Major complications during laparoscopic cholecystectomy.

Laparoscopic cholecystectomy may lead to serious complications, some of which can be disastrous if they are not recognized and managed immediately. Over the past 12-year period, 1225 laparoscopic cholecystectomies were performed. Totally, major complications occurred in 19 cases (1.5%). The conversion rate was 7.4%. Complications included common bile duct injury in 2 cases (0.16%), vessel injury by trocar or Veress needle in 4 cases (0.32%) including 1 case of aorta injury (0.08%), bleeding from the gallbladder bed or the cystic artery in 10 cases (0.8%), bile leak in 1 case (0.08%), duodenum injury in 1 case (0.08%), and transient liver ischemia in 1 thalassanemic patient (0.08%). The complication was recognized during the operation in 11 cases. Reoperation was necessary in five cases (0.4%), and conservative management was applied in three cases. Although infrequent, major complications may occur during laparoscopic cholecystectomy. Immediate recognition and management is critical and may lead to a safe outcome.

Imaging of metastatic medullary carcinoma of the thyroid with 131I-meta-iodobenzyl guanidine.

The uptake of 131I-MIBG by medullary carcinoma of the thyroid was studied in six patients after total thyroidectomy in whom persistent raised plasma calcitonin levels were indicative of residual disease. The only patient in whom any activity in a possible metastasis was seen had by far the highest level of circulating calcitonin of the group and in contrast one patient with a presumptive metastatic deposit showed no uptake of MIBG into it. In conclusion the uptake of 131I-MIBG by medullary carcinoma of the thyroid is unreliable and unpredictable.