Volume 1 Number 1 2004

1. The Effect of Gum-Chewin in the Resolution of Postoperative Ileus Following Gynecologic Laparoscopic Surgery: A Randomized Controlled Trial

Early feeding is advocated for the resolution of postoperative ileus. After gynaecologic laparoscopy, patients usually resume regular diet once the anesthesia has resolved. Gum-chewing is a form of sham feeding which may stimulate gut motility via vagal cholinergic stimulation. This study aimed to determine if gum-chewing is comparable to early feeding in the resolution of postoperative ileus. Thirty patients undergoing elective gynaecologic laparoscopic surgery were randomized to the control group, who immediately resumed regular diet, and the gum-chewing group, who were asked to chew gum three times a day until passage of flatus. The mean operative times were comparable. The mean time to passage of first flatus of the control group was 22.675 hours while that of the gum-chewing group was 23.174. The difference between the two was not significant with a P value of 0.8185. Gum-chewing is comparable to early feeding in the resolution of postoperative ileus.

A Case of Spontaneous Heterotopic Pregnancy with Tubal Rupture: Successful Management with Salpingenctomy and Continuation of Intrauterine Pregnancy

A 33-year-old primigravid presented with 2 months of amenorrhea adn an 11-day history of left lower quadrant pain. Three months prior to admission, patient underwent operative laparoscopy, bilateral salpingoneostomy for a history of primary infertility, Pelvic inflammatory disease with bilateral hydrosalpinges. Transvaginal sonography revealed simultaneous intrauterine and tubal pregnancies, with documented fetal heart activities. The patient showed signs of hemodynamic instability thus, she underwent an immediate laparotomy with left salpingectomy. Immediate surgical intervention resulted to a successful continuation of intrauterine pregnancy and avoided serious morbidity and mortality. This paper aims to discuss the diagnostic pitfalls and management of this condition.
 
Key words: Extra-uterine, Heterotopic, Intra-uterine, Rupture, