Feasibility of laparoscopy for small bowel obstruction

<p>Abstract</p> <p>Background</p> <p>Adherential pathology is the most common cause of small bowel obstruction. Laparoscopy in small bowel obstruction does not have a clear role yet; surely it doesn't always represent only a therapeutic act, but it is always a diagnostic act, which doesn't interfere with abdominal wall integrity.</p> <p>Methods</p> <p>We performed a review without any language restrictions considering international literature indexed from 1980 to 2007 in Medline, Embase and Cochrane Library. We analyzed the reference lists of the key manuscripts. We also added a review based on international non-indexed sources.</p> <p>Results</p> <p>The feasibility of diagnostic laparoscopy is high (60–100%), while that of therapeutic laparoscopy is low (40–88%). The frequency of laparotomic conversions is variable ranging from 0 to 52%, depending on patient selection and surgical skill. The first cause of laparotomic conversion is a difficult exposition and treatment of band adhesions. The incidence of laparotomic conversions is major in patients with anterior peritoneal band adhesions. Other main causes for laparotomic conversion are the presence of bowel necrosis and accidental enterotomies. The predictive factors for successful laparoscopic adhesiolysis are: number of previous laparotomies ≤ 2, non-median previous laparotomy, appendectomy as previous surgical treatment causing adherences, unique band adhesion as phatogenetic mechanism of small bowel obstruction, early laparoscopic management within 24 hours from the onset of symptoms, no signs of peritonitis on physical examination, experience of the surgeon.</p> <p>Conclusion</p> <p>Laparoscopic adhesiolysis in small bowel obstruction is feasible but can be convenient only if performed by skilled surgeons in selected patients. The laparoscopic adhesiolysis for small bowel obstruction is satisfactorily carried out when early indicated in patients with a low number of laparotomies resulting in a short hospital stay and a lower postoperative morbidity. Although a higher small bowel obstruction recurrence remains the major postoperative risk of the laparoscopic management of these patients.</p

Virtual colonoscopy in stenosing colorectal cancer

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A case of esophageal perforation: Clinical and diagnostic management in emergency medicine

Esophageal perforation is a welldefined and severe clinical condition. The associated mortality rates range between 5% and 40% and are worsened by delayed diagnosis. Rapid diagnosis and therapy provide the best chance for survival; however, a delay in diagnosis is common, resulting in substantial morbidity and mortality. There are several aetiologies of esophagus perforation. Most esophageal ruptures are secondary to medical instrumentation. Other causes are Boerhaave syndrome, toxic ingestions and radiation, foreign body ingestion, penetrating trauma, and, rarely, blunt chest trauma. We reported the clinical management and the diagnostic work-up case of esophagus perforation due to the foreign body ingestion