Charalampos Lazaridis

Conservative management for an esophageal perforation in a patient presented with delayed diagnosis: a case report

BackgroundEsophageal perforation is a serious condition with a high mortality rate. Successful therapy depends on the size of the rupture; the time elapsed between rupture and diagnosis, and the underlying health of the patient. Common causes of esophageal perforation include medical instrumentation, foreign-body ingestion, and trauma.Case reportA case of esophageal perforation due to fish bone ingestion in a 67-year-old male is described here, with a review of the pertinent literature. The patient presented with chest pain, fever and right-sided pleural effusion. Initial evaluation was nondiagnostic. The water-soluble contrast swallow test showed no evidence of leakage. Computed tomography scan demonstrated a pneumomediastinum, and right-sided hydropneumothorax.ConclusionThe patient was successfully treated using conservative measures.

Laparoscopic enucleation of a giant submucosal esophageal lipoma. Case report and literature review.

Patient: Female, 40 Final Diagnosis: Esophageal lipoma Symptoms: — Medication: — Clinical Procedure: Laparoscopic enucleation Specialty: Surgery Objective: Rare disease Background: Benign tumors of the esophagus are very rare, constituting only 0.5% to 0.8% of all esophageal neoplasms. Approximately 60% of benign esophageal neoplasms are leiomyomas, 20% are cysts, 5% are polyps, and less than 1% are lipomas. Case Report: A 40-year-old woman was referred to our department with dysphagia that had progressively worsened during the previous 2 years. Physical examination on admission produced normal findings. Upper gastrointestinal endoscopy revealed a submucosal space-occupying mass in the posterior wall of the lower esophagus, with normal mucosa. The mass was yellowish and soft. A computed tomography (CT) of the chest revealed a submucosal esophageal lesion in the posterior wall, with luminal narrowing of the distal esophagus. Thus, a submucosal tumor was identified in this region and esophageal submucosal lipoma was considered the most likely diagnosis. A laparoscopic operation was performed. The tumor was completely enucleated, and measured 10×7×2.5 cm. The pathology showed lipoma. The postoperative course was uneventful, and the patient was discharged 4 days after the operation. Conclusions: Benign tumors of the esophagus are very rare. Laparoscopic transhiatal enucleation of lower esophageal lipomas and other benign tumors is a safe and effective operation.

Factors Significantly Contributing to a Failed Conventional Endoscopic Stone Clearance in Patients with ''Difficult'' Choledecholithiasis: A Single-Center Experience

The objective of this study is to retrospectively evaluate factors significantly contributing to a failed stone extraction (SE) in patients with difficult to extract bile duct stones (BDS). Patients and Methods. During a 10-year period 1390 patients with BDS underwent successfully endoscopic sphincterotomy. Endoscopic SE was graded as easy; relatively easy; difficult; and failed. Difficult SE was encountered in 221 patients while failed SE was encountered in 205. A retrospective analysis of the criteria governing the difficulty of endoscopic SE following the index endoscopic intervention was performed to evaluate their significance in determining failure of complete SE among patients with difficult to extract bile duct stones. Results. Age ≥ 85 years, periampullary diverticula, multiple CBD stones (>4), and diameter of CBD stones (≥15 mm) were all significant contributing factors to a failed SE in univariate statistical tests. In the definitive multivariate analysis age, multiple stones and diameter of stones were found to be the significant, independent contributors. Conclusion. Failed conventional endoscopic stone clearance in patients with difficult to extract BDS is more likely to occur in overage patients, in patients with multiple CBD stones >4, and in patients with CBD stone(s) diameter ≥15 mm.

Successful Treatment of Recurrent Cholangitis by Constructing a Hepaticojejunostomy with Long Roux-en-Y Limb in a Long-term Surviving Patient after a Whipple Procedure for Pancreatic Adenocarcinoma

