Primary segmental infarction of the greater omentum: a rare cause of RLQ syndrome: laparoscopic resection.

The authors report a rare case of a patient with a primary segmental infarction of the greater omentum who reported acute abdominal pain. Despite preoperative clinical studies and imaging evaluation, an etiologic diagnosis could not be determined. The diagnosis of this uncommon disease was determined after initial laparoscopic exploration. A laparoscopic resection was performed. The patient had an uneventful recovery and was discharged within 12 hours. The differential diagnosis of the right lower quadrant syndrome includes several disorders, of which the primary segmental infarction of the greater omentum is not frequent. The authors emphasize the usefulness of routine laparoscopic exploration in patients with RLQ syndrome because it adds the possibility of mini-invasive treatment to the initial diagnosis.

Relation between postoperative infections and gallbladder bile leakage during laparoscopic cholecystectomies.

BACKGROUND: In 1,577 laparoscopic cholecystectomies, 111 due to acute and 1,466 due to chronic cholecystitis, the incidence of intraoperative gallbladder rupture and its relationship with abdominal wound infections were evaluated. METHODS: A sampling test for binomial proportions and a binomial approximation test for discrete data were employed for statistical analysis. Gallbladder accidental opening took place in 250 (19%) out of the 1,466 chronic and in 44 (40%) out of the 111 acute cholecystitis, disclosing a statistically significant difference (p < 0.01). Postoperatively, there were 32 (2%) surgical wound infections, 17 (1.3%) in the absence of gallbladder injury and 15 (5%) when gallbladder injury was observed, likewise showing a statistically significant difference (p < 0.05). RESULTS: It should be pointed out that all 32 wound infections involved the umbilical incision, of which 3 with chronic suppuration required reintervention where remnants of stones were found in the parietal route. The seven with symptomatic abdominal fluid resolved without specific treatment. As regards the seven intraabdominal infections, two remitted with antibiotics and five required percutaneous drainage. There was no significant correlation between the presence of cavity fluid abdominal collections or infections and bile spillage. CONCLUSION: Gallbladder injury proved more frequent in laparoscopic cholecystectomies performed due to acute cholecystitis, while bile spillage increased the incidence of umbilical wound infection, particularly in the presence of remnants of stones, but there was no correlative increase in the incidence of intraabdominal collections or infections.