No abstract

In patients with acute pancreatitis, the biochemical analysis within 24 hours of admission provided a simple, rapid, and more accurate prediction of cholelithiasis than USS. The combination of LFT and USS detected or excluded a biliary etiology in almost all patients.

The two patients with observable deficit had their instrumentation left in situ after discussion with them and/or parents. Spinal cord monitoring in this population is possible but potentially unreliable. Surgeons will need to carefully consider the use of monitoring in their management of this challenging population.

Buried bumper syndrome is an uncommon long-term complication of gastrostomy tubes. The overgrowth of the gastric mucosa over the internal bumper of the tube often is symptomatic and leads to mechanical failure of feed delivery and peritubal discharge. Whilst removal of the buried internal bumper has been accomplished endoscopically in some cases, it is traditionally removed at laparotomy. This is the first description, however, of a successful laparoscopic removal of a percutaneous endoscopic gastrostomy tube in a patient with a buried bumper syndrome. The patient made an uneventful recovery and was discharged home on the third postoperative day. The operative technique is described, and its merits are discussed.

The Devine exclusion gastroenterostomy is an effective procedure for the relief of gastric outlet obstruction in patients with unresectable carcinoma of the gastric antrum. We report on the successful laparoscopic application of this technique in two male patients aged 61 and 76 years with unresectable and obstructing antral gastric cancer. The operating time was 90 minutes for each patient, and the postoperative hospital stay was 3 and 4 days, respectively. There were no delays in gastric emptying and no recurrences of gastric outlet obstruction until the time of death, 3.5 and 9 months postoperatively, respectively. The laparoscopic approach to a Devine exclusion gastroenterostomy is a safe and effective minimally invasive approach to the palliation of unresectable obstructing gastric carcinoma.