Double intussusception secondary to Meckel's diverticulum in a seventeen-year-old female: a case report

Meckel's diverticulum (MD) is the most common congenital malformation of the gastrointestinal tract. It rarely presents in adults and is usually asymptomatic. Attention to clinical history, examination and imaging studies are crucial for a successful diagnosis. A 17-year-old female presented with vomiting and acute peri-umbilical abdominal pain. Ultrasound examination showed an intussusception measuring 3.2cm in diameter and over 8cm in length. Exploratory laparoscopy showed two ileal intussusceptions. The first was reduced via laparoscopy; the second appeared suspicious for MD and ultimately required a mini-laparotomy for reduction and resection of the MD. Ultrasonography is a useful modality in the presence of perforation, occlusion, hemorrhage, neoplasia, or fistula and avoids exposure to radiation. Laparoscopic or laparoscopic-assisted mini-laparotomy is the route for the resection of MD. The choice depends on the clinical presentation and surgeon expertise. A careful history and physical examination are vital factors in diagnosis and treatment MD.

Feasibility prospective study of laparoscopic cholecystectomy with suprapubic approach

BACKGROUND

Since the publication of laparoscopic cholecystectomy (LC) using three ports instead of four, no significant evolution has impacted on our clinical practice in order to improve length of stay, postoperative pain, time of recovery and cosmetic results. Recently, a renewed interest has been observed with the suprapubic approach, called occult scar laparoscopic cholecystectomy (OSLC). The aim of this prospective multicentric study was to evaluate the feasibility of OSLC in 2 French centers.

METHODS

From March to September 2014, 60 patients were prospectively included in this study. The operation incisions consisted of an umbilical incision for camera; an incision in the right groin for maneuvers of exposition and a suprapubic incision for instrumental dissection and clipping. Outcome was by operative time, operative complications, hospital length of stay, analgesia required after surgery, and cosmetic outcomes. The Patient Satisfaction Scale and Visual Analog Score (VAS) also were used to evaluate the level of cosmetic result and postoperative pain.

RESULTS

No laparoscopy was converted to an open procedure, the mean operative time was 53±20min. No patient had intraoperative bile duct injury or significant bleeding. The mean length of stay was 1.70±0.76 days. Two patients (3%) experienced postoperative complication (1 intra-abdominal abscess treated by antibiotics and 1 subcutaneous seroma of the 11-mm port wound treated successfully by needle aspiration).

CONCLUSION

The technique proved to be safe and feasible with no specific complication and without specific instrument. It offers satisfactory postoperative pain level and good cosmetic results.

Gallstone ileus: analysis of eight cases and review of the literature

OBJECTIVE

We hereby analyzed a series of gallstone ileus cases operated on in our department starting from a Bouveret syndrome case.

METHOD

Retrospective analysis of all gallstone ileus cases who underwent surgery in our department during the last 26 years. We took into consideration diagnostic elements, time from admission to surgery, type of surgery and post-operative outcome.

RESULTS

During this period 9,143 gallstones were deferred to surgery; 27 biliary-digestive fistulae were discovered during surgery; gallstone ileus complicated fistula in 8 patients. Gallstone ileus was exclusively present in elderly women with associated comorbidities. Diagnosis was suggested by clinical features of acute or incomplete intestinal obstruction; it was sustained by imagistic studies with different degrees of relevance. The average time from admission to surgery was 2.6 days. Surgical approach varied from simple enterolithotomy to additional fistula repair. The outcome was uneventful in most of the cases with only one exception.

CONCLUSIONS

gallstone ileus is a rare condition, occurring in elders with important comorbidities. The choice for surgical procedure depends on the obstructive syndrome's gravity and associated comorbidities; the type of intervention does not significantly influence post-operative morbidity and mortality rates.