Acute Pulmonary Embolism Following Baker’s Cyst Excision – A Life Threatening Complication: A Case Report

@#A 55-year-old women was diagnosed with Baker’s cyst and underwent open Baker’s cyst excision. She had developed acute pulmonary embolism in the post-operative period. Our case report is to emphasise the sub-clinical concomitant deep vein thrombosis with Baker’s cyst. Such a fatal complication has not been reported in literature and preventive measures of pre-operative venous Doppler and post-operative thrombo-prophylaxis can prevent them.

Totally laparoscopic surgical treatment of congenital choledochal cysts in adult patients / 中华普通外科杂志

Objective To evaluate feasibility of totally laparoscopic surgical treatment of congenital choledochal cysts(CCC) in adult patients.Methods The clinical data of 36 adult CCC patients were analyzed retrospectively.In this study there were 31 type Ⅰ cases and 5 type Ⅳ cases,divided into laparoscopic operation group (n =18) and open operation group (n =18).Results There were no death cases in perioperative period and all patients were followed up.The total operative time of laparoscopy group compared with open group respectively was (212 ± 43) min and (135 ± 20) min (P ＜ 0.05),the volume of blood loss during operation was (75 ± 20) ml and (150 ± 49) ml,(respectively t =6.875,6.000,P ＜0.05).Postoperative recovery time of intestinal function was (65 ± 15) h vs (94 ± 12) h,celiac drainage tube indwelling time was (72 ± 20) h vs (89 ± 26) h,postoperative hospital stay was (5.8 ± 1.4) d vs (8.9 ± 0.9) d,(respectively t =6.444,2.199,7.908,P ＜ 0.05).One case suffered from reflux cholangitis in the laparoscopic group,1 case of choledochojejunostomy stricture and recurrence of intrahepatic calculi in the open group.Conclusion Laparoscopic cystectomy and cholangiojejunostomy for congenital choledochal cyst in adults is safe and feasible.

Laparoscopic Management of a Hydatid Cyst of the Adrenal Gland

Hydatid disease is endemic in parts of India, yet genitourinary involvement is rare. Laparoscopic management of such cases is uncommonly reported. We present a case of an adrenal hydatid and its management by laparoscopic aspiration, instillation of scolicidal solution, and partial excision of the cyst.

Diffrences in improved surgery and normal excision of large dermoid cyst by laparoscope / 中国综合临床

Objective To investigate the effectiveness and surgical techniques of the improved laparoscopic treatment of ovarian dermoid cyst to prevent the occurrence of intraoperative rupture of teratomat, so to preserve the ovarian function at the maximum. Methods The modified laparoscopic extra-cavity and cavity outside the teratoma removed surgical suture treatment from February 2005 to February 2009,39 cases with large dermoid cyst were trea-ted by improved surgery and 45 cases treated by normal removal of laparoscope. The rupture, surgery time, bleeding volume,frequency of use of electrocoagulation and the effect of body temperature on intestinal canal and hospitaliza-tion day after operation as well. Results 39 cases of dermoid cyst were successfully managed by improved laparo-scopie surgery, during which no cyst contents broke into the abdominal cavity, no one was placed on electrocoagula-tion to stop bleeding, bleeding volume was (35.13±5.49) ml, operative time was (36.07±12.53) min, significantly leas than that of normal laparoscopic surgery group [the cyst rupture rate was 46.7% (21/45), the frequency of elec-trocoagulation was (5.0±3.0) times, the duration of electrocoagulatian was (5.5±2.5) s, bleeding loss was (40.73±6.04) ml and the time for operation was (67.47±20.73) min], with significant difference between the two groups (P<0.05 or 0.01);howevere, there was no remarkable difference in the effect of the two types of surgery on postoperative body temperature,anal exhaust time,postoperative hospitalization day. Conclusions In addition to minimally invasive laparoscopic surgery in the treatment of gastro-intestinal effects of small, quick recovery, the im-proved laparoscopic surgery for dermoid cyst shortens the operation time. The improved abdominal cavity and suture outside the strip surgical method can effectively prevent the complication caused by intraoperative tumor capsule rup-ture,reduce electrocoagulation injury,and preserve the ovarian function at the maximum.

Late Complications after Excisional Operation for Choledochal Cyst

PURPOSE: Even after excision of choledochal cyst, late postoperative complications can develop. This study was conducted to examine the long-term outcome of cyst excision. METHODS: Of 50 choledochal cysts treated over a 10-year period (1991~2000), excluding cancer and rare types, 39 patients (type I: 21, IVa: 18) who underwent cyst excision were reviewed to evaluate the late outcome. RESULTS: Median follow-up period was 24 months after surgery. Late complications (5 intrahepatic duct stone, 4 cholangitis, 4 pancreatitis, and 1 malignancy) developed in 14 (35.9%) patients. Of the 5 patients with intrahepatic duct stone, 2 underwent choledochoscopic stone removal, one of whom additionally underwent balloon dilatation for anastomotic stricture. The remaining 3 patients were free of symptoms and didn't need further management. Of the 4 patients with cholangitis, one underwent left lateral sectionectomy for remaining intrahe patic cyst in type IVa and another patient balloon dilatation for anastomotic stricture. The remaining 2 patients developed cholangitis because of incomplete excision and ascending cholangitis, and they were conservatively managed. Of the 4 patients with pancreatitis, 2 developed pancreatitis because of pancreas divisum and probably residual distal cyst. The symptoms of all four patients with pancreatitis were mild and treated with conservative management. Periampullary cancer developed 18 months after cyst excision in one patient. CONCLUSION: To minimize hepatopancreatobiliary complications and malignancy after cyst excision, complete excision of the extrahepatic bile duct should be performed. Moreover, long-term follow-up is necessary because of these late complications.

