Abdominal cocoon syndrome (sclerosing encapsulated peritonitis) causing small bowel occlusion in a patient with gastric bypass.

A rare condition, sclerosing encapsulating peritonitis, is characterized by a fibrotic membrane forming over the bowels, leading to intestinal obstruction. In this case of a 56-year-old male patient with a history of laparoscopic gastric bypass, a computed tomography scan showed findings indicative of the condition. Extensive adhesiolysis was performed, and biopsies confirmed the presence of fusiform cells (D2-40 positive on immunochemistry) resembling fibroblasts, within dense collagenous peritoneal tissue sheets, typical of sclerosing encapsulating peritonitis. The prevalence of this condition is uncertain, and diagnosis typically requires a peritoneal biopsy due to the nonspecific clinical presentation.

La peritonitis esclerosante encapsulada es una condición rara caracterizada por una membrana fibrótica que se genera sobre las asas intestinales causando cuadros de oclusión intestinal. Se presenta el caso de un paciente varón de 56 años con antecedente de derivación gastroyeyunal por laparoscopia que presenta oclusión intestinal. Se realizó tomografía computada que evidenció sitio de transición previo al sitio de anastomosis. Se realizó de anastomosis extensa y toma de biopsias. Histológicamente se observó engrosamiento de la membrana peritoneal, células fusiformes (D2-40 positivo en inmunohistoquímica) similares a fibroblastos con láminas de colágeno peritoneal denso. La peritonitis esclerosante encapsulada es una patología de prevalencia desconocida. El cuadro clínico es inespecífico y el diagnóstico definitivo es por patología con biopsia peritoneal.

Short and long-term reproductive outcomes after hysteroscopic adhesiolysis for infertile women.

OBJECTIVE: To evaluate reproductive outcomes after hysteroscopic adhesiolysis for patients with Asherman syndrome (AS) who presented with infertility and/or subfertility. METHODS: A retrospective study was conducted in the Women's Specialized Hospital, King Fahad Medical City, from December 2010 to December 2018. The medical records were reviewed for all infertile women who had hysteroscopic adhesiolysis. The specific study's main reproductive outcomes included: [1] the overall rate of conception, [2] the overall rate of conception according to the severity degree of intrauterine adhesions (IUAs), [3] the reproductive methods for achieving conception, and [4] pregnancy outcomes. Reproductive methods for conception included spontaneous conception, ovulation induction (OI), intrauterine insemination (IUI), and in-vitro fertilization (IVF) with/without intracytoplasmic sperm injection (ICSI). Outcomes of pregnancy included ectopic pregnancy, miscarriage, and live birth events. RESULTS: Forty-one patients (n=41) were analyzed. Their mean age was 32.2±4.6 years. The most common menstrual pattern amongst these patients was hypomenorrhea 46.4%. All patients resumed regular menstrual cycles after the adhesiolysis procedure. The overall conception rate during the 24 months follow up was 53.6%, and the overall live birth rate was 34.2%. Of the 22 patients who conceived, 12 patients (29.2%) conceived spontaneously, 2 (4.9%) with IUI, and 8 (19.5%) with IVF-ICSI. The patients with minimal IUAs had a significantly higher pregnancy rate (71.4%) when compared to those with moderate (47%) and severe (40%) IUA (two-tailed log-rank test, p=0.041). CONCLUSIONS: The spontaneous cumulative conception rate following hysteroscopic adhesiolysis was higher in patients with minimal IUAs than those with moderate and severe IUAs.

Mesenteroplicatura total con tutor transitorio: Prevención de la obstrucción recurrente por adherencias / Total mesenteric plication with temporary suture support: Prevention of recurrent bowel obstruction due to adhesions

La preocupación por los trastornos intestinales y la oclusión, como consecuencia de la formación de bridas peritoneoviscerales producidas por gestos quirúrgicos manuales e instrumentales, ha dado lugar a procedimientos con miras a evitarlas o minimizarlas. En este marco, la técnica de mesenteroplicatura con sostén transitorio tiene el propósito de favorecer el ordenamiento fibrointestinal, cuando la patología tratada haga sospechar que se producirán adherencias y más aún si la intervención ha sido causada por estas. Los fundamentos del procedimiento son los mismos que sostienen las técnicas usuales, por lo tanto no hay controversias en cuanto a las indicaciones. La lógica de la sutura transitoria está en que el tutor pierde su objetivo y se retira cuando finaliza el proceso adherencial, alrededor de las dos semanas de la intervención. Se presentan tres casos de oclusión intestinal operados con el procedimiento, controlados y con buenos resultados.

