The present article is the first in the literature reporting short- and medium-term results using a totally laparoscopic technique for aortoiliac disease.Forty-nine patients, 6 having an associated small aneurysm, were scheduled for totally laparoscopic surgery (TLS) for aortoiliac occlusive disease and 2 for treatment of aortic aneurysmal disease (AAA). Patients' characteristics, intraoperative, postoperative data and mid-term data were recorded.TLS was successfully completed in 45 patients. Of those patients, 41 received an aortobifemoral bypass; three, an iliofemoral bypass; and one, an aortoaortic bypass. Five patients were converted from TLS to video-assisted laparoscopic surgery using incisions varying in size from 7 cm to 11 cm. One patient underwent conversion to standard open surgery. One death occurred unrelated to the technique. Major perioperative complications related to the technique were few and presented in the early phase of the study: One intraoperative embolization to the lower limbs that needed embolectomy, and one acute aortic false aneurysm. Midterm results were favorable, demonstrating two limb graft thromboses. Hernias at trocar sites occurred in only 3.9%. The patients benefited from this procedure, which is considered definitive like its standard open counterpart. The conversion rate is lower than that reported for acute cholecystitis. Selection of patients has been less stringent during the second half of the study in term of inclusion of patients with AAA and of more TASC IV patients. Surgeons willing to learn this technique should attend dedicated courses. In the future, as this surgical innovation matures, controlled randomized studies should be initiated.
We retrospectively analyzed the clinical presentation and imaging investigation in 4 cases of surgically (2 cases) or endoscopically (2 cases) proven toothpick-related gastrointestinal perforation. The toothpick perforated the stomach (2 cases), the sigmoid (1 case), and the ileum (1 case). Sonographic appearance of the toothpick was a linear, hyperechoic (3 cases) or hypoechoic (1 case) image of variable length (mean: 2.5 cm) with inconsistent posterior shadowing in the longitudinal axis. In transverse section a hyperechoic dot (4 cases) with clear, thin, sharp, posterior shadowing (3 cases) was seen. Following sonography (4 cases), CT scan (2 cases), and upper GI study (2 cases), the preoperative diagnosis of GI perforation by foreign body compatible with toothpick was made in all cases, although none of the patients was aware of having swallowed a toothpick. This information will be of help in making early sonographic diagnosis of toothpick-related GI perforation in patients with or without symptoms.
Ingested foreign bodies usually proceed uneventfully through the intestinal tract; complications rarely occur. The wide variety of clinical presentations they produce often make the diagnosis difficult. We report two cases of sonographic detection of foreign bodies in the inferior vena cava, namely one toothpick and one small (chicken?) bone, which probably caused a duodenocaval fistula. Both patients were initially investigated for recurrent septic episodes, weight loss, and deterioration of general condition.
Ultrasonography was useful in the detection of primary carcinoid tumors of small bowel. Their sonographic characteristics were described and some of them were highly suggestive of the diagnosis.
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