Image-guided Retrieval of Foreign Body in the Abdomen - A Case Report

The presence of retained surgical blade as a foreign body is uncommon and poses significant patient safety challenge issues. Most common etiologies for the presence of such foreign bodies are accidental, traumatic, or iatrogenic. Here, we report a successful management of the case with a rare foreign body in the abdomen, that is, surgical blade accidentally left during pigtail procedure of the liver abscess. Most of the iatrogenic injuries are preventable. In our case, a misfit of a blade in the handle might have been responsible for the complication. The use of radiological guidance for localization and removal of the foreign bodies embedded in the soft tissues is well established. With imaging guidance retrieval of a foreign body in the abdomen, laparotomy was prevented and facilitated early recovery

Ileosigmoid knotting—A disastrous double closed loop obstruction

AbstractINTRODUCTIONIleosigmoid knotting (ISK) is a rare entity which needs prompt recognition and immediate surgical intervention to avoid catastrophic complications caused by gangrenous bowel and subsequent peritonitis. Preoperative investigations are only diagnostic of obstruction and CT findings are helpful but are not always available.PRESENTATION OF CASEThis case report describes a 22 year old male presenting with acute abdomen managed with emergency exploration in view of findings of peritonitis. Intra-operatively an ileal segment was wrapped around the base of sigmoid colon with gangrenous ileal segment suggesting ISK. Resection of gangrenous ileal segment with double barrel ileostomy was done. Patient tolerated procedure well.DISCUSSIONPatients with ileosigmoid knotting present with frank obstruction and require immediate medical and surgical treatment. This condition rapidly progresses to gangrenous bowel, generalized peritonitis and sepsis with very high mortality.CONCLUSIONEarly diagnosis, prompt fluid resuscitation, preoperative antibiotics and immediate surgical exploration are keys for optimal management of this condition

Indian Survey on Management of Choledocholithiasis—Opportunities for Improvement and Future Studies

Background In clinical practice, decision about management of choledocholithiasis is driven by availability of resources and expertise, patients and healthcare professional preferences. This survey is aimed to describe the approach of physicians and surgeons for the management of choledocholithiasis. Method A 36-question online survey was conducted using Google Forms on various aspects of management of choledocholithiasis. Results The responses from 323 participants were included, of which 202 (62.54%) were physicians and 121 (37.46%) were surgeons. The proportion of responders who do not follow American or European Society of Gastrointestinal Endoscopy guidelines is associated with increasing age and experience of responders (p = 0.0001), while place of work (private vs. teaching) and broad specialty (physician vs surgeon) are not associated (p >0.05). For patients with high likelihood of choledocholithiasis, 123 (38.1%) participants prefer to do endoscopic ultrasound/magnetic resonance cholangiopancreatography (EUS/MRCP) rather than directly performing endoscopic retrograde cholangiopancreatography/intraoperative cholangiography (ERCP/IOC). For intermediate likelihood, MRCP is more commonly preferred compared with EUS, due to local availability (44%), expertise (39.6%), healthcare professionals preference (30.7%), and patients preference (17.3%). For difficult common bile duct (CBD) stones, short biliary sphincterotomy with large balloon sphincteroplasty (59.4%), followed by laparoscopic CBD exploration are commonly used approaches. Prophylactic CBD stent placement after ERCP and CBD clearance is common practice. Preoperative ERCP followed by cholecystectomy is more preferred approach than cholecystectomy and CBD exploration. Conclusion There is considerable variability in the management of choledocholithiasis. The practices such as use of EUS/MRCP for high likelihood group, use of prophylactic CBD stent placement after ERCP and CBD clearance, and use of single stage approach especially in patient with intermediate likelihood group should be addressed in future studies