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Órgão Oficial de Divulgação Científica da
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ISSN: 1679-1796
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Relatos de Casos Selecionados
Selected Related Cases
Edna Delabio Ferraz (RJ)
Membro Titular da Sobracil, Membro Titular da SBCP, Membro ACBC, UFRJ-Rio de Janeiro, Brasil
Editora da Revista Brasileira de Videocirurgia
Prezados Colegas,
Esta seção foi criada com a finalidade
de divulgar Relatos de Casos, de
ocorrência incomum em Videolaparoscopia, obtidos
de periódicos nacionais e internacionais.
Os interessados em publicar Resumo ou Abstract de sua autoria, serão muito bem-vindos.
O material poderá ser enviado para o endereço de sede da SOBRACIL ou via
correio eletrônico, para:
sobracil@sobracil.org.br
ou
ednaferraz@pobox.com.br
Choledocholithiasis caused by migration of a surgical clip after video laparoscopic cholecystectomy.
Dell'Abate P; Del Rio P; Soliani P;
Colla G; Sianesi M
Institute of General Surgery and Organ Transplant,
School of Medicine, University of Parma, Italy.
J Laparoendosc Adv Surg Tech A 2003; 13(3): 203-4
Abstract
We present a case of a 67-year-old woman, in
which a clip in the common bile duct (CBD) was the
nidus of stone formation. The ultrasonographic examination reported a CBD with an
abnormally large diameter and an endoscopic
retrograde sphincterotomy showed a stone in the ampulla.
The stone was extracted through the Vater's Papilla
and the patient was discharged after 24 hours.
Port-site tuberculosis after laparoscopy:
report of eight cases.
Ramesh H; Prakash K; Lekha V; Jacob G;
Venugopal A; Venugopal B
Department of Gastrointestinal Surgery, PVS
Memorial Hospital, 31/543, Subhash Nagar, Edappally,
Cochin 682024, Kerala, India. hramesh@vsnl.com
Surg Endosc 2003 Jun; 17(6): 930-2
Abstract
In light of the explosive increase in
laparoscopic surgery, there is concern about the effectiveness
of sterilizing reusable laparoscopic instruments
by immersion in 2% glutaraldehyde. This article describes the clinical features of eight patients
who presented with biopsy-proven tuberculosis at the
port-site unassociated with other clinical features
of tuberculosis. Three of the eight patients had
positive cultures for Mycobacterium tuberculosis. The
port-site sinuses healed with antituberculous chemotherapy. There is conflicting information
in the literature regarding the effectiveness of a
20-min instrument soak in 2% glutaraldehyde to
clear M. tuberculosis. In light of the preceding information, the current practice of
glutaraldehyde disinfection for reusable laparoscopes needs to
be reexamined.
Laparoscope-assisted distal gastrectomy for early gastric cancer in a 76-year-old man with situs inversus totalis.
Yamaguchi S; Orita H; Yamaoka T; Mii S;
Sakata H; Hashizume M
Department of Disaster and Emergency Medicine, Graduate School of Medical Sciences, Kyushu
University, Japan. shohei@surg2.med.kyushu-u.ac.jp
Surg Endosc 2003 Feb; 17(2): 352-3
Abstract
We report a case of a 76-year-old man with
situs inversus totalis (SIT) who developed early
gastric cancer. He was successfully treated by
laparoscope-assisted distal gastrectomy for the gastric cancer. This case suggests that
patients with SIT with malignancy could also
undergo laparoscopic surgery. To the best of our knowledge, no case of laparoscopic surgery
for malignant neoplasms associated with SIT has
been reported in the English literature. We
therefore believe this is the first case report.
Gallstone in a hernia sac
Aspelund G; Halldorsdottir BA;
Isaksson HJ; Moller PH
Department of Surgery, Landspitali-University
Hospital, Reykjavik, Iceland.
Surg Endosc 2003 Apr; 17(4): 657
Abstract
Perforation of the gallbladder with spillage of stones into the abdominal cavity is
relatively common during laparoscopic cholecystectomy.
We report a patient presenting with a symptomatic groin hernia 10 days after
laparoscopic cholecystectomy for acute cholecystitis.
The hernia sac was found to contain a gallstone.
The patient underwent an uneventful hernia repair. Various complications due to retained
gallstones have been described as case reports
emphasizing how important it is to prevent perforation of
the gallbladder or else make an effort to retrieve spilled stones from the abdomen.
Fatal aortic injury during laparoscopy:
report of two cases.
