Rupture of the colon caused by high pressure compressed air is a rare, unique and traumatic intra-abdominal injury. As the use of compressed air in industrial work has increased, so has the risk of associated pneumatic injuries from its improper use. Recently we experienced a case of pneumatic rupture of the sigmoid colon accompanied by tension pneumoperitoneum, which caused respiratory distress. The patient's respiration was very rapid with the rate of 44 breaths per minute. On arterial blood gas analysis, pH was 7.40, pO2 68 mmHg, pCO2 44 mmHg, and SaO2 90%. Chest X-ray film showed marked pneumoperitoneum and an elevated diaphragm. The respiratory distress was severe and required immediate relief by emergency decompression peritoneocentesis before surgical intervention consisting of the serosal tear repair, colonic rupture colostomy and abdominal cavity irrigation. A follow up operation 2 months later for colostomy repair completed the patient's recovery.
Adult ; Case Report ; Colonic Diseases/etiology* ; Human ; Male ; Pneumoperitoneum/complications* ; Pressure ; Rupture, Spontaneous

BACKGROUND: Several methods are performed to control the pain after a laparoscopic cholecystectomy. Recently, the transverse abdominis plane block has been proposed to compensate for the problems developed by preexisting methods. This study was designed to evaluate the effect of the ultrasound-guided transverse abdominis plane block (US-TAP block) and compare efficacy according to the concentration of local analgesics in patients undergoing laparoscopic cholecystectomy. METHODS: Fifty-four patients undergoing laparoscopic cholecystectomy were randomized into three groups. The patients in Group Control did not receive the US-TAP block. The patients in Group B(0.25) and Group B(0.5) received the US-TAP block with 0.25% and 0.5% levobupivacaine 30 ml respectively. After the general anesthesia, a bilateral US-TAP block was performed using an in-plane technique with 15 ml levobupivacaine on each side. Intraoperative use of remifentanil and postoperative demand of rescue analgesics in PACU were recorded. The postoperative verbal numerical rating scale (VNRS) was evaluated at 20, 30, and 60 min, and 6, 12, and 24 hr. Postoperative complications, including pneumoperitoneum, bleeding, infection, and sleep disturbance, were also checked. RESULTS: The intraoperative use of remifentanil, postoperative VNRS and the postoperative demand of rescue analgesics were lower in the groups receiving the US-TAP block (Group B(0.25) and Group B(0.5)) than Group Control. There were no statistically or clinically significant differences between Group B(0.25) and Group B(0.5). No complications related to the US-TAP block were observed. CONCLUSIONS: The US-TAP block with 0.25% or 0.5% levobupivacaine 30 ml (15 ml on each side) significantly reduced postoperative pain in patients undergoing laparoscopic cholecystectomy.
Analgesics ; Anesthesia, General ; Bupivacaine ; Cholecystectomy, Laparoscopic ; Hemorrhage ; Humans ; Pain, Postoperative ; Piperidines ; Pneumoperitoneum ; Postoperative Complications

Small bowel diverticulosis is a rare finding within all bowel diverticuloses and jejunal diverticulosis is even rarer. Their relative clinical rarity and varied presentation may make diagnosis both delayed and difficult. We experienced a case of jejunal diverticulosis, which was diagnosed intraoperatively. A 55-year-old woman was admitted to Emergency Department with pneumoperitoneum on plain chest and abdominal film from a local clinic. She was hemodynamically stable with minimal tenderness on the left upper quadrant of the abdomen but no rebound tenderness. At surgery, small bowel torsion and jejunal diverticulosis were confirmed. Over 30 variable sized small bowel diverticula were noted on the mesenteric side of the proximal jejunum. The affected segment of the jejunum was about 180 cm. On exploration, we could not find any perforation site. No postoperative complications were observed, and the patient made a full recovery. Jejunal diverticulosis is rare, but it should not be regarded as insignificant.
Abdomen ; Diagnosis ; Diverticulum* ; Emergency Service, Hospital ; Female ; Humans ; Jejunum ; Middle Aged ; Pneumoperitoneum* ; Postoperative Complications ; Thorax

Laparoscopic ureterolithotomy has been attempted in the management of the large, long-standing, impacted ureter stone. However it was not commonly used because of difficulties in technique. So we report 2 cases of laparoscopic ureterolithotomy using the gasless technique. We performed the laparoscopic ureterolithotomy in two patients with ureter stones by transperitoneal approach. We used the laparolift system which was connected by laparofan retractor. The abdominal wall was elevated effectively, and the ureters were exposed with ease. The stone was successfully removed in all two cases. The operative time was 120 and 140 miniutes respectively. There was no intraoperative or postoperative complication including urinary leak in all cases. Postoperative pain was minimal. This gasless technique is convenient and safe because an operator can use the conventional surgical instruments and avoid the complications directly associated with pneumoperitoneum.
Abdominal Wall ; Humans ; Operative Time ; Pain, Postoperative ; Pneumoperitoneum ; Postoperative Complications ; Surgical Instruments ; Ureter

We report our experience with a case of stomach perforation after accidental ingestion of liquid nitrogen. A 13-year-old boy ate a snack at an amusement park and began to complain of sudden onset of severe abdominal pain with shortness of breath. It was determined that the snack he had ingested had been cooled with liquid nitrogen. A computed tomography scan of the abdomen and a chest X-ray showed a large volume of pneumoperitoneum. During surgery, a 4-cm perforation of the angularis incisura of the stomach was identified. Primary repair and omentopexy was performed. The patient was discharged without postoperative complications.
Abdomen ; Abdominal Pain ; Adolescent ; Barotrauma ; Dyspnea ; Eating ; Humans ; Male ; Nitrogen* ; Pneumoperitoneum ; Postoperative Complications ; Snacks* ; Stomach* ; Thorax

