Laparoscopic Resection of Gangrenous Small bowel with acute small bowel obstruction – World’s First reported case

Abstract

Introduction: Diagnostic laparoscopy is now frequently used for small bowel obstructionwith a varying degree of success. However, emergency laparoscopic resection ofgangrenous small bowel has not yet been reported in the English literature. We reportthe world first case of successful laparoscopic assisted resection of gangrenous smallbowel in a 64 year old female with an excellent postoperative outcome.Presentation of Case: A 64 years old woman with a virgin abdomen presentedwith a clinical and radiological features of small bowel obstruction. The patient washemodynamically stable with mild central abdominal distension and tenderness butthere was no guarding or rebound tenderness. On diagnostic laparoscopy a loop ofgangrenous small bowel was noted secondary to an adhesion band. The patient had asuccessful laparoscopic assisted resection and extra-corporal anastomosis of the smallbowel with an excellent postoperative outcome.Discussion: Diagnostic laparoscopy plays a vital role for the diagnosis and treatmentof selected cases of small bowel obstruction in a virgin abdomen. However, appropriatepatient selection as well as the availability of a skilled laparoscopic surgeon is offparamount importance for a successful outcome. Contrast enhanced CT scan is alsoa useful tool for appropriate patient selection. The morbidity of laparotomy can oftenbe avoided in presence of a skilled laparoscopic surgeon.Conclusion: Laparoscopic approach can be attempted in selected patients with firstepisode of SBO and/or anticipated single band obstruction. Similarly, gangrenoussmall bowel can be resected laparoscopically in highly selected patients in the presenceof an experienced laparoscopic surgeon.