An unusual case of pneumoperitoneum: nephrocolic fistula due to a giant renal staghorn calculus.

Gastrointestinal perforations usually lead to pneumoperitoneum and peritonitis. Rarely, if ever described, a complete giant staghorn renal stone might cause a nephrocolic fistula with sigmoid impaction and perforation similar to gallstone ileus. Few nephrointestinal fistulae have been described in the literature and none of them were presented as an acute abdomen with pneumoperitoneum and pneumoretroperitoneum.

Is the Advanced Trauma Life Support simulation exam more stressful for the surgeon than emergency department trauma care?

Background: Stress affects surgeons both during training and during professional activity.

Objective: To compare stress levels affecting surgical residents during the simulated initial assessment and management in the Advanced Trauma Life Support practical exam vs initial assessment and management of trauma patients in the emergency room.

Method: Eighteen surgical residents were evaluated under basal conditions, during the Advanced Trauma Life Support simulation, and during emergency room initial care.

Laparoscopic pneumoperitoneum in acute peritonitis does not increase bacteremia or aggravate metabolic or hemodynamic disturbances.

The use of laparoscopy in generalized peritonitis has become increasingly frequent in recent years. However, CO2 pneumoperitoneum in association with increased intraperitoneal pressure may have deleterious effects in patients with hemodynamic or metabolic disturbances caused by bacterial peritonitis. The purpose of this study was to investigate the effect of CO2 pneumoperitoneum on bacteremia, mean arterial pressure, and blood gas disturbances in an animal model of bacterial peritonitis.

Laparoscopy in the new century.

Minimally invasive surgery already has established itself as a useful tool in the management of trauma. The future holds exciting possibilities for this field, borne and fostered by innovative developments in imaging, computer technology, and artificial intelligence. The next millennium may witness the disappearance of trauma surgery as it is known today.

Diagnostic and therapeutic laparoscopy for penetrating abdominal trauma: a multicenter experience.

Background: Considerable skepticism still exists about the role of diagnostic laparoscopy in the evaluation of penetrating abdominal trauma. The reported experience with therapeutic laparoscopy has been limited.

Methods: Retrospective analysis of a collective experience from three large urban trauma centers with 510 patients (316 stab wounds, 194 gunshot wounds) who were hemodynamically stable and had no urgent indications for celiotomy.

Extrahepatic bile ducts injury: a report on 14 cases.

Traumatic injuries of the extrahepatic biliary tract are infrequent, occurring in approximately 0.5% of all patients with blunt and penetrating abdominal trauma. The incidence of this injury due to blunt abdominal trauma is rare.

Gallstone ileus as a cause of upper intestinal obstruction.

Gallstone ileus, a mechanical intestinal obstruction caused by the passage of a gallstone into the intestinal lumen through a fistula, although not common, deserves to more carefully studied due to its morbidity and mortality. Its incidence among older-age groups explains its association with chronic and degenerative diseases, which increase the complexity of the treatment choice. The need and appropriateness of a surgical approach to a cholecystenteric fistula to solve the obstructive emergency, in a one or two stage procedure, has been discussed in the literature.

Autotransfusion with laparoscopically salvaged blood in trauma: report on 21 cases.

Autotransfusion is being increasingly used to avoid the complications of homologous blood transfusion. In abdominal trauma, however, the collected blood may be contaminated by intestinal contents when digestive or urinary lesions are present. In such situations, the reinfusion of blood is contraindicated.

Gallstone ileus resulting in strong intestinal obstruction.

Mechanic intestinal obstruction, caused by the passage of biliary calculus from vesicle to intestine, through fistulization, although not frequent, deserve study due to the morbi-mortality rates. Incidence in elder people explains the association with chronic degenerative diseases, increasing complexity in terms of therapy decision. Literature discusses the need and opportunity for the one or two-phase surgical attack of the cholecyst-enteric fistule, in front of the resolution on the obstructive urgency and makes reference to Gallstone Ileus as an exception for strong intestinal obstruction.

[Traumatic injuries of the gallbladder and of the extrahepatic biliary tract: analysis of 45 cases].

Injury of the extra-hepatic biliary tract is infrequent, occurring in approximately 3.5% of all patients with blunt and penetrating abdominal trauma. The incidence of this injury caused by blunt abdominal trauma is rare.

[Gallbladder injury in abdominal trauma: analysis of 32 cases].

Gallbladder lesion is infrequent, occurring in approximately 0.5 to 8.5% of all patients with blunt and penetrating abdominal trauma.

[Conservative treatment of severe liver trauma: report of a case and review of therapeutic methods].

The emergency surgical treatment of severe hepatic traumas still carries a high mortality risk. We report a case of severe blunt trauma to the liver managed without surgery under CT guidance. This attitude requires haemodynamic stability of the patient, close monitoring in a surgical intensive care unit and repeated CT scans.

Bilateral diaphragmatic injury diagnosed by laparoscopy.

Rupture of the diaphragm from blunt trauma is uncommon, but greatly improved prehospital care and transportation of victims has increased the frequency at which patients who sustain this injury arrive at the emergency room alive. We report a case of bilateral diaphragmatic rupture from blunt abdominal trauma in a 33-year old man. Diagnosis was established by laparoscopy after suggestive chest X-rays, liver scintigraphy, CT scan and magnetic resonance imaging.

Gallbladder injuries due to blunt abdominal trauma: report on five cases and review of the literature.

Gallbladder lesions by blunt abdominal trauma are rare, due to the organ's anatomical particularities. Diagnosis is difficult, and it generally occurs during surgery. The trauma is usually associated with other lesions and is related to very serious traumas or to deceleration.

[Laparoscopy as an auxiliary aid in abdominal emergencies].

The authors present a prospective study of 159 diagnostic laparoscopy performed in patients about whom doubts existed about the actual visceral involvement after initial clinical and laboratory examination by the Surgical Staff on duty. Patients whose initial diagnosis was easily made were immediately submitted to surgery and were not examined by laparoscopy. The laparoscopic exam was shown to be able to diagnose a large number of acute intra-abdominal disturbances, whether or not traumatic, and to be efficient, with accuracy values of 97.

Emergency laparoscopy in patients submitted previously to abdominal surgery: a study of 20 cases.

The authors performed 20 laparoscopies in patients previously submitted to abdominal surgery, in whom after clinical evaluation by the medical staff, the existence of intra-abdominal affection was still questioned. In this study group 14 patients exhibited more than 19 days old former abdominal incisions while in six patients they were recent ones. The incisions were median and para-median, McBurney incisions and Pfannenstiel incisions; one patient had been previously submitted to laparoscopy.

[Comparative analysis of the diagnostic value of ultrasonography and laparoscopy in acute abdomen].

Patients with traumatic or non-traumatic acute abdomen, often exhibit difficulties in the assessment of the real intra-abdominal visceral compromise. This study intends to compare laparoscopy and ultrasonography in patients with non-traumatic or traumatic acute abdomen, in whom there is a doubt on the actual visceral compromise. Forty-five patients were studied in this protocol.

[Diagnostic laparoscopy in nontraumatic acute abdomen].

Laparoscopy was performed in 49 patients admitted to the Emergency Service of Hospital das Clínicas of the Medical School of the University of São Paulo with a possible diagnosis of acute non traumatic abdomen. The procedure was indicated because routine clinical and laboratory investigations had proved inconclusive. Accuracy (96%), sensitivity (97.