Bowel obstruction from benign adnexal mass i an elderly patient

Bowel obstruction resulting from ovarian masses is a serious complication of these diseases. This may be caused by bulky masses filling the pelvis and the abdomen, and should be carefully worked out by pre-operative imaging because of their non-specific clinical signs that may be confused with those due to other conditions such as: volvulus, cancer or adhesions. We report the case of a 70 years old woman with a bulky pelvic-abdominal mass of 27 × 20 cm that was found to be an “ovarian serous cystadenoma” and clinical signs of intestinal obstruction, which was treated by uterus sparing surgery

Laparoscopic cholecystectomy in acute cholecystitis: A proposal of safe and effective technique

Laparoscopic cholecystectomy is slowly taking its place also in an emergency setting, regardless of its initial unfortunate course when iatrogenic lesions during surgery, complications and conversion rate make the laparoscopic approach in acute cholecystitis a hazard. With the development of laparoscopic technique, the laparoscopic cholecystectomy for acute cholecystitis becomes a reality, but its role in emergency is not yet defined. From December 1998 to December 2005, 133 consecutive laparoscopic cholecystectomies for acute cholecystitis were performed in our institution by the same surgeon. The mean age of patients was 48 years old, 21 were over seventy. In the series patients in ASA III and IV were included. All procedures were performed with the same technique, developed in the examined period, which represents a standardized downwards laparoscopic cholecystectomy, easy to reproduce and safe to perform. We report our surgical technique and our results. We did not report mortality, and there was very low morbidity. Only one patient was converted, giving an extremely low conversion rate of 0.7%. The average operating time was 52 min (range 17-70 min). Analyzing the operating time and the time between the onset of symptoms to surgery, we found that these two variables seem to be alike with a linear relationship; we found that the best timing for surgery is within 60 hr from the onset of symptoms. The latter analysis is reported. Laparoscopic cholecystectomy, when performed with an adequate technique and as early as possible represents a safe procedure to treat acute cholecystitis in an emergency setting. The technique described, considering the results, lack of iatrogenic lesions and acceptable operating time, represents a standardized surgical strategy to approach acute cholecystitis (AC) in a safe, effective and reproducible manner. © H.G.E. Update Medical Publishing S.A

Mechanical small bowel obstruction due to an inflamed appendix wrapping around the last loop of ileum

Acute apendicitis rarely presents with a clinical picture of mechanical small-bowel obstruction. The Authors report a case of this inusual clinical occurrence, arised like a complication of a common disease, characterized by a chronically inflamed appendix (mucocele) wrapping around the last loop of ileum that produced volvolus and strangulation. The few similar cases reported in the literature are moreover reviewed