Naslov
Diagnosis and treatment in case of small intestine pathology: laparoscopy does it all?

Autori
Stipančić, Igor ; Servis, Dražen ; Bušić, Željko ; Cvjetičanin, Bruno ; Dojčinović, Bojan

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, stručni

Izvornik
Abstract book of 10th world congress of endoscopic surgery / - Veldhoven : EAES, IFSES, 2006

Skup
10th world congress of endoscopic surgery

Mjesto i datum
Berlin, Njemačka, 13.09.2006. - 16.09.2006

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
exploratory laparoscopy

Sažetak
Exploratory laparoscopy is currently considered to be a most useful diagnostic tool, in some cases replacing traditional diagnostic methods. For example, standard approach for the diagnosis of Meckel's diverticulum involves radioisotope scanning. However, there are reports arguing that in cases where Meckel's diverticulum is implicated as a cause of the disease, diagnostic laparoscopy should be perfomed immediately. It's advatage is that if necessary, resection of diverticulum can be performed at once. Here we present a case where a 19-yr old male was admitted for a diagnostic work-up for repeated bloody stools. Because of his age and symptoms, bleeding from Meckel's diverticulum was suspected. In spite of that the patient was submitted to extenisve investigations. First, gastroscopy and colonoscopy were performed and were both negative. A radioisotope scanning using pertechnetate showed collection of radioisotope in the distal part of small intestine, with later scans showing radioisotope migration in the colon. Such finding was not sufficient to confirm the diagnosis, although it was strongly suspicios of bleeding from Meckel's diverticulum. Subsequent contrast-enhanced CT of pelvis and abdomen showed a part of small intestine with inflammatory changes and no extravasation of contrast. High resolution ultrasound examination was also inconclusive. The patient was then transferred to surgical department and exploratory laparoscopy was performed. Intraoperatively, we found a thickened part of ileum that adhered to it's mesenterium. At the first sight, it looked like it was a case of Crohn's disease. We exteriorized the affected part of ileum using minilaparotomy incision at the site of a port incision and resected it. Patohistological examination revealed a Meckel's diverticulum, completely covered with adhesions, with chronic inflammatory changes in surrounding tissue. The patient recovered with no postoperative complications. This case shows that diagnostic laparoscopy can simultaneously diagnose and treat cases of unclear small intestine pathology, such as conditions caused by Meckel's diverticulum, regardless of other diagnostic techniques. Such approach may eliminate the need for costly diagnostic procedures and thus shorten patient's hospital stay.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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