2/25/2024 0 Comments Endo gia stapler priceIn 2006, the European Association for Endoscopic Surgery (EAES) announced its guidelines of laparoscopic management of acute abdomen without specific reference to colonoscopic perforation. Closure using endo-clips has also been described. Several studies of laparoscopic primary closure or wedge excision and suturing of the perforation have been reported. However, a defunctioning stoma was created using the site of the perforation in 18% of patients. In a review by Tam et al., more than two thirds of patients that had an endoscopic procedure related perforation could have been managed through a primary repair. Reported causes of caecal perforations include trauma and organ injury, inflammatory conditions, ischemia, and malignancy. reported a 1/1400 chance of overall colonic perforation and a 1/1000 chance of perforation following therapeutic colonoscopy. The operation was explained to the patient and the consent was obtained. In view of his recent surgery urgent laparoscopy was recommended. The chest radiograph showed free gas under the right hemi diaphragm ( Fig. White blood cells (WBC) of 17,000 mL 3 (per cubic millilitre) (4–10 10 9/L) and C Reactive Protein (CRP) of 115 mg/dL (milligrams per decilitre) (<1.0 mg/dL). Dullness to percussion was noted on the right side of the abdomen with absent bowel sounds. On examination he had a tender, distended abdomen with generalized guarding and rigidity. The patient was re-admitted 4 h later with severe constant right-sided abdominal pain and vomiting. The patient was discharged after 2 h of recovery time. The polyp was completely excised and the histology was tubulovillous adenoma. The polypectomy was completed using a classical technique of raising the polyp (with a mixture of normal saline, adrenaline, and tattooing) then snaring with low power coagulation (25 W). The bowel preparation was good, Ottawa Bowel Preparation Scale and no other colonic pathology was identified. The procedure was carried out using conscious sedation, (midazolam and fentanyl) on a morning list by an experienced gastroenterologist. The polyp was 1.5 cm (centimeter) and sessile in nature. It is a new and effective surgical treatment option that has been successful under our care.Ī 66-year-old man with diabetes underwent an elective colonoscopy and caecal polypectomy. The procedure is completed under direct vision of freeing the appendix with healthy tissue margins prior to applying the endoloop process proximal to the small perforation. A novel approach of endolooping (detachable snares) the site of perforation, as we present, has not been described in current literature and it could be applied for early perforations that are within a short distance from the appendicular base. We present a 4 min and 50 s video on a new improvisation undertaken during laparoscopic management of post-polypectomy caecal perforation. In a recently published series of 110,785 diagnostic and therapeutic colonoscopy procedures (86,800 diagnostic cases and 23,985 therapeutic cases), a total of 14 incidents (0.012 %) of colonic perforation were reported. The risk of colonic perforation after diagnostic colonoscopy is reported as 0.03%. The emergence of laparoscopy has allowed localized repair under direct vision with numerous benefits, such as reduction in pain, decrease length of hospital stay, and faster post-operative recovery. Traditionally, it has been managed with exploratory laparotomy, primary closure, or bowel resection. An iatrogenic caecal perforation is rare, but a serious complication associated with significant morbidity and mortality.
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