Postoperative gastric dilatation causing abdominal compartment syndrome

<p>Abstract</p> <p>Objective</p> <p>To study the effect of postoperative gastric dilatation on intra-abdominal pressure (IAP).</p> <p>Design and setting</p> <p>Single case report from a primary teaching hospital.</p> <p>Patients and methods</p> <p>A 72-year-old woman demonstrated a sudden respiratory and cardiovascular collapse following resection of a retroperitoneal sarcoma. This collapse was caused by abdominal compartment syndrome due to gastric dilatation.</p> <p>Results</p> <p>The patient was re-explored, an enormously distended stomach was found with the nasogastric tube situated in a small sliding hernia which prevented drainage of the distended stomach. Re-positioning of the nasogastric tube, allowed the decompression of the stomach and the patient's condition immediately improved.</p> <p>Conclusion</p> <p>Acute abdominal distention following major abdominal surgery may result from acute gastric dilatation, leading to oliguria and increased airway pressures. Untreated gastric dilatation can cause abdominal compartment syndrome.</p

Laparoscopic diagnostic peritoneal lavage (L-DPL): A method for evaluation of penetrating abdominal stab wounds

BACKGROUND: The management of penetrating abdominal stab wounds has been the subject of continued reappraisal and controversy. In the present study a novel method which combines the use of diagnostic laparoscopy and DPL, termed laparoscopic diagnostic peritoneal lavage (L-DPL) is described METHOD: Five trauma patients with penetrating injuries to the lower chest or abdomen were included. Standard videoscopic equipment is utilized for the laparoscopic trauma evaluation of the injured patient. When no significant injury is detected, the videoscope is withdrawn and 1000 mL of normal saline is infused through the abdominal trochar into the peritoneal cavity, and the effluent fluid studied for RBCs, WBC, amylase debry, bile as it is uced in regular diagnostic peritoneal lavage RESULTS: Laparoscopic peritoneal lavage (L-DPL) was then performed and proved to be negative in all 5 patients. RBC lavage counts above 100,000/mcrl were not considered as a positive lavage result, because the bleeding source was directly observed and controlled laparoscopically. All patients recovered uneventfully and were released within 3 days. This procedure combines the visual advantages of laparoscopy together with the sensitivity and specificty of DPL for the diagnosis of significant penetrating intra-abdominal injury, when the diagnostic strategy of selective consevatism for abdominal stab wounds is adopted. CONCLUSION: A method of laparoscopic diagnostic peritoneal lavage (L-DPL) in hemodynamically stable patients with penetrating lower thoracic or abdominal stab wounds is described. The method is especially applicable for trauma surgeons with only basic experience in laparoscopic technique. This procedure is used to obtain conclusive evidence of significant intra-abdominal injury, confirm peritoneal penetration, control intra-abdominal bleeding, and repair lacerations to the diaphragm and abdominal wall. The combination of laparoscopy and DPL afforded by the L-DPL method adds to the sensitivity and specificity of DPL, and avoids under or over sesitivty, that have limited the use of DPL in the hemodynamically stable trauma patients with suspicious or proven peritoneal penetration

Laparoscopic totally extra peritoneal inguinal hernia repair – our method to treat inguinal hernia

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Correção de hérnia laparoscópica: tela sem fixação é viável? Laparoscopic hernia repair: nonfixation mesh is feasibly?

RACIONAL: Várias técnicas cirúrgicas têm sido desenvolvidas ao longo dos últimos anos, e a correção de hérnia inguinal pré-peritoneal totalmente extraperitoneal e transabdominal são as técnicas endoscópicas que são mais comumente utilizadas. OBJETIVOS: Descrever e discutir a técnica de Dulucq e as modificações do uso da tela 3-D na correção de hérnia inguinal totalmente extraperitoneal. MÉTODOS: Foram incluídos prospectivamente neste estudo pacientes submetidos à correção de hérnia inguinal eletiva. Foram estudados os aspectos operatórios e pós-operatórios. RESULTADOS: Um total de 261 correções herniárias foram incluídas neste estudo. Elas foram realizadas pela técnica totalmente extraperitoneal; duas (0,75%) foram convertidos para técnica anterior de Liechtenstein. O tempo operatório médio foi de 43,38 min em hérnia unilateral e 53,36 min em hérnia bilateral. A maioria dos pacientes (95%) teve alta no mesmo dia da operação. A taxa de morbidade pós-operatória foi de 5,7%. A incidência de recidiva foi de 0,0% em média de 26 meses. CONCLUSÃO: Hernioplastia totalmente extraperitoneal é procedimento eficaz e seguro nas mãos de cirurgiões experientes e com formação específica. É uma opção interessante para hérnia bilateral e recidivante, uma vez que obtém resultados satisfatórios em termos de dor pós-operatória e morbidade.<br>BACKGROUND: Several surgical techniques have been developed over the past years, and total extraperitoneal and transabdominal preperitoneal inguinal hernia repair are the endoscopic techniques that are most commonly used. AIM: To describe and discuss Dulucq's technique and the modifications of using 3-D mesh in total extraperitoneal inguinal hernia repair. METHODS: Patients who underwent an elective inguinal hernia repair were enrolled prospectively in this study. Operative and postoperative course were studied. RESULTS: A total of 261 hernia repairs were included in the study. The hernias were repaired by total extraperitoneal technique; two hernias (0.75%) were converted to open anterior Liechtenstein technique. Mean operative time was 43.38 min in unilateral hernia and 53.36 min in bilateral hernia. Most of the patients (95%) were discharged at the same day of the surgery. The overall postoperative morbidity rate was 5.7%. The incidence of recurrence rate was 0.0% in median follow-up period of 26 months. CONCLUSION: Total extraperitoneal hernioplasty is a very effective and safe procedure in the hands of experienced surgeons with specific training. It is an interesting option in bilateral and recurrent hernia as it obtains satisfactory results in terms of postoperative pain and morbidity

