Small bowel obstruction after hand-assisted laparoscopic sigmoid colectomy for cancer

Hand-assisted laparoscopic surgery (HALS) was introduced as a bridge towards totally laparoscopic procedures. Some concerns are raised regarding its long-term complications such as incisional hernia and adhesive small bowel obstruction. A woman was admitted with colicky central abdominal pain, distension and vomiting. She had a hand-assisted laparoscopic sigmoid colectomy for cancer 6 years earlier. Clinical examination revealed a well-healed periumbilical scar with no evidence of incisional hernia. The abdomen was distended with exaggerated bowel sounds. A CT scan showed dilated loops of small bowel with a transitional zone and distally collapsed bowel. A diagnostic laparoscopy revealed a twisted segment of small bowel that was adherent to the anterior abdominal wall at the hand-port closure site. This segment was released laparoscopically without the need for a resection. Adhesive small bowel obstruction to the hand-port site closure may occur years after HALS and can simply be relieved by laparoscopic exploration.

Diagnostic peritoneal lavage--an obituary (Br J Surg 2005; 92: 517-518)

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Obscure Gastrointestinal Bleeding Due to Non-steroidal Anti-inflammatory Drug-Induced Colopathy

Obscure gastrointestinal (GI) bleeding poses a diagnostic challenge and is associated with high mortality. We report a case of life-threatening obscure GI bleeding precipitated by the ingestion of a non-steroidal anti-inflammatory drug (NSAID). The source of bleeding could not be identified preoperatively, and hence exploratory laparotomy was performed. An ileocaecal resection was undertaken based on the findings of the intraoperative enteroscopy. However, the bleeding recurred and repeated endoscopy examination identified the source to be multiple NSAID-induced ulcers that were scattered in the colo-rectum. The bleeding stopped spontaneously after a period of intensive supportive therapy and sulphasalazine enemas. This case highlights the diagnostic challenge of obscure GI bleeding. It also highlights the potentially life-threatening danger of GI bleeding secondary to NSAID-induced colopathy, even after a short course of treatment.