Peritoneal adhesions produced as a consequence of manual or instrumental manipulation during surgery cause bowel obstruction. Several procedures have been developed to avoid or minimize adhesions. Mesenteric plication with temporary suture support organizes the healing process in the bowel in case of high suspicion of adhesions will develop, particularly when bowel obstruction is produced by adhesions. The basis of this technique is the same as for standard procedures and, thus, there are no controversies about its indications. The rationale of temporary suture support is that when the healing process is over, about two weeks after the intervention, the suture support is no longer needed. We report three cases of intestinal obstruction undergoing mesenteric plication and temporary suture support, with favorable outcomes.

Tasa de conversión y morbilidad en el abordaje laparoscópico en pacientes seleccionados con obstrucción intestinal adherencial / Morbidity and Conversion Rate in Laparoscopy Approach in Selected Patients with Adhesive Intestinal Obstruction

Introducción: El síndrome adherencial es la causa más frecuente de obstrucción de intestino delgado. La laparotomía es el abordaje estándar. El avance de la cirugía mínimamente invasiva hace posible la resolución de cuadros obstructivos por laparoscopia. Objetivo: Analizar el abordaje laparoscópico de la obstrucción intestinal y compararlo con la vía abierta. Método: Análisis retrospectivo de los pacientes tratados de obstrucción intestinal aguda mediante laparoscopia en nuestro hospital desde 2012 hasta 2016. Se utilizó como referencia un grupo de pacientes tratados desde 2002 hasta 2005, cuando sólo se usaba el abordaje abierto. Se analizaron datos demográficos, riesgo quirúrgico, comorbilidades, métodos diagnósticos y complicaciones (Clavien). Resultados: De los 134 pacientes intervenidos de obstrucción intestinal aguda, se inició un abordaje laparoscópico en 47 (35 pr ciento). Por esta vía sólo se completaron 32 pacientes (68 por ciento). La tasa de conversión fue del 32 por ciento, estos pacientes fueron eliminados del estudio. En el grupo de referencia se analizaron al azar 32 pacientes. Ambos grupos son comparables. El grupo tratado con abordaje laparoscópico tuvo un 9 por ciento de complicaciones y un 3 por ciento de reintervenciones, con una sola lesión inadvertida. El grupo laparoscópico tuvo un 12,5 por ciento de reintervenciones, todas por evisceración, pero tuvo una lógica mayor tasa de resecciones intestinales. No hubo mortalidad hospitalaria. Conclusión: Los resultados en los pacientes en que se ha completado la cirugía por laparoscopia se comparan favorablemente con los del abordaje abierto en un grupo histórico homogéneo de referencia, y sin el riesgo añadido de evisceración(AU)

Introduction: Adherence syndrome is the most frequent cause of small bowel obstruction. Laparotomy is the standard approach. The progress of minimally invasive surgery makes it possible to resolve obstructive frames by laparoscopy. Objective: To analyze the laparoscopic approach for intestinal obstruction and compare it with the open pathway. Method: Retrospective analysis of patients treated for acute intestinal obstruction by laparoscopy in our hospital, from 2012 to 2016. A group of patients treated from 2002 to 2005 were used as reference, when only the open approach was used. We analyzed demographic data, surgical risk, comorbidities, diagnostic methods and complications (Clavien). Results: Within the 134 patients operated for acute intestinal obstruction, a laparoscopic approach was started in 47 (35 percent). Only 32 patients (68 percent) were completed in this way. The conversion rate was 32 percent, these patients were eliminated from the study. In the reference group, 32 patients were randomly analyzed. Both groups are comparable. The group treated with laparoscopic approach had 9 por ciento complications and 3 percent reoperations, with a single unexpected lesion. The laparoscopic group had 12.5 of reintervention, all due to evisceration, but had a higher rate of intestinal resections. There was no hospital mortality. Conclusion: In patients who have completed laparoscopic surgery, the results are compared favorably with those of the open approach in a homogeneous historical reference group, and without the added risk of evisceration(AU)

