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Stercoral perforation of the cecum:A case report

World Journal of Gastrointestinal Surgery 2024年第4期16卷 1189-1194页

作者： Hung-Chun Yu Ta-Wei Pu Jung-Cheng Kang Chao-Yang Chen Je-Ming Hu Ruei-Yu Su Department of Surgery Taichung Armed Forces General HospitalTaichung 411228Taiwan Department of Surgery Tri-Service General HospitalNational Defense Medical CenterTaipei 11490Taiwan Division of Colon and Rectal Surgery Department of SurgeryTri-Service General Hospital Songshan BranchNational Defense Medical CenterTaipei 105Taiwan Division of Colon and Rectal Surgery Department of SurgeryTaiwan Adventist HospitalTaipei 105Taiwan Division of Colon and Rectal Surgery Department of SurgeryTri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan Department of Pathology Tri-Service General HospitalNational Defense Medical CenterTaipei 105Taiwan Department of Pathology and Laboratory Medicine Taoyuan Armed Forces General HospitalTaoyuan 325Taiwan

BACKGROUND With less than 90 reported cases to date,stercoral perforation of the colon is a rare occurrence.Stercoral ulceration is thought to occur due to ischemic pressure necrosis of the bowel wall,which is caused by the presence of a stercoraceous mass.To underscore this urgent surgical situation concerning clinical presentation,surgical treatment,and results,we present the case of a 66-year-old man with a stercoral perforation.CASE SUMMARY A 66-year-old man with a history of hypertension,hyperlipidemia,and gout presented at the emergency department with lower abdominal pain and a low-grade fever lasting for a few hours.Abdominal computed tomography indicated a suspected bezoar(approximately 7.6 cm)in the dilated cecum,accompanied by pericolic fat stranding,mild proximal dilatation of the ileum,pneumoperitoneum,and minimal ascites.Intraoperatively,feculent peritonitis with isolated cecal perforation were observed.Consequently,a right hemicolectomy with peritoneal lavage was performed.A histopathological examination supported the intraoperative findings.CONCLUSION In stercoral perforations,a diagnosis should be diligently pursued,especially in older adults,and prompt surgical intervention should be implemented.

关键词： Acute abdomen Colectomy Peritoneal lavage pneumoperitoneum Bezoars Case report

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Effects of pneumoperitoneum of laparoscopic cholecystectomy on the coagulation system of patients： a prospective observational study

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Chinese Medical Journal 2014年第14期127卷 2599-2604页

作者： Amin Buhe Zhang Chengcai Yan Wei Sun Zhipeng Zhang Yankai Du Dexiao Gong Ke Capital Med Univ Dept Gen Surg Beijing Shijitan Hosp Beijing 100038 Peoples R China Zibo Cent Hosp Dept Laparoscopy Surg Zibo 255036 Shandong Peoples R China

BacKground Laparoscopic cholecystectomy has been widely used in clinical practice during the recent decades; however, the effects of pneumoperitoneum and the surgery on the coagulation system are largely unknown. This clinical study aimed to observe any possible effects of pneumoperitoneum and the surgery on the coagulation system of patients. Methods This was a prospective observational study. The inclusion criteria included （1） patients with chronic cholecystitis and/or cholecystic polyps and （2） patients in the relief stage of acute cholecystitis. The exclusion criteria included （1） patients in the episodic stage of acute cholecystitis and those complicated with cholangiolithiasis; （2） patients with concomitant hematologic diseases, damages to the liver function, malignant tumors or immune system diseases, or patients complicated with thrombotic or hemorrhagic disorders; and （3） patients who had taken anticoagulant medication within a week before surgery. Fifty patients who were hospitalized into our department for elective laparoscopic cholecystectomy between November 2011 and February 2013 were eligible and enrolled into this study. Of the 50 patients, 22 were male and 28 female. The age of the patients ranged from 29 to 78 （mean 56.7±11.5） years. The surgery for each of the 50 patients was performed with the same equipment and conditions. The surgeries for all the patients were performed under general anesthesia with the patients in a 30-degree head-up tilted posture, and the pressure of pneumoperitoneum was maintained at 13 mmHg. Venous blood specimens were taken from each patient before and at the end of pneumoperitoneum （i.e., 0 hour after surgery） and at 8 hours after surgery for determination of prothrombin time （PT）, activated partial thromboplastin time （APTT）, fibrinogen （Fib）, thrombin time （TT）, and D-dimer （DD）. The results of the determinations of these parameters were compared. Results （1） All the patients recovered well without any complications. （2） The pre-pneumoperitoneum values of the para

