Paraplegia can be caused by different factors like rupture or repair of the aortic aneurysm or aortic thrombosis, aortic dissection, anterior spinal cord artery emboli, coagulation disorders and lupus disease, all of which cause impaired spinal cord blood flow and spinal cord ischemia. In addition, hypotension may be the cause of spinal cord infarction but Medline researches have reported a few cases of spinal cord infarction in patients laparotomized for the reasons other than aortic lesions. In this paper we report one case of paraplegia who had experienced spinal infarction and paraplegia after internal bleeding and two times laparatomies due to long lasting hypotension. In this case regarding the patients age, occupation and physical health, the possibility of cardiovascular lesions and consequent thromboembolism seems very unlikely. Furthermore, considering the two operations performed and the temporal space between them, the only factor that could have led to ischemia and infarction of the spinal cord in this patient is long-standing hypotension.

Background & Objective: Comparative study between laparoscopic and laparotomy scoring in patients with advanced ovarian cancer. Materials & Methods: This prospective study included 27 patients with advanced ovarian cancer who underwent laparoscopy and laparotomy scoring at hospitals affiliated with Isfahan University of Medical Sciences (IUMS) during 2020 and 2021. The laparoscopic predictive index value (PIV) score (range: 0-14) was calculated for all patients. In patients with PIV scores <8, primary cytoreductive surgery (PCS) was performed, and patients with scores ≥, 8 were candidates for neoadjuvant chemotherapy (NACT). In the PCS group, laparotomy scoring and surgical findings for each anatomical area were registered for all patients, and concordance between laparoscopy and laparotomy findings was compared. Residual disease following PCS was documented for all patients. Results: A total of 27 patients underwent laparoscopic scoring surgery,25 patients (92/5%) had a PIV score <8, and two patients (7/5%) had a PIV score ≥, 8. There was 92% agreement between PIV scores at laparoscopy and laparotomy. Agreements in different anatomical regions in laparoscopy and laparotomy were as follows: involvement of the bowel 76%, mesenteric 92%, liver 96%, omental 92%, diaphragm 96%, stomach 100%, peritoneal carcinomatosis 96%. A laparoscopic PIV score of <8 had a PPV of 84% at predicting R0 at PCS. Conclusion: Laparoscopic scoring is a precise approach in the management of patients with advanced ovarian cancer. Laparoscopic scoring is a screening method of selecting patients for primary surgery or NACT and improved R0 resection at PCS. The present study was designed to assess patients who would gain the maximum benefits from primary surgery.

Approximately 1% of pregnancies are ectopic. The incidence of ectopic pregnancy (EP) appears to be increasing especially among young women. The diagnosis of EP is often based on clinical suspicion and usually the history and physical findings aren't typical.In this articlewe reporta 42-year old female with abdominal pain, nausea and vomiting, 17 days retard of mense and vaginal bleeding. In paraclinic work up there was positive Grave Index test and b-HCG titer was 18000mu/ml and according to sonography findings a 7x8cm mixed echo mass in cul-de-sac was present and uterine cavity was empty. In Laparatomy there was partial obstruction in small intestine with adhesion bands from the site of salpingectomy related to a previous ectopic pregnancy. This condition (intestinal obstruction with complete abortion) is very rare in ectopic pregnancy differential diagnosis.

Background: Intraperitoneal adhesion is one of the most important complications after laparatomy and it may cause many problems for patients in long time such as infertility, bowel obstruction, and chronic pelvic pain. This study was done to determine a way to reduce the formation of adhesion after laparatomy.Methods: In this experimental and laboratory study, 40 adult female rats divided in two equal groups, randomly (case and control). In stage 1, all of the rats were anesthetized. Then, we opened the abdominal wall; 6 about 2-cm incisions were made on the right side and in left, a 1×1-cm piece was excised from abdominal wall. In stage 2, after 2 weeks we opened abdominal wall and according to Cook scale, we scored adhesion banding; then we added 3 cc amniotic fluid in case and 3 cc distilled water in control group. In stage 3, after 2 weeks, we opened abdominal wall by midline incision and adhesion were scored. Data were analyzed by tests such as t-test and paired t-test.Finding: The adhesion was less in case group (P<0.001). Also, the difference between grades of two groups was significant (P=0.02).Conclusion: Our study showed that amniotic fluid is capable to lyses of adhesion band after laparatomy. More researches are needed to find out positive effects of this material to use as anti adhesive agent in human.

