We present a rare case of abdominal compartment syndrome due to a bulimic attack in a 19-year-old female patient with bulimia nervosa. She was admitted to our emergency room with complaints of progressive abdominal pain following bulimia. Computed tomography showed dilated stomach with food and air pressed other visceral organs and major abdominal vessels. Decompression using nasogastric tube or gastric lavage tube failed. At laparotomy, we performed gastrotomy and decompression was performed. After decompression, she fell into hypovolemic shock due to bleeding in the intra-gastric and peritoneal cavity. Twelve hours after the operation, the patient died due to refractory hypovolemic shock from uncontrolled bleeding following decompression of abdominal compartment. It should keep in mind that binge-eating habits in patients with bulimic nervosa could cause abdominal compartment syndrome due to gastric distension and this may be a potentially fatal condition.
Abdominal Pain ; Bulimia ; Bulimia Nervosa ; Compartment Syndromes ; Decompression ; Emergencies ; Female ; Gastric Lavage ; Hemorrhage ; Humans ; Intra-Abdominal Hypertension ; Laparotomy ; Peritoneal Cavity ; Reperfusion Injury ; Shock ; Stomach ; Young Adult

PURPOSE: The aim of this study was to evaluate the effects of preoperative ropivacaine infiltration in patients undergoing robotic thyroidectomy using the bilateral axillary breast approach method. METHODS: Using a randomized, double-blind study design, 34 consecutive female patients who underwent robotic thyroidectomy were randomly assigned to receive local infiltration to the skin flap site using either only 0.9% saline solution, 3 mL/kg (group C, n = 17) or 0.1% ropivacaine with saline, 3 mg/kg (group L, n = 17). Local anesthetic was administered prior to skin incision after the induction of general anesthesia. Postoperative pain was rated at 2, 6, 18, 30, 42, and 66 hours postoperatively by visual analogue scale (VAS) score. The bottom hit counts (BHC) from patient controlled analgesia and fentanyl consumption were evaluated. CRP levels, mean blood pressure (BP), and heart rate (HR) were also evaluated. RESULTS: VAS pain scores were significantly lower in group L than in group C from 2 to 42 hours (P < 0.05). Fentanyl use for analgesia and BHC were also significantly lower in group L compared with group C during the first postoperative 6 and 2 hours, respectively (P < 0.05). The total consumption of fentanyl was significantly lower in group L than in group C (P = 0.009). No significant differences were noted for baseline, postoperative mean BP, or HR. CONCLUSION: Preoperative infiltration using ropivacaine with saline to all flap sites is a safe and effective method for reducing postoperative pain and postoperative fentanyl consumption in patients with robotic thyroidectomy.
Analgesia ; Analgesia, Patient-Controlled ; Anesthesia, General ; Blood Pressure ; Breast ; Double-Blind Method ; Female ; Fentanyl ; Heart Rate ; Humans ; Pain, Postoperative* ; Prospective Studies* ; Robotics ; Skin ; Sodium Chloride ; Thyroidectomy*

Adult intussusception is a rare entity. Most adult intussusceptions require surgical intervention because they have a high rate of pathologic leading point. Mandatory laparotomy and en bloc resection is recommended in colonic intussusceptions due to the possibility of malignancy. We report herein 3 cases of adult colonic intussusceptions. The intussusceptions were located in the sigmoid and rectum, which were managed by laparoscopic colectomy. Case 1 was managed by laparoscopic anterior resection and diverting ileostomy combined with perineal reduction. Perineal approach facilitated laparoscopic reduction. In case 2, intraoperative colonoscopy was performed to determine the distal resection margin. Intraoperative colonoscopy showed edematous bowel mucosa as well as leading point after reduction of intussusceptions. Case 3 showed asymptomatic transient rectorectal colonic intussusceptions.
Adult ; Colectomy ; Colon ; Colon, Sigmoid ; Colonoscopy ; Humans ; Ileostomy ; Intussusception ; Laparoscopy ; Laparotomy ; Mucous Membrane ; Rectum

