Case Report Intraluminal Bowel Erosion: A Rare Complication of Retained Gallstones after Cholecystectomy

Laparoscopic cholecystectomy for acute cholecystitis and cholelithiasis is one of the most common operations performed in the United States. Inadvertent perforation and spillage of gallbladder contents are not uncommon. The potential impact of subsequent retained gallstones is understated. We present the case of an intraperitoneal gallstone retained from a previous cholecystectomy eroding into the bowel and leading to intraluminal mechanical bowel obstruction requiring operative intervention. This case illustrates the potential risks of retained gallstones and reinforces the need to diligently collect any dropped stones at the time of initial operation

Use of the esophageal echo-Doppler to guide intensive care unit resuscitations: A retrospective study

Purpose: The esophageal Doppler monitoring (EDM) has emerged as an alternative to the pulmonary artery catheter (PAC). The purpose of this study is to better define its role in the ICU. Materials and Methods: Retrospective review of Hemosonic 100 EDM probe use between 2003 and 2005. Patient- and EDM-related characteristics, indications, complications, resuscitation end points (lactate, base excess - BE, left ventricular ejection time - LVET) were recorded. Comparisons between EDM and PAC were made. Results: Thirty-nine patients were monitored using the EDM. EDM-guided interventions resulted in significantly improved lactate, BE and LVET (all, P < 0.01). The change in BE correlated with change in LVET (R=0.7143, P < 0.0002). Cardiac output (CO) measurements by EDM and PAC were compared using the Bland-Altman method (mean = 0.0167, standard deviation = 0.9351, variance = 0.8745, 95% CI -1.854 to 1.887), which demonstrated that the EDM tended to underestimate CO in the lower ranges of measurements and overestimate CO in the upper ranges. Conclusions: EDM may be most helpful in ventilated/sedated patients requiring short-term hemodynamic monitoring. When compared to PAC, the EDM tends to underestimate CO in the lower range and overestimate CO in the upper range of measurements. We recommend EDM use concurrently with end-points of resuscitation