Romain N; Michaud K;
Brandt-Casadevall C; Mangin P
Institut Universitaire de Medecine Legale de
Lausanne, Lausanne, Switzerland.
Am J Forensic Med Pathol 2003 Mar; 24(1): 80-2
Abstract
The authors report the cases of two young women who died of massive hemorrhage resulting
from trocar aortic injuries during abdominal laparoscopy. In the first case, wherein the
patient underwent laparoscopy for cecopexy, the
forensic autopsy showed a through-and-through perforation of the abdominal aorta and of
the ileum. The other woman, who had morbid
obesity, underwent a laparoscopy for gastroplasty. In
this second case, the main postmortem findings
were stab wounds of the thoracic aorta and of the diaphragm.
Diagnosis of a small, androgenizing Brenner cell
tumor in a postmenopausal woman aided by laparoscopic salpingo-oophorectomy.
A case report.
Silva PD; Caplan RH; Virata RL
Sections of Reproductive Endocrinology and
Medical Endocrinology, Department of Pathology, Gundersen
Lutheran Medical Center, La Crosse, Wisconsin, USA.
J Reprod Med 2003 May; 48(5): 381-3
Abstract
BACKGROUND: Rapidly progressive hirsutism or virilization in the postmenopausal woman raises
the suspicion of an androgen-secreting tumor.
Hormonal testing and imaging studies usually rule out
an adrenal tumor. However, small, androgenizing ovarian tumors may not be detectable by
imaging studies. CASE: A postmenopausal woman
presented with rapidly progressive hirsutism and
elevated androgens. Imaging studies did not localize
the tumor. Bilateral laparoscopic oophorectomy was performed, and a small, androgenizing Brenner
cell tumor of the left ovary was demonstrated on histologic examination.
CONCLUSION: Because of the low morbidity associated with laparoscopic
salpingo-oophorectomy, it may be reasonable to remove
the ovaries of postmenopausal women who display virilization or rapidly progressive hirsutism
and elevated androgens, even if imaging studies do
not detect the ovarian tumor.
Adenomatous hyperplastic polyp of the gall bladder associated with cholelithiasis in a child.
Kikiros C; Arunachalam P; Lam MH
Division of Paediatric Surgery, Princess Margaret Hospital
for Children, G.P.O. Box D184, Perth 6001, Western
Australia. colin.kikiros@health.wa.gov.au
Pediatr Surg Int 2003 Apr; 19(1-2): 118-9
Abstract
Polyps of the gall bladder are uncommon conditions in children. We present a case
report of a 14-year-old girl who had calculous cholecystitis and an adenomatous
hyperplastic polyp of the gall bladder. She was treated
by laparoscopic cholecystectomy.
Omental trophoblastic implants and hemoperitoneum after
laparoscopic salpingostomy for ectopic pregnancy.
A case report.
Pal L; Parkash V; Rutherford TJ
Departments of Gynecology and Pathology, Yale
University School of Medicine, Yale New Haven Hospital,
New Haven, Connecticut, USA. lubnapal@hotmail.com
J Reprod Med 2003 Jan;48(1):57-9
Abstract
BACKGROUND: In this era of cost containment, laparoscopic management of ectopic
pregnancy has become the mainstay of dealing with
this common gynecologic emergency. The aim of surgical intervention remains conservation of
the fallopian tube, if possible; salpingectomy is reserved for cases of tubal rupture
and/or recurrent ectopic pregnancy, where little
hope exists of salvaging tubal function. CASE: A
28-year-old woman, para 2, underwent laparoscopic salpingostomy for ectopic pregnancy.
She experienced intraabdominal bleeding within the initial 12 hours of the postoperative period.
On exploratory laparotomy, there was active
bleeding from the site of the salpingostomy, and a salpingectomy was performed. The patient
was lost to follow-up and on postoperative day 21 presented with signs of intraabdominal
bleeding; repeat laparotomy revealed active bleeding
from trophoblastic implants within the greater omentum. The omentum was adherent to
the anterior abdominal wall at the site of
umbilical trocar placement. An infracolic omentectomy
was performed, with a subsequent uneventful postoperative course; the patient was
followed until resolution of the serum beta-hCG.
CONCLUSION: Postoperative surveillance is important. Positive intraabdominal
pressure during laparoscopic surgery and the Trendelenburg position may be contributory
to cephalad migration of trophoblast remnants,
with the scavenging action of the omentum and adherence to the site of umbilical
trocar placement theoretically providing a
mechanism for neovascularization and sustenance of
the parasitic trophoblast.
