Intraperitoneal Spillage Research Articles

Abscesso intrabdominal tardio pós colecistectomia laparoscópica

Perforation of the gallbladder during laparoscopic cholecystectomy may be associated with intraperitoneal gallstone spillage. Several complications secondary to lost gallstones in the abdominal cavity have been described. We report a rare complication of abdominal abscess secondary to two gallstones left in the abdominal cavity. A 75-year-old female presented with spontaneous drainage of pus through the umbilicus five years after laparoscopic cholecystectomy. An ultrasonographic evaluation of the abdomen revealed a solid mass of 56x26 mm of diameter, with acoustic shadow, localized distal to the umbilicus. At laparotomy, an abscess with two biliary calculi was drained. The patient had good recovery, with no complication.

Surgical treatment of ovarian dermoid cysts: a comparison between laparoscopic and vaginal removal

Background: In the last years transvaginal ultrasonographic diagnosis of ovarian dermoid cyst together with laparoscopic approach have greatly improved the treatment of this benign lesion. Vaginal approach with laparoscopic assistance has been proposed as an alternative to total laparoscopic removal. Methods: A retrospective comparison between total laparoscopic (56 patients) and direct vaginal removal (30 patients) of ovarian dermoids. Results: There were few, but significant, advantages of vaginal removal, especially regarding operating time, intraperitoneal spillage of dermoid tissue and post-operative outcome. Conclusion: Vaginal approach to the removal of dermoid cysts can be considered a safe alternative procedure to laparoscopy.

SPONTANEOUS PERFORATION OF THE GALLBLADDER AS A COMPLICATION OF RADICAL CYSTOPROSTATECTOMY

An 81-year-old man underwent uneventful radical cystoprostatectomy and ileal conduit urinary diversion for muscle invasive transitional cell carcinoma of the bladder. Postoperative course was complicated by prolonged ileus, which required nasogastric suction and total parenteral nutrition. On postoperative day 13 the patient had a low grade fever, and epigastric tenderness was noted on physical examination. Computerized tomography of the abdomen revealed a markedly enlarged gallbladder with inflammatory changes consistent with cholecystitis (see figure). After a general surgical consultation, cholecystectomy was scheduled for the following morning. Appropriate intravenous antibiotics were started. Later that evening abdominal pain worsened dramatically. Examination was consistent with frank peritonitis. Emergency exploratory laparotomy revealed a ruptured gallbladder with bilious intraperitoneal spillage. The patient underwent cholecystectomy and peritoneal lavage. He was in the intensive care unit 3 days before recovery. Pathological examination of the specimen revealed small calculi and acute cholecystitis.

Management of Early Dislodgment of Percutaneous Endoscopic Gastrostomy Tubes

One of the most serious complications of percutaneous endoscopic gastrostomy (PEG) is premature removal of the gastrostomy tube. In an attempt to clarify the optimal therapy of this complication, the records of 197 patients undergoing PEG were reviewed. Six patients whose PEG tubes were removed 2.9 +/- 1.3 days after placement were identified; only one patient required an emergent operation. The patients managed nonoperatively were treated by immediate replacement of tubes through the tracts (two patients), observation prior to repeat PEG (two), and delayed laparoscopic gastrostomy (one). Nonoperative management is feasible in the majority of patients suffering this complication. When an operation is indicated because of suspected intraperitoneal spillage, laparoscopy allows wide visualization and irrigation of the peritoneal cavity, closure of the gastrotomy, and placement of new enteral access while avoiding the morbidity associated with laparotomy in these often-debilitated patients.

Traumatic rupture of hydatid cysts: a 12-year experience from an endemic region.

Trauma as a cause of hydatid cyst rupture leads to various clinical sequelae. However, extensive data in the current literature regarding clinical presentation and management of such patients are lacking. This article is a retrospective review of 16 patients with traumatic rupture of hydatid cysts treated at a university hospital in an endemic area. Falls (44%) were the most common cause of trauma. The ruptured cysts were located in the liver in 13 patients (81%), in the spleen in 2 patients, and in the lung in 1 patient. Computerized tomography had a sensitivity of 100% in demonstrating cyst rupture; whereas, ultrasonography had a sensitivity of 85%. Ten patients (62%) had rupture into the peritoneal cavity and 5 patients (31%) into the biliary tree. Five (31%) of the cysts were infected. Surgical procedures included introflexion (five patients), pericystectomy-choledochoduodenostomy (three patients), external drainage-choledochoduodenostomy (two patients), unroofing-external drainage (two patients), splenectomy (two patients), unroofing (one patient), and right hepatectomy (one patient). Mean length of hospitalization was 15.9 days (range, 5-61 days). One patient (6%) died, and eight patients (50%) developed complications. Nine patients (56%) were followed-up for an average of 30 months (range, 3-72 months), and there was no recurrence. Computed tomography is currently the most sensitive diagnostic tool for demonstrating hydatid cyst rupture. The surgical options vary depending on intraoperative findings. Allergic reactions and recurrence as a result of intraperitoneal spillage are not as common as once believed. Biliary rupture is associated with an increased rate of wound infection.