Background and Aim: Emergency Laparatomy is a therapeutic and surgical method which is applied for many kinds of diseases especially abdominal trauma. Abdominal trauma (penetrating and blunt trauma) is one of the most common causes of emergency laparatomy. Some years ago all the patients with abdominal penetrating trauma underwent laparatomy but since the results were incredible and negative laparatomy had increased, some new criteria were determined for surgery and as a result the elective laparatomy replaced the obligatory laparatomy.Materials and Methods: This is a descriptive prospective study on the patients who had undergone emergency laparatomy following the abdominal trauma. The data were based on the available dossiers in Hospital.Result: out of 138 trauma patients who had undergone laparatomy, 96 of them contacted blunt trauma and 42 penetrating trauma. The largest number of laparatomy patients was in the third decade of their life. The most common reasons for trauma were stab and car accident. CT scan and abdominal lavage were not used for any of the patients. In blunt trauma, clinical symptoms and examinations were used but in penetrating trauma just because it is penetrating, laparatomy was used. In penetrating and blunt trauma there were respectively 20 and 8 cases of negative laparatomy. The rate of mortality in traumatic patients was reported just 5 cases.Conclusion: 52.2% of laparatomy in blunt trauma was the result of car accident and 26.1% of laparatomies in penetrating trauma was the result of stab. This statistics show that social-cultural problems should be taken more seriously. The prevalence of negative laparatomy in penetrating trauma is the best reason for changing the obligatory laparatomy to the elective laparatomy, so being penetrative isn't sufficient for laparatomy .

Introduction & Objective: Many studies were done and designed to determine the pathophysiology and to find a way to reduce the formation of adhesion bands after laparatomy. The purpose of our study was to determine the effect of aminiotic fluid in prevention of post laparatomy adhesion formation in rat models. Materials & Methods: Our study was experimental and laboratory. Thirty adult male rat were used in this study, divided in to two equal groups randomly.We opened the abdominal wall, then 1 * 1 cm peritoneal layer was excised from the left abdominal wall and 10 longitudinal incision of 2 to 3 cm in length were made on the right parietal peritoneum after that we filled the abdomen of the rats of group I (case group) with 5 cc of amniotic fluid and filled the abdominal of the rats group II (control group) with 5 cc normal saline. Second laparatomy carried out 14 day after the first laparatomy and abdominal adhesion were scored in order to Ahmet Canbaz scale and analyzed with Mann – withney test; P< 0.05 was significant.Results: After analysis we saw a significant difference between two group (P=0.008). The average of adhesion score were 1.13 ±1.3 in group I and 2.5 ± 1.18 in group II (P<0.05).Conclusions: Our study showed that Aminiotic fluid is capable to reduce the formation of adhesion bands after laparatomy.

Background: There are many methods to provide pain relief after operation, that includes: IV or IM opioids injections, patient controledl analgesia, uses NSAIDs useing (IM, IV or rectal).All of these methods have advantages and disadvantages. Another techniques for post operative analgesia is epidural catheter insertion and administration of opioids or local anesthetic continously. The goal of this study is to compare intrathecal administration of combination of sufentanil and morphine for postoperative pain relief after laparatomy.Materials and Methods: 40 ASA I-III patients who were candidates for laparatomic surgeries enrolled in two groups in this clinical trial study after written inform consent (randomly assigned).One group (N=20) before general anesthesia received a spinal injection of Sufentanil (5m) and morphine (0.3 mg) (S-M groups) and another group (control group) didn't receive intrathecal opioids.Post-operative pain was rated on a visual analogue scale (VAS) at rest in 6 and 12 hours after operation and also total dose of injected morphine for 24 hours after operation calculated. The data were analyzed by SPSS16, T-test, Chi-Square and paired T-test.Results: Intrathecal injection of sufentanil and morphine caused VAS scores at rest were significantly higher in the control group in 6 and 12 hours after operation and total dose of morphine consumption was significantly lower in the SM group.Conclusion: Combination of intrathecal sufentanil and morphine produce good analgesic effect after laparatomic surgery at 12 hours after operation.

