Foreign body ingestion is a commonly seen accident in emergencies, usually in children (80%), elderly, mentally impaired, or alcoholic individuals, whereas it may occur intentionally in prisoners or psychiatric patients. According to the literature, 90% of ingested foreign bodies pass through the gastrointestinal tract without complications, 10% to 20% necessitate endoscopic removal, whereas only 1% of them will finally need surgical intervention. In clinical practice, we often face the dilemma of choosing the appropriate treatment modality. We present 13 cases treated in our department, emphasizing in a "waiting and close observation" policy. Among these cases, only 1 patient needed to be operated because of obstruction of ileocecal valve by a large coin. Indications for treatment where applicable are also being discussed.
Situs inversus totalis is an inherited condition characterized
by a mirror-image transposition of thoracic and abdominal organs. It often coexists
with other anatomical variations. Transposition of the organs imposes special demands
on the diagnostic and surgical skills of the surgeon. We report a case of a 34-year-old
female patient presented with left upper quadrant pain, signs of acute abdomen, and
unknown situs inversus totalis. Severe acute cholecystitis was diagnosed,
and an uneventful laparoscopic cholecystectomy was performed. A posterior cystic
artery was identified and ligated. Laparoscopic cholecystectomy is feasible in patients
with severe acute calculus cholecystitis and situs inversus totalis; however,
the surgeon should be alert of possible anatomic variations.
A ruptured middle colic artery aneurysm should be included in the differential diagnosis of any unexplained intra-abdominal haemorrhage. Aneurysmatectomy is the treatment of choice, with radiologic interventional techniques gaining ground in the management of this entity.
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