Laparotomia / Laparotomy

Celiotomia, que significa precisamente incisão da parede abdominal em qualquer região, é considerado sinônimo de laparotomia, cuja acepção exata é "secção do flanco". A abertura da cavidade abdominal para fins diagnósticos e terapêuticos remonta a antiguidade, mas tornou-se rotineira a partir dos meados do século XX com o advento da anestesia geral, utilizando drogas curarizantes e entubação orotraqueal. Serão discutidos a classificação das laparotomias quanto a finalidade, direção, a complexidade e a relação com estruturas da parede abdominal.

Celiotomy, which precisely means incision of any region of the abdominal wall, is considered a synonym of laparotomy, whose exact definition is 'section of the flank'. Opening of the abdominal cavity for diagnostic and therapeutic purposes dates back to ancient times, but it became a routine procedure in the midtwentieth century with the advent of general anesthesia, by means of curaric agents and orotracheal intubation. We will discuss the classification of laparotomies according to their purposes, direction, complexity, and relation with abdominal wall structures.

Surgical removal of stones in the stomach of a tiger shovelnose catfish

A seven months old, tiger shovelnose catfish was referred to the veterinary medical teaching hospital of the college of veterinary medicine, Konkuk university because of suspecting a foreign body in the stomach. By physical and radiologic examinations, the catfish revealed abdominal enlargement, vomiting, inactivity and radiopaque foreign bodies in the stomach. Under general anesthesia with dilute isoflurane solution, celiotomy was performed. Stomach was atonic, and three foreign bodies were palpated in the stomach. In this process, three stones came out through mouth. Abdominal muscles were closed with a simple continuous suture pattern, and skin was closed with a simple mattress suture pattern. Sutured site was covered with glue and mucous taken from allogenic skin. On the second day after surgery, the patient recovered to normal condition, showing increased appetite and activity.

Intraperitoneal Explosion Resulting from the Use of Electrocautery

Explosion of the gastrointestinal tract during use of the electrocautery have been reported previously. Most reports deal with explosions of the lower large bowel. A careful search of the literature has revealed no previous reference to explosions of the intraperitoneum during a celiotomy of which the patient had a pneumoperitoneum resulting from a perforation of the gastrointestinal tract. We report a case of an intraperitoneal explosion resulting from the use of electrocautery in an 83 year-old female. The patient visited our hospital complaining abdominal pain that had been sustained during 10 months and was aggravated one day before admission. The plain X-ray showed a massive pneumoperitoneum. The patient underwent an emergency laparotomy and was used to open the abdominal wall by electrocautery. A loud explosion followed as soon as the peritoneum was opened by the electrocautery. No change in the patient's vital sign was noted and all the abdominal viscera were intact. The operative finding showed gastric outlet obstruction due to an antral mass, gastric laceration on the body and an enlargement of multiple lymph nodes. The pathological evaluation diagnosed it as a gastric adenocarcinoma. We report this rare case with a review of the relevant literature.

Fetal Surgery: Gastroschisis Model in Rabbits

This study was to develop a technique for creating gastroschisis by fetal surgery on a pregnant New Zealand white rabbit and to develop a technique for full-term delivery of a mature fetal rabbit after the repair of the abdominal wall incision in the fetal rabbit. The fetal surgery was done on the 24th or the 25th day of pregnancy and the experiment was divided into two parts: the creation of gastroschisis in the fetal rabbit and celiotomy-repair in the fetal rabbit. To creat gastroschisis, celiotomy and evisceration of the intes-tine in the fetal rabbit was made at both cornua on the 24th or the 25th day of pregnancy. After 6 days, a Caesarean section was done to deliver two gastroschisis fetal rabbits and two normal fetal rabbits. For the celiotomy-repair, celiotomy-evisceration and immediate repair of the fetal rabbit was made at both cornua on the 24th or the 25th day of pregnancy. After 6 days, a Caesarean section was done to deliver two experimental fetal rabbits and two normal fetal rabbits. Gastroschisis was successfully produced in 10 out of the 38 fetal rabbits operated on. Celiotomy-repair was done in 38 fetal rabbits. The abdominal wound was successfully repaired in 9 out of these 38 cases. Microscopically, inflammation or scarring was found neither at the gastroschisis wall margin nor at the repaired abdominal wound; however, fibroblast proliferation was found at the repaired abdominal wound. This result coincided with the general tissue finding of the fetal surgery. The conclusions are as follows: 1. By fetal surgery, experimental gastroschisis was created in fetal rabbits, and 2. The experimental abdominal wound was successfully repaired by surgery on the fetal rabbits.

Mandatory celiotomy for penetrating abdominal stab wounds: An analysis of 483 cases

It has been suggested in a number of studies that penetrating abdominal stab wounds may be managed conservatively although only a few local studies support this claim. This study reviews experience based on 483 patients, who underwent celiotomy for a single penetrating abdominal stab wound inflicted by a single bladed knife from Jan. 1989 to June 1991. The cases were divided into two (2) groups, those who underwent celiotomy with indications and those who underwent celiotomy without indications. Tabulation of operative findings according to the location of the stab wound in the nine (9) regions of the anterior abdomen showed that 89% of all patients with indications for surgery had significant injury. In the group who underwent celiotomy without indications, 78% had positive findings. The data for groups A and B stratified into the nine regions did not show any significant difference in the frequency of abdominal injury except in the right lumbar, left lumbar, left iliac and umbilical region. In these last four regions, the frequency of abdominal injury in the group with indications is statistically higher than in the group without indications. Therefore, a trial of observation in these regions is therefore acceptable in the absence of indications for celiotomy.