The obstruction was due to an intraluminal gallstone, held up in a mid-ileal loop EMD 1214063 caught by adhesions against the anterior abdominal wall. With further distal adhesiolysis, this loop was delivered up through the single-port access site allowing enterotomy, removal of the gallstone, and primary ileal closure. The patient made an uneventful recovery and was discharged home on the fifth postoperative day. Case 2 �� A 59-year-old woman (BMI 23.5kg/m2) presented with fatigue and intermittent abdominal pain in addition to iron deficiency anaemia (haemoglobin 7.5g/dL). As both upper and lower gastrointestinal endoscopy (including terminal ileal intubation) were normal, a CT of abdomen was performed and revealed a tight distal ileal stricture with appearances consistent with either Crohn’s disease or possible lymphoma.
After complete mobilisation of the right colon and distal ileum, the diseased loop of bowel was exteriorised and resected. Subsequent pathological examination confirmed the diagnosis of Crohn’s disease. Case 3 �� A 78-year-old woman (BMI 25.2kg/m2) presented with subacute small bowel obstruction on a background of intermittent, recurrent episodes of abdominal pain with vomiting over the previous three months. She had had no previous abdominal surgery or abdominal wall herniae on physical examination. A CT scan of her abdomen showed dilated proximal ileum with a transition point at the level of the mid-ileum but no obvious mass. Single-port laparoscopy revealed an obstructing lesion around the circumference of the bowel with mesenteric extension at this location (see Figure 2).
Surgical relief was achieved by its mobilization, exteriorisation, resection, and extracorporeal anastomosis. Subsequent histological examination revealed a B-cell lymphoma. Case 4 �� A 48-year-old woman (BMI 28kg/m2) presented with a five-day history of right iliac fossa pain and tenderness. CT abdomen suggested an inflammatory focus related to her distal ileum. Single-port laparoscopy identified a cicatrising mesenteric lesion nearer to the base of her mesentery and allowed its biopsy by means of a tru-cut needle passed through a separate 2mm stab incision. This biopsy revealed a diagnosis of a carcinoid tumor and allowed planning for its definitive resection at a subsequent operation. Case 5 �� A 70-year-old woman (BMI 22kg/m2) presented with metastatic sigmoid cancer.
Due to extensive liver and lung deposits, she was treated with palliative chemotherapy without resection of the primary tumour. During her treatment, she developed signs and symptoms (pneumaturia, fecaluria, and recurrent urinary tract infections) of a colovesical fistula. To alleviate this problem, she underwent a single-port laparoscopy via a right rectus sheath incision which allowed assessment of Carfilzomib the peritoneum and sigmoid.