Four year experience in laparoscopic dissection of intact ovarian dermoid cysts

Background: Intraperitoneal spillage of dermoid cyst content, if not followed immediately by abundant peritoneal lavage, can cause a chemical peritonitis with subsequent adhesion formation. Study Design: We performed an open clinical study in a university hospital. Forty-four consecutive ovarian dermoid cysts were removed intact from 40 premenopausal women operated on between October 1993 and December 1997. The laparoscopic technique included: 1) creation of a cleavage plane between the cyst and the ovary; 2) dissection of the cyst by a combination of water, scissors, and gravity without direct traction on the cyst; and 3) extraction of the cyst after its placement inside a laparoscopic bag. Results: The mean cyst diameter was 6.5 cm (range 3 to 12 cm). Mean operating time was 125 minutes (range 50 to 180 minutes). All patients were discharged within 48 hours. The cysts were dissected completely intact and were extracted without spillage in the abdominal cavity in all cases. Operative followup was available in 15 of the 40 patients; mild adhesions were found on the treated ovary in 3 (20%). Conclusions: It is always possible to prevent rupture and spillage of dermoid cysts during laparoscopic operations, but this approach is time consuming and needs expert surgical technique.

Broncholithiasis and Thoracoabdominal Actinomycosis From Dropped Gallstones

We report a case of successfully managed invasive, thoracoabdominal actinomycosis caused by the intraperitoneal spillage of gallstones during laparoscopic cholecystectomy. The infected gallstones traversed the diaphragm, migrated into the lung parenchyma, and obstructed a segmental bronchus, causing pneumonia. Treatment involved retrieval of the obstructing stone, debridement and drainage of the pleuroperitoneal phlegmon/abscess, and intravenous antibiotics. The case illustrates the need to remove gallstones at the time of cholecystectomy.

Laparoscopic convervative excision of ovarian dermoid cysts with and without an endobag

To compare outcomes of conservative laparoscopic treatment of dermoid cysts removed from the abdominal cavity without (group A) and with an endobag (group B). Prospective, randomized, 4-year (June 1992-June 1996) study (Canadian Task Force classification I). Department of Obstetrics and Gynecology of the Catholic University of the Sacred Heart in Rome. Fifty-five premenopausal women with dermoid cysts. Intervention. Patients were randomly assigned to removal of dermoid cysts from the abdominal cavity with or without an endobag through a 10- to 12-mm cannula sleeve. We assessed surgical time, spillage, complications, length of hospitalization, recurrences, and pregnancies. In the 55 women, 58 dermoid cysts (mean diameter 5.6 +/- 2.03 cm) were enucleated and removed at operative laparoscopy through a 10- to 12-mm cannula sleeve without intraoperative or postoperative complications. Mean operating time was 73 minutes. When cysts were removed with an endobag, operating time was significantly reduced over removal without the endobag (63 vs 81 min, p <0.05). Obvious spillage of endocystic contents occurred in 13 (43.3%) patients in group A but in only 1 patient in group B because the bag ruptured (p <0.05). No signs or symptoms of peritonitis were observed in women with evident cystic spillage or in those in group A in whom spillage was possible. Average postoperative hospital stay was 1.7 days and did not differ between groups. Among 20 infertile women, 9 (45%) experienced spontaneous pregnancy within a year, with no differences between groups. Echographic follow-up did not reveal cyst recurrence. Laparoscopic conservative cystectomy of dermoid cysts in premenopausal women is safe and effective and appears to be a valuable alternative to laparotomy. Removing cysts in an endobag significantly reduced both operating time and spillage. However, controlled intraperitoneal spillage of cyst contents does not increase postoperative morbidity as long as the peritoneal cavity is thoroughly washed.

