• Title/Summary/Keyword: exploratory laparotomy

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Large Mesenteric Pedunculated Lipoma in a Horse

  • Seokho Son;Seyoung Lee;Eun-bee Lee;Kyung-won Park;Ji-Youl Jung;Jae-Hoon Kim;Hyohoon Jeong;Jong-pil Seo
    • Journal of Veterinary Clinics
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    • v.41 no.2
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    • pp.123-126
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    • 2024
  • A seven-month pregnant 15-year-old Thoroughbred mare presented with acute abdominal pain to Jeju National University Equine Hospital. At presentation, a nasogastric intubation revealed 10 L of gastric reflux; rectal palpation and ultrasound revealed dilated loops and thickening of the walls of the small intestine. An exploratory laparotomy revealed strangulation of the small intestine due to a large abdominal mass. The mass was double-ligated and resected blindly due to the short pedicle. An enterectomy was not performed as intestinal motility was detected following the mass removal. Histopathological examination confirmed that the mass was a lipoma, measuring 24 cm × 16 cm × 16 cm in size. On day 8 post-surgery, the mare was discharged without complications. This case report describes the diagnosis and treatment of strangulation of the small intestine by a pedunculated lipoma, thus providing useful information on lipoma in horses.

Initial Clinical Experience with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in Signet-Ring Cell Gastric Cancer with Peritoneal Metastase

  • Konigsrainer, Ingmar;Horvath, Philipp;Struller, Florian;Konigsrainer, Alfred;Beckert, Stefan
    • Journal of Gastric Cancer
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    • v.14 no.2
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    • pp.117-122
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    • 2014
  • Purpose: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been shown to improve survival in select patients with gastric cancer and peritoneal metastases. It remains unclear, however, whether this multimodal treatment protocol is also beneficial for signet-ring cell gastric cancer (SRC) patients with peritoneal metastases. Materials and Methods: Clinical data of patients scheduled for upfront systemic chemotherapy consisting of 5-FU (2,600 $mg/m^2$), folinic acid (200 $mg/m^2$), docetaxel (50 $mg/m^2$), and oxaliplatin (85 $mg/m^2$) followed by CRS and HIPEC using cisplatin (50 $mg/m^2$) at the Comprehensive Cancer Center, University Hospital T$\ddot{u}$bingen, Germany were retrospectively analyzed. Results: Eighteen consecutive patients for whom irresectability has been ruled out by a computed tomography scan were enrolled. However, complete cytoreduction could only be achieved in 72% of patients. When categorizing patients with respect to the completeness of cytoreduction, we found no difference between both groups considering tumor- or patient-related factors. The overall complication rate following complete cytoreduction and HIPEC was 46%. Within a median follow-up of 6.6 (0.5~31) months, the median survival for CRS and HIPEC patients was 8.9 months as opposed to 1.1 months for patients where complete cytoreduction could not be achieved. Following complete cytoreduction and HIPEC, progression-free survival was 6.2 months. Conclusions: In SRC with peritoneal metastases, the prognosis appears to remain poor irrespective of complete CRS and HIPEC. Moreover, complete cytoreduction could not be achieved in a considerable percentage of patients. In SRC, CRS and HIPEC should be restricted to highly selective patients in order to avoid exploratory laparotomy.

Clinical Review of Ovarian Tumors in Children (소아 난소 종양의 임상적 고찰)

  • Cho, Sam-Jea;Yoon, Sang-Yong;Jung, Sung-Eun;Lee, Seong-Cheol;Park, Kwi-Won;Kim, Woo-Ki
    • Advances in pediatric surgery
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    • v.1 no.2
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    • pp.115-121
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    • 1995
  • We reviewed 45 cases of ovarian tumors treated at Seoul National University Children's Hospital from 1983 to 1993. Forty-five patients were operated upon for 52 ovarian tumors. The most common pathologic diagnosis was mature teratoma. The next were functional cyst, the tumors of epithelial cell origin, and those of stromal origin in order of frequency. Six patients(13%) had malignant tumor. There were one malignant teratoma, two dysgerminomas, one endodermal sinus tumor, and two granulosa cell tumors. Four cases were diagnosed as torsion of ovarian cyst preoperatively, and emergency exploratory laparotomy were performed. There were three cases of ovarian tumors associated with precocious puberty. The most widely used diagnostic tool was ultrasonography. In the treatment of these 45 patients, unilateral oophorectomy was done in 38 cases, unilateral oophorectomy with wedge resection of contralateral ovary was done in 5 cases, unilateral oophorectomy with contralateral simple cystectomy was done in one case and total abdominal hysterectomy with bilateral salpingooophorectomy was done in one case. Of the six cases of malignancy, five patients are alive 2 to 6 years after operation and one case was lost to be followed up.

