ABSTRACT
Laparoscopic cholecystectomy at the time of elective cesarean delivery eliminates the need for separate operations. Hand-assisted laparoscopy takes technical advantage of the cesarean abdominal incision to facilitate laparoscopic maneuvers with retention of pneumoperitoneum. A 39-year-old woman with two previous cesarean sections and recurrent cholecystitis throughout her third pregnancy underwent full-term, elective cesarean section, tubal sterilization, and hand-assisted laparoscopic cholecystectomy under general anesthesia. Total operating time was 53 minutes, estimated blood loss was 550 ml, and postoperative hospital stay was 72 hours. The operation and recovery were uneventful.
Subject(s)
Cesarean Section , Cholecystectomy, Laparoscopic/methods , Adult , Cholecystitis/surgery , Chronic Disease , Female , Humans , Pregnancy , Pregnancy Complications/surgery , Sterilization, TubalABSTRACT
Right-sided colonic diverticulitis is an uncommon disorder that most frequently mimics appendicitis. During pregnancy, displacement of the diseased cecum and ascending colon into the right upper quadrant may result in symptomatology that mimics cholecystitis. A 37-year-old white woman with a history of previous benign incidental appendectomy presented at 20 weeks' gestation with right upper abdominal pain and nausea for 2 days. Significant findings included local rebound tenderness and palpable fullness over the gallbladder, leukocytosis, and low-grade fever, but otherwise unremarkable routine serum laboratory test results and sonographic evidence of biliary tract disease. Cholescintigraphy was rejected by the patient. Persistence of symptoms for 3 hospital days despite administration of broad-spectrum parenteral antibiotics prompted surgical intervention. Laparoscopy demonstrated a normal-appearing gall-bladder and an acutely infected, solitary diverticulum of the midascending colon with adhesions to the omentum and to the parietal peritoneum near the gallbladder. Adhesiolysis, omental biopsy, and peritoneal drainage were performed endoscopically. The patient recovered uneventfully and delivered vaginally at term without fetal or maternal complications. Right-sided colonic diverticulitis may present during pregnancy and may mimic symptoms of acute cholecystitis. Laparoscopic treatment of a solitary, acutely infected colonic diverticulum is feasible in this setting.
Subject(s)
Cholecystitis/diagnosis , Diverticulitis, Colonic/diagnosis , Pregnancy Complications/diagnosis , Adult , Biopsy/methods , Diagnosis, Differential , Diverticulitis, Colonic/therapy , Drainage/methods , Female , Humans , Laparoscopy , Pregnancy , Pregnancy Complications/therapyABSTRACT
A 29-year-old woman with recurrent cholelithiasis in pregnancy and a history of previous cesarean section underwent elective repeat abdominal delivery combined with laparoscopic cholecystectomy under general anesthetic. A transverse suprapubic incision was employed for fetal extraction and for facilitating the placement of three upper abdominal laparoscopic cannulas. After closure of the laparotomy incision, a pneumoperitoneum was established, and the gallbladder was removed laparoscopically. The surgery was uneventful, and the patient was discharged on the third postoperative day.
Subject(s)
Cesarean Section, Repeat , Cholecystectomy, Laparoscopic , Adult , Cholecystectomy, Laparoscopic/methods , Cholelithiasis/surgery , Female , Humans , Pregnancy , Pregnancy Complications/surgery , RecurrenceABSTRACT
This paper presents the first recorded combined laparoscopic hysterectomy, appendectomy, and cholecystectomy. The performance of these procedures, in experienced hands, did not alter the outcome. Underlying pathology included uterine myomas, pelvic adhesive disease, and symptomatic gallstones.