Long-term consequences of intraoperative spillage of bile and gallstones during laparoscopic cholecystectomy

Laparoscopic cholecystectomy is associated with a higher incidence of iatrogenic perforation of the gallbladder than open cholecystectomy. The long-term consequences of spilled bile and gallstones are unknown. Data were collected prospectively from 1059 consecutive patients undergoing laparoscopic cholecystectomy over a 3-year period. Details of the operative procedures and postoperative course of patients in whom gallbladder perforation occurred were reviewed. Long-term follow-up (range 24 to 59 months) was available for 92% of patients. Intraoperative perforation of the gallbladder occurred in 306 patients (29%); it was more common in men and was associated with increasing age, body weight, and the presence of omental adhesions (each P < 0.001). There was no increased risk in patients with acute cholecystitis ( P = 0.13). Postoperatively pyrexia was more common in patients with spillage of gallbladder contents (18% vs. 9%; P < 0.001). Of the patients with long-term follow-up, intra-abdominal abscess developed in 1 (0.6%) of 177 with spillage of only bile, and in 3 (2.9%) of 103 patients with spillage of both bile and gallstones, whereas no intra-abdominal abscesses occurred in the 697 patients in whom the gallbladder was removed intact ( P < 0.001). Intraperitoneal spillage of gallbladder contents during laparoscopic cholecystectomy is associated with an increased risk of intra-abdominal abscess. Attempts should be made to irrigate the operative field to evacuate spilled bile and to retrieve all gallstones spilled during the operative procedure.

Long-term consequences of intraoperative spillage of bile and gallstones during laparoscopic cholecystectomy.

Laparoscopic cholecystectomy is associated with a higher incidence of iatrogenic perforation of the gallbladder than open cholecystectomy. The long-term consequences of spilled bile and gallstones are unknown. Data were collected prospectively from 1059 consecutive patients undergoing laparoscopic cholecystectomy over a 3-year period. Details of the operative procedures and postoperative course of patients in whom gallbladder perforation occurred were reviewed. Long-term follow-up (range 24 to 59 months) was available for 92% of patients. Intraoperative perforation of the gallbladder occurred in 306 patients (29%); it was more common in men and was associated with increasing age, body weight, and the presence of omental adhesions (each P < 0.001). There was no increased risk in patients with acute cholecystitis (P = 0.13). Postoperatively pyrexia was more common in patients with spillage of gallbladder contents (18% vs. 9%; P < 0.001). Of the patients with long-term follow-up, intra- abdominal abscess developed in 1 (0.6%) of 177 with spillage of only bile, and in 3 (2.9%) of 103 patients with spillage of both bile and gallstones, whereas no intra- abdominal abscesses occurred in the 697 patients in whom the gallbladder was removed intact ( P < 0.001). Intraperitoneal spillage of gallbladder contents during laparoscopic cholecystectomy is associated with an increased risk of intra-abdominal abscess. Attempts should be made to irrigate the operative field to evacuate spilled bile and to retrieve all gallstones spilled during the operative procedure.

Ascitic Positive Cytology and Intraperitoneal Metastasis in Ovarian Dysgerminoma

To verify the pattern of the spread of tumors in ovarian dysgerminoma, with special reference to intraperitoneal metastasis, and to assess clinicopathologic factors for predicting tumor extension. Detailed data regarding ascitic cytology, macroscopical findings at surgery, and the histopathology of the surgical specimens were retrospectively reviewed in 12 patients with dysgerminoma who were treated at Kyoto University Hospital. The relationships between the tumor extension and the period of symptoms, the serum lactic dehydrogenase (LDH) level, and the operative findings also were analyzed. Ascitic cytology revealed a high incidence of positivity in 6 of the 10 (60%) cases examined. Extraovarian metastases were present in 4 of the 6 (67%) cases with positive cytology, and in 1 of the 4 (25%) cases with negative cytology. Intraperitoneal metastatic nodules were detected in 5 of the 12 (42%) patients either by inspection during surgery or by postsurgical histological examination. In addition, these metastatic lesions were 5 or fewer in number and 7 mm or less in diameter, except in 1 patient with widespread disease. The presence or absence of extraovarian spread of the tumor was not significantly correlated with the period of symptom, the serum LDH level, the size of the primary tumor, or the volume of the ascitic fluid. The incidence of intraperitoneal spillage and/or metastases of dysgerminoma cells might be higher than previously reported. These findings indicate the importance of ascitic cytology and careful inspection at the time of operation, as well as the rationale of postsurgical chemotherapy for dysgerminoma of an apparently early stage.