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An imported case of hepatic unilocular hydatid disease (해외에서 유입된 간 포충 낭종증 1례)

  • CHAI, Jong-Yil;SEO, Min;SUH, Kyung-Suk;LEE, Soon-Hyung
    • Parasites, Hosts and Diseases
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    • v.33 no.2
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    • pp.125-130
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    • 1995
  • A 38-year old man visited a private clinic complaining of epigastric discomfort for 2 months A huge hepatic cyst was found by sonography and computerized tomography. An exploratory Laparotomy was performed under the impression of hydatid disease. The cyst was successfully removed. A lot of living protoscolices of Echinocucur Sranulosus were found from the cystic fluid under light microscopy. During the operation, however. the cyst was accidentally ruptured and the cystic fluid spilled out. The patient was medicated with albendazole, and had been well without any signs of anaphylaxis or recurrence for 1 year follow-up period. He had been in Saudi Arabia for 3 years. This is the 16th case of hydatid disease reported in Korea and a case without immediate complication in spite of rupture of the cyst.

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Treatment Outcomes of Traumatic Duodenal Injury (외상성 십이지장 손상의 치료 성적)

  • Yu, Byunghyuk;Cho, Jayun;Lim, Kyoung Hoon;Park, Jinyoung
    • Journal of Trauma and Injury
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    • v.28 no.3
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    • pp.129-133
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    • 2015
  • Purpose: The purpose of this study is to evaluate the surgical outcome of duodenal injuries and to analyze the risk factors related to the leakage after surgical treatment. Methods: A retrospective review of 31 patients with duodenal injuries who managed by surgical treatment was conducted from December 2000 to May 2014. The demographic characteristics, injury mechanism, site of duodenal injury, association of intraabdominal organ injuries, injury severity score (ISS), abdominal abbreviated injury scale (AIS), injury-operation time lag, surgical treatment methods, complications, and mortality were reviewed. Results: Duodenal injury was more common in male. Twenty four (77.4%) patients were injured by blunt trauma. The most common injury site was in the second portion of the duodenum (n=19, 58.6%). Fourteen patients (45.2%) had other associated intraabdominal organ injuries. The mean ISS is $13.6{\pm}9.6$. The mean AIS is $8.9{\pm}6.5$. Eighteen patients (58.1%) were treated by primary closure. The remaining 13 patients underwent various operations, including exploratory laparotomy (n=4), pancreaticoduodenectomy (n=3), pyloric exclusion (n=3), Resection with end-to-end anastomosis (n=2), and duodenojejunostomy (n=1). Most common postoperative complications were intraabdominal abscess (n=9) and renal failure (n=9). Mortality rate was 9.7%. Conclusion: ISS, AIS>10, operative time, pancreaticoduodenectomy, sepsis, and renal failure are significant predictors of a postoperative leak after duodenal injury. Careful management is needed to prevent a potential leak in patient with these findings.

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Diagnostic Imaging of Isolated Splenic Torsion in a German Shepherd Dog (독일셰퍼드 견에서 단독으로 발생한 비장 염전의 영상진단)

  • Lee, Ki-Ja;Jeong, Seong-Mok;Choi, Ho-Jung;Lee, Young-Won
    • Journal of Veterinary Clinics
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    • v.28 no.6
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    • pp.613-616
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    • 2011
  • A 5-year-old male German shepherd dog was presented with a 4 day-history of anorexia and depression. Abdominal radiographs showed a large soft tissue mass and loss of serosal detail. Ultrasonographs revealed splenomegaly with the lacy pattern parenchyma, perivenous hyperechoic region at the splenic hilum, and loss of splenic venous flow. Computed tomographic findings included the enlarged non-enhanced spleen except perivenous region at the splenic hilum and a whirled soft tissue mass at the splenic hilum. Exploratory laparotomy confirmed the diagnosis of splenic torsion. Ultrasonographic findings including lacy appearance, hyperechoic perivenous echogenicity and absence of splenic blood flow and CT findings including no or minimal enhancement of the spleen and a whirled appearance of splenic pedicle could be useful for diagnosing isolated splenic torsion in the dog.

Treatment of prednisolone for eosinophilic enteritis in a dog (개에서 prednisolone을 이용한 호산구성 장염 치료 증례)

  • Lee, Jin-Woo;Lee, Sun-Hee;Lim, Soo-Jung;Park, Hyung-Jin;Jung, Dae-Wook;Kim, Tae-Sin;Kim, Duck-Hwan;Song, Kun-Ho
    • Korean Journal of Veterinary Research
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    • v.50 no.4
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    • pp.327-330
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    • 2010
  • A 7-year-old, castrated male Yorkshire terrier dog with chronic vomiting, and melena lasted for 3 weeks was referred to the Veterinary Medical Teaching Hospital of Chungnam National University. The complete blood counts and serum biochemistry revealed no remarkable findings. Gastrointestinal series revealed irregular margin in small intestinal lumen. After upper gastrointestinal series, erythema of the small intestinal lesions was found by exploratory laparotomy and full-thickness biopsy was performed. Histopathologic examination revealed infiltration of predominantly eosinophils and other inflammatory cells in small intestine. Based on these findings, the dog was diagnosed as eosinophilic enteritis. After 4 weeks medical treatment and hypoallergenic diet, the patient showed no vomiting, melena and other complications.

