Acute massive gastric dilatation is a rare event that is usually underdiagnosed. It can occur due to multiple etiologies, including medical and surgical, or as a postoperative complication. Acute massive gastric dilatation can lead to life-threatening fatal complications, including perforation, bleeding, or shock. We report a rare case of acute massive gastric dilatation with perforation of the stomach due to closed-loop obstruction of the stomach, which occurred in a patient with cricopharyngeal carcinoma due to a kink at the feeding jejunostomy site. Early diagnosis and treatment are essential, as acute massive gastric dilatation with perforation carries high morbidity and mortality.
BackgroundLaparoscopic closed cystectomy of the hepatic hydatid cyst (HHC) is increasingly being performed as it has improved postoperative recovery and reduced morbidity. However, laparoscopic closed cystectomy of HHC is difficult when located in segments VI, VII, and VIII. This study aimed to assess the laparoscopic closed cystectomy feasibility of the HHC when cysts are located at the difficult access site. MethodologySeven patients out of 13 patients of HHC treated laparoscopically in the surgery department from 2014 to 2018 were included. These patients had cysts located in segments VI, VII, and VIII of the liver. All patients received perioperative albendazole, underwent ultrasonography (USG) and contrast-enhanced computed tomography for diagnosis. We noted the demographic character of all the patients, cyst's location, cyst size, type of the cyst, mean operative time, intraoperative and postoperative complications, duration of the hospital stay, and recurrence of the cyst. ResultsAll patients underwent laparoscopic closed cystectomy of HHC. One patient had a conversion to open procedure, and one patient had an additional thoracoscopic approach added. The mean operative time was 191.86 minutes. There were no intraoperative complications. One patient had developed a surgical site infection, and three had a minor bile leak postoperatively. The hospital stay's mean duration was four days, and there was no recurrence in the 21 months follow-up. ConclusionThe laparoscopic closed cystectomy of HHC located at segments VI, VII, and VIII is feasible, safe, and costeffective. A thorough preoperative evaluation, preparation, and radiological planning of the procedure should be done.
Injury to the inferior epigastric artery is infrequent and iatrogenic in most cases, which can be fatal and lifethreatening in some cases due to unnoticed excessive hemorrhage. We present a 23-year-old male who underwent sigmoidectomy, end-to-end colorectal anastomosis with covering loop ileostomy for sigmoid volvulus. He developed intra-abdominal pus collection one week following surgery, for which ultrasoundguided aspiration was attempted. Post aspiration, the patient developed abdominal distension, pain with a significant drop in hemoglobin. Imaging showed active bleed from the branch of the inferior epigastric artery with massive intra-abdominal hematoma. The hematoma was evacuated, and the bleeding artery was identified and ligated. Postoperatively, there was no further drop in hemoglobin, and the patient was stable and hence discharged.
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