Hand Assisted Laparoscopic Surgery

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Unusual cause of haemoperitoneum managed laparoscopically

A  33 year  female from Angola, Africa presented to Indraprastha Apollo Hospital with a 2 month history of progressive painless distension of the abdomen. Prior to presentation she had been diagnosed to have ascites (fluid in the abdomen) at another hospital. On two occasions 1 to 1.5 liters fluid had been removed from the abdomen which she described to he deep red in  colour. Evaluation at our hospital revealed the presence of  large  volume  ascites which was possibly related to Endometriosis suspected on MRI scan. She was planned for diagnostic laparoscopy which confirme d the  haemorrhagic ascites to be a result of oozing from one of the endometriotic nodules on the surface of the uterus. The bleeding was stopped successfully by laparoscopic cauterization. Post operatively the patient did well and there  has  been no recurrence of ascites after starting medical treatment for endometriosis.
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Cystic lesion of pancreas treated with distal pancreatico-splenectomy

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Cystic lesion of pancreas treated with distal pancreatico-splenectomy A 62 yearold gentleman presented to us with complaints of upper abdominal pain with radiation to back since 2 months. He also complained of weight loss, however this was not significant. Ultrasound and contrast enhanced CT scan of the abdomen (figure 1) was suggestive of a cystic lesion in body and tail of pancreas. To further characterize the lesion a MRI with MRCP of the abdomen was done. This was suggestive of a mixed-micro & macro-cystic lesion in tail of pancreas. A communication between the lesion and pancreatic duct was demonstrated (figure 2). These features pointed to a branch duct intraductal papillary mucinous neoplasm (BD-IPMN). An endoscopic ultrasound (figure 3) was suggestive of a mixed micro- and macrocystic lesion of pancreas and myxoid material was aspirated. The cyst fluid amylase and CEA was 154 U/L and 0.12 ng/ml respectively and were normal, indicating a non-mucinous cyst. In view o...
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