关键词： pneumoperitoneum cholecystectomy laparoscopic coagulation system

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Low-pressure pneumoperitoneum with abdominal wall lift in laparoscopic total mesorectal excision for rectal cancer:initial experience

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World Journal of Gastroenterology 2018年第11期24卷 1278-1284页

作者： Ping-Tian Xia Maimaiti Yusofu Hai-Feng Han Chun-Xiao Hu San-Yuan Hu Wen-Bin Yu Shao-Zhuang Liu Department of General Surgery Qilu Hospital of Shandong University

AIM To evaluate the safety and feasibility of a new technology combining low-pressure pneumoperitoneum(LPP) and abdominal wall lift(AWL) in laparoscopic total mesorectal excision(TME) for rectal cancer.METHODS From November 2015 to July 2017,26 patients underwent laparoscopic TME for rectal cancer using LPP(6-8 mm Hg) with subcutaneous AWL in Qilu Hospital of Shandong University,Jinan,China.Clinical data regarding patients' demographics,intraoperative monitoring indices,operation-related indices andpathological outcomes were prospectively collected.RESULTS Laparoscopic TME was performed in 26 cases(14 anterior resection and 12 abdominoperineal resection) successfully,without conversion to open or laparoscopic surgery with standard-pressure pneumoperitoneum.Intraoperative monitoring showed stable heart rate,blood pressure and paw airway pressure.The mean operative time was 194.29 ± 41.27 min(range:125-270 min) and 200.41 ± 20.56 min(range:170-230 min) for anterior resection and abdominoperineal resection,respectively.The mean number of lymph nodes harvested was 16.71 ± 5.06(range:7-27).There was no positive circumferential or distal resection margin.No local recurrence was observed during a median follow-up period of 11.96 ± 5.55 mo(range:5-23 mo).CONCLUSION LPP combined with AWL is safe and feasible for laparoscopic TME.The technique can provide satisfactory exposure of the operative field and stable operative monitoring indices.

关键词： Laparoscopic surgery Abdominal wall lift Low-pressure pneumoperitoneum Rectal cancer Total mesorectal excision

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Fatal systemic emphysematous infection caused by Klebsiella pneumoniae:A case report

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World Journal of Clinical Cases 2022年第8期10卷 2610-2615页

作者： Jun-Qiang Zhang Chan-Chan He Bo Yuan Rui Liu Yu-Jing Qi Zi-Xia Wang Xiao-Na He Yu-Min Li Department of General Surgery Lanzhou University Second HospitalLanzhou 730030Gansu ProvinceChina

BACKGROUND Systemic emphysematous infection caused by Klebsiella pneumoniae(K.pneumoniae)is a rare but severe infection which can be lethal if the diagnosis is delayed.CASE SUMMARY We report a rare case of systemic emphysematous infection via hematogenous dissemination from a liver abscess caused by K.pneumoniae,complicated by multiple organ dysfunction syndrome,septic shock,bacteremia,emphysematous cystitis,prostate and left seminal vesicle abscesses in a diabetic patient.The patient simultaneously presented with spontaneous pneumoperitoneum secondary to rupture of the emphysematous liver abscess.His condition after admission deteriorated rapidly and he died within a short period.This disease is a great challenge for the clinician as K.pneumoniae can cause multifocal emphysematous infections and fulminant septic shock.pneumoperitoneum following spontaneous rupture of the liver abscess can result in intra-abdominal sepsis that further increases mortality rate.Moreover,appropriate site-specific intervention and adequate drainage of numerous emphysematous liver lesions are difficult.CONCLUSION Early diagnosis followed by efficient antibiotic therapy and surgical management are essential for systemic emphysematous infection.