No abstract available.
Adult ; Humans

Protein S (PS) deficiency is a rare blood disorder associated with thrombosis. Only a small number of cases of isolated celiac artery dissection can be found in the literature. We now report a case of isolated celiac artery dissection and splenic infarction in a 44-year old male with PS deficiency. Abdominal computed tomography revealed celiac artery dissection and splenic infarction. The patient's PS activity was 64% (nl : 70~140%) upon admission and 52% four weeks later. He was started on a regimen of NPO, antibiotics, and analgesics. He resumed oral intake of food and drugs on hospital day 3 and was discharged to his home on hospital day 8. We report a case of isolated celiac artery dissection with splenic infarction in a patient with PS deficiency that improved with conservative treatment. The patient's management did not include anti-platelet/thrombotic agents or endovascular/operational procedures.
Analgesics ; Anti-Bacterial Agents ; Celiac Artery ; Humans ; Male ; Protein S ; Protein S Deficiency ; Splenic Infarction ; Thrombosis

PURPOSE: Lymph node (LN) metastasis of papillary thyroid carcinoma (PTC) is related to a high local recurrence rate and a low disease-specific survival rate. So, the diagnosis of LN metastasis according to the compartment is important for surgical planning. We evaluated the value of preoperative USG and CT for predicting LN metastasis METHODS: USG, CT or both were performed preoperatively for 325 consecutive patients who were newly diagnosed with PTC and who were operated on between Dec 1, 2004 and Dec 31, 2008. The reports of the preoperative USG and CT were compared with the histopathologic results. The accuracy of these studies for assessing LN metastasis were calculated, and we investigated whether combined USG and CT (US/CT) showed any additional benefit over USG or CT only. RESULTS: For the central compartment, USG, CT and US/CT showed high specificities (98.2%, 98.6%, 98.2%, respectively) and low sensitivities (7.1%, 4.6%, 12.0%, respectively), and US/CT showed higher sensitivity than CT only. For the lateral compartment, USG demonstrated higher sensitivity and lower specificity compared with CT (76.2% vs 43.5%, 50.0% vs 70.0%, respectively), and US/CT had a higher sensitivity than CT only (81.0% vs 43.5%, respectively). By the per patient analysis, the sensitivity of US/CT (38.6%) was higher than those of USG (30.6%) or CT (19.3%),and the specificity was highest for CT (96.4%). CONCLUSION: Prophylactic central LN dissection for PTC can be justifiedby the low sensitivity and high specificity of USG and CT for predicting central LN metastasis. For the lateral LN compartment, a combination of USG and CT can increase the sensitivity for predicting LN metastasis.
Diagnosis ; Humans ; Lymph Nodes ; Neoplasm Metastasis* ; Recurrence ; Sensitivity and Specificity ; Survival Rate ; Thyroid Gland* ; Thyroid Neoplasms* ; Tomography, X-Ray Computed*

Internal abdominal hernia is an unusual cause of intestinal obstruction. Paraduodenal hernia is relatively rare congenital malformations resulting from incomplete rotation of the midgut with entrapment of the small intestine beneath the developing colon. We report a case of paraduodenal hernia treated by laparoscopic approach. The patient was a 45-year-old man presenting with severe abdominal pain for 5 hours. Left paraduodenal hernia with jejunum hernia containing jejunal loops showed in abdominal CT. At operation, herniation of the small intestine into a retroperitoneal space through a defect on the left mesocolon was noted. After the herniated bowel was fully reduced, the hernia orifice was closed intra-corporeally in the manner of interrupted sutures with absorbable suture materials. The patient was discharged home without any serious complications on postoperative day 9. Conclusively, we think laparoscopic surgery in left paraduodenal hernia is feasible.
Abdominal Pain ; Colon ; Hernia ; Hernia, Abdominal ; Humans ; Intestinal Obstruction ; Intestine, Small ; Jejunum ; Laparoscopy ; Mesocolon ; Middle Aged ; Retroperitoneal Space ; Sutures

PURPOSE: The purpose of this study is to analyze the treatment strategies of patients with endoscopic retrograde cholangiopancreatography (ERCP)-related perforations. This is a retrospective study. METHODS: We experienced 13 perforations associated with ERCP. We reviewed the medical recordsand classified ERCP-related perforations according to mechanism of injury in terms of perforating device. Injury by endoscopic tip or insertion tube was classified as type I, injury by cannulation catheter or sphincterotomy knife as type II, and injury by guidewire as type III. RESULTS: Of four type I injuries, one case was managed by conservative management after primary closure with a hemoclip during ERCP. The other three patients underwent surgical treatments such as primary closure orpancreatico-duodenectomy. Of five type II injuries, two patients underwent conservative management and the other three cases were managed by surgical treatment such as duodenojejunostomy, duodenal diverticulization and pancreatico-duodenectomy. Of four type III injuries, three patients were managed conservatively and the remaining patient was managed by T-tube choledochostomy. CONCLUSION: Type I injuries require immediate surgical management after EPCP or immediate endoscopic closure during ERCP whenever possible. Type II injuries require surgical or conservative treatment according to intra- and retro-peritoneal dirty fluid collection findings following radiologic evaluation. Type III injuries almost always improve after conservative treatment with endoscopic nasobilliary drainage.
Catheterization ; Catheters ; Cholangiopancreatography, Endoscopic Retrograde ; Drainage ; Humans ; Retrospective Studies

PURPOSE: In addition to the oncological results, cosmetic results are very important to cancer patients. Currently, the use of oncoplastic surgery is an emerging approach. In this study, we examined the clinical outcomes of the use of a corrective procedure with an absorbable implant, a Vicryl mesh(R), as compared with the use of conventional breast conserving surgery (BCS). METHODS: Fifty six patients who completed questionnaire were enrolled in the study. For 33 cases, BCS was performed concurrently with the use of a Vicryl mesh and for the other 23 cases, conventional BCS alone was performed. Contraindications of the use of corrective procedure were a patient age over 60 year, diabetes, neoadjuvant chemotherapy and a previous excisional biopsy performed on the same breast. Patients rated their cosmetic outcomes by use of a four point scale. RESULTS: For one of 34 cases, the Vicryl mesh was removed due to infection and this patient was excluded from the study. Twenty seven of the remaining 33 patients (82%) who underwent the corrective procedure with Vicryl mesh were satisfied with their outcome. For patients that received conventional BCS only ten of 23 patients (43%) were satisfied with their outcome (p=0.05). Patient age, body mass index (BMI) and tumor location did not affect the cosmetic outcomes of the corrective procedure. When the resection area of the breast was 40-70 cm2, 88% of the patients were satisfied with their outcome. CONCLUSION: This study suggested that the use of Vicryl mesh correction was superior to the use of conventional BCS alone for cosmesis. This method appears to provide a satisfactory outcome for oncoplastic surgery of the breast.
Absorbable Implants ; Biopsy ; Body Mass Index ; Breast ; Cosmetics ; Humans ; Mastectomy, Segmental ; Polyglactin 910 ; Surveys and Questionnaires

PURPOSE: To evaluate changes in tuberculous cavities, one of the major factors used to determine the activityof tubereulosis, by high-resolution CT(HRCT) in active pulmonary tuberculosis patients after antituberculoustherapy. MATERIALS AND METHODS: The HRCT findings of 41 patients with active tuberculosis were analyzed withparticular emphasis on the appearance of tuberculous cavities before and after therapy. We measured the largestdiameter and maximal wall thickness of the cavities, as well as accompanying changes occurring during follow-up.The mean interval between initial and follow-up study was 8.7 months(minimum:4.1, maximum:33.2;S.D.: +/-5.0) andthe mean duration of antituberculous therapy was 7.5 months(minimum:4.7, maximum:14.8;S.D.: RESULTS: Among 41patients, 54 cavities were found on initial HRCT. Thirty one(57.4%) of these disappeared during follow up HRCTwith residual changes such as residual fibrotic scar(n=15), granuloma(10), paracicatrical emphysema(7),calcification(3), traction bronchiectasis(3), consolidation(3) and bullous emphysema(1). Twenty three of thecavities(42.6%) decreased in size and wall thickness, but did not disappear completely during follow-upexamination. Mean largest diameter and maximal thickness of 23 cavities were 32.0mm(+/-13.9) and 7.9mm(+/-4.8) oninitial HRCT, falling to 20.9mm(+/-12.5) and 4.1mm(+/-2.6), respectively, during follow-up HRCT. Among four patientswho underwent a second follow-up, the largest diameter and maximal thickness of the cavities decreasedcontinuously. In two patients, however, the cavities did not did not disappeas, though in the other two they haddisappeared by the time follow-up HRCT was performed a second time. CONCLUSION: During follow-up HRCT afterantituberculous therapy(mean duration of 7.5 months), 57.4%(31/54) of cavities were seen to have disappeared, withresidual changes such as fibrotic scars, granulomas, paracicatrical emphysema and calcification ; 42.6% of thecavitivies still remained, however, with retractive and fibrotic change. Such fibrotic and retractive changesshould not, therefore, be taken as indicative of active tuberculosis, especially in patients who have successfullycompleted their medication.
Cicatrix ; Emphysema ; Follow-Up Studies ; Granuloma ; Humans ; Lung ; Traction ; Tuberculosis ; Tuberculosis, Pulmonary