liver injures resulting from blunt trauma. Associated injuries, clinical signs at presentation, used diagnostic tools, injury grading, transfusion requirements, morbidity and mortality were documented. Results: Medical records of 275 patients aged from 17 to 81 years with blunt splenic and liver trauma and associated injuries were analyzed. Patients with hemodynamic instability or obvious peritoneal signs were excluded from further study. Surgery was indicated in 106 patients without response or transient response for fluid challenge. 131 of 237(55%) patients were selected for NOM: 78 with splenic, 46 with liver and 7 with injuries to both. 25(19%) patients were older 55 years. The mean injury severity score was 25.2. Injury grade ranged from I-IV and the degree of hemoperitoneum was from mild to severe. 8 patients failed NOM (6%). Mean blood transfusion requirement during first 24 hours at admission was 0.3 units. Morbidity rate was 1.2%. Two patients (1.5%) died following severe head trauma. Conclusion: Nonoperative strategy is the preferred modality for the care of blunt splenic and liver injuries in the hemodynamically stable patients, irrespective of age, grade of injury, associated injuries or degree of hemoperitoneum