No abstract available.
Adolescent ; Emphysema/etiology* ; Face ; Human ; Male ; Mediastinal Emphysema/etiology ; Neck ; Peptic Ulcer Perforation/complications* ; Pneumoperitoneum/etiology ; Stomach Ulcer/complications*

PURPOSE: This study aims to determine the prognostic factors of pneumoperitoneum in neonates. METHODS: We reviewed 35 neonates who underwent operations for pneumoperitoneum between 1999 and 2007. The prognostic factors on survival were evaluated. RESULTS: Twenty-eight patients were male and 7 were female. Mean gestational age was 35.9+/-4.6 weeks and birth weight was 2,703.1+/-999.2 gr. Mean apgar-score were 6.0+/-2.9 at 1 min, and 6.7+/-2.6 at 5 min. The most common clinical finding was abdominal distension. Most patients were diagnosed with a simple abdominal X-ray. Perforation sites were stomach (n=8), small bowel (n=20), colon (n=5), and small bowel and colon (n=2). Operative methods were bowel resection with enterostomy (n=15), resection with anastomosis (n=9), wedge resection (n=4), primary closure (n=3), primary closure with enterostomy (n=3), and penrose-drain insertion (n=1). Postoperative complications occurred in 16 patients, and 26 patients survived and 9 expired. Mortality rate was significantly higher in lesser gestational age, lower birth weight and apgar-score, need of preoperative ventilator, and abnormalities in ABGA or platelet count. CONCLUSION: The significant prognostic factors were gestational age, birth weight, Apgar-score, need of preoperative ventilator, and abnormal laboratory findings in ABGA and platelet count. The other variables including sex, symptom duration, underlying diseases, perforation sites, and operation methods were not correlated with survival.
Birth Weight ; Colon ; Enterostomy ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Male ; Platelet Count ; Pneumoperitoneum ; Postoperative Complications ; Stomach ; Ventilators, Mechanical

PURPOSE: This study was conducted to compare postoperative complications, hospitalization days and treatment expenses to postoperative prophylactic antibiotics administrated to hysterectomy or not. METHODS: A retrospective survey study was performed with 128 cases in which elective hysterectomy had undergone. They were divided into two groups by identifying whether postoperative prophylactic antibiotics was administered for hysterectomy: a) one group who received postoperative prophylactic antibiotics and; b) those who did not. Data were collected using the electric medical record at a hospital and analyzed by SPSS 23.0 for χ2 test, t-test and ANCOVA. RESULTS: Postoperative complications including wound infection (p=1.000), pneumonia (p=.496), hematoma (p=.530), and pneumoperitoneum (p=.496) showed no significant differences between two groups. Hospitalization days for the prophylactic antibioticsadministrated group were significantly longer than the non-administered for prophylactic antibiotics (p=.004). The treatment expenses of the prophylactic antibiotics-administrated group were significantly higher than those of the non-administered prophylactic antibiotics (F=4.31, p=.040). CONCLUSION: These results can be provided for the evidence of administrating postoperative prophylactic antibiotics to hysterectomy. Additionally, it can contribute to decreasing the medication errors caused by infrequently administrating postoperative prophylactic antibiotics as well as to lessening likelihood of infection of intravenous injection site.
Anti-Bacterial Agents* ; Hematoma ; Hospitalization* ; Hysterectomy* ; Injections, Intravenous ; Medical Records ; Medication Errors ; Pneumonia ; Pneumoperitoneum ; Postoperative Complications* ; Retrospective Studies ; Wound Infection

Pneumoperitoneum, free intra-abdominal air, usually results from the perforation of a hollow viscous. In approximately 10% of cases, however, pneumoperitoneum is not caused by gastrointestinal perforation. These cases of "spontaneous pneumoperitoneum" generally follow more benign course and may not require surgical intervention. Examples include cardiopulmonary resuscitation (CPR), malrotation, mechanical ventilator support, gynecologic manipulation, blunt abdominal trauma, and chronic intestinal pseudoobstruction in infancy (Sieber syndrome). But, it is extremely rare of spontaneous pneumoperitoneum secondary to idiopathic intestinal pseudoobstuction in adult. We herein report a patient with chronic idiopathic intestinal pseudoobstuction who developed a pneumoperitoneum.
Adult ; Chronic Disease ; Humans ; Intestinal Pseudo-Obstruction/complications/*diagnosis/surgery ; Intestine, Small/pathology ; Male ; Pneumoperitoneum/*diagnosis/etiology/radiography ; Tomography, X-Ray Computed

We report two colorectal trauma patients whose rectosigmoid region was ruptured due to a jet of compressed air directed to their anus while they were playing practical jokes with their colleagues in their place of work. It was difficult to diagnose in one patient due to vague symptoms and signs and due to being stunned by a stroke of the compressed air. Both patients suffered from abdominal pain and distension, tension pneumoperitoneum and mild respiratory alkalosis. One patient was treated with primary two layer closure, and the other with primary two layer closure and sigmoid loop colostomy. Anorectal manometry and transanal ultrasonography checked 4 weeks after surgery, revealed normal anorectal function and anatomy. The postoperative courses were favorable without any wound infection or intraabdominal sepsis.
Accidents, Occupational ; Case Report ; Colon/*injuries/surgery ; Female ; Human ; Male ; Middle Age ; Play and Playthings ; Pneumoperitoneum/*complications/surgery ; Rectum/*injuries/surgery ; Rupture