Extensive retroperitoneal hematoma after laparoscopic appendectomy

The retroperitoneum is the abdominal portion located behind the sac of the peritoneal cavity and extending from the diaphragm to the pelvic inlet. A Retroperitoneal hematoma is a rare but a fearsome complication after appendectomy. The management of retroperitoneal hematomas can be difficult as the decision between a surgical intervention, angiographic embolization, and conservative management with fluids can be difficult to make. This case report would be outlining the clinical presentation, radiological findings, and outcome of a 60-year-old male who has been diagnosed with an intra-abdominal, retroperitoneal hematoma and flank ecchymosis with no signs of active bleeding after laparoscopic appendectomy. Retroperitoneal hematomas can be extensive post-laparoscopic abdominal surgeries. A comprehensive physical examination, radiological imaging, and laboratory investigations should be considered to rule out the possibilities of bleeding disorders and/or active bleeding contributing to the development of retroperitoneal hematomas.

Upper Gastrointestinal Bleeding Caused by a “Hypophrenic” Diverticulum of the Distal Esophagus

Distal esophageal diverticula are uncommon acquired anomalies of the distal thoracic esophagus. We report a case of an elderly man presenting with a history of upper gastrointestinal bleeding secondary to a distal esophageal diverticulum arising from the intra-abdominal portion of the esophagus. To our knowledge, this is the first report of upper gastrointestinal bleeding from a subdiaphragmatic esophageal diverticulum. We propose the term “hypophrenic diverticulum of the esophagus” for this disease entity, and we would like to bring it to the attention of readers of The American Surgeon.

Aging of Silastic Peritoneal Catheters

Increasing the survival of patients on CAPD is related to the long-term reliability of the peritoneal access. Six silicone Tenckhoff catheters (with strip or diffuse barium sulphate inclusion) removed after 39-69 months because of the appearance of external segment fissures, were analysed by scanning electron microscopy (SEM) and infrared spectroscopy with attenuated total refractance (ATR). The extracorporeal portion of the catheters showed (by ATR) a more prominent oxidation peak on the external than the internal surface; SEM showed marks and cracks on the external surface and exfoliation and flattening of the silastic reticle on the intraluminal surface. No evidence of oxidation was found in the intra-abdominal portion of the catheters but biofilm was found. We suggest that barium sulphate may render the silastic brittle and physiological and environmental long-term factors (such as uv-rays, temperature, sweat and disinfectants) could cause oxidation and loss of physico-chemical properties, with critical aging of the silastic and loss of catheter resistance to mechanical injury.