Herniation through the foramen of Winslow: a laparoscopic approach.

We describe a case of a young woman with acute epigastric pain. Extensive diagnostic workup suggested a hernia through the foramen of Winslow. A laparoscopic exploration of the abdomen revealed an internal herniation of the cecum and ascending colon behind the hepatoduodenal ligament into the lesser sac. Successful management requires prompt diagnosis and surgical treatment. In our case the internal herniation was uncomplicated and could be reduced laparoscopically. To our knowledge, this is the first documented case of a laparoscopically treated Winslow hernia.

Pneumoperitoneum in repair of giant hernias and eventrations.

The common use of laparoscopy has made many surgeons familiar with the use of pneumoperitoneum. It is important to know the therapeutic advantage of this technique in the repair of giant hernias and eventrations where the viscera are forced out of the abdominal cavity.

Primary mechanical stapled anastomosis in surgery for colorectal emergencies.

From May 91 to March 99 a consecutive series of 100 acute obstructions or perforations of the left colon or rectum were treated by primary resection with mechanical anastomosis using a double or triple stapling technique without proximal colostomy. There were 8 postoperative deaths (8%) due to sepsis, acute respiratory distress syndrome, pulmonary embolism, stroke, and cachexy. Complications occurred in 29% of surviving patients. Clinical anastomotic leaks were observed in 7%, respiratory infection in 8%, wound infection in 8% and major cardiovascular problems in 4% of patients. The median hospital stay was 19 days. The morbidity and mortality of this series did not exceed the cumulative morbidity and mortality that can be expected after staged surgery. Compared with staged surgery, immediate resection and anastomosis using an entirely mechanical suture, thereby avoiding the problems of colostomy and reducing the length of hospital stay, has significant advantages for patients.

[Retroperitoneal leiomyosarcoma: case report and literature review]. / Leiomyosarcome rétropéritonéal: rapport d'un cas et revue de la littérature.

Retroperitoneal sarcomas are rare tumors, 25% of them are leiomyosarcomas. On the other hand, 19% of leiomyosarcomas are located in the retroperitoneum. Generally, the diagnosis is made at late stage due to poor symptomatology. Computed tomodensitometry is the most reliable diagnostic procedure. However, the final diagnosis is always obtained after histologic examination. Complete surgical excision is the best treatment. In fact, survival depends on histologic grading and resectability. The roles of radiation therapy and chemotherapy are not yet established.

[Biliary ileus]. / Ileus biliaire.

A case of gallstone ileus in an elderly woman is described and attention is drawn to the insidious clinical presentation and the significance of the often subtle radiological signs. The data from the literature specifies these aspects and allows a more complete review of this relatively rare pathology in order to remind its importance in differential diagnosis to emergency clinicians and radiologists.