Trauma is frequently not purely penetrating or purely blunt. Such mixed trauma can result from the mechanism of injury. Recently, we encountered a patient who accidentally shot himself with a shotgun. He had a 15 x 8-cm-sized penetrating injury on left flank that did not penetrate into the peritoneal cavity and a blunt splenic injury with hemoperitoneum. Surgical and interventional treatments were performed for each injury. We present this case with a review of the related literature.
Hemoperitoneum ; Humans ; Peritoneal Cavity

An unusual case of pinealoblastoma metastasizing through a ventriculoperitoneal(VP) shunt to the peritoneal cavity in a 10-year-old girl is presented with a review of the literatu re.
Child ; Female ; Humans ; Peritoneal Cavity

Gastrointestinal cancer peritoneal metastasis(GICPM) is one of the biggest challenges of clinical treatment. The ultimate solution to the problem requires the clinicians to accurately understand cytologic and molecular pathological mechanisms behind GICPM, and apply such knowledge in the clinical decision-making process for diagnosis and treatment of individual patient, so as to realize "prevention" and "treatment" proactively. The core cytopathological mechanisms behind GICPM, which are closely related to clinical treatment decisions, are as follows: (1) free cancer cells or clusters in peritoneal cavity colonize the peritoneum, resulting in irreversible pathological damage to peritoneal mesothelial cells; (2) the colonized cancer cells further invade the specific structure of the peritoneal milky spots and initiate an accelerated invasive growth process; (3) the process of peritoneal interstitial fibrosis aggravates the structural destruction of the peritoneum; (4) the interaction between cancer cells and immune cells in the milk spots forms a permissive immune microenvironment that promotes the growth of peritoneal metastatic cancer. These four core cytopathological mechanisms are mutually causal and promote each other, forming a vicious circle of GICPM development. As long as clinicians accurately understand these four points, it is possible to grasp the opportunity of clinical diagnosis and treatment, change reactive and passive treatment into preventive and proactive treatment, and improve the clinical diagnosis and treatment landscape of GICPM.
Humans ; Intestinal Neoplasms ; Peritoneal Cavity ; Peritoneal Neoplasms ; Peritoneum ; Tumor Microenvironment

Regarding the removal of a gastric bezoar, laparoscopic surgery was performed and it was shown that the laparoscopic approach is safe and feasible. However, the laparoscopic method has the risk of intraabdominal contamination, when the gastric bezoar is retrieved from the gastric lumen in the peritoneal cavity. We developed and applied a new procedure for the removal of the gastric bezoar using one surgical glove and two wound retractors as a fashion of intragastric single port surgery. Herein we present this new minimal invasive procedure, so named "hybrid access surgery" which involves the use of existing devices and overcomes the weakness of laparoscopic removal of the gastric bezoar. Our new procedure, combining the concept of intragastric and single port access, is acceptable and feasible to retrieve the gastric bezoar. In the future, this procedure may be one of the alternative procedures for retrieving gastric bezoar even when it is incarcerated in the pylorus.
Bezoars ; Gloves, Surgical ; Laparoscopy ; Peritoneal Cavity ; Pylorus

BACKGROUND/AIMS: To introduce and review the results of the different treatment modalities of infected pancreatic necrosis and abscess that have been used during a 1-year period. As well, to assess the technique and indications of retroperitoneal drainage that is selectively performed for the management of peripancreatic necrosis because of the problem of intraperitoneal drainage. METHODS: Five patients with infected pancreatic necrosis or abscess were operated on from July 1997 to June 1998. Two undrewent surgical necrosectomy and retroperitoneal drainage and 3 had a classical procedure of multiple intraperitoneal drainage after necrosectomy. RESULTS: Two of 5 patients that had retroperitoneal drainage performed were successful of wide ranging necrosectomy of retroperitoneal necrosis or abscess through one drainage site and the left flank, resulting in a decreased rate of intraperitoneal contamination, discomfort and disability. CONCLUSION: The advantages of retroperitoneal drainage for wide ranging retroperitoneal pancreatic necrosis are made possible by draining the retroperitoneal route from the retroperitoneal cavity to the same retroperitoneal external opening. The use of retroperitoneal drainage seemed to be a significant factor for improvement by providing a reliable drainage of retropancreatic areas and by avoiding the opening of the peritoneal cavity
Abscess ; Drainage* ; Humans ; Necrosis* ; Peritoneal Cavity