One of the most common problems in today"s  developing world is the very high rate of population growth or "explosion of population". Therefore we need a reliable method of contraception which not only should have the least complications for patients but also the most efficacy in producing contraception. Tubal ligation (TL) is one of these methods. In this study late complications and failure rates of two common methods of TL were studied. In this randomized semi-experimental study, 100 women who volunteered for TL were randomly divided into two equal groups. The operation on women in the first group was performed using minilaparotomy technique (M) and for the women in the second group laparoscopic technique (L) was used. Furthermore, the condition of the women was observed closely for a period of one year after the operation. The study showed that L group had more menstrual irregularity, menorrhagia and dysmmenorrhea than M group (p<0.01, p<0.05 and p<0.0001 respectively). There was no difference in psychiatric morbidity in the two groups (4% of patients in both groups). No one regretted TL. Libido increased or was unchanged in 96% and decreased in the others. These percentages were the same for both groups. No severe menstrual irregularity needing hospitalization for laparotomy, D&C or hysterectomy was observed in either of the two groups. The only complication which was higher in M group than L group was problems with incision location (36% versus 18% value (P<0.05). No Failure rate was observed. There was no change in incidence of menometrorrhgia after M operation and even decreasing of menstrual bleeding (8 cases) and regularity of menses (2 cases) were observed. This study demonstrated that TL has no effect on menstrual function, has no effect on psychiatric morbidity and menstrual bleeding dysfunction, but it can slightly increase the incidence of dysmenorrhea, especially when performed by laparoscopy method. High rate of complications in unipolar electrocoagulation TL by laparoscope can be precluded by using bipolar electrocoagulation or clips and bands.

Background: Volvulus of colon is a very rare phenomenon in post cardiac surgery course, and their predicting factor in most patients is unknown. Between colonic volvulus, splenic flexure is the rarest site for torsion in general population. The main symptoms are vague abdominal pain, vomiting and distension. The primary diagnostic images include plain chest x-ray, CT scan and colonoscopy. Case Presentation: We report the case of a 57-year-old opium male addict, who was. Admitted for abdominal pain, nausea, and vomiting five days after off-pump coronary artery bypass surgery (OPCAB). An abdominal x-ray reported a colonic volvulus. Exploratory laparotomy showed acute abdomen resulting from a gangrene of long segment of splenic flexure caused by volvulus. Conclusion: Gastrointestinal complication such as volvulus is an exceedingly rare complication of OPCAB, despite the absence of anatomic abnormalities only complete colonic malrotation as the result of mega colon and constipation, the main pathogenetic causes. This patient was unique because of careful literature search revealed that this case was the first reported volvulus that has been described so far.

Most ingested foreign bodies pass through the gastrointestinal tract without a problem. Occasionally complications like obstruction and hallow viscus perforation occurs. Duodenal perforation due to foreign body ingestion is not common and observation is enough for most cases, but if it is long with sharp margins, especial consideration for its early removal with endoscopic intervention is needed. This could be true for long foreign bodies with blunt ends. Otherwise severe complications may occur, like our case study. The patient is a 3.5 years old boy come to emergency ward with complaint about generalized abdominal pain for 3 days ago with nausea and vomiting and normal defecation. The patient underwent laparatomy because of generalized tenderness and intraperitoneal free air; and there was a duodenal perforation in duodenojejunal junction due to foreign body and it was repaired with omental patch. The aim of this report is to attract especial attention to log ingested foreign bodies even with blunt end.