Is early appendectomy in adults diagnosed with acute appendicitis mandatory? A prospective study

Abstract Introduction Prompt appendectomy has long been the standard of care for acute appendicitis in order to prevent complications such as perforation, abscess formation, and diffuse purulent or fecal peritonitis, all resulting in increased morbidity and even mortality. Our study was designed to examine whether the time from the beginning of symptoms to operation correlates with the pathological degree of appendicitis, incidence of postoperative complications, or increased length of hospital stay. Methods A prospective study of 171 patients who underwent emergent appendectomy for acute appendicitis in the course of 2 years was conducted in a single tertiary medical center. The following parameters were monitored and correlated: demographics, time from the onset of symptoms until the arrival to the emergency department (patient interval (PI)), time from arrival to the emergency department (ED) until appendectomy (hospital interval (HI)), time from the onset of symptoms until appendectomy (total interval (TI)), physical examination, preoperative physical findings, laboratory data, pathologic findings, complications, and length of hospital stay. Results The degree of pathology and complications were analyzed according to the time intervals. The time elapsed from the onset of symptoms to surgery was associated with higher pathology grade (p = 0.01). We found that longer time from the onset of symptoms to hospital arrival correlates with higher pathology grade (p = 0.04), while there was no correlation between the hospital interval and pathology grade (p = 0.68). A significant correlation was found between the pathology grade and the incidence of postoperative complications as well as with increased length of hospital stay (p = 0.000). Conclusion Time elapsed from the symptom onset to appendectomy correlates with increased pathology grade and complication rate. This correlation was not related to the HI. Since the HI in our study was short, we recommend an early appendectomy in adults in order to shorten the TI and the resulting complications

Subjective discount rates among Israeli Arabs and Israeli Jews

In this study, we compare the subjective discount rate for Israeli Jews and Arabs. All the subjects were bank customers, who were asked to bid and ask prices for delayed fixed amounts and for lotteries. The two populations live in the same country under the same laws. Nevertheless, according to the literature, Israeli Arabs seem to be a discriminated minority, who exhibit traits of a traditional collectivist culture, while Israeli Jews are a majority, who exhibit traits of an individualistic culture. As a discriminated minority, Israeli Arab may suffer from lower trust and as a result, according to the "trust" hypothesis, exhibit higher subjective discount rates and higher risk aversion. On the other hand, according to the "cushion" hypothesis, a collectivist society such as Israeli Arabs, provides a safety net for the individual and as a result, he will exhibit lower subjective discount rates and lower risk-aversion. The experimental findings show that the subjective discount rate and risk aversion of Israeli Arabs are significantly higher than that of Israeli Jews. Moreover, higher percent of Israeli Jews are at the low range of the discount rates (below 10%) and lower percent of Israeli Jews are at the high range of discount rate (above 20%) compared to Israeli Arabs. This is consistent with the "trust" hypothesis. For Israeli Jews, the discount rates are closer to the bank interest rate, while Israeli Arabs rates are much higher particularly for receipt. The dispersion of the distribution of discount rate is much larger for Arabs than for Jews.Discounting Risk aversion Cross-cultural Israeli Arabs Israeli Jews

Comparison of Rhabdomyolysis Markers in Patients Undergoing Bariatric Surgery with Propofol and Inhalation-based Anesthesia

Background: Rhabdomyolysis is a relatively uncommon, severe complication of anesthesia and surgery in the morbidly obese. As the use of propofol-based anesthesia has been associated with an increased risk of rhabdomyolysis and metabolic acidosis, this pilot study was designed to assess the effect of propofol anesthesia on the incidence of rhabdomyolysis in morbidly obese patients undergoing bariatric surgery. Methods: Thirty, morbidly obese patients (body mass index 43 ± 3\ua0kg/m) scheduled for bariatric laparoscopic sleeve gastrectomy were randomized to receive either propofol (P) or inhalational anesthetic (I)-based balanced general anesthesia. A sample of venous blood gas analysis including pH, bicarbonate concentrations, and calculated base excess was taken at the end of the operation. Creatine phosphokinase (CPK), troponin I, blood urea nitrogen, and creatinine plasma concentrations were measured at the end of the surgery and again 24\ua0h later. Results: All patients enrolled to the study completed it without significant complications. CPK, troponin I, blood urea nitrogen, and creatinine plasma concentrations at the end of the operation and at 24\ua0h, as well as the bicarbonate concentration and the base excess at the end of the operation were not significantly different between the two study groups. A statistically significant mild respiratory acidosis was noted in the inhalational anesthetic group (pH\ua07.30 ± 0.04 vs. 7.36 ± 0.02 in the propofol group) Conclusions: This small-size pilot study may suggest that propofol-based anesthesia is not related to increased incidence of rhabdomyolysis in morbidly obese patients undergoing short, uncomplicated bariatric surgery