Laparoscopic surgery in a patient with foramen of Winslow hernia due to large uterine fibroids: a case report and literature review

Background Foramen of Winslow hernia (FWH) is a rare but emergent condition caused by an increase in the foramen diameter, visceral mobility, and intra-abdominal pressure. To the best of our knowledge, this is the first study to report a case of FWH secondary to large uterine fibroids that was successfully treated with laparoscopic surgery. Case presentation A 52-year-old woman with large uterine fibroids was diagnosed with FWH. Because of the absence of signs of bowel ischemia and peritonitis, we performed an elective laparoscopic surgery through a 5-port system after bowel decompression using a long intestinal tube. Although foramen of Winslow closure was not performed, her postoperative course was uneventful. Conclusions Laparoscopic surgery for FWH is considered an extremely effective surgical treatment option because of its safety and efficacy in performing delicate procedures (such as adhesiolysis) with a good magnified field of view.

Should nasogastric tube insertion during the COVID-19 pandemic be considered as an aerosol-generating procedure?

Nasogastric tubes are used frequently in surgical patients for bowel decompression, provision of enteral nutritional support and preventing aspiration of gastric contents. There is no conclusive research into the risk of COVID-19 transmission associated with nasogastric tube insertion, although evidence from the severe acute respiratory syndrome outbreak appears to suggest that there is no increased risk of transmission. However, close contact with a COVID-19 patient, especially those displaying respiratory symptoms, is likely to increase the risk of transmission. Nasogastric tube insertion requires increased time spent at a patient's bedside and can also cause pharyngeal irritation, resulting in coughing. In addition, the nasogastric tube can expose the healthcare worker to potentially infectious saliva. Therefore, there is a clear need for increased evidence regarding the risk of transmission associated with nasogastric tube insertion, to ensure that such risks can be mitigated.

Time-dependent management of Hirschsprung disease during Covid-19 pandemic

INTRODUCTION – During Covid-19 pandemic, some elective non-deferrable surgical procedures has been maintained on a local basis to avoid complications of time-dependent issues. The aim of this paper is to suggest a possible strategy for the management of patients with Hirschsprung (HSCR) during this dramatic Covid-19 pandemic considering.MATERIALS AND METHODS - A systematic literature search on PubMed and Embase of all available literature addressing “Hirschsprung”, “preoperative enterocolitis”, “preoperative mortality”, “complications”, and “timing” in all possible combination has been performed limiting documents to the last 10 years and excluding non-English papers.RESULTS – Systematic review assessed 170 papers and focused on 10 full-text papers addressing the same issues as above. The incidence of preoperative HAEC proved to be as high as 34% with a mortality between 2.4% and 8%. Age at surgery varied in literature reports but recent evidences suggested that patients should be operated around 3 months of age after effective bowel decompression. Rectal irrigations should not be continued over 2 to 4 months to avoid nutritional issues and subsequent possible increase of surgical complications.CONCLUSIONS – Based on available literature, contingent shortage of health resources and necessity to avoid hospital overcrowding during this pandemic, we suggest as follows: 1) surgery should be delayed for healthy neonates up to 3 months of age, and a diverting enterostomy consider for those with ultralong HSCR, unwell or with ineffective nursing; 2) surgery can be delayed but rectal irrigations cannot be maintained indefinitely (ideally within 2 to 4 months at maximum); 3) Surgery could be postponed in older patients, provided previous bouts of HAEC are excluded. This chosen behaviour of our Center for Digestive Diseases aims at avoiding risk of complication and serve the best for our patients in this delicate setting of Covid-19 pandemic.