A Clinical Use of CT Scan in Rectal Cancer (직장암 단층촬영(CT)의 임상적 이용)

  • Suh, Bo-Yang;Chung, Yong-Sik;Lee, Su-Jeung;Shim, Min-Chul;Kwun, Koing-Bo
    • Journal of Yeungnam Medical Science
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    • v.3 no.1
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    • pp.67-72
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    • 1986
  • Authors evaluated the accuracy of preoperative pelvic CT scan staging and its effects on management in 12 biopsy proved rectal cancer patients. Authors also studied postoperative CT in 5 patients to detect disease recurrence and metastasis. Preoperative CT staging was identical to surgical and/or pathological staging in 9 patients(75%), but it was underestimated in two cases and overstimated in one instance than in surgical stagings. In 7 cases, CT scan didnot alter original choice of procedures. However, preoperative CT staging gave definitive informations to change management plans in 5 cases otherwise the treatment would be difficult and inadequate. Postoperative CT showed local recurrence in one and liver metastases in 2 cases. One of them was not detected at exploratory laparotomy.

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May the Platelet to Lymphocyte Ratio be a Prognostic Factor for Epithelial Ovarian Cancer?

  • Kokcu, Arif;Kurtoglu, Emel;Celik, Handan;Tosun, Migraci;Malatyalıoglu, Erdal;Ozdemir, Ayse Zehra
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.22
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    • pp.9781-9784
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    • 2014
  • Background: The study aimed to evaluate changes in hematologic parameters, including white blood cell, platelet count, platelet indices, the platelet to lymphocyte and neutrophil to lymphocyte ratios in patients with early and advanced stages of epithelial ovarian cancers. Materials and Methods: The study included 100 patients with epithelial ovarian cancer who underwent primary staging exploratory laparotomy. Preoperative hematologic parameters, tumor histopathologic type, grade, stage and serum CA-125 levels were retrospectively analyzed. These parameters were compared between the patients with early (stage I-II) and advanced (stage III-IV) ovarian cancer. Results: White blood cell count and platelet indices, including mean platelet volume, platelet distribution width and platelet crit did not show a statistically significant difference between groups with early and advanced ovarian cancer. However, the neutrophil to lymphocyte ratio, platelet count, the platelet to lymphocyte ratio and CA-125 level showed a statistically significant difference between the two groups (p<0.05, p<0.01, p<0.001, p<0.01 respectively). Conclusions: It was found that the neutrophil to lymphocyte ratio, platelet count and the platelet to lymphocyte ratio increased with the increasing stage of ovarian cancer. Furthermore, it was seen that the platelet to lymphocyte ratio is an independent prognostic factor related to the stage of epithelial ovarian cancer.

Arteriovenous Fistula between Renal Artery and Inferior Vena Cava following Penetrating Abdominal Trauma; A Case Report (자상 후 발생한 신동맥과 하대정맥간 정맥루)

  • Kim, Joong Suck;Go, Seung Je;Kim, Ji Dae;Sul, Young Hoon;Ye, Jin Bong;Park, Sang Soon;Ku, Gwan Woo;Kim, Yeong Cheol
    • Journal of Trauma and Injury
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    • v.28 no.4
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    • pp.262-265
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    • 2015
  • An arteriovenous fistula (AVF) from the renal artery following a penetrating abdominal trauma is not common. We report the case of a 19-year-old male who presented with a knife stab wound in the right upper quadrant. Due to unstable vital signs and to the protrusion of the mesentery through the stab wound, providing definite evidence of peritoneal violation, an emergent exploratory laparotomy was carried out. There were injuries at the proximal transverse mesocolon and the second portion of the duodenum, with bile leakage. There was also a mild amount of retroperitoneal hematoma near the right kidney, without signs of expansion or pulsation. The mesocolon and the duodenum were repaired. After the operation, abdominal computerized tomography (CT) was performed, which revealed contrast from the right renal artery shunting directly into the vena cava. Transcatheter arterial embolization with a coil and vascular plug was performed, and the fistula was repaired. The patient recovered completely and was discharged without complication. For further and thorough evaluation of an abdominal trauma, especially one involving the retroperitoneum, a CT scan is recommended, when possible, either prior to surgery or after surgery when the patient is stabile. Furthermore, a lateral retroperitoneal hematoma and an AVF after a penetrating trauma may not always require exploration. Sometimes, it may be safely treated non-operatively or with embolization.

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