Renal Cyst Excision Through Camera Port Incision / 대한비뇨기과학회지

PURPOSE: In the treatment of symptomatic renal cysts, sclerotherapy has high recurrence rate. Laparoacopic cyst excision has high success rate but has some limitations concerning expensive devices, CO2 use and requiring trained laparoscopist. We conceived less invasive surgical technique for renal cyst excision. MATERIALS AND METHODS: The method is as follows. 1) Minimal skin incision of camera port size at PCN site nearest to the cyst. 2) Access to retroperitoneum by Kelly clamp and finger dilatation. 3) Finger dissection with or without ballooning. 4) Aspiration of cystic fluid. 5) Drawing the redundant cyst wall out of the incision. 6) Excision of the redundant cyst wall by open surgical method. RESULTS: Clinical trials of 5 patients have been performed since March 1999, with a mean age for the patients of 60 years old (range, 56-66), cyst size of 8.3cm (7.7-9.8), wound length of 2.4cm (2.1-3), operation time of 28 minutes (20-35) and blood loss of 1.6 Hb (0.5-3). There was no drain insertion except in one case, and no use of narcotics post op 2 days. Patients were discharged post op 3 days (2-5). There is no evidence of recurrence in short term follow up (mean 8 months, range 3-15). CONCLUSIONS: Though limited trials, we think expected merits over conventional laparoscopic surgery are better or comparative cosmetic results, no CO2 use, short operation time, less technical expertise and additionally economical advantages. If necessary, conversion to laparoscopic surgery, using the initial incision as camera port is possible during the procedures. So we suggest trial of this method before conventional laparoscopic renal cyst excision.

Clinical Characteristic of Lacrimal Ductal Cyst

PURPOSE: Through 13 cases of lacrimal ductal cysts which were diagnosed by clinical or histopathological findings, we investigated the clinical characteristic and the effect of cyst excision on lacrimal secretion. METHODS: As a primary treatment, cyst excisions(6 cases), marsupialzations(4 cases), and needle aspirations(3 cases) were performed and their results were compared. Pre-and postoperative lacrimal secretion tests(Schirmer I & BST) were performed on 10 cases which underwent cyst excision either primarily or secondarily(due to recurrences). A biochemical analysis of cyst fluid and serum IgA level was also done on 7 cases. RESULT: There were no recurrences on 6 surgically excised cases, but 1 out of 4 cases with marsupia-lizations and all 3 cases with needle aspirations recurred and underwent cyst excisions secondarily. Two out of 10 surgically excised cases showed reduced value of postoperative lacrimal secretion tests. Cyst fluid IgA levels were higher than that of serum in all 7 cases. CONCLUSION: The higher cyst IgA level may signify the presence of an active secretory precess within cyst walls. A complete cyst excision seems to be the best treatment choice for the prevention of recurren-ces and marsupialization is also considered as an alternative treatment modality. The cyst excision itself does not seem to affect lacrimal secretion.

Bile Peritonitis Due To Choledochal Cyst Perforation In Infants

Choledochal cyst is rare in the Western countries, but common in the Oriental countries. The reported complicatioins of choledochal cyst are ascending cholangitis, recurrent pancreatities, progressive biliary cirrhosis, portal hypertension, stone in the cyst, and malignant in the biliary tract. Bile peritonitis secondary to rupture is one of the rarest complications of choledochal cyst, and its reported incidence was 1.8% (Yamaguci, 1980) to 18% (Karnak et al, 1997). The exact cause of perforation of choledochal cyst is unknown, but an anomalous arrangement of the pancreatobiliary ductal system with a long common channel may contribute to the formation of choledochal cyst and even perforation of cyst.Authors reviewed 4 cases (14.2%) of bile peritonitis among 28 cases of choledochal cyst in infants from Jan. 1983 to Jan. 1998. Their ages ranged from 6 months to 3 years and three of them were female. Abdominal distension, pain, and vomiting were common symptoms, and clinical jandice and palpable mass were present in one case. Pre-operative laboratory investigations showed elevated serum bilirubin, serum AST and serum ALT in 3 cases, and elevated serum amylase in one case. The perforation sites were located on the common bile duct at its junction with the cystic duct in 2 cases, distal cyst wall in 1 case and left hepatic duct at its junction with cyst in 1 case. The types of choledochal cysts according to Todani's classification (1977) were as follows;Type IVa was in 3 cases, type I was in 1 case. The results of operative cholangiogram according to new Komi's classification (1992) were as follows;Type Ia was 2 cases, type IIb 1 case, and type III 1 case. One stage primary cyst excision and hepaticojejunostomy(Roux-en Y type) was done in 3 cases, and two staged operation in 1 case. All patients have recovered unevenfully after surgery and discharged at post -operative 9.8th day averagely. Authors concluded that the primary choledochal cyst excision with biliary recontinuity was a safe surgical procedure in ruptured choledochal cyst in infants.