Aims and Objectives: In an attempt to avoid the high morbidity and mortality associated with exploratory laparotomy in a patient of duodenal ulcer perforation (DUP), an attempt was made to treat patients with spontaneous DUP with endoscopic clips. Background: DUP is a common cause of surgical emergency. Traditional form of treatment includes nasogastric decompression, fluid resuscitation, and exploratory laparotomy or laparoscopy for repair. Considering the compromised state of such patients, endoscopic treatment and avoiding surgery will play a great role in preventing the further stress caused by surgery and facilitate quicker recovery. On thorough review of literature, we found few articles stating successful endoscopic clipping of iatrogenic duodenal perforation occurred during upper endoscopy. Our case series appears to be first of its kind reporting the use of endoclips for treating spontaneous (noniatrogenic) DUP. Materials and Methods: Three young male patients presenting with a short duration history of abdominal pain and vomiting and chest radiograph suggesting pneumoperitoneum were selected for endoscopic clipping. All of them were hemodynamically stable with near normal blood pressure and pulse rate. Under local anesthetic spray and mild sedation, endoscopic clipping was carried out along with supportive treatment. Postoperatively, patients were monitored clinically and radiographically and discharged after they could tolerate full diet. Results and Conclusion: We recommend that in selected group of young patients of DUP who have presented early and are hemodynamically stable, endoclips may be applied to approximate mucosa. With supportive conservative treatment offered, thereafter healing of perforation occurs without the need for laparotomy or laparoscopy for suturing the same.
Postoperative perinephric collections are known complications of a transplant kidney with decapsulation injury being one of its rare etiologies. It can be early onset due to capsular injury during laparoscopic donor nephrectomy or late onset usually due to immunosuppressive medications or spontaneous in nature. We report a rare case of late onset decapsulation injury following insertion of a percutaneous nephrostomy drain for treating hydronephrosis. It was subsequently treated with marsupialization of the collection and creating a peritoneal window. Complete resolution of the perinephric collections was noted on follow up. On review literature, it was found that there is no unanimous management protocol related to decapsulation injuries. We have made an attempt to concise various treatment approaches mentioned in the literature for such cases and their outcomes. In case of patients with late onset decapsulation injuries such as ours, marsupialization has shown success in majority of cases obviating the need for nephrectomy. We suggest that marsupialization can form a reliable first line treatment following late onset decapsulation without any clear etiology, in majority of cases.
In patients with periampullary carcinoma presenting in the inoperable stage, self-expansible metallic stents (SEMS) are preferred for palliation of jaundice. The primary common bile duct (CBD) stones are very rare in a patient who is treated with SEMS for ampullary cancer. We report here a case of primary CBD stones after 2 years of placement of SEMS, whether, reflux of duodenal contents or foreign body reaction to the stent material is the etiology of the formation of stone is a matter of debate.
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