T.S.

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T.S.

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1. T.S. 39M presents with abdominal pain after ingestion of foreign body on 1/16 States nail fell into drink Ingested a hamburger afterwards PMHx: HTN, pancreatitis, depression, s/p appy and expl. Lap and LOA ~6 mos ago Exam: Afebrile, Abd- soft, diffusely mildly tender, no peritoneal signs GI consulted: EGD to be performed in AM after pt. had full stomach

2. Admission AXR

3. AXR in AM

4. Admission CT

5. Nail remains in RLQ

6. T.S. 1/21 - Exploratory laparoscopy, extensive lysis of adhesions, romoval of foreign body via enterotomy, repair of cystotomy

7. Iatrogenic Bladder Perforations Jason S. Frischer, MD Englewood Hospital and Medical Center January 26, 2005

8. 65 patients in 12 year period at Lenox Hill

9. 80% had a predisposing risk factor Risk Factors: previous surgery (adhesions) - 50% inflammation - 38.5% radiation malignant infiltration pregnancy hemorrhage 1 complication - vesicovaginal fistula

10. Bladder Injury During Laparoscopic Surgery Ostrzenski, Adam; Ostrzenska, Katarzyna M. Department of Gynecology and Obstetrics, Howard University, College of Medicine and Department of Internal Medicine George Washington University Medical Center, Washington, DC. Meta analysis of laparoscopic bladder injuries Incidence ranges from 0.02 - 8.3%

12. Bladder Injury Predisposing Risk Factors: inflammation Endometriosis malignancy bladder diverticula previous surgery adhesions radiation amyloidosis Distended bladder Oliguria is a cardinal post-op symptom of bladder injury

13. Bladder Injury Multiple reports of laparoscopic bladder repair in 1, 2, or 3 layers, and with staplers Complications Fistula

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