关键词： Klebsiella pneumoniae Emphysematous liver abscess pneumoperitoneum Emphysematous cystitis Emphysematous prostate abscess Septic shock

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Study on incisional implantation of tumor cells by carbon dioxide pneumoperitoneum in gastric cancer of a murine model

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World Journal of Gastroenterology 1999年第6期5卷 544-546页

作者： Wang H Zheng MH Zhang HB Zhu J He JR Lu AG Ji YB Zhang MJ Jiang Y Yu BM Li HW Shanghai Second Med Univ Ruijin Hosp Dept Surg Shanghai 200025 Peoples R China Shanghai Inst Digest Surg Shanghai 200025 Peoples R China

INTRODUCTIONPort-site recurrence after laparoscopic tumor surgery is a frequent complication in cancer operations, such as gallbladder, stomach, ovary and colon[1-5]. The incidence of port-site recurrence after laparoscopic colectomy ranged from 1.1% to 6.3%, in contrast to a 0.68% tumor wound recurrence rate in patients undergoing curative open colectomy[6-8]. The possible mechanisms proposed were: ① contaminated laparoscopic instruments passing in and out of the port frequently; ② increased exfoliated cancer cells from laparoscopic manipulation; ③ adhered tumor cells by pneumoperitoneum[9-12]. Some experiments reported that desufflation related to seeding of port wounds via a stable suspension of tumor cells in CO2 gas was an unlikely cause of port tumors, some supported a direct intraperitoneal seeding of exfoliated tumor cells as its etiology and the instruments passing in and out of the port may play an important role in local recurrence[13-15]. The colon tumor cells were more common since laparoscopic colectomy was wildly performed.

关键词： stomach neoplasms colonic neoplasms cell movement carbon dioxide pneumoperitoneum murine model

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Paradoxical carbon dioxide embolism during laparoscopic hepatectomy without intracardiac shunt:A case report

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World Journal of Clinical Cases 2022年第9期10卷 2908-2915页

作者： Soeun Jeon Jeong-Min Hong Hyeon Jeong Lee Yesul Kim Hyunjong Kang Boo-young Hwang Dowon Lee Young-hoon Jung Department of Anesthesia and Pain Medicine Pusan National UniversitySchool of MedicineBusan 49241South Korea Biomedical Research Institute Pusan National University HospitalBusan 49241South Korea

BACKGROUND Laparoscopic hepatectomy has recently become popular because it results in less bleeding than open hepatectomy.However,CO_(2)embolism occurs more frequently.Most CO_(2)embolisms during laparoscopic surgery are self-resolving and non-symptomatic;however,severe CO_(2)embolism may cause hypotension,cyanosis,arrhythmia,and cardiovascular collapse.In particular,paradoxical CO_(2)embolisms are highly likely to cause neurological deficits.We report a case of paradoxical CO_(2)embolism found on transesophageal echocardiography(TEE)during laparoscopic hepatectomy,although the patient had no intracardiac shunt.CASE SUMMARY A 71-year-old man was admitted for laparoscopic left hemihepatectomy.During left hepatic vein ligation,the inferior vena cava was accidentally torn.We observed a sudden drop in oxygen saturation to 85%,decrease in systolic blood pressure(SBP)below 90 mm Hg,and reduction in end-tidal CO_(2)to 24 mm Hg.A“mill-wheel”murmur was auscultated over the precordium.The fraction of inspired oxygen was increased to 100%with 5 cm H2O of positive end-expiratory pressure(PEEP)and hyperventilation was maintained.Norepinephrine infusion was increased to maintain SBP above 90 mm Hg.A TEE probe was inserted,revealing gas bubbles in the right side of the heart,left atrium,left ventricle,and ascending aorta.The surgeon reduced the pneumoperitoneum pressure from 17 to 14 mm Hg and repaired the damaged vessel laparoscopically.Thereafter,the patient’s hemodynamic status stabilized.The patient was transferred to the intensive care unit,recovering well without complications.CONCLUSION TEE monitoring is important to quickly determine the presence and extent of embolism in patients undergoing laparoscopic hepatectomy.

关键词： Carbon dioxide Embolism Laparoscopy pneumoperitoneum Transesophageal echocardiography Case report

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Idiopathic neonatal pneumoperitoneum with favorable outcome: A case report and review

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World Journal of Gastroenterology 2015年第20期21卷 6417-6421页

作者： Tao-Zhen He Chang Xu Yi Ji Xiao-Yan Sun Min Liu Department of Pediatric Surgery West China Hospital of Sichuan University Health Management Centre West China Hospital of Sichuan University

