Video-assisted thoracoscopic surgery in the management of penetrating and blunt thoracic trauma.

BACKGROUND: The role of video-assisted Thoracoscopic Surgery (VATS) is still being defined in the management of thoracic trauma. We report our trauma cases managed by VATS and review the role of VATS in the management of thoracic trauma. MATERIALS AND METHODS: All the trauma patients who underwent VATS from 2000 to 2007 at Cedars-Sinai Medical Center were retrospectively studied. RESULTS: Twenty-three trauma patients underwent 25 cases of VATS. The most common indication for VATS was retained haemothorax. Thoracotomy was avoided in 21 patients. VATS failed in two cases. On an average VATS was performed on trauma day seven (range 1-26) and the length of hospital stay was 20 days (range 3-58). There was no mortality. VATS was performed in an emergency (day 1-2), or in the early (day 2-7) or late (after day 7) phases of trauma. CONCLUSION: VATS can be performed safely for the management of thoracic traumas. VATS can be performed before or after thoracotomy and at any stage of trauma. The use of VATS in trauma has a trimodal distribution (emergent, early, late), each with different indications.

Amyand's hernia: history, imaging, and management.

BACKGROUND: Amyand's hernia is an inguinal hernia containing vermiform appendix. We report a case of this rare condition, diagnostic findings, and management considerations. A short review and history of Amyand's hernia is presented as well. METHODS: A literature search from Medline was done, and the published articles were reviewed. A case of Amyand's hernia, which was recently managed by the authors, was studied and the data reviewed. RESULTS: Diagnosis of the Amyand's hernia is usually made intraoperatively. The majority of the existing literature recommends doing open or laparoscopic appendectomy with open repair of the inguinal hernia, although some authors advise mesh repair of the hernia if the appendix is normal. CONCLUSION: Amyand's hernia can be a challenge for the surgeon. We recommend laparoscopic appendectomy and open repair of the inguinal hernia without using mesh.

Abdominal compartment syndrome secondary to retroperitoneal hematoma as a complication of ERCP after liver transplantation.

Endoscopic retrograde cholangiopancreatography (ERCP) is frequently employed in the management of postoperative biliary complications in the liver transplant patient. Bleeding after ERCP most commonly presents as gastrointestinal bleeding and often can be managed with repeat endoscopy. ERCP can also be complicated by retroperitoneal hematoma, which in rare cases can lead to hemodynamic compromise due to relentless hemorrhage or from secondary abdominal compartment syndrome. We describe the first reported case of post-ERCP retroperitoneal hematoma in a liver transplant recipient that led to abdominal compartment syndrome and shock liver. We will present the case, discuss management, and review the complications of ERCP in the liver transplant recipient. Close post-procedure monitoring, rapid detection, and low threshold for decompressive laparotomy are keys to the successful management of the liver transplant recipient experiencing expanding retroperitoneal hematoma after ERCP.