תוצאת חיפוש

The Fate of Gallstones "Dropped" during Laparoscopy

Menashe Barzilai, Arie Bitterman, Dorit Schlag-Eisenberg, Nathan Peled

Depts. of Radiology and Surgery B, Carmel Medical Center, Haifa

Laparoscopic cholecystectomy is considered the procedure of choice for removing symptomatic, stone-containing gallbladders. It is estimated that in 30-40% of these operations stone(s) spill into the peritoneal cavity. It was assumed that these "dropped stones" are harmless and are dissolved and absorbed spontaneously. We present a 70-year-old woman in whom such a stone, dropped during laparoscopy, led to formation of an intraperitoneal abscess.

Radiologic Appearance of "Falling Gallstones" during Laparoscopic Cholecystectomy

E. Alkalay, D. Yaffe, Z. Spindel

Eyn Vered Clinic and Depts. of Radiology and Surgery, Sapir Medical Center, Kfar Saba and Sackler Faculty of Medicine, Tel Aviv University

Laparoscopic cholecystectomy is the "gold standard" in treating cholelithiasis. Stones are frequently lost in the peritoneal cavity during the procedure, but "missing stones" have been regarded as insignificant. However, there is accumulating evidence that untreated "lost" stones may cause complications even years after operation.

We present a 65-year-old woman who presented with vague complaints, anemia and an elevated ESR. CT scan showed an infiltrating process in extra-abdominal muscles compatible with sarcoma. At operation, 2.5 years after previous laparoscopic cholecystectomy, an abscess was found which contained biliary stones. Because of their small size they were not visible on CT scan. We discuss the possible ways of handling "falling stones."

Salivary Gland Endoscopy: a New Technique for Diagnosis and Treatment of Sialolithiasis

O. Nahlieli, A.M. Baruchin, H. Librus, D. London

Oral and Maxillofacial Surgery Unit, Plastic Surgery Service and Radiology Institute, Barzilai Medical Center, Ashkelon

The use of an endoscopic, minimally invasive technique for the removal of salivary gland stones from the submandibular or parotid duct is described. A 2.0-2.7 mm endoscope is inserted into an incision in the parotid or submandibular duct. When the stone is visualized through the endoscope it is removed using suction and forceps. We used this technique in 45 cases for removal of calculi, screening the ductal system to rule out residual calculi. and determination of ductal dilatation. The success rate was 80% and there were no major postoperative complications. To the best of our knowledge these are the first such cases reported in Israel.