Patient: Female, 74 Final Diagnosis: Recurrent cholangitis Symptoms: — Medication: — Clinical Procedure: — Specialty: Gastroenterology and Hepatology Objective: Unusual clinical course Background: Cholangitis may result from biliary obstruction (e.g., biliary or anastomotic stenosis, or foreign bodies) or occur in the presence of normal biliary drainage. Although reflux of intestinal contents into the biliary tree after hepaticojejunostomy appears to be a rare complication, it is important to emphasize that there are few available surgical therapeutic techniques. Case Report: A 74-year-old woman presented to our hospital after 17 years of episodes of cholangitis. The patient had undergone a pancreatoduodenectomy (Whipple procedure) 18 years earlier due to pancreatic adenocarcinoma. The reconstruction was achieved through the sequential placement of pancreatic, biliary, and retrocolic gastric anastomosis into the same jejunal loop. The postoperative course was uneventful and the patient received adjuvant chemotherapy. Approximately 6 months after the initial operation, the patient started having episodes of cholangitis. Over the next 17 years she experienced several febrile episodes presumed to be secondary to cholangitis. A computing tomography (CT) scan of the abdomen revealed intrahepatic bile ducts partially filled with orally administered contrast material (Gastrografin). Magnetic resonance cholangiopancreatography (MRCP) showed dilatation of the left intrahepatic bile ducts. A percutaneous transhepatic cholangiography showed that the bilioenteric anastomosis was normal, without stenosis. Based on these findings, a diagnosis of a short loop between the hepaticojejunostomy and the gastrojejunostomy permitting the reflux of intestinal juice into the biliary tree was made. During the re-operation, a new hepaticojejunal anastomosis in a 100-cm long Roux-en-Y loop was performed to prevent the reflux of the intestinal fluid into the biliary tree. The patient was discharged on postoperative day 10. One year after the second procedure, the patient enjoys good health and has been free of fever and abdominal pain and has not received any antibiotic therapy. Conclusions: Lengthening the efferent Roux-en-Y limb should be considered as a therapeutic option when treating a patient with recurrent episodes of cholangitis after hepaticojejunostomy.

Open-access technique and "critical view of safety" as the safest way to perform laparoscopic cholecystectomy.

Background: The 2 main challenges of laparoscopic cholecystectomy are primary peritoneal access and safe identification, ligation, and division of the cystic duct and cystic artery. Patients and Methods: This is a 13-year period retrospective study from January 2000 to December 2012. All the operations were performed by 1 surgeon and all the data were collected from the hospitals archive. A total of 929 laparoscopic cholecystectomies were performed for symptomatic cholelithiasis. The first author was involved in all the operations either by performing or assisting in them. The open access (OA) technique was used in all cases for the creation of pneumoperitoneum. After establishing the pneumoperitoneum, the “critical view of safety” (CVS) technique was used to ligate and divide the cystic duct and cystic artery. When the OA was not possible or CVS was not feasible, the operation was converted to open. Results: Successful establishment of pneumoperitoneum with OA was possible in 911 of 929 (98.06%) patients and CVS was achieved in 873 patients (95.82%). In 18 patients the operation was converted to open because of dense adhesions not permitting the establishment of the pneumoperitoneum. No intraoperative or postoperative complications occurred in these patients. No bile duct injury occurred in this series. Postoperative complications were recorded in 19 patients (2.04%). Five patients had bleeding from port sites, 12 patients had wound infection at the umbilical incision, and 2 patients developed subhepatic collections, which were drained percutaneously under computed tomographic guidance. Conclusions: In this series of laparoscopic cholecystectomies, we used the “open access” technique to create pneumoperitoneum and we obtained the “critical view of safety” for the identification of the cystic duct. Our results show that this approach is the safest way to perform and teach laparoscopic cholecystectomy.

Antithrombin - III Reduces Intestinal Ischemia / Reperfusion Deleterious Effects on Kidney : A Study in Rats

Background: Mesenteric ischemia - reperfusion (I/R) is a well - known cause for both local and remote organ injuries. A natural inhibitor of serine proteases, Antithrombin - III, was previously shown to attenuate the tissue damage after local I/R in several organ systems. Here, we examined Original Research Article

The value of endothelin 1 in the early diagnosis of severe intestinal strangulation

In patients with intestinal strangulation, early diagnosis and prompt intervention can play a key role in the final outcome. Physical signs and routine laboratory findings only raise the level of suspicion to the presence of intestinal ischaemia. Several markers such as alkaline phosphtase,1 creatinine phosphokinase,2 and lactate dehydrogenase3 and procalcitonin (Pct) serum levels have been proposed for the early diagnosis of intestinal ischaemia.4 Plasma levels of endothelin 1 (ET1) have been recently associated with cardiac ischaemia.5 It has also been reported that ET1 plays a central role in the pathophysiology of intestinal ischaemic injury.6 Wang et al 7 recently reported that ligation of mesenteric vessels caused an increase in serum ET1 levels in rats. On the other hand, other researchers reported that in spite of increased release of ET1 …