Tasa de conversión y morbilidad en el abordaje laparoscópico en pacientes seleccionados con obstrucción intestinal adherencial / Morbidity and Conversion Rate in Laparoscopy Approach in Selected Patients with Adhesive Intestinal Obstruction

Introducción: El síndrome adherencial es la causa más frecuente de obstrucción de intestino delgado. La laparotomía es el abordaje estándar. El avance de la cirugía mínimamente invasiva hace posible la resolución de cuadros obstructivos por laparoscopia. Objetivo: Analizar el abordaje laparoscópico de la obstrucción intestinal y compararlo con la vía abierta. Método: Análisis retrospectivo de los pacientes tratados de obstrucción intestinal aguda mediante laparoscopia en nuestro hospital desde 2012 hasta 2016. Se utilizó como referencia un grupo de pacientes tratados desde 2002 hasta 2005, cuando sólo se usaba el abordaje abierto. Se analizaron datos demográficos, riesgo quirúrgico, comorbilidades, métodos diagnósticos y complicaciones (Clavien). Resultados: De los 134 pacientes intervenidos de obstrucción intestinal aguda, se inició un abordaje laparoscópico en 47 (35 pr ciento). Por esta vía sólo se completaron 32 pacientes (68 por ciento). La tasa de conversión fue del 32 por ciento, estos pacientes fueron eliminados del estudio. En el grupo de referencia se analizaron al azar 32 pacientes. Ambos grupos son comparables. El grupo tratado con abordaje laparoscópico tuvo un 9 por ciento de complicaciones y un 3 por ciento de reintervenciones, con una sola lesión inadvertida. El grupo laparoscópico tuvo un 12,5 por ciento de reintervenciones, todas por evisceración, pero tuvo una lógica mayor tasa de resecciones intestinales. No hubo mortalidad hospitalaria. Conclusión: Los resultados en los pacientes en que se ha completado la cirugía por laparoscopia se comparan favorablemente con los del abordaje abierto en un grupo histórico homogéneo de referencia, y sin el riesgo añadido de evisceración(AU)

Introduction: Adherence syndrome is the most frequent cause of small bowel obstruction. Laparotomy is the standard approach. The progress of minimally invasive surgery makes it possible to resolve obstructive frames by laparoscopy. Objective: To analyze the laparoscopic approach for intestinal obstruction and compare it with the open pathway. Method: Retrospective analysis of patients treated for acute intestinal obstruction by laparoscopy in our hospital, from 2012 to 2016. A group of patients treated from 2002 to 2005 were used as reference, when only the open approach was used. We analyzed demographic data, surgical risk, comorbidities, diagnostic methods and complications (Clavien). Results: Within the 134 patients operated for acute intestinal obstruction, a laparoscopic approach was started in 47 (35 percent). Only 32 patients (68 percent) were completed in this way. The conversion rate was 32 percent, these patients were eliminated from the study. In the reference group, 32 patients were randomly analyzed. Both groups are comparable. The group treated with laparoscopic approach had 9 por ciento complications and 3 percent reoperations, with a single unexpected lesion. The laparoscopic group had 12.5 of reintervention, all due to evisceration, but had a higher rate of intestinal resections. There was no hospital mortality. Conclusion: In patients who have completed laparoscopic surgery, the results are compared favorably with those of the open approach in a homogeneous historical reference group, and without the added risk of evisceration(AU)

[A preliminary experience in the laparoscopic approach to bowel obstruction]. / Experiencia inicial en el abordaje laparoscópico de la obstrucción intestinal.

