Early diagnosis of anastomotic dehiscence after colonic surgery

Anastomotic leaks are often responsible for severe sepsis can lead to death. Rapid diagnosis and early intervention are needed to improve prognosis. To identify predictors of early diagnosis of anastomotic leakage after colonic resection followed by immediate anastomosis without protective stoma to ensure a rapid therapeutic care and improve prognosis. This retrospective study involved patients who had a colonic resection over a period from 1st January 1998 to December 31th, 2009. The diagnosis of anastomotic dehiscence was selected on clinical, radiological and / or surgery. Statistical analysis was undertaken to identify clinical and biological changes leading to early diagnosis. The significance level was set at 0.05. Anastomotic leaks were identified in 28 patients, a rate of 8.9%. Revision surgery was indicated in 23 patients. Univariate analysis identified 3 preoperative factors associated with anastomotic dehiscence [ASA score, the urgency of intervention, and neoplastic etiology], and 5 postoperative factors [parietal complications, respiratory problems, the cardiac disorders, neurological disorders, and bloating]. Multivariate analysis identified only three factors related to the anastomotic dehiscence, they were respiratory symptoms, bloating, and neurological disorders. The median length of stay was 15.6 days [5-84] The mortality rate was 1.2%. It was higher in patients with leakage [7.4%] than in patients without leakage [0.7%] Better knowledge of these early clinical and laboratory manifestations related to anastomotic leaks, can ask the early indication of a radiological drainage or reoperation, which can improve the prognosis of this dreaded disease

[Laparoscopic treatment of mechanical small bowel obstruction]

A history of abdominal surgery have long been considered a contraindication to laparoscopy. There was a reluctance to advocate the use of laparoscopy in mechanical bowel obstruction due to technical difficulties related to a distended small intestine, and a small work space. To report the results of laparoscopic treatment of small bowel mechanical obstruction and to study the factors for conversion to laparotomy. Our study is retrospective, having compiled 32 patients between January 2001 and December 2009. The average age was 35 years [20-54]. There were 17 men and 15 women. History of laparotomies were noted in 27 patients. Were excluded from this study patients with strangulated hernia or eventration. An analysis was conducted to determine the conversion factors to laparotomy. The flanges or postoperative adhesions were responsible for 27 of the 32 intestinal obstructions [84%]. In 24 cases there was a single flange or localized adhesions treated by simple section successfully in 18 patients [56% of cases]. A conversion was performed in 14 cases [44%]. The median time to recovery of intestinal transit was shorter after laparoscopic surgery completely after conversion [1.5 vs. 2.5 days, p = 0.004]. Similarly, the median length of postoperative stay was shorter in the absence of conversion [2.4 vs 7, p <0.001]. Statistical analysis identified four factors related to conversion, which are: the presence of peritoneal signs, the number of brackets > 1, and the need for a bowel resection. Laparoscopy is an option for the treatment of mechanical bowel obstruction when performed in selected patients. His best indication could be the occlusion of single flange. This alternative to laparotomy could reduce adhesion formation and potentially reduce future episodes of obstruction

