Laparoscopic Lysis of Adhesions for Closed Loop Small Bowel Obstruction
Jade Refuerzo, BS; Nicole B. Cherng, MD
UMass Memorial Medical Center
Laparoscopic lysis of adhesions is a minimally-invasive approach to the resolution of a closed loop small bowel obstruction (SBO) due to adhesions. A patient with an SBO can present with nausea, vomiting, abdominal pain, and obstipation. History of prior abdominal surgeries serves as a significant risk factor for development of intra-abdominal adhesions. Imaging using either plain abdominal radiography or computed tomography (CT) can be diagnostic for closed loop SBOs. Conservative management with gastrografin can be considered in some SBOs, but closed loop SBOs are considered surgical emergencies. Utilization of specific signs (two transition points, pneumoperitoneum, signs of bowel ischemia) on imaging and patient presentation can facilitate earlier intervention.
Laparoscopic lysis of adhesions can resolve symptoms through releasing the bowel from the adhesion to improve flow. Lysis of adhesions can be performed open, laparoscopically, or with robotic techniques. This case presents a laparoscopic lysis of adhesions in a patient with a closed loop small bowel obstruction.
Exploratory Laparotomy for Bowel Obstruction with Primary Repair of Two Diaphragmatic Hernias
Katherine H. Albutt, MD
Massachusetts General Hospital
A diaphragmatic hernia (DH) is characterized by protrusion of abdominal organs into the chest cavity through an opening in the diaphragm. A sliding or paraesophageal hernia is the most prevalent type, characterized by its occurrence near the esophageal hiatus. Typically present since birth, it can also develop later in life, occasionally arising as a result of severe trauma or iatrogenic injury. Less often, congenital DHs protrude through posterolateral or substernal diaphragmatic defects, referred to as Bochdalek and Morgagni hernias, respectively.
DH can remain asymptomatic and is commonly detected as an incidental finding during evaluation for other medical issues. Hiatal hernias differ from abdominal wall hernias in that they are influenced by the constant motion of the diaphragm, which exerts continuous friction and pressure changes on the esophagus and the stomach. As a result, hiatal hernias have a higher likelihood of recurrence following surgical correction in comparison to abdominal hernias.
This is the case of an exploratory laparotomy for bowel obstruction and primary pledgeted repair of two diaphragmatic hernias.
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