BACKGROUND: The laparoscopic approach to bowel obstruction is still controversial. OBJECTIVE: To evaluate our initial results in the laparoscopic treatment of bowel obstruction. MATERIAL AND METHODS: A retrospective study on patients diagnosed with bowel obstruction that underwent laparoscopic surgery within the time frame of January 2008 to June 30, 2012. The variables employed were: age, sex, occlusion etiology, previous surgeries, clinical progression, pneumoperitoneum creation, use of an auxiliary incision, anesthesia duration, conversion rate, postoperative hospital stay, time needed to tolerate liquids, and complications. RESULTS: Twenty-six patients, 18 women (69.2%) and 8 men (30.8%), with a mean age of 64.35 years (range: 21-92 years) were analyzed. The most frequent obstruction etiology was secondary to adhesions and presented in 12 cases. Nine patients (34.6%) underwent a completely laparoscopic approach and laparoscopy was complemented by an auxiliary incision in another 9 patients (34.6%), resulting in 18 cases (69.2%) of successful laparoscopic approach. Eight patients (30.8%) required conversion to open surgery. The mean anesthesia duration was 95min (range: 55-165min), mean postoperative hospital stay was 6 days (range: 3-72 days), and the mean amount of time needed to tolerate liquids was 3 days (range: 1-10 days). The patients that underwent complete laparoscopic approach presented with shorter hospital stay, they were able to ingest liquids earlier, and they presented with a lower number of postoperative complications; this latter variable was the only one that was statistically significant. CONCLUSIONS: The initial results of our experience were good, although more patients are needed in order to standardize and extend the use of this technique.

Laparoscopic adhesiolysis in a mini pony

Background: Intraperitoneal adhesions are common in equines, especially following exploratory celiotomy. Adhesiolysis is the treatment of choice for patients presenting postsurgical adhesions. Laparoscopic approach for adhesiolysis presents several advantageous aspects in human patients. The aim of the current study was to report a case of successful laparoscopic adhesiolysis in a mini pony horse. Case: A male Shetland Pony, weighing 140 kg, was admitted under complaint of right hind limb trauma and treated surgically for metatarsal fracture reduction. The patient has also had intermittent episodes of colic and was always treated clinically without major complications. The pony had no history of previous abdominal surgery and no episodes of acute abdomen were seen during hospital stay. Three months following ostheosynthesis, an exploratory laparoscopic approach was carried out to assess the possible cause or consequences of the episodes of acute abdomen. The patient was submitted to general anesthesia, positioned in dorsal recumbency and the abdomen was clipped and aseptically prepared for surgery. During the laparoscopic inspection, there were adhesions involving the ventral abdominal wall and a ventral mesogastric segment of duodenum. Laparoscopic adhesiolysis was performed using a two-port approach, by gently breaking the adhesion bands using meticulous traction with a 10-mm laparoscopic atraumatic Babcock forceps. Afterwards, the intestinal loop was rinsed with heparin sodium solution diluted in normal saline. The pneumoperitoneum was completely drained and the trocars sequentially withdrawn from the abdominal wall. The synthesis of the muscular layer was carried out using an interrupted cross mattress pattern, followed by synthesis of the skin with an interrupted cushion pattern. Total surgical time was 58 min. the patient was able to recover without complications. In the early postoperative period, the surgical recovery was considered excellent. No apparent adhesion involving the previously affected intestinal loop was found during the ultrasound exam following 15 days of surgery. Furthermore, the surgical wounds had healed completely, with no complications. Discussion: In the current case report, the primary cause of the acute abdomen episodes was not determined since the patient had never undergone abdominal surgery. It was hypothesized that an acute inflammation of the duodenal loop that was involved by the adhesion bands may have triggered the adhesiogenesis. Laparoscopy was efficient and presented a short operative time, due to magnification of image and adequate observation of structures surrounded by adhesion bands. Although the use of Babcock forceps is not usually recommended for adhesiolysis in the current literature, it was both effective in manipulating the bowel and performing the adhesiolysis. The heparin solution diluted in normal saline was effective in preventing the recurrence of new adhesions, which was evidenced by ultrasonography following 15 days. The laparoscopic approach usually minimizes the new formation of adhesions as trauma to the peritoneal surfaces is minimized by the use of delicate instruments, as observed in the current study. In addition, laparoscopy reduces the possibility of contact among the peritoneal surfaces and foreign bodies, such as gauze, glove powder and room air particles. Moreover, it maintains the abdominal surfaces in adequate humidity environment.