Neonatal pneumoperitoneum is a surgical emergency indicative of gastrointestinal perforation that requires immediate treatment to prevent death. There have been non-surgical conditions secondary to neonatal pneumoperitoneum(e.g., mechanical ventilation, pulmonary diseases and pneumatosis cystoides intestinalis) that neonates were able to overcome without the need for abdominal exploration. Idiopathic pneumoperitoneum, although similar to perforation of the alimentary tract and the previously mentioned non-surgical conditions, is a more rare and benign condition that does not yet have a definite cause. Hence, inexperienced surgeons may have a difficult time providing the right treatment for idiopathic pneumoperitoneum. We report a case of a neonate with a massive pneumoperitoneum who obtained a favorable outcome without surgical intervention. Nonetheless, the cause of pneumoperitoneum remains unclear. We hypothesize that the right sized perforation(range: 2 mm to 4 mm in diameter) at the anterior wall of the stomach is needed for pneumoperitoneum to occur. As the baby cries(aerophagia), the air in the stomach accumulates until it can enter the intraperitoneal cavity through the leak compressed by gastric peristalsis, hence forming a large pneumoperitoneum. Small amounts of gastric juice are able to penetrate the gastric wall; therefore, no signs or symptoms of peritonitis occur. The gastric leak self-seals, preventing further passage of the air, allowing the intraperitoneal free gas to dissipate gradually. This case demonstrated that laparotomy can be avoided in neonates with idiopathic pneumoperitoneum if a timely diagnosis is established.

关键词： Intestinal perforation pneumoperitoneum Newborn Therapeutics

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Air embolism after deflation of the pneumoperitoneum in fast-track laparoscopic assisted hemicolectomy

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Chinese Medical Journal 2013年第19期126卷 3798-3798页

作者： Javier Galipienzo Rogelio Rosado Beatriz Zarza Jose Olarra Servicio de Anestesiología y Reanimación.Hospital Universitario de Fuenlabrada.Fuenlabrada.Madrid.Spain Hospital Universitario Ramón y Cajal.Madrid.Spain

To the editor：Post-deflation air embolism （AE） is an infrequent and rarely published manifestation in laparoscopic surgery,its pathophysiological mechanisms being barely understood.We present a case of AE during a ... 详细信息

关键词： pneumoperitoneum laparoscopic hemicolectomy

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Massive Idiopathic pneumoperitoneum in Children: A Case Report

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Open Journal of Pediatrics 2018年第3期8卷 249-254页

作者： Sourou Bruno Noukpozounkou Yacoubou Imorou Souaibou Amoussou Sedjro Clotaire Romeo Houegban Houenoukpo Koco Orion Akokpe Michel Armand Fiogbe University Clinic of Pediatric Surgery National University Hospital Center “Hubert Koutoukou Maga” Cotonou Benin University Clinic of Visceral Surgery “A” National University Hospital Center “Hubert Koutoukou Maga” Cotonou Benin

The pneumoperitoneum is the abnormal presence of free air in the peritoneal cavity. In most cases it is related to the perforation of hollow organs. Nevertheless there are cases of pneumoperitoneum without obvious causes called idiopathic. We report a case of massive pneumoperitoneum of radiological discovery in a patient of 16 years old boy, sickle-cell of type SS, during the exploration of an angiocholitis. It was medically treated successfully. No obvious etiology had been found. This particular situation is a dogma which runs up against the classic interventionist spirit;therefore each of pneumoperitoneum needs to be studied case by case. The presence of signs of peritoneal irritation allows surgical exploration. Otherwise, laparoscopy seems to be a minimally invasive surgical method and allows a visual diagnosis by eliminating a hollow organ perforation.

关键词： pneumoperitoneum Spontaneous Idiopathic Laparoscopy

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Progressive pre-operative pneumoperitoneum is not necessary for large inguinoscrotal hernia repair: Report of a case

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Case Reports in Clinical Medicine 2012年第2期1卷 6-8页

作者： Sofoklis Panteleimonitis Ugochukwu Ihedioha Chris Mann Zee Gechev Guy Jonathan Finch Department of Surgery Northampton General Hospital Northampton UK

Huge inguinoscrotal hernias are a challenging operation. The technical aspects of the procedure can be very difficult and the recovery may be complicated by ventilatory problems. Progressive preoperative pneumoperitoneum (PPP) is a method which has been used for many years to reduce both intra and postoperative complications. However, it is associated with a prolonged preoperative hospital stay which is expensive and often stressful to patients. We report a case of a morbidly obese patient with a huge inguinoscrotal hernia. PPP was not implemented. The operation was uneventful and he was discharged 8 days later with no major post-operative complications. This case therefore questions the necessity of PPP for huge inguin- oscrotal hernias.

关键词： Large Inguinoscrotal Hernia pneumoperitoneum

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