Educational Tutorial: An Unusual Complication at Laparoscopy

August 9, 2011

In this educational tutorial, a patient had a diagnostic laparoscopy done by an inexperienced laparoscopist. When the patient presented, she had multiple sinuses around the umbilicus and was taking antibiotics without any benefit.

1. An Unusual Complication at Laparoscopy

Presented by Dr. Narayan M. Patel, M.D.,D.G.O.

FICS Emeritus Professor Muni. Medical college Ahmedabad

Download the .PPT version of this presentation for off line viewing (198.5 KB)

2.

This patient had diagnostic laparoscopy done by a less experienced laparoscopist. No reports were available with the patient. The one possibility was, the surgeon might not have been able to enter peritoneal cavity, in spite of multiple attempts at laparoscopy.

This may be because of extravasations of gas between peritoneum and rectus sheath.

It is a common experience that, when extravasion occurs, it becomes difficult, even for an experienced laparoscopist to enter peritoneal cavity.

3.

When the patient came to me, she was tired of having dressing for number of days, for multiple sinuses which she had around umbilicus.

Antibiotics were already given to her for number of days without any benefit in draining of pus from these sinuses, around umbilicus.

I had to take the opinion of a general surgeon and as per his advice, we did a sonogram by injecting contrast media in one of the sinuses.

We used Colvins Canula, which we are frequently using for doing ysterosalpingography.

Next slide shows the x-ray picture after injecting contrast media.

4. Colvins canula was inserted in one of the sinuses.

The dye has entered multiple sinuses. The dye has not gone in peritoneal Cavity, other wise picture would have a different look.

We operated this patient under spinal anesthesia and removed a big junk of skin and fat along with all the sinus tracts.

The patient had to come to us for dressing for many days, but she recovered.

5. The picture shows big junk of skin and fat along with all the sinus tracts removed at operation.

The measuring tap under the specimen measures a little more than 7 inches.

We did not open the peritonium.

The specimen removed at dissection.

6. We presented this case because this type of complication, I had never seen before.

While doing laparoscopy and also at all other surgeries, it is very much necessary to have strict aseptic precaution to prevent such complication.