Page 44 - World Journal of Laparoscopic Surgery

CASE SERIES
Laparoscopy in Three Cases of Unusual Abdominal

Emergencies: Report and Literature Review

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Balram Goyal , Chandra Kishor Jakhmola , Sreejith Bhasavan Nair Remanidevi , Amit Singh 4
Received on: 27 May 2023; Accepted on: 26 July 2023; Published on: 05 September 2023
AbstrAct
Common abdominal emergencies like acute appendicitis, acute pancreatitis, hollow viscus perforation, and diverticulitis are being managed
with laparoscopy.
We here present three cases of unusual abdominal emergencies which were managed successfully by laparoscopy at a tertiary care center.
These cases are of anaphylactic shock due to hepatic hydatid cyst with free peritoneal rupture, upper GI bleeds due to early gastric volvulus in a
patient with a posttraumatic left-sided diaphragmatic hernia and the last case was a patient of blunt abdominal trauma with splenic laceration
with hypotension. The postoperative course was very satisfying and possibly laparotomy was avoided in all cases.
We reviewed the literature on the role of laparoscopy in acute abdominal conditions.
Keywords: Acute abdomen, Blunt and penetrating trauma, Laparoscopy in emergency, Ruptured hydatid, Splenic laceration.
World Journal of Laparoscopic Surgery (2023): 10.5005/jp-journals-10033-1544

IntroductIon 1 Department of Gastrointestinal Surgery, Command Hospital (SC)
With expanding surgical experience and skills application of Pune, Pune, Maharashtra, India
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laparoscopy in the emergency setting has proved its role. This 2 Department of Gastrointestinal Surgery, Command Hospital (WC)
approach allows both the evaluation in case of a diagnostic dilemma Chandimandir, Panchkula, Haryana, India
as well as the accomplishment of procedure in a wide variety 3 Department of Gastrointestinal Surgery, Command Hospital (EC)
of abdominal surgeries, such as acute appendicitis, blunt and Kolkata, West Bengal, India
penetrating trauma, perforated peptic ulcer disease, and a variety of 4 Department of Gastrointestinal Surgery, Command Hospital (CC)
conditions that seem set to expand further. 2–4 Initially, laparoscopy Lucknow, Uttar Pradesh, India
was limited to elective surgery, however with accumulated surgical Corresponding Author: Balram Goyal, Department of Gastrointestinal
experience and skills over the past decades the application of Surgery, Command Hospital (SC) Pune, Pune, Maharashtra, India,
laparoscopy into the emergency setting has stepped in. It also has Phone: +91 9599386202, e-mail: balramneetu.goyal@gmail.com
a significant impact on the reduction of wound complications, How to cite this article: Goyal B, Jakhmola CK, Remanidevi SBN, et al.
postoperative pain, hospital stay and overall costs, and high Laparoscopy in Three Cases of Unusual Abdominal Emergencies:
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patient satisfaction. Our aim is to present three cases of relatively Report and Literature Review. World J Lap Surg 2023;16(1):43–46.
uncommon abdominal emergencies managed with a laparoscopic Source of support: Nil
approach with a positive outcome. Conflict of interest: None
Patient consent statement: The author(s) have obtained written
cAse reports informed consent from the patients (for case 1, 2 and 3) for publication
of the case report details and related images.
Case 1: Anaphylactic Shock
A 40-year-old male presented with sudden onset epigastric pain
associated with profuse sweating, giddiness, and brief loss of 300 mL peritoneal clear fluid with ruptured hydatid cyst right lobe
consciousness of 3 hours duration. There was no history of fever, of the liver (segment IVB with 3 cm × 3 cm rent) (Fig. 2).
chills, and seizure. He underwent deroofing of the cyst and peritoneal lavage
On examination, he was drowsy his vital parameters were as with normal saline and placement of two drains 28 Fr size. Cyst wall
pulse rate 110/minute, BP 84/58 mm Hg, RR 22/minute, and was submitted to histopathological examination and which confirmed
afebrile. Systemic examination was essential within normal limits hydatid in nature. In postoperative period, he recovered well and
except for having urticarial rashes all over the body. was started on tab albendazole 400 mg twice a day for 6 months,
He was started on inotropic support, injection of hydrocortisone and on follow-up at 3 and 6 months was asymptomatic.
100-mg stat, and intravenous (i.v.) fluids.
On further evaluation by contrast-enhanced computed Case 2: Hematemesis with Left Diaphragmatic
tomography (CECT) abdomen was found to have a liver cystic Hernia
lesion in segment IV/V of the liver with an impression of ruptured A 41-year-old male had a history of a road traffic accident 10 years
hydatid cyst (Fig. 1). back which was without any immediate clinical consequences
With this, he was referred to our center and was taken up for as he remained asymptomatic till now. He now presented with
emergency diagnostic laparoscopy and found to have around acute onset pain epigastrium with three episodes of hematemesis

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