Laparoscopic management of left thoracoabdominal stab wounds: a prospective study.

BACKGROUND: Left thoracoabdominal stab wounds (LTSWs) leading to diaphragmatic injuries can cause serious morbidity and mortality. The diagnosis and treatment of LTSWs are controversial. This study investigated the reliability of laparoscopy for the diagnosis and treatment of diaphragmatic lacerations in hemodynamically stable patients with an LTSW, hypothesizing that laparoscopy is sufficient for diagnosing and treating diaphragmatic injury after an LTSW. METHODS: This study included 36 cases of LTSWs with no hemodynamic instability or abdominal tenderness seen between June 2002 and June 2007. After systemic examination and resuscitation of the patients, chest x-ray and focused assessment with sonography for trauma were carried out and then laparoscopic exploration was performed in all cases. RESULTS: Of the 36 cases, 36.1% (n=13) had injuries to the diaphragm and 53.8% (7/13) had associated intraabdominal injuries. Nine (69.2%) of the patients with diaphragmatic injuries, but no hollow organ injuries, were repaired through laparoscopy. The hemopneumothorax was found in 33.3% (n=12) of the patients. No relationship was seen between diaphragmatic injuries and the location of the LTSW and existence of hemopneumothorax. CONCLUSIONS: Laparotomy was required in only 11.1% (4/36) of the cases with LTSWs and 30.8% (4/13) of the cases with diaphragmatic injury. Diagnostic and therapeutic laparoscopy was a sufficient and necessary surgical procedure in cases with a hemodynamically stable LTSW, when emergency surgery (laparotomy or thoracotomy) was not necessary.

[Bouveret'S syndrome: gastric outlet obstruction by a gallstone]. / BOUVERET SENDROMU: SAFRA TASINA BAGLI MIDE CIKIS OBSTRUKSIYONU.

This rare syndrome first described by Bouveret in 1896, occurs when a stone migrates through a cholecysto or choledochoduodenal jistula lodging in the duodenal bulb and resulting in obstruction. Up to date, less than 100 cases reported in the literature. This rare type of gallstone ileus can be diagnosed and treated endoscopically, although there are a few previous reports of successful endoscopic, removal. However, surgical removal is safe and effective but the most controversial aspect is the proper treatment, simple enterotomy and removal ofthe gallstone alone or enterolithotomy in association with cholecystectomy and dejinitive correction ofthe biliodigestive fistula. This paper presents a case report of a 65 year old man with gastric outlet obstruction caused by a large gallstone. The diagnose and treatment of this case who was admitted in 1.General Surgical Department of Taksim Teaching and Research Hospital was researched under the reference of recent literature.