Inadvertent vaginal insertion of barium sulfate is an uncommon complication of a barium enema examination. In the few reported cases, venous embolizaton of barium occurred and this usually resulted in death. We present here a case of vaginal insertion of the enema catheter in a young woman, resulting in barium in the uterus, fallopian tubes and abdominal cavity, but not in the veins. After an emergency laparoscopic operation, the patient had been doing well for 6 months without evidence of complication.
Abdominal Cavity ; Barium ; Barium Sulfate ; Catheters ; Colon ; Emergencies ; Enema ; Fallopian Tubes ; Female ; Humans ; Peritonitis ; Uterus ; Veins

Acute appendicitis is the most common cause of an acute abdomen. But torsion of the appendix is a rare disorder that causes abdominal symptoms that are indistinguishable from acute appendicitis. So, making the preoperative diagnosis of torsion of the appendix is difficult. In 1918, Payne et al. reported the first case of torsion of the appendix in a 37 years old woman. Since then, more than thirty cases have been reported. Torsion of the appendix can occur at any age & gender. Here, we report on a case of secondary torsion of appendix with mucinous cystadenoma in a 52 year-old woman, which was initially thought to be a right adnexal mass. Abdomen CT showed an 11x5 cm sized intra-abdominal mass growing along the right fallopian tube. On the small bowel series, an extra-luminal mass was found and this was pushing aside the small intestine. We performed diagnostic laparoscopic exploration and found inflammation of appendix with torsion. It was twisted 720degrees in a clockwise direction with ischemic change. The histological result was mucinous cystadenoma.
Abdomen ; Abdomen, Acute ; Appendicitis ; Appendix ; Cystadenoma, Mucinous ; Fallopian Tubes ; Female ; Humans ; Inflammation ; Intestine, Small

PURPOSE: Laparoscopic instruments have been remarkably developed through many trials. Various studies and experiments on laparoscopic instruments are underway in other countries. Laparoscopic surgery is also very actively applied in Korea. However, research on the use and safety of the instruments is stagnant. Furthermore, reuse of some disposable laparoscopic instruments is frequently observed, but there are only rare studies on the safety of this. Thus, we tried to provide study cases on the safety of repeated use of disposable laparoscopic instruments. METHODS: To investigate the effectiveness of sterilization and a re-package procedure, we divided the laparoscopic instruments that are commonly used in our institution into 10 types. Among all the available instruments, 32 instruments were selected for the simulation experiment. Each instrument was sterilized using ethylene oxide gas or glutaraldehyde 2%, and then packaged. Then, each was observed grossly and microscopically under aseptic conditions and we looked for any remnant foreign body or contaminant. When remnant foreign body or contaminant was found, they were collected and separately cultured. RESULTS: Residual contaminants were found in 15 instruments (46.9%) out of a total of 32 and microorganisms, including coagulase-negative staphylococcus and gamma-hemolytic streptococcus, were cultured from (9.38%), and each had different types of microorganisms. CONCLUSION: It is remarkable that the bacteria were cultured from recycled laparoscopic instruments after sterilization. The reuse of laparoscopic instruments might be cost-effective, but further studies on its safety are required. Moreover, careful inspection on the method of surgical instrument sterilization in each institution will be necessary.
Bacteria ; Ethylene Oxide ; Ethylenes ; Foreign Bodies ; Glutaral ; Korea ; Laparoscopy ; Staphylococcus ; Sterilization ; Streptococcus ; Surgical Instruments