GALLSTONE ILEUS: POST CHOLECYSTECTOMY

A case of gallstone ileus occurring 5 months after laparoscopic cholecystectomy is presented. The possible aetiology is discussed and the literature regarding consequences of intraperitoneal stone spillage reviewed.

Laparoscopic treatment of hydatid cyst of the liver: initial experience with a small series of patients.

A laparoscopic technique to manage hydatid cyst of the liver is described. The technique is safe and simple and has the advantages of other abdominal laparoscopic operations. It also fulfills the prerequisite of open surgery of hydatid cyst of the liver, namely, the prevention of intraperitoneal spillage of cyst contents. Our technique enables treatment of the residual cyst cavity following aspiration of contents. In the past 15 months, 10 cysts (5-17 cm in diameter) in 6 patients were managed successfully using this approach, with no mortality or short-term recurrence.

Cholelithoptysis and cholelithorrhea: Rare complications of laparoscopic cholecystectomy

Laparoscopic Cholecystectomy is now considered a safe procedure for the management of cholelithiasis. During the procedure, stone spillage can occur and is usually not considered a serious complication. Clearance of stones can be laborious and is often avoided. Two patients with complications from gross intraperitoneal stone spillage during laparoscopic Cholecystectomy, namely Cholelithoptysis and Cholelithorrhea, are presented. Both patients developed Cholelithoptysis, or the coughing up of gallstones, within 1 year of their laparoscopic surgery. In addition, the second patient also experienced the passage of stones from a fistula at the incision site of a remote lumbar laminectomy, which we term Cholelithorrhea. We propose that Cholelithoptysis developed from the transdiaphragmatic extension of intraperitoneal abscesses and the subsequent formation of bronchopleural fistulas. We believe that gross intraperitoneal stone spillage should be avoided and remedied, if possible, by removal of stones and copious irrigation.

Diagnosis and management of hydatid disease of the liver. A 15-year North American experience.

Since 1967, 40 patients with hydatid disease of the liver have been treated at our hospital. Diagnosis was made using clinical criteria, serology, skin tests, and imaging techniques. Thirty-five patients were operated upon. In 18 patients the cyst was uncomplicated (Group I), and in 17 the cyst was infected or communicated with the biliary tract (Group II). Three forms of surgical treatment were used: A) cyst evacuation, scolicidal irrigation, and primary cyst closure, B) evacuation, irrigation, and external drainage, and C) complete or partial cyst resection. Mebendazole was used in six patients, four of whom were also treated surgically. In Group I, one of 11 patients (8%) treated by primary closure had complications, versus four of five patients (80%) treated with external drainage (p less than 0.001). Mean postoperative hospital stay for these two groups was 11.8 versus 20.8 days, respectively (p less than 0.001). Complication rates in Group II were higher, and were evenly distributed among treatments. Patients have been followed yearly, with a median follow-up of 5 years. Active hydatid disease has been found in three patients, who all had known residual disease at initial operation. The best treatment for an uncomplicated hydatid liver cyst is evacuation, scolicidal irrigation, and primary closure. External drainage is used for infected cysts or those communicating with the biliary tract, and excision for extrahepatic and peripheral, easily resectable cysts. Mebendazole is used for intraperitoneal spillage of cyst contents and in patients with inoperable disease.

Intraperitoneal spillage of formalin after intravesical instillation

Intravesical instillation of formalin appears to be a method of choice in the control of massive hematuria following radiation cystitis. It is generally described as a safe, cheap, effective procedure. We report a case of intraperitoneal spillage of formalin and describe the metabolic and extensive medical problems encountered in the four-week period following the incident before the patient's death.

Results of Postoperative Megavoltage Radiotherapy of Malignant Surface Epithelial Tumors of the Ovary

The results of postoperative radiotherapy in 151 patients with malignant epithelial tumors of the ovary are presented. Actuarial survival at five years for patients in FIGO Stage I was 76%; in Stage II, 56%; Stage III, 16%; and Stage IV, 0%. Survival also varied with histopathological type, the best prognoses occuring in the serous (malignant) and endometrioid types (NED survival of 35% and 50%, totalling all stages, respectively). The presence of ascites or intraperitoneal surgical spillage did not adversely affect survival. The role of lymphangiography in staging is discussed. New approaches to diagnosis, staging and treatment are required for improving the prognosis of patients with ovarian carcinoma.