Idiopathic spontaneous pneumoperitoneum (ISP) refers to intraperitoneal air of unknown origin when other more common etiologies such as traumatic, intrathoracic, and gynecologic etiologies have been excluded. We present a case of a 42-year-old woman with insignificant history presenting with ISP who underwent exploratory laparoscopy and thorough diagnostic workup that was ultimately unrevealing. This case report adds to the existing literature of ISP, and the authors recommend initiating a multi-institutional database to improve our understanding of ISP and contribute to developing consensus guidelines for presumed ISP.
Some forms of bariatric surgery make patients susceptible to calcium malabsorption, and the parathyroid hormone (PTH) axis is important for maintaining normocalcemia in these patients. Injury to the parathyroid glands due to anterior neck surgery commonly causes PTH axis disruption and can result in severe hypocalcemia in bariatric surgery patients. Herein, we present a case of a patient with a history of stomach intestinal pylorus-sparing bariatric surgery who developed refractory hypocalcemia requiring daily intravenous (IV) calcium 2 years after thyroidectomy. PTH levels were inappropriately normal during episodes of hypocalcemia, and urinary calcium level was <3.0 mg/dL following large oral doses of calcium, suggesting that both inadequate PTH response and malabsorption contributed to her severe hypocalcemia. In order to enhance calcium absorptive capacity while minimizing the risk of weight regain, she was surgically treated with a Roux-en-Y gastric bypass proximal to the prior operation. The surgery successfully improved blood calcium levels; the patient was successfully weaned from IV calcium and was able to maintain normocalcemia with oral supplements. We discuss the case in the context of available literature and provide our recommendations.
Bariatric Surgery/adverse effects , Gastric Bypass/methods , Hypocalcemia/etiology , Hypocalcemia/surgery , Postoperative Complications/etiology , Postoperative Complications/surgery , Thyroidectomy/adverse effects , Adult , Bariatric Surgery/methods , Female , Humans , Organ Sparing Treatments , Pylorus , Remission Induction
Component separation (CS) has been advocated as the technique of choice to reconstruct complex abdominal hernia defects, especially in the setting of gross contamination. However, open CS was reported to have relatively high incidences of wound complications. Minimally invasive approaches to CS were proposed by several surgeons to reduce wound morbidity. To date, there are limited comparative data between minimally invasive CS (MICS) versus open CS. In this article, we reviewed existing literature on open CS versus MICS with respect to their recurrence and complication rates. Our analysis appeared to show that MICS has comparable recurrence and complication rates relative to open CS although our analysis had several limitations. To demonstrate the management of complications after MICS, we reported our experience of using MICS to repair a recurrent incisional hernia in a 63-year-old man after a perforated ulcer.
Hernia, Abdominal/surgery , Laparoscopy/methods , Laparotomy/methods , Surgical Mesh , Female , Follow-Up Studies , Hernia, Abdominal/diagnosis , Hernia, Ventral/diagnosis , Hernia, Ventral/surgery , Humans , Laparoscopy/adverse effects , Laparotomy/adverse effects , Male , Postoperative Complications/physiopathology , Postoperative Complications/surgery , Recurrence , Reoperation/methods , Risk Assessment , Severity of Illness Index , Surgical Wound Dehiscence/diagnosis , Surgical Wound Dehiscence/surgery , Treatment Outcome
INTRODUCTION: Stasilon(R) is a novel hemostatic woven textile composed of allergen-free fibers of continuous filament fiberglass and bamboo yarn. The development of this product resulted from controlled in vitro thrombogenic analysis of an array of potentially hemostatic textile materials and it has been cleared for both external and internal use by the United States Food and Drug Administration for the arrest of hemorrhage. The goal of the study was to assess the hemostatic and adhesive properties of Stasilon(R) in the setting of life-threatening refractory hemorrhage. CASE PRESENTATION: A 39-year-old Caucasian man presented with severe necrotic pancreatitis that failed multiple aggressive attempts to control associated bleeding with electrocautery, suture ligation, and sequential anatomic packing with cotton-based sponges. Subsequent retroperitoneal packing with Stasilon(R) produced a non-adherent wound-dressing interface and resulted in the achievement of persistent hemostasis in the operative field. CONCLUSION: In our patient, Stasilon(R) was demonstrated to be effective in the arrest of refractory hemorrhage.