Intestinal Obstruction: An Overview of Aetiology, Evaluation and Management

Intestinal obstruction occurs when there is an interruption in the forward flow of intestinal contents. This interruption can occur at any point along the length of the gastrointestinal tract, and clinical symptoms often depend on the level of obstruction. Intestinal obstruction is most commonly caused by intra-abdominal adhesions, malignancy, or intestinal herniation. The clinical presentation generally includes colicky abdominal pain, vomiting, abdominal distension and constipation. Radiologic imaging can confirm the diagnosis. Although radiography is often the initial study, non-contrast computed tomography is recommended if the index of suspicion is high or if suspicion persists despite negative radiography. Management of uncomplicated obstructions includes fluid resuscitation with correction of metabolic derangements, intestinal decompression, and bowel rest. Evidence of vascular compromise or perforation, or failure to resolve with adequate bowel decompression is an indication for surgical intervention. Journal of Surgical Sciences (2013) Vol. 17 (2): 89-95

COMPARATIVE EVALUATION OF GUT DECOMPRESSION METHODS IN OPERATIONS ON TOXIC WIDESPREAD PERITONITIS

The aim of the paper is to conduct a comparative assessment of bowel decompression methods in operations on toxic widespread peritonitis. Materials and Methods. The authors examined 162 patients with widespread peritonitis of various etiologies. Using generally accepted methods, they compared treatment results using one of the three methods of intestinal decompression: cecostomy, nasointestinal intubation, and cecostomy with intubation of the small intestine. Results. It was detected that in case of small intestine intubation through the cecostomy (in comparison with other methods), intra-abdominal pressure returned to normal on the 2nd day, and in case of cecostomy or nasointestinal intubation – on the 5th and 7th day, respectively. Also, decrease in intoxication indicators was observed 2 days earlier than usual. Conclusion. Intubation of the small intestine through the cecostoma provides the most adequate intestinal decompression in patients with advanced toxic peritonitis. Early normalization of intra-abdominal pressure in patients with advanced toxic peritonitis improves treatment outcomes. Keywords: widespread peritonitis, intestinal decompression. Цель – сравнительная оценка способов декомпрессии кишечника при операциях по поводу распространённого перитонита в токсической стадии. Материалы и методы. Наблюдали 162 пациента с распространённым перитонитом различной этиологии. С использованием общепринятых методик сравнивались результаты лечения при применении одного из трёх способов декомпрессии кишечника: цекостомии, назоинтестинальной интубации и наложения цекостомы с интубацией тонкой кишки. Результаты. Установлено, что при использовании интубации тонкого кишечника через цекостому, в сравнении с другими применявшимися нами способами, внутрибрюшное давление нормализовалось на второй день, а при использовании цекостомии или назоинтестинальной интубации – на 5-й и 7-й дни соответственно. Также на 2 сут раньше происходило снижение показателей интоксикации. Выводы. Наиболее адекватную декомпрессию кишечника у пациентов с распространённым перитонитом в токсической стадии обеспечивает интубация тонкого кишечника через цекостому. Ранняя нормализация внутрибрюшного давления у пациентов с распространённым перитонитом в токсической стадии позволяет улучшить результаты лечения. Ключевые слова: распространённый перитонит, декомпрессия кишечника.

THE QUALITY OF LIFE OF TODDLER POST COLOSTOMY IN BANDUNG

Congenital abnormalities in children are still quite high in Indonesia such as hirschsprung disease and anorectal malformations which require the fabrication of colostomy as bowel decompression and faecal expenditure alternatives. Stoma fabrication can have a physical or psychosocial impact on a child's life. This study aimed to determine the perception of parents on the quality of life in toddler-aged children with post colostomy. The method of this research was quantitative descriptive with 35 respondents obtained by consecutive sampling technique. The participants involved in this study were the parents of toddler-aged children who had experienced colostomy surgery. The data were collected using a Pediatric Quality of Life Inventory (Peds QL) questionnaire. The data were analyzed with descriptive statistics. The results showed that 19 people (54.28%) of toddler-aged children who had experienced colostomy surgery had poor quality of life with the lowest score on cognitive function. The conclusions of this study indicated that most of parents perceived the quality of life of toddler-aged children who had experinced colostomy surgery in the bad category. The poor quality of life can affect the child growth. One of the efforts to improve the quality of life of children is by providing psychological therapy to help children deal with negative emotions and providing psychoeducation to parents about the importance of providing stimulus in toddler-aged childern so that children can have a better quality of life.