Management of sigmoid volvulus

The objective of this work paper is to report our experience in the management of the sigmoid volvulus. This retrospective study relates to 40 cases of sigmoid volvulus operated in Surgical Departments B of Rabta University Hospital, Tunis, from January 1999 to December 2008. It refers to 35 men and 5 women, of 55 years as average age. Twenty six patients have been subjected to cm volvulus removal through rectosigmondoscopy, which allowed an untwisting of the volvulus in 23 cases. Those patients have been subjected to a colorectal anastomosis within an average 9 day term. Among those patients, 5 subjects have undergone a sigmoidectomy assisted by laparoscopy. Urgent laparotomy has been performed in 17 patients following failure or complication of the endoscopy [3 cases], or straightaway laparotomy [14 cases] which showed a colic necrosis in 10 cases, of which 4 cases had stercoral peritonitis. One patient had a pre perfrorative lesions on right colon has been subjected to a total colectomy, followed by an ileorectal anastomosis. A sigmoidectomy has been performed in 16 patients, followed by a colorectal anastomosis [n=2]. An Hartman intervention [n = 4] and a double stomy [n = 10]. All those patients have had restoration of digestive continuity within an average 90 days term. Postoperative complications have consisted in 5 pneumopathy cases, 2 heart insufficiency cases, 3 urinary tract infection cases and on peristomial eventration case. No patient has showon an anastomotic loosening or a recurrence after elective surgery. The average follow-up duration was 110 days. Four deaths have occurred immediately after urgent laparotomy. This relates to a state of septic shock with multiple organ failure [n = 2], a lung embolus [n = 1] and a pneumapathy [n = 1] The best treatment for sigmoid volvulus consists to an endoscopic volvulus removal intervention followed by a sigmoidal resection during the same hospitalization period. Urgent laparotomy is indicated in case of signs of necrosis or failure of endoscopy. Sigmoidal resection without immediate restoration of digestive continuity is recommended in presence of risk factors of anastomotic loosening

[Laparoscopic management of abdominal wounds]

The management of abdominal wounds apart from an extreme emergency remains controversed. Means vary between explorative laparotomy and mere monitoring. Between these two extreme cases, laparoscopy as an exploration means plays a significant role, by avoiding laparotomy and by establishing the early diagnosis of lesions. The objective of this study is to report our experience in laparoscopic management of frontal abdominal wounds caused by a blank arm. Between January 2004 and December 2008, 61 patients with 27-year average age showing anterior abdominal wounds caused by a blank arm, with stable hemodynamic status have been subjected to a laparoscopic exploration. Laparoscopic exploration revealed a penetrating wound in 36 patients [59% of cases] of whom 27 had perforating wound. Six patients had a frontal abdominal wound, of which four have required a thoracic drainage in addition to the laparoscopic exploration of abdominal cavities. Two patients had a left diaphragmatic wound. Twelve patients [19.7%] have required a therapeutic action that consisted in an electro coagulation of filled organs, a simple suture or a resection-anastomosis for the digestive tract, and suture of diaphragmatic wounds. A conversion was performed in 7 patients [11.5%]. The death rate was nul. Morbidity rate was 3.2%. Average hospitalization course was 2.54 days. Laparoscopy is a safe and efficient means for exploration of abdominal cavity in patients showing a frontal abdominal wound. It allows avoiding a systematic or useless laparotomy in 88.5% of wounded individuals and then allows to trait some lesions without recours to laparotomy

[Primary hepatic carctnoid tumor: a case report]

Primary hepatic carcinoid tumors are extremely rare, and fewer than 60 cases have been reported in the literature. Long-term follow-up is necessary for establishing the primary nature of liver carcinoids. We report a case arising in a young 20 years-man having Zollinger-Ellison syndrome on presentation. Intensive and careful investigation revealed no other origin of the tumor. Resection is the treatment of choice for primary hopatic carcinoid tumors. Their prognosis seems to be more favorable when compared with other hepatic carcinomas

[Usefulness of endoscopic ultrasonography for diagnosis between multivesicular hydatid cyst and serous cystadenoma of the pancreas. Case report]

Hydatid cyst of the pancreas is very rare. However, it should be suspected in every case of pancreatic cyst, especially in hydatid countries where hydatic cyst disease is endemic. In the paper we report the first case of a multivesicular hydatid cyst of the pancreas explored by endoscopic ultrasonography. Endoscopic ultrasonography is very reliable in the investigation of pancreatic cystic tumors. However it did not allow us to define semiological criteria capable of permitting a differential diagnosis between a hydatid cyst and serous cystadenoma. Per-echoendoscopic transduodenal puncture might improve the efficiency of this procedure with of hydatid cysts of the head of the pancreas