Amit J. Dwivedi

Laparoscopic colectomy vs. open colectomy for sigmoid diverticular disease.

AbstractPURPOSE: The feasibility of laparoscopic colectomy for colon surgery has now been well established. Most of the studies on laparoscopic colectomies include all types of colonic pathologies without discrimination. Our goal was to compare laparoscopic sigmoid colectomy vs. open sigmoid colectomy for simple sigmoid diverticular disease, to assess whether it can be done safely and whether the proposed advantages could be realized. METHODS: We evaluated the differences in outcomes of 66 laparoscopic sigmoid colectomy patients and 88 open sigmoid colectomy patients. We report a five-year outcomes analysis of 154 patients undergoing sigmoid colectomy for diverticular disease. We compared age, gender, history of prior abdominal surgery, estimated blood loss, operative time, total conversions with reason for conversion, time until a liquid diet was started, postoperative complications, hospital length of stay, operation costs, and total hospital charges incurred for both laparoscopic sigmoid colectomy and open sigmoid colectomy. RESULTS: Mean age and gender were similar in the two groups. However, the mean estimated blood loss (143 ml vs. 314 ml), time until a liquid diet was started (2.9 vs. 4.9 days), and hospital length of stay (4.8 vs. 8.8 days) were all significantly less in laparoscopic sigmoid colectomy patients. The mean operative time for laparoscopic sigmoid colectomy was 212 minutes as compared with 143 minutes for open sigmoid colectomy (P < 0.05). Conversion rate of laparoscopic sigmoid colectomy to open procedure was 19.7 percent. All laparoscopic sigmoid colectomy patients received a lighted ureteral stent preoperatively, which was removed at the end of surgery. Relevant complications for laparoscopic sigmoid colectomy vs. open sigmoid colectomy were as follows: anastomotic leak in 1 vs. 3 (1.5 vs. 3.4 percent) patients, hematuria in 64 vs. 6 (97 vs. 6.8 percent) patients, with an average duration for 2.93 vs. 3 days, urinary tract infection in 5 vs. 4 (7.6 vs. 4.5 percent) patients, and ureteral injury in 1 vs. 2 (1.5 vs. 2.2 percent) patients. Although the mean operating room charges were greater in the laparoscopic sigmoid colectomy patients (

Abdominal Wall Endometriomas

9,566 vs.

CASE REPORT: Primary Psoas Abscess

7,306) the mean hospital charges (

Mesenteric arterial thrombosis as a complication of Crohn's disease.

13,953 vs.

CASE REPORT: Gastric Phytobezoar

14,863) were less. CONCLUSIONS: We recommend laparoscopic sigmoid colectomy as the modality of treatment for diverticular disease. Laparoscopic sigmoid colectomy seems to be a reliable, safe and efficacious treatment modality with better outcomes for diverticular disease of the sigmoid colon. The operative time for laparoscopic sigmoid colectomy is decreasing as surgeons gain more experience.

Angiosarcoma of the Breast Following Breast Preservation Therapy and Local Radiation Therapy for Breast Cancer

Endometriosis is a condition in which uterine mucosal tissue is located outside the uterus. Endometriosis may be pelvic or extrapelvic. The term endometrioma is used when endometriosis appears as a circumscribed mass. Abdominal wall endometriomas are usually a secondary process in scars after surgical procedures. A retrospective study of abdominal wall endometrioma, from March 1992 through April 1999 at our institution was done. The mean age of the patients was 28.4 years. Twelve of these reported cases were secondary to previous surgery. One patient presented primarily with an abdominal wall mass without previous surgical history. The most common presentation was an abdominal wall mass associated with pain during the menstrual cycle. Endometrioma was considered as a differential diagnosis in seven patients. All patients underwent surgery. Along with the literature review on endometrioma, the importance of considering it in the differential diagnosis for patients of child-bearing age is discussed.

Pinch‐off Syndrome: A Rare Complication of Totally Implantable Venous Devices

: Psoas abscess is an uncommon condition with varied etiology. Diagnosis is based on symptoms, signs, and CT scan of the abdomen. Treatment consists of adequate drainage either percutaneously or surgically with antibiotic coverage. Serious complications such as sepsis and mortality may result if there is a delay in treatment.

CASE REPORT: Schwannoma of the Psoas Major Muscle Presenting with Abdominal and Back Pain

Crohn’s disease is associated with a granulomatous vasculitis, and deposition of fibrin is a component of this inflammatory process (1, 2). The microvascular injury occurs principally within the deeper layers of the bowel wall, although mucosal vessels may also be involved. The incidence of systemic thromboembolic events in inflammatory bowel disease is reported to be higher than in the normal population (3, 4). These thromboembolic complications are mainly found in young patients and are associated with a high morbidity. Several independent risk factors for thrombotic vascular disease have been identified (5–7). We report here a case of celiac and superior mesenteric arterial thrombosis in a 43-year-old patient with a 10-year history of Crohn’s disease with no other risk factors for thrombosis. Included in this case report is a review of the literature on this rare complication along with a discussion on management decisions.

An unusual presentation of colon cancer in a young individual

The term bezoar is thought to be a corruption of the Persian word padzahr (1), which denotes counterpoison or antidote (2). Bezoars are persistent concretions of foreign matter found in the stomach. They may contain or consist of a wide variety of substances, but the most common are composed of plant and vegetable fibers (phytobezoars), persimmons (disopyrobezoars), hair (trichobezoars), or medications (pharmacobezoars). Gastric outlet obstruction, anemia, hematemesis, melena, perforation, peritonitis, and intestinal obstruction may occur as complications. This is a case report of an adult female who underwent Billroth II gastrectomy for complicated duodenal ulcer, and four years subsequent to the operation presented with gastric outlet obstruction due to the presence of a phytobezoar.In summary bezoars are rarely symptomatic. CT scan of the abdomen is rapidly becoming the first tool of diagnosis, while endoscopy still remains the best diagnostic test. Medical treatment is usually successful, as in this case and rarely do patients require surgery.

CASE REPORT: Intestinal Obstruction Following Biliopancreatic Diversion

Abstract: This is a case of angiosarcoma following breast preservation therapy and local radiation therapy over a 3‐year period.