BACKGROUND External biliary fistula (Biliocutaneous fistula) are known to occur following trauma as well as surgery. A multidisciplinary approach including Internal Medicine, Surgery, Endoscopy and Interventional Radiology Specialists are required to manage the complex disease. Surgery is reserved for cases where expectant and endoscopic management fails. Till today the procedure of choice is hepaticojejunostomy. We propose to introduce a new technique: fistula-enteric anastomosis, which has significant advantages as compared to the standard hepaticojejunostomy procedures. This technique not only reduces the post-operative complications associated with a major procedure like Hepaticojejunostomy, but is also easier to perform not requiring highly skilled resources and expertise and has lesser post-operative morbidity.
Introduction: Situs inversus totalis (SIT) is an entity in which there is transposition of both the abdominal and thoracic organs. Presentation of acute abdomen in a case of SIT poses a challenge to the treating surgeon. We present a rare case report in which we identify the role of laparoscopy in confirming acute appendicitis with a simultaneous left paraovarian hemorrhagic cyst as a cause of left iliac fossa pain. Case report: A 17-year-old female presented with pain in the left lower abdominal quadrant. Ultrasonography and computed tomography confirmed a left-sided inflamed appendix and a left paraovarian hemorrhagic cyst along with transposition of other organs. A diagnostic laparoscopy was done to confirm the diagnosis with subsequent appendectomy and cyst enucleation as a definitive treatment for left iliac fossa pain. Discussion: Management of acute abdomen in a case of SIT can be challenging, keeping in mind the transposed organs and also that the nervous supply may still be normal in up to 50% of the cases. The role of diagnostic laparoscopy is pertinent in arriving at diagnosing and treatment of the underlying pathology or pathologies as in our case.
Introduction: Situs inversus totalis (SIT) is an entity in which there is transposition of both the abdominal and thoracic organs. Presentation of acute abdomen in a case of SIT poses a challenge to the treating surgeon. We present a rare case report in which we identify the role of laparoscopy in confirming acute appendicitis with a simultaneous left paraovarian hemorrhagic cyst as a cause of left iliac fossa pain.
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