The CT findings were reviewed in two patients with injuries to the gallbladder following blunt trauma. In one patient high attenuation of intraluminal blood clot within the gallbladder and associated hemoperitoneum were identified. Another patient was represented hemoperitoneum and bile leakage into the peritoneal cavity due to laceration of the fundus of the gallbladder which appeared contrasted.
Bile ; Gallbladder ; Hemoperitoneum ; Humans ; Lacerations ; Peritoneal Cavity

Natural orifice translumenal endoscopic surgery (NOTES) involves the intentional perforation of the viscera with an endoscope to access the abdominal cavity and perform an intraabdominal operation. In a brief time period, NOTES has been shown to be feasible in laboratory animal and human studies. Easy access to the peritoneal cavity and complete gastric closure should be secured before NOTES can be recommended as an acceptable alternative in clinical practice. The concept of submucosal endoscopy has been introduced as a solution to overcome these two primary barriers to human NOTES application. Its offset entry/exit access method effectively prevents contamination and allows the rapid closure of the entry site with a simple mucosal apposition. In addition, it could be used as an endoscopic working space for various submucosal conditions. Herein, the detailed procedures, laboratory results and human application of the submucosal endoscopy will be reviewed.
Abdominal Cavity ; Animals, Laboratory ; Endoscopes ; Endoscopy ; Humans ; Peritoneal Cavity ; Viscera

The Y-TEC(R) system is an equipment for the peritoneoscopic placement of peritoneal dialysis catheter. The advantage of this method is the direct visualization of peritoneal cavity by using a small diameter minitrocar and dilatable guide. But this method has some limitations because of the expensive equipment and the difficulty in being expert at peritoneoscopy. We placed the CAPD catheter by using a minitrocar without peritoneoscopy(so called Modified Y- tec(R) system) in 44 patients who had no history of major abdominal surgery(MY-group), the classic Y- tec(R) system in 8 patients(Y-group), and surgical method in 13 patients with history of major abdominal surgery(S-group) and compared the effecacy and safety of three methods. In conclusion, the short and long term results of blind minitrocar placements were comparable to, or better than the surgical and other percutaneous methods of catheter implantation when they were used in the patients without history of major abdominal surgery.
Catheters* ; Humans ; Laparoscopy ; Peritoneal Cavity ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory

PURPOSE: This study is aimed to evaluate the efficacy of a novel method (RT-PCR for CEA) to diagnose free cancer cells in peritoneal cavity of gastric cancer patients, which can be used as a indication of prophylactic treatment to prevent peritoneal recurrence after curative resection of gastric cancer. MATERIALS AND METHODS: 114 gastric adenocarcinoma patients were included for this study. With pellet of peritoneal washing fluid, cytology and RT-PCR for CEA were performed with specific primers. RESULTS: Positive rate of PCR as a whole was 55.3% (63 cases); however, that of cytology was 15.8% (18 cases). Positive rate of PCR increased with depth of invasion of the lesion (p=0.026); however, that of cytology didn't (p=0.233). In early gastric cancer and seeding cases, PCR was not more sensitive than cytologic examination in detection of free cancer cell, but in pm, ss and si cancers, PCR was much more sensitive than cytology (p<0.001). CONCLUSION: PCR was more sensitive to diagnose free cancer cells in peritoneal cavity of gastric cancer patients especially in pm, ss and si cancers than conventional cytologic examination, and it can be a good candidate of indication of prophylactic treatment to prevent peritoneal recurrence after curative resection.
Adenocarcinoma ; Humans ; Peritoneal Cavity ; Polymerase Chain Reaction ; Recurrence ; Stomach Neoplasms*

We describe a case of poorly differentiated gastric neuroendocrine carcinoma presenting as a wandering exophytic mass. CT imaging revealed a 14.5x10.0x8.0 cm, lobulated, solid mass with a multifocal necrotic portion at the right of the peritoneal cavity. It was attached to the antrum of the stomach by a broad stalk, and shown by MR imaging to be well-defined, lobulated and solid, with a multifocal necrotic portion, and at the left of the peritoneal cavity. Isointensity was apparent at T1-weighted imaging, and slightly hyperintensity at T2-weighted imaging, and after gadolinium injection, enhancement was stronger than at precontrast imaging.
Carcinoma, Neuroendocrine* ; Gadolinium ; Magnetic Resonance Imaging ; Peritoneal Cavity ; Stomach