Foreign body ingestion in children: 67 cases presenting in Pediatric Emergency

Aim: The aim of the study was to determine the clinical presentation, types and characteristics of foreign bodies in the pediatric age group and their management. Materials and Methods: The study was conducted over a period of 6 months. Out of 100 random cases with age <14 years attending emergency department with the suspicion of foreign body ingestion, 67 cases were included in the study. Note was made of their clinical presentation, diagnosis, type of foreign body ingested, whether spontaneously passed or not, management and outcome. Results: Most of the children were between 6 months and 6 years of age. A variety of gastrointestinal symptoms such vomiting and drooling as well as respiratory symptoms such as coughing and stridor were associated with foreign body ingestion. The oesophagus, in particular the upper third, was the common site of foreign body obstruction. Coins were the most commonly ingested foreign body. Objects in the stomach and intestine were spontaneously passed more frequently than at any other sites in the gastrointestinal system. Conclusion: Foreign body ingestion is a common pediatric problem presenting with a wide range of symptoms depending upon the site of lodgement. Although most foreign bodies in the gastrointestinal tract pass spontaneously without complications, endoscopic or surgical removal may be required in a few children. Endoscopy has a high success rate in removing ingested foreign bodies. Laparotomy may be required rarely when foreign body gets impacted in intestine. Sharp objects should be removed immediately to avoid complications while others can be observed for spontaneous passage

Evaluation of low-pressure pneumoperitoneum laparoscopic cholecystectomy

Laparoscopic cholecystectomy has become the most standard procedure for management of symptomatic cholelithiasis or acute cholecystitis in patients without and specific contraindications. Exposure of gallbladder anatomy during laparoscopic cholecystectomy requires creation of pneumoperitoneum by carbon dioxide insufflation. However, the application of carbon dioxide pneumoperitoneum may induce undesirable consequences due to either hypercapnea or increased intraabdominal pressure. The physiological changes observed during laparoscopic surgery are a result of patient position, introduction of exogenous insufflation gas and increased intraabdominal pressure due to pneumoperitoneum. Although laparoscopic cholecystectomy results in less postoperative pain and reduced analgesic consumption as compared with open cholecystectomy. The type of pain after laparoscopy differs considerably from that after laparotomy i.e; visceral pain. Shoulder pain is a common complaint following laparoscopic surgery, initially being recognised by gynaecologists during early experience with laparoscopic sterilization. The present study was conducted to evaluate the technique of low-pressure pneumoperitoneum during laparoscopic cholecystectomy. Fifty patients admitted for elective laparoscopic cholecystectomy were included in the study. Laparoscopic cholecystectomy was performed using standard four ports. Low pressure pneumoperitoneum was generated using carbon dioxide insufflation at a pressure of 8 mmHg. Rest of the steps followed were same as in conventional laparoscopic cholecystectomy. No major intraoperative or postoperative complication was noted. No conversion was required to standard pressure laparoscopic cholecystectomy or open cholecystectomy. Low-pressure pneumoperitoneum offers the surgeon the same safety and versatility during laparoscopic cholecystectomy as it confers during normal pressure pneumoperitoneum and helps in reducing immediate postoperative complications especially postoperative shoulder pain

Clinical evaluation of fundus first laparoscopic cholecystectomy in obscured calot’s triangle

Background: During laparoscopic cholecystectomy dissection at the calot’s triangle can be difficult due to dense adhesions, abnormal anatomy or mirizzi’s syndrome. This increases the incidence of bile duct injuries resulting in conversion to open cholecystectomy and increased hospital stay and cost effectiveness and decreases the advantages conferred by laparoscopic cholecystectomy. Fundus first laparoscopic cholecystectomy offers the advantage of laparoscopic surgery without any increase in the incidence of bile duct injuries. This study was done to evaluate and observe the complications and clinical outcome of fundus first laparoscopic cholecystectomy. Material Methods: The prospective study was conducted on 30 patients undergoing fundus first laparoscopic cholecystectomy over a period of one year. Approval for the study was obtained from the institutional ethical committee. During laparoscopic cholecystectomy where ever the calot’s triangle was found obscured, the decision of performing laparoscopic cholecystectomy using the fundus first technique was taken. Intraoperative and postoperative observations were made and complications were noted. Results: Fundus First Laparoscopic cholecystectomy was done in 30 patients among 138 patients undergoing Laparoscopic cholecystectomy. 73% of our patients had marked fibrosis at cystic pedicle. Operating time in our cases ranged from 80 to 140 minutes (mean, 106.73 ± 16.85 minutes). We observed a mean hospital stay of 7.70 ± 2.55 days in present study (range, 5 - 15 days). We had two cases of External biliary fistula due to leakage from stump and got settled with endoscopic retrograde cholangiopancreatography (ERCP) stenting. We had port site infection in 3 cases and drain site infection in 2 cases. Conclusion: Fundus first laparoscopic cholecystectomy is a better alternative and a bail out procedure in difficult cholecystectomy reducing incidence of bile duct injuries and offers the surgeon the same safety and versatility during laparoscopic cholecystectomy that it confers during open cholecystectom