Laparoscopic extraction of a swallowed fork in a patient first diagnosed with bulimia nervosa.

Swallowed foreign bodies are relatively common problem. The first reports date back about 3000 years. The first medical report was done by Mestivier in 1759. Several studies show that up to 90% of the foreign bodies (FBs) pass spontaneously and 10% to 20% require an endoscopic removal. Surgical intervention is only indicated in approximately 1% of the cases. Surgical intervention is only necessary, for example, when large or sharp FBs are involved because of the potential risk of perforation and obstruction. The surgical therapy can be carried out by means of laparotomy or laparoscopy; laparoscopy has to be given the first priority whenever possible. The advantages of a laparoscopic procedure are well-known: reduced postoperative pain, better lung function, less postoperative bowel obstruction, shorter hospital stay, and faster reconvalescence. We report an unusual case of an unintentional ingested fork, which required a laparoscopic extraction using three trocars. The 20-year-old female patient was then subsequently diagnosed with bulimia nervosa for the first time during her hospital stay. The patient was discharged home on the fourth postoperative day after an unremarkable course.

[Laparoscopic adhesiolysis - results following prospective surveillance]. / Die laparoskopische Therapie des Adhäsionsbauchs. Ergebnisse einer prospektiven Beobachtungsstudie.

INTRODUCTION: About 90 % of the patients have abdominal surgery develop adhesions afterward. Studies analyzing complications and follow-up even in emergency cases are rare. METHODS: Intra- and postoperative findings and complications and follow-up were analyzed in a prospective trial between January 1994 and June 1998. RESULTS: We performed laparoscopic procedures in 56 patients with complaints of obstructing adhesive bands or adhesions. Ninety-six percent of the patients have had abdominal surgery; 51.8 % were treated as emergency cases with acute pain, 48.2 % with chronic abdominal pain. Intraoperatively, 37.5 % of the patients showed single adhesive bands; 62.5 % showed adhesions. Mean operation time was 60 min, conversion rate: 5.4 %. Complications were recorded according to the "Cologne classification": class I: 78.6 %, class II: 8.9 %, class III: 1.8 %, class IV: 10.8 %, class V: 0 %. The postoperative hospital stay was 6 days on average. CONCLUSION: Our study suggests that laparoscopic adhesiolysis can be done safely in emergency cases and in patients with extensive adhesions as well.