Situs inversus totalis is a rare autosomal recessive disorder which can cause diagnostic confusion in a lot of clinical conditions including calculous cholecystitis due to the reversed anatomical positions of abdominal viscera. Laparoscopic cholecystectomy is much more challenging in the presence of this disorder due to loss of usual orientation. We present a case of a 43-year-old woman who was diagnosed at our centre to have calculous cholecystitis in the presence of situs inversus totalis. Laparoscopic cholecystectomy was performed safely after adjustment of the positions of the team inside the operative theatre and of the port sites. The patient tolerated the operation very well and was discharged home after 24h. On follow-up visit the patient was doing very well and completely free of symptoms.
We report our experience of four cases of long-standing unilateral, secondary lymphoedema of the lower limb, for which conservative treatment has failed, that were treated in our centre using pedicled omental flap. The four patients were followed for a period of 1 year after the procedures and frequent measurements of the circumference of the affected limb revealed a reduction in the circumference ranging between 50% in the first patient to 75% in the fourth patient together with an excellent functional improvement in terms of resuming walking, daily activities, sports and work. We think that pedicled omental flap is an important, relatively easy and safe option that deserves consideration in refractory cases of lymphoedema of the lower limb.
SummaryWe present a rare case of a 3-year-old child with a history of recurrent attacks of haematemesis, melena and severe anaemia. Upper gastrointestinal endoscopy revealed a vascular mass at the fundus and greater curvature of the stomach, CT revealed an ill-circumscribed mass of mixed attenuation in the left upper abdomen, which was related to the fundus and greater curvature of the stomach, extending to the spleen, greater omentum and transverse colon with a homogeneous enhancement following contrast injection suggesting the diagnosis of haemangioma. Explorative laparotomy was done and partial gastrectomy together with splenectomy and omentectomy was performed. Histological examination confirmed the diagnosis of cavernous haemangioma.
BACKGROUND
Objective: To evaluate laparoscopy as a diagnostic and therapeutic method in selected cases in abdominal trauma, and its value in avoiding unnecessary laparotomies at Al-Jumhoori Teaching Hospital in Mosul, Iraq. Patients and methods: From October 2009 to October 2011, sixty hemodynamically stable patients who were admitted with abdominal trauma (48 blunt, and 12 penetrating injuries), were submitted to diagnostic laparoscopy (DL) in the operating theatre of the Emergency Department of Al-Jumhoori Teaching Hospital in Mosul. Data collected and analyzed. Results: Negative and non therapeutic laparotomies were avoided in 38 patients (63.3%), and laparoscopic intervention was done in 4 patients (17.4%). The mean hospital stay of the (DL) negative patients was 2.1 days, and for the (DL) positive patients with laparoscopic intervention was 2.4 days, while of the patients with therapeutic laparotomy was 5.7 days. All the patients were discharged with no reported complication and no deaths were reported. Conclusion: Laparoscopy can be performed safely and effectively in hemodynamically stable patients with abdominal trauma. The most important advantages are reduction of the negative and non therapeutic laparotomy rate and shortening of hospitalization.
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