Laparoscopic adhesiolysis in a mini pony / Laparoscopic adhesiolysis in a mini pony

Background: Intraperitoneal adhesions are common in equines, especially following exploratory celiotomy. Adhesiolysis is the treatment of choice for patients presenting postsurgical adhesions. Laparoscopic approach for adhesiolysis presents several advantageous aspects in human patients. The aim of the current study was to report a case of successful laparoscopic adhesiolysis in a mini pony horse.Case: A male Shetland Pony, weighing 140 kg, was admitted under complaint of right hind limb trauma and treated surgically for metatarsal fracture reduction. The patient has also had intermittent episodes of colic and was always treated clinically without major complications. The pony had no history of previous abdominal surgery and no episodes of acute abdomen were seen during hospital stay. Three months following ostheosynthesis, an exploratory laparoscopic approach was carried out to assess the possible cause or consequences of the episodes of acute abdomen. The patient was submitted to general anesthesia, positioned in dorsal recumbency and the abdomen was clipped and aseptically prepared for surgery. During the laparoscopic inspection, there were adhesions involving the ventral abdominal wall and a ventral mesogastric segment of duodenum. Laparoscopic adhesiolysis was performed using a two-port approach, by gently breaking the adhesion bands using meticulous traction with a 10-mm

Background: Intraperitoneal adhesions are common in equines, especially following exploratory celiotomy. Adhesiolysis is the treatment of choice for patients presenting postsurgical adhesions. Laparoscopic approach for adhesiolysis presents several advantageous aspects in human patients. The aim of the current study was to report a case of successful laparoscopic adhesiolysis in a mini pony horse.Case: A male Shetland Pony, weighing 140 kg, was admitted under complaint of right hind limb trauma and treated surgically for metatarsal fracture reduction. The patient has also had intermittent episodes of colic and was always treated clinically without major complications. The pony had no history of previous abdominal surgery and no episodes of acute abdomen were seen during hospital stay. Three months following ostheosynthesis, an exploratory laparoscopic approach was carried out to assess the possible cause or consequences of the episodes of acute abdomen. The patient was submitted to general anesthesia, positioned in dorsal recumbency and the abdomen was clipped and aseptically prepared for surgery. During the laparoscopic inspection, there were adhesions involving the ventral abdominal wall and a ventral mesogastric segment of duodenum. Laparoscopic adhesiolysis was performed using a two-port approach, by gently breaking the adhesion bands using meticulous traction with a 10-mm

Laparoscopic adhesiolysis in a mini pony / Laparoscopic adhesiolysis in a mini pony

Background: Intraperitoneal adhesions are common in equines, especially following exploratory celiotomy. Adhesiolysis is the treatment of choice for patients presenting postsurgical adhesions. Laparoscopic approach for adhesiolysis presents several advantageous aspects in human patients. The aim of the current study was to report a case of successful laparoscopic adhesiolysis in a mini pony horse.Case: A male Shetland Pony, weighing 140 kg, was admitted under complaint of right hind limb trauma and treated surgically for metatarsal fracture reduction. The patient has also had intermittent episodes of colic and was always treated clinically without major complications. The pony had no history of previous abdominal surgery and no episodes of acute abdomen were seen during hospital stay. Three months following ostheosynthesis, an exploratory laparoscopic approach was carried out to assess the possible cause or consequences of the episodes of acute abdomen. The patient was submitted to general anesthesia, positioned in dorsal recumbency and the abdomen was clipped and aseptically prepared for surgery. During the laparoscopic inspection, there were adhesions involving the ventral abdominal wall and a ventral mesogastric segment of duodenum. Laparoscopic adhesiolysis was performed using a two-port approach, by gently breaking the adhesion bands using meticulous traction with a 10-mm

Background: Intraperitoneal adhesions are common in equines, especially following exploratory celiotomy. Adhesiolysis is the treatment of choice for patients presenting postsurgical adhesions. Laparoscopic approach for adhesiolysis presents several advantageous aspects in human patients. The aim of the current study was to report a case of successful laparoscopic adhesiolysis in a mini pony horse.Case: A male Shetland Pony, weighing 140 kg, was admitted under complaint of right hind limb trauma and treated surgically for metatarsal fracture reduction. The patient has also had intermittent episodes of colic and was always treated clinically without major complications. The pony had no history of previous abdominal surgery and no episodes of acute abdomen were seen during hospital stay. Three months following ostheosynthesis, an exploratory laparoscopic approach was carried out to assess the possible cause or consequences of the episodes of acute abdomen. The patient was submitted to general anesthesia, positioned in dorsal recumbency and the abdomen was clipped and aseptically prepared for surgery. During the laparoscopic inspection, there were adhesions involving the ventral abdominal wall and a ventral mesogastric segment of duodenum. Laparoscopic adhesiolysis was performed using a two-port approach, by gently breaking the adhesion bands using meticulous traction with a 10-mm