PURPOSE: The aim of this study was to determine the advantage of adequate PTGBD in acute complicated cholecystitis patients. METHODS: We performed a retrospective review of a collected database from September 2001 to July 2008. Acute cholecystitis with gangrene or perforation was defined as acute complicated cholecystitis. A PTGBD was performed for these patients immediately after the diagnosis using US or CT and then a tubogram was performed after 5~7 days. After evaluating the gallbladder (GB) and common bile duct (CBD) with a tubogram, we removed the drainage tube and the patients underwent a LC after readmission. RESULTS: Three hundred seventy four of the 893 patients who were diagnosed with acute cholecystitis underwent PTGBD. While 19 (3.2%) of the total acute cholecystitis patients were converted to open cholecystectomy due to severe inflammation, 14 (3.7%) of the acute complicated patients were converted to open cholecystectomy. In 79 patients, the pre-operative tubogram showed the presence of CBD stone and so ERCP was performed. There were no post-operative deaths. CONCLUSION: PTBGD in acute complicated cholecystitis patients allows the early relief of acute cholecystitis symptoms. This allows sufficient evaluation and treatment for CBD during the PTGBD state. Furthermore, this decreases the mortality and morbidity in the high-risk patients due to sufficient evaluation and management of the underlying critical disease, which allows elective cholecystectomy when the patients is in better condition for surgery. Therefore, PTGBD can be useful for acute complicated cholecystitis.
Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Cholecystitis, Acute ; Common Bile Duct ; Drainage ; Gallbladder ; Gangrene ; Humans ; Imidazoles ; Inflammation ; Nitro Compounds ; Retrospective Studies

PURPOSE: Due to coverage by the nationwide medical insurance system for laparoscopic appendectomy, the laparoscopic approach for complicated appendicitis has been widely performed in Korea. The aim of this study is to evaluate the surgical outcomes and cost effectiveness of laparoscopic appendectomy for complicated appendicitis. METHODS: This study included 33 patients who underwent the laparoscopic approach (LA) and 26 patients who underwent the open approach (OA) for the complicated appendicitis between March, 2005 and February, 2010. We compared the outcomes of the length of stay, the complications and the costs. RESULTS: The hospital stay was 4.9 days for LA and 6.2 days for OA. (p>0.05) The overall complication rates were 21% (7/33) for LA and 27% (7/26) for OA. (p>0.05) All the complications were managed conservatively and there was no mortality in either group. The total cost and the patient's charge was Won 3,390,421 and Won 1,574,093 for LA and Won 3,260,523 and Won 1,493,510 for OA, respectively (p>0.05). CONCLUSION: The laparoscopic approach is safe, efficacious and cost effective. It should be the initial procedure of choice for most cases of complicated appendicitis.
Appendectomy ; Appendicitis ; Cost-Benefit Analysis ; Fees and Charges ; Humans ; Insurance ; Korea ; Length of Stay ; Retrospective Studies

PURPOSE: Compared to traditionally used abdominoperineal resection and low anterior resection for the treatment of rectal neoplasm, transanal excision (TAE) has several benefits such as a lower complication rate, a shorter average hospital stay and improved quality of life. Transanal endoscopic microsurgery (TEM) was recently introduced for resecting rectal neoplasm. The aim of this study was to compare the therapeutic results between TAE and TEM in patients with rectal neoplasm. METHODS: From October 2000 to December 2008, 115 patients underwent TEM or TAE at the NCC. Among the patient with rectal neoplasm, the patients with recurred rectal cancer and pathologic T2 or T3 stage were excluded. Thirty four and 33 patients were included for this study in the TAE and TEM groups, respectively. The locations of the lesion, the average number of fragmented specimens, the resection margin, postoperative complications and recurrence were retrospectively compared between the TEM and TAE groups. For the patients with T1 cancer, the disease-free survival rates were compared between the TAE and TEM groups. RESULTS: The median distance of lesions from the anal verge in the TEM group was higher than that in the TAE group: (mean distance: 6.75 cm, range: 3~15 cm) for TEM group and (mean distance: 3.13 (range: 1~8 cm) for the TAE group, p<0.001). The TAE group had more fragmented specimens than the TEM group (mean for the TAE: 1.44 (range: 1~4), mean for the TEM group: 1.06 (range: 1~2), p=0.031). For the patients with T1 cancer, the 3 year disease-free survival rate was not significantly different between the two groups (83.9% for the TAE group and 91.7% for the TEM group p=0.734). CONCLUSION: TEM can remove higher located rectal neoplasm and a less fragmented specimen was aquired that that in TAE. TEM seems to have similar oncologic outcomes as compared with TAE.
Disease-Free Survival ; Humans ; Length of Stay ; Microsurgery ; Postoperative Complications ; Quality of Life ; Rectal Neoplasms ; Recurrence ; Retrospective Studies

