Enterocutaneous fistula as a postoperative complication of laparoscopic inguinal hernia repair.

Trocar injuries to the small bowel during laparoscopic hernia repair are a rare complication, the most common complications being postoperative neuralgias, scrotal swelling, scrotal ecchymosis, and hematoma. A 15-year-old boy was admitted 5 days status-post transabdominal laparoscopic inguinal hernia repair of a symptomatic right pantaloon hernia, with signs and symptoms of a retrocecal abscess. Despite laparotic intervention and appendectomy, the next 2 years passed with almost daily, purulent, right lower quadrant wound drainage, in an otherwise asymptomatic patient. Superficial wound exploration and sinogram in 1996 revealed a sinus tract in direct communication with the small bowel. Elective laparotomy in December 1997 involved a successful resection of a 2.5-cm fistula with involved mesh, and the communicating small bowel through a midline incision, followed by a primary closure of the small-bowel opening. The patient has recovered without complications.

Selective hepatic arterial embolization of grade IV and V blunt hepatic injuries: an extension of resuscitation in the nonoperative management of traumatic hepatic injuries.

BACKGROUND: Recognizing the significant mortality and complications inherent in the operative management of blunt hepatic injuries, hepatic arterial embolization was evaluated as a bridge between operative and nonoperative interventions in patients defined as hemodynamically stable only with continuous resuscitation. METHODS: Seven of 11 patients with grade IV or V hepatic injuries identified by computed tomography underwent hepatic arterial embolization. A prospective evaluation of hepatic embolization based on subsequent hemodynamic parameters was assessed by matched-pair analysis. A summary of this study population's demographic data and outcomes is presented, including age, Glasgow Coma Scale score, Injury Severity Score, Revised Trauma Score, computed tomography grade, intensive care unit and hospital length of stay, transfusion requirements, complications, and mortality. RESULTS: No statistical difference was demonstrated between pre-embolization and postembolization hemodynamics and volume requirements. After embolization, however, continuous resuscitation was successfully reduced to maintenance fluids. Hepatic embolization was the definitive therapy for all seven patients who underwent embolization. CONCLUSION: Results of this preliminary investigation suggest that hepatic arterial embolization is a viable alternative bridging the therapeutic options of operative and nonoperative intervention for a subpopulation of patients with hepatic injury.

Frequency of breast biopsy and breast cancer diagnosis in central Connecticut--trends from 1993 to 1997.

The frequency of diagnosed breast cancer at Hartford Hospital has risen 75% from 1993 to 1997 (153 vs 87 cases during January-March 1997 as compared to January-March 1993). During the same intervals the frequency of breast biopsies performed also increased 45% (455 vs 312 biopsies). The rate of "positive" biopsies has increased slightly (27.9%, 28.3%, 31.5%, 30.7%, and 33.6% for the first three months of each year 1993 to 1997, respectively). When stratified into thirds based on decreasing practice activity of Hartford Hospital surgeons with regard to breast surgery, the "positive" biopsy rates were 28.7%, 31.2%, and 33.0% respectively. Local breast cancer incidence is rising, however surgeons are not "overusing" breast biopsy as compared to recent past practice despite the fact that many more breast biopsies are now being performed.