Laparoscopic exploration of the biliary ducts in calculosis is an efficient, safe and reliable method to manage this serious complication of gall-stone disease in the hands of an experienced laparoscopic surgeon. The results of its application are comparable and in some cases even better than those of ERCP used as a therapeutic procedure as regards clearance of the CBD and the complications involved in these two procedures.

Cystic lymphangioma is a benign congenital disease that is more seen in head and neck regions. We report a case of a 54-year-old man with a growing supraclavicular mass. The ultrasonography and magnetic resonance imaging suggested a cystic lymphangioma. The mass was surgically totally removed without any recurrence. Histology examination confirmed the diagnosis. Cystic lymphangioma in adults is a rare entity and the literature on the subject is poor with no global recommendations.

We report a case of small bowel occlusion due to the formation of a bezoar around a knot at the distal end a gastro-jejunal catheter used for continuous levodopa/carbidopa intestinal gel (LCIG) in a patient with advanced Parkinson’s disease. The patient presented with a history of abdominal pain and vomiting starting 24 h before admission and frequent failure of his LCIG device for the past week. Small bowel occlusion along with a knot formation on the distal catheter was confirmed by contrast enhanced CT scan. After failure of endoscopic extraction, the patient was taken to theater. The presence of a knot and a bezoar was confirmed and extraction proceeded via transverse enterotomy without the need for bowel resection. Despite inhalation pneumonia and prolonged ileus, the patient recovered fully. LCIG treatment was reinstated a month later through new gastro-jejunal catheter. This case highlights a severe and surprising complication of LCIG treatment.

Laparoscopic resections of the pancreas have gained in popularity in the last few years. Those preserving the integrity of the spleen are performed very rarely and are a challenge for every surgeon. We hereby report a case of laparoscopic resection of the pancreatic tail with preservation of the spleen and the integrity and the blood supply to the spleen in a 26 year-old patient with a large pseudopapillary tumor of the pancreas. Postoperative recovery was quick and without complications. The functional and aesthetic result was satisfactory. Laparoscopic resection of the pancreas is a safe and effective therapeutic procedure in selected patients. Key words: laparoscopic resection, pseudopapillary tumor of the pancreasFolia Medica 2014; 56(1): 56-59 Copyright © 2014 Medical University, Plovdiv РЕЗЮМЕ За последние годы лапараскопические резекции поджелудочной железы стали особо популярными. Резекции со сохранением целостности селезенки выполняются очень редко и представляют своего рода провокацию для каждого хирурга. Авторы сообщают о случае лапароскопической резекции каудальной части поджелудочной железы со сохранением целостности и кровообращения селезенки у 26-илетней пациентки с большой псевдопапиллярной опухолью панкреаса. Постоперативное восстановление протекло быстро и без осложнений. Функциональный и эстетический результаты налицо. Лапароскопические резекции поджелудочной железы являются безопасными и эффективными лечебными процедурами у селективных больных. Folia Medica 2014; 56(1): 56-59 Ключевые слова: лапараскопическая резекция, псевдопапиллярная опухоль панкреаса

A 52-year-old woman developed atraumatic splenic rupture 1 week after appendectomy for perforated appendicitis. The emergency computed tomography (CT) revealed abscessed appendicitis. We performed a laparoscopic appendectomy and meticulous peritoneal lavage of the right lower quadrant peritonitis. Intravenous antibiotics were prolonged after surgery. Six days after appendectomy, she presented acute signs of hypotensive shock associated with abdominal pain and blood in the pelvic drain. Emergency CT scan revealed splenic rupture with major hemoperitoneum and active splenic bleeding. Embolization of the splenic artery was initially successful, but she relapsed into shock a few hours later. We proceeded to splenectomy. Pathological examination only found inflammation. She was discharged 1 month after the initial operation. Spontaneous splenic rupture is a rare but life-threatening complication of appendicitis with major peritonitis. It must be identified and treated immediately. Colic microbiota could be responsible of acute splenitis and congestion after a bacteremia.