Laparoscopic Resection of a Colonic Duplication

Case Report: A previously healthy eighteen-year-old female presented to the emergency department with sudden onset of severe left lower quadrant abdominal pain, fever, and tachycardia. Symptoms began two hours prior to admission and were not associated with nausea, vomiting, or constipation. Laboratory studies were significant for a leukocytosis of 16.8 and a negative urine pregnancy test. Abdominal ultrasound was only significant for a small amount of free pelvic fluid. CT scan of the abdomen and pelvis was significant for a thin walled fluid collection in the left mid-abdomen adjacent to the descending colon. The patient was taken to the operating room for exploratory laparoscopy. A ruptured colonic duplication was identified attached to the transverse colon and omentum. The descending colon and splenic flexure were mobilized and the omental attachments of the enteric duplication were divided. Following this the segment of the transverse colon that was densely adherent to the enteric duplication was delivered through a Bianchi type incision. The enteric duplication cyst was then dissected from the transverse colon. There was no communication between the cyst and the lumen of the transverse colon. The patient was discharged home on the second post-operative day tolerating a regular diet, her symptoms alleviated. LAPAROSCOPIC MANAGEMENT OF A MISSED SUBHEPATIC APPENDICULAR ABSCESS IN A 5-YEAR-OLD CHILD Salmai Turial MD, G Abdul-Aziz, R Brzezinska MD, V Engel MD, F Schier, Pediatric Surgery, University Medical Centre, Mainz, Germany