Acute congestive heart failure after laparoscopic cholecystectomy: a case report.
Giaquinto D; Swigar K; Johnson MD
Melrose Wakefield Hospital, Melrose, Mass., USA.
AANA J 2003 Feb;71(1):17-22
Abstract
Compared with open procedures, laparoscopic surgery is safe with a low incidence
of complications. In rare circumstances, however, intraoperative complications such as
acute pulmonary edema have been reported. The patient described herein is a 59-year-old
woman with obesity, gastroesophageal reflux disease,
and chronic obstructive pulmonary disease who developed acute congestive heart failure
(CHF) and cardiomegaly immediately following laparoscopic cholecystectomy. She
required emergent reintubation, diuresis, and
admission to the intensive care unit for
postoperative mechanical ventilation. Potential causes
of pulmonary edema associated with laparoscopic surgery (extreme Trendelenburg position,
venous carbon dioxide embolism, absorption of
crystalloid irrigation fluid, cardiopulmonary disease,
adverse drug reactions, negative pressure
[postobstructive pulmonary edema]) were considered. A
process of exclusion revealed that the hemodynamic changes induced by insufflation with an
intra-abdominal pressure of 20 mm Hg were the most likely causes of the CHF. Suggestions to
prevent occurrence of CHF are tight control of hemodynamics with use of invasive
monitoring in high-risk patients and gentle, slow
insufflation of the abdomen to an intra-abdominal
pressure of 15 mm Hg or less. Intraoperative
and/or postoperative CHF should be treated with diuretics, intravenous nitroglycerin,
arterial vasodilators, and/or inotropic agents as
needed.
Mesh penetration of the sigmoid colon following a transabdominal preperitoneal hernia repair.
Lange B; Langer C; Markus PM; Becker H
Department of Surgery, University of Gottingen,
Robert-Koch-Strasse 40, 37075 Gottingen, Germany.
Surg Endosc 2003 Jan; 17(1): 157
Abstract
The laparascopic transabdominal preperitoneal (TAPP) repair of an inguinal hernia is
an established technique associated with notably low rates of recurrence and
complication. Inguinal pain and anal bleeding following a
TAPP procedure may result from the penetration of
the repair mesh into the sigmoid colon. In this
case report, we discuss this particular
complication following the TAPP procedure. Subsequently,
we describe the diagnostics as well as the
surgical treatment necessary.
Portal vein thrombosis after laparoscopic sigmoid colectomy for diverticulitis:
report of a case.
Baixauli J; Delaney CP; Senagore AJ;
Remzi FH; Fazio
Department of Colorectal Surgery/A-30, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland,
OH 44195, USA.
Dis Colon Rectum 2003 Apr;46(4):550-3
Abstract
Portal vein thrombosis is a very uncommon complication after laparoscopic surgery.
Although only one case of portal vein thrombosis has
been reported after laparoscopic colectomy, there
are several reports of mesenteric vascular
occlusion after other laparoscopic procedures. We
present a case of portal vein thrombosis in a patient
with no other demonstrable hypercoagulable states
or risk factors, who underwent an uneventful laparoscopic sigmoid colectomy.
Because alteration in coagulation may occur after establishing a pneumoperitoneum, we
suggest that heparin prophylaxis may be advisable to
avoid these kinds of complications, especially if a
past history of coagulable disorders is present.
Culdolaparoscopic cholecystectomy during vaginal hysterectomy.
Tsin DA; Sequeria RJ; Giannikas G
Department of Gynecology, The Mount Sinai Hospital
of Queens, Astoria, New York, USA. lasergyn@aol.com
JSLS 2003 Apr-Jun; 7(2): 171-2
Abstract
BACKGROUND: Exploration of the abdominal cavity is routinely performed during abdominal
and laparoscopic hysterectomies. The visualization of
the abdomen during vaginal hysterectomy, however,
is not usually done. During a vaginal
hysterectomy, after the uterus is removed, an opening is present
in the cul-de-sac, which offers a unique
opportunity for the performance of not only exploratory but
also concomitant surgeries, such as a
cholecystectomy. METHOD: Culdolaparascopy is a culdoscopy
assisted laparoscopic technique that utilizes a 12-mm
trocar in the vagina as a multifunctional port in conjunction with laparoscopy and
minilaparoscopy. A cholecystectomy was performed utilizing
the vaginal trocar as an insufflation, visual, and extracting port during a vaginal
hysterectomy. CONCLUSION: Culdolaparoscopy, when
performed during vaginal hysterectomy, can be used
for exploration and operation in the abdominal
cavity. This case report illustrates the feasibility of
a cholecystectomy performed using this surgical concept.
