Retention of surgical materials occurs after diverse surgical procedures, often times after counting of surgical materials pre and post operatively. A 45 year old female in whom a surgical sponge was left in the pelvis post hysterectomy with spontaneous transurethral partial extrusion is reported. Risk factors that could predispose to a gossypiboma and suggestions to prevent it are reported.
Damage control surgery (DCS) is an abbreviated laparotomy used as a temporising measure in critically unwell patients who have limited physiological reserves to tolerate complex definitive surgeries. The aim of DCS is to address life-threatening haemorrhage and manage abdominal contamination. Following an abbreviated laparotomy, patients are continuously resuscitated in intensive care unit until physiological stability can be maintained for definitive surgeries. The role of DCS in the trauma setting is well-described; however, its principles can also be applied in General Surgery for a variety of indications such as mesenteric ischaemia, uncontrolled haemorrhage, and secondary peritonitis. Judicious selection of the non-trauma patient who will benefit from this strategy is paramount. We present two cases of a polytrauma patient (Patient A), and non-trauma patient with abdominal septic shock (Patient B) who underwent DCS at our tertiary centre. Patient A is a 49-year-old male involved in a road traffic accident who sustained multiple injuries including liver laceration, splenic laceration, and colonic injury. Intra-abdominal packing and repair of serosal tears were performed, with a re-look laparotomy 48 hours later -- no further bleeding or visceral injuries were identified. Patient B is a 51-year-old gentleman who re-presented in septic shock due to infected retroperitoneal collection following a bleeding duodenal ulcer, initially managed radiologically. A T tube was inserted into the duodenum with two abdominal drains at initial DCS. After thorough washout, a feeding jejunostomy was sited at the re-look laparotomy. 30-days mortality is 0% and both patients are under follow-up.
Introduction Chronic pancreatitis can be complicated by the development of a pancreatic pseudocyst in 20 – 40% of cases. Splenic rupture is usually associated with blunt trauma but can be associated with non-traumatic causes like pancreatic pseudocysts associated with chronic pancreatitis. Atraumatic splenic rupture (ASR) is rare, and a life-threatening process with a mortality of about 12%. Possible mechanisms of action of pancreatic pseudocysts causing ASR to have been described in literature, with some of them involving the action of proteolytic enzymes on the splenic vessels, parenchyma and hilum. Management of these cases involves resuscitation, and emergency splenectomy because they usually present with haemodynamic instability. Case report A 50-year-old woman with a background of pancreatic pseudocyst secondary to alcoholic chronic pancreatitis presented with severe left sided abdominal pain. A Computed Tomography (CT)scan confirmed the presence of splenic rupture with moderate haemoperitoneum. Emergency laparotomy revealed a ruptured and necrotic spleen adjacent to a ruptured pancreatic pseudocyst. A splenectomy was performed with abdominal packs left insitu with the view to a relook surgery 24 /48 hours later. She recovered uneventfully after HDU care. Conclusions ASR secondary to pancreatic pseudocyst as a complication of chronic pancreatitis is a rare phenomenon which requires a high index of suspicion for diagnosis. CT is the gold standard imaging modality for investigation in a haemodynamically stable patient. Management is surgical with adequate resuscitation and perioperative critical care.
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