Thoracoscopic treatment for spontaneous hemopneumothorax

Abstract

diseases. Direct 2 retroperitoneal pelvic access seems interesting in children when low urinary tract malformations are concerned. We report a case of a 12-year-old boy with a blind ectopic ureter managed by pelvic retroperitoneoscopy. We describe the surgical technique, focusing on the di culty in the pediatric population. Nevertheless, retroperitoneoscopy is an excellent alternate way to manage such ureteral malformations. Abstract Ectopic liver has been but rarely described usually in the vicinity of liver such as on the gallbladder, hepatic ligaments, diaphragm, thoracic cavity, adrenal glands, pancreas, omentum, spleen, esophagus and umblical cord. A simple classi®cation for anomalous liver tissues found on the wall of gallbladder is 1. Accessory liver lobe 2. Ectopic nodule 3. Aberrant microscopic tissue. Ectopic nodules of liver tissue attached to the gallbladder are completely detached from the liver and has been described by various names such as accessory lobe, ectopic liver, accessory liver and heterotopic liver but the speci®c pathological term for this entity is choristoma introduced by Albert in 1904 meaning displacement. Several possible mechanisms may explain ectopic liver at various sites such as the development of an accessory lobe of the liver with atrophy or regression of the original connection to the main liver or migration of pars hepatica to the rudiment of various organs. In this paper we present a case of ectopic liver or choristoma attached to the gallbladder encountered during an elective laparoscopic cholecystectomy which was successfully removed with the gallbladder. Abstract Spontaneous hemopneumothorax is a rare clinical entity sometimes requiring an operation in the early stage. Two patients who underwent successful video-assisted thoracic surgery (VATS) for spontaneous hemopneumothorax are presented. In both cases, the bleeding point was clearly identi®ed, and hemostasis was easily obtained by clipping the point and 1 placing three access ports in the usual fashion. Furthermore, the evacuation of clotted blood and resection of bulla were performed with no di culties. The postoperative courses were smooth, and no complications occurred, although the preoperative general condition in the second case was hemodynamically unstable. The advantages of VATS over conventional thoracotomy include less time required to access the pleural cavity, a better view, and more facilitated manipulation during surgery. Because spontaneous hemopneumothorax is a benign disease, VATS should be considered an initial treatment option in all patients with this condition, even those with active bleeding.

Video‐assisted thoracic surgery for spontaneous haemopneumothorax

“…Surgical intervention is reserved for patients with massive bleeding with haemodynamic instability, persistent bleeding more than 24 h or retained blood clot refractory to tube drainage 14,24–26 . Before 1990, the surgical approach for SHP was usually through thoracotomy, 24–26 which was gradually replaced by VATS approach with or without axillary mini‐thoracotomy 14,15 , 27–29 . At present, VATS has been regarded as an easy, accessible and safe procedure that could be applied as an initial treatment of patients with SHP.…”

Diagnosis and treatment of primary spontaneous pneumothorax

“…Earlier reports suggest that SHP can be treated with chest tube insertion (de Perrot et al, 2000), and surgical intervention is reserved for patients with massive bleeding and hemodynamic instability, persistent bleeding for more than 24 h or retained blood clots refractory to tube drainage (Hart et al, 2002). Since VATS has gradually replaced open thoracotomy as the standard surgical approach for patients with PSP, its minimal invasiveness, excellent safety, and effectiveness makes it the primary treatment for SHP (Miyazawa et al, 2002;Luh and Tsao, 2007). Treatments of SHP through VATS include controlling the bleeders, which are most commonly on the parietal pleural side, and stapling or looping the bullae/blebs, usually on the visceral pleural side near the bleeding area, to seal off the air-leakage (Luh and Tsao, 2007).…”

Evaluation of patients diagnosed with spontaneous hemopneumothorax

“…In a study by Miyazawa et al, the advantages of VATS over conventional thoracotomy include less time required accessing the pleural cavity, a better view, and more fast manipulation during surgery [13]. Calvin et al, reported that VATS, which is associated with potentially fewer post-operative complications and shorter hospital stays when compared with thoracotomy, should be considered in patients with spontaneous hemopneumothorax who are hemodynamically stable [3].…”

“…Two surgical approaches that are known as thoracotomy and VATS are recommended. Thoracotomy should be performed immediately in case of hypovolemic shock, whereas thoracoscopic draining is usually for stable patients [11][12][13]14]. Haciibrahimoğlu et al, reported that seven patients were treated conservatively (closed underwater drainage) and two required VATS and thoracotomy because of worsening clinical condition [9].…”