Rupture of a uterine horn after
laparoscopic salpingectomy.
A case report.
Ayoubi JM; Fanchin R; Lesourd F; Parant O; Reme JM; Monrozies X
Departments of Obstetrics and Gynecology,
University Hospital, Grenoble, Antoine Beclere Hospital,
Clamart, France. jamayou@aol.com
J Reprod Med 2003 Apr; 48(4): 290-2
Abstract
BACKGROUND: Uterine rupture after
salpin-gectomy, especially associated with cornual resection, is
a rare, serious pregnancy complication. CASE: A spontaneous uterine rupture occurred during
the second trimester of pregnancy, following salpingectomy with resection of the
interstitial portion. Conservative treatment was performed,
and fertility was preserved. CONCLUSION: Postsalpingectomy pregnancies must be
carefully and frequently monitored, with
ultrasonography used at the slightest clinical symptom.
A postsalpingectomy rupture must be treated surgically, preferably with conservative
treatment rather than hysterectomy.
Malignant struma ovarii: a case report of laparoscopic management.
Volpi E; Ferrero A; Nasi PG; Sismondi P
Department of Gynecologic Oncology, University of
Turin, Turin, Italy. ginecologia@mauriziano.it
Gynecol Oncol 2003 Jul; 90(1): 191-4
Abstract
BACKGROUND: Struma ovarii is a rare disease. Malignant transformation is even rarer. Data
about its management are lacking. We describe the
first reported case of a malignant struma ovarii
treated and staged by laparoscopy. CASE: A
49-year-old patient was operated by laparoscopy for a
right ovarian teratoma. The patient did not show symptoms of hyperthyroidism. The ovarian
teratoma was removed in a plastic bag and definitive
histology showed foci of papillary adenocarcinoma in a
struma ovarii. The patient was then staged by
laparoscopic surgery undergoing left adnexectomy,
multiple peritoneal and omental biopsies, and common
iliac and paracaval lymph node sampling.
Hysterectomy was not performed. The postoperative course
was uneventful and the patient was released on the second day. Thyroglobulin level was monitored
and the patient is free of disease after more than 1
year. CONCLUSION: The preoperative diagnosis of malignant struma ovarii is difficult. Even
with cautious evaluation of the patient, some risk
of wrong diagnosis is possible. This is why a
meticulous technique of laparoscopic surgery in removing
the ovary is important. Laparoscopic staging may
also intervene in very limited cases; the expertise
to perform open staging of the patient is necessary
but the postoperative course is fast.
[Intraperitoneal neoplastic dissemination of incidental gallbladder carcinoma
after laparoscopic surgery]
[La disseminazione neoplastica
intraperitoneale da carcinoma incidentale della
colecisti dopo chirurgia laparoscopica.]
Cucinotta E; Lorenzini C; Lazzara S;
Melita G; Melita P
Cattedra di Chirurgia Generale, Universita degli
Studi, Messina.
Tumori 2003 Jul-Aug; 89(4 Suppl): 34-9
Abstract
BACKGROUND: Several laboratory and clinical studies have raised the concern that
laparoscopic procedures might worsen the prognosis of
patient with malignant disease due to premature intraperitoneal cancer cell dissemination. The
aim of the study was to examine the risk of the dissemination in patients with
unsuspected gallbladder cancer diagnosed after
laparoscopic cholecystectomy (LC). METHODS: A
retrospective clinicopathologic study was performed on 5
patients with unsuspected gallbladder cancer
without preoperatively diagnosis among 1280 patients
that underwent LC in the period 1993-2002. The
possible neoplastic dissemination was compared to
that reported in 8 patients affected from
unsuspected gallbladder cancer diagnosed after
open cholecystectomy. RESULTS: Two patients with unsuspected gallbladder cancer (T1a-T2)
presented a port-site recurrence after respectively six and
four months. There was not statistically
significant difference between types of cholecystectomy
(LC or OC). Survival rate did not change according
to whether the operation was carried out using LC
or OC. CONCLUSION: After an accurate checking of the factors indicated to explain the early
neoplastic dissemination frequently observed in the
patients undergone LC and an analysis of their own experience the Authors conclude that LC does
not worsen the prognosis of unsuspected
gallbladder cancer.