In the case of using surgical clips for division of the cystic duct during laparoscopiccholecystectomy, surgical clip migration into the common bile duct is known to be an extremely rare complication. However, its mechanism is currently unclear. The incidence of performing laparoscopic hepatectomy has significantly increased in the laparoscopic center of hospitals. Accordingly, the complications associated with using clips in laparoscopic cholecystectomy have increase as well. A 49 year-old female patient underwent laparoscopic left hepatectomy due to left intrahepatic duct stones with cholangitis. We report here on a case of a clip that migrated into the common bile duct and the duct had bile stones. We also review the relevant literature.
Bile ; Bile Ducts, Extrahepatic ; Cholangitis ; Cholecystectomy, Laparoscopic ; Common Bile Duct ; Cystic Duct ; Female ; Hepatectomy ; Humans ; Incidence ; Surgical Instruments

Chronic constipation has been successfully treated with specific medications and bio-feedback therapy. Surgical manipulation for this condition can be an option when non-surgical interventions fail. We report here on a patient who was diagnosed as having intractable chronic constipation with hypoganglionosis. The patient was a 60 year-old male with the history of seizure and diabetes. This patient did not gain any clinical benefits from non-surgical regimens. Therefore, we performed a laparoscopically assisted total colectomy with J-pouch ileorectal anastomosis on this patient. The patient recovered from the surgery without complications and he had normal bowel functions. The postoperative anatomical pathology revealed a hypogaglionosis. In conclusion, a laparoscopically assisted total colectomy for a patient with intractable chronic constipation with hypoganglionosis is a good option and it may be a curative method.
Colectomy ; Colonic Pouches ; Constipation ; Humans ; Male ; Seizures

Laparoscopic wedge resection for treating a gastric submucosal tumor is a widely accepted and feasible procedure. As the skills for performing laparoscopic surgery have been developed, a great deal of effort has also been given to minimize the size of the abdominal wound and its scar. Some studies have introduced single port laparoscopic surgery for these purposes, but most of these single port laparoscopic surgeries were carried out to perform appendectomy and cholecystectomy. There have been fewer reports on this for gastric surgeries. We report here on 2 cases of single port laparoscopic gastric wedge resection for treating gastric submucosal tumor.
Appendectomy ; Cholecystectomy ; Cicatrix ; Laparoscopy

PURPOSE: We determined the rate of an occult contralateral inguinal hernia by conducting only a physical examination for the unilateral inguinal hernia patients who visited our hospital. METHODS: One hundred thirty nine patients were prospectively evaluated between September 2009 and October 2010. We divided the patients into 3 groups according to a physical examination of the contralateral inguinal area: Group A (no abnormality), Group B (suspicious) and Group C (definite). We defined Group B and Group C as possible occult bilateral hernia. In Group B, selective diagnostic laparoscopy was performed after the totally extraperitoneal herniorrhaphy was finishedover. We analyzed the rate of detecting a contralateral hernia, the positive predictive value and the accordance rate. RESULTS: Of the 139 patients, the number of patients in Group A, B and C were 113 cases, 4 cases and 22 cases, respectively. The age of the patients ranged from 18~86 years (mean age: 57.1), with a male to female ratio was 7:1. Twenty-six patients (18.7%) had possible occult bilateral hernia. For the left inguinal hernia patients, the incidence of contralateral hernia was 18.2% (12/66). For the right inguinal hernia patients, this was 19.2% (14/73). The detection rate of contralateral hernia by physical examination was 14.1% (19/135) and the positive predictive value was 86.4% (19/22). The accordance rate of simultaneous bilateral hernia was 57.9% for the direct hernia patients and it was 26.3% for the indirect patients. There was no recurrence or metachronous contralateral inguinal hernia occurrence. CONCLUSION: We can discover occult contralateral inguinal hernia by conducting a careful physical examination of the contralateral inguinal area. Conducting a proper physical examination is very important for detecting inguinal hernia.
Female ; Hernia ; Hernia, Inguinal ; Herniorrhaphy ; Humans ; Incidence ; Laparoscopy ; Male ; Physical Examination ; Prospective Studies ; Recurrence