Laparoscopic Appendectomy for Acute Appendicitis Caused by Enterobius Vermicularis

Enterobius vermicularis (pinworm) infection occurs in 4~28% worldwide. Although the most common clinical manifestation is perianal pruritis, it may cause gastrointestinal manifestations, including acute appendicitis in about 0.2~41.8% of infections. Preoperative diagnosis of pinworms in patients with acute appendicitis is not routinely performed. We performed a laparoscopic appendectomy for an acute appendicitis caused by Enterobius vermicularis. To our knowledge, this is the first report of a laparoscopic appendectomy for acute appendicitis caused by Enterobius vermicularis in Korea.

Laparoscopic Giant Parastomal Hernia Repair

Parastomal hernia is not an uncommon complication after stoma formation. Although there are a variety of open surgical techniques, rates of morbidity, recurrence and complications are high. Nowadays, with improvements in techniques and equipment, laparoscopic surgery is being increasingly used in every field of surgery. Herein, we present a case study of a patient suffering from a large parastomal hernia who underwent a laparoscopic hernia repair. A 71-year-old man who had undergone an abdominoperineal resection for an adenocarcinoma of the rectum 5 years ago was admitted to our hospital for a large parastomal hernia, which was repaired by using a laparoscopic approach with Gore-Tex and protack (auto-suture(R), USA). We found the laparoscopic approach for a large parastomal hernia to be technically feasible and to be a good alternative to conventional open surgery with the advantage of minimal invasivess.

Clinical Analysis of Fournier's Gangrene

PURPOSE: Fournier's gangrene is a rapidly progressive (and aggressive), necrotizing fasciitis of the genitalia and perineum. Despite the use of broad spectrum antibiotics and surgical debridement, morbidity and mortality remain significant. The purpose of this study is to investigate and evaluate the clinical and laboratory characteristics of this disease. METHODS: We reviewed 17 cases of Fournier's gangrene during 10 years from January, 1990 to December, 1999. We retrospectively analyzed these patients and considered several factors, which were age, sex, combined and etiologic factors, symptom and location of infection, duration of admission, operation and its complication, result of bacterial culture and sensitivity of antibiotics, morbidity and mortality. RESULTS: the mean age was 47.4 years with an age range of 3 to 77. The etiologies included unknown (65.7%), anorectal infection (23.5%) and hemorrhoidectomy (11.8%). The combined diseases (predisposing factors) included diabetes mellitus (52.9%), alcohol abuse, steroids or chemotherapy, liver cirrhosis and malignancy. Aggressive surgical debridement with broad spectrum antibiotics therapy was done on 16 patients, 1 patient refused operation. There were 3 colostomy cases, one orchiectomy, one suprapubic cystostomy case. The most common cultured organism was E.coli, 8 cases (53.3%). The mean hospital stay was 32.9 days. 3 patients (17.6%) were died due to sepsis and multiorgan failure. CONCLUSIONS: Our results showed that the early recognition, aggressive debridement of devitalized tissue, antibiotic therapy, search for primary source are considered as the treatment of choice for Fournier's gangrene.