Alumi Laparoscopic Discussion Board

Post Appendicectony
Discussion in 'All Categories' started by Dr Vinu G - Nov 30th, 2017 3:27 pm.
Dr Vinu G
Dr Vinu G
Respected sir, Hope you are doing fine. I was a student of July 2015 at WLH.Due to delay in procuring instruments, I could start laparoscopy this year only... And completed 25 cases of lap appendix and ovarian cyst, Started chole also. I had a case of acute appendicitis last day and it was uneventful intraop. However second post op the child developed vomiting .Abdomen is soft, but bowel sounds sluggish. Plain X-ray showing bilateral significant air shadow. Sir, how to differentiate this from a possible inadvertent perforation? Uss showing fluid also. I am putting the patient on observation. No clinical signs of peritonitis till now. Shall I put in scope and verify or wait for any signs of peritonitis to appear? My assistant couldn't deflate air fully before he took out the port. How long the co2 expected to be inside? CT can also be confusing to rule out a perforation in this setting? Please give your valuable advice
re: Post Appendicectony by Dr J S Chowhan - Jan 5th, 2018 2:34 pm
Dr J S Chowhan
Dr J S Chowhan
Dear Dr Venu G

Sorry for delayed reply. Although the erect chest X-ray is a much more sensitive investigation for pneumoperitoneum, there are several signs that may be useful in detecting free gas on an abdominal X-ray. Rigler's sign (also known as the double wall sign) is the appearance of lucency (gas) on both sides of the bowel wall.

Free gas, or pneumoperitoneum, is gas or air trapped within the peritoneal cavity, but outside the lumen of the bowel. Pneumoperitoneum can be due to bowel perforation, or due to insufflation of gas (CO2 or air) during laparoscopy. Both these causes have identical X-ray appearances, but very different clinical significance. If you have doubt you can have a re-look laparoscopy and inspect the bowel and can put a drain.

With regard
Dr J S Chowhan
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