Three-Port Laparoscopic Cholecystectomy in a Brazilian Amazon Woman with Situs Inversus Totalis: Surgical Approach

Situs inversus totalis (SIT) is an uncommon anomaly characterized by transposition of organs to the opposite side of the body in a mirror image of normal. We report on an adult woman, born and resident in Brazilian Amazonia, presenting acute pain located at the left hypochondrium and epigastrium. During clinical and radiological evaluation, the patient was found to have SIT and multiple stones cholelithiasis. Laparoscopic cholecystectomy was safely performed with the three-port technique in a reverse fashion. In conclusion, this case confirms that three-port laparoscopic cholecystectomy is a safe and feasible surgical approach to treat cholelithiasis even in rare and challenging conditions like SIT

Foreign bodies ingestion: what responsibility?

The ingestion of foreign bodies is one of the most important and difficult emergencies for a physician to diagnose. Accidental ingestion is more common in children, in patients with dental implants, in individuals with mental disability and in drug users. Voluntary ingestion is found in patients who are psychologically unstable, in prisoners or those who attempt suicide. Foreign bodies may be divided into food as fish bones, chicken bones, food bolus, meat, etc. or real foreign bodies such as orthodontic implants, needles, pins, glass, coins, etc. The authors present a case of management, from the medicolegal point of view, of a female patient age 80, who complained, for some weeks of modest pain in the left iliac fossa, and afterwards the endoscopy showed a toothpick into the wall of the sigmoid colon. Assessed of the clinical status of the patient presented severe cardiac comorbidities so that before processing the patient to a second resolutive endoscopy, it was necessary to obtain the hemodynamic stability. However the management of cases of accidental ingestion of foreign bodies is particularly difficult. Medical errors can arise from the very first contact with the patient resulting in delays in appropriate treatment. The doctor to avoid compromising its position on medical liability, must use all the knowledge and diligence known by the art and science of medicine

Il dolore addominale acuto in chirurgia d'urgenza. Studio clinico-epidemiologico su 450 pazienti

A retrospective study on 450 patients admitted in emergency with acute abdominal pain in a general surgical unit of the Ist Institute of Surgery of the University of Rome "La Sapienza" was carried out during a 7 years period. The aim of the study was to identify the most frequent causes of acute abdominal pain correlated with age, sex, onset of pain and other conditions in order to improve diagnosis and reduce mobility for mortality. Appendicitis was the most frequent diagnosis (75 pts = 16.4%). Non-specific abdominal pain (NSAP), found in 71 pts (15.5%), cholelithiasis in 57 pts (12.5%), abdominal malignancy in 47 pts (10.3%) were other frequent conditions. The largest number of admissions occurred in the age groups 60-70 years (16.6%) and 20-30 years (14.2%). Surgical operations were performed in 206 patients (45.7%). The overall mortality was 4.2% (19/450 pts) and the rate increased significantly in patients aged > 60 years. Postoperative mortality was 5.8% (12/206 pts) while mortality rate in non-operated patients was 2.8%. The causes of perioperative death included perforated peptic ulcer, abdominal malignancies (15.4%) and urgent colonic resections (9.4%). The duration of inpatients stay increased significantly with the age of the patients, including those with nsap. The results of the study indicate a need to review the methods of diagnosis of appendicitis and to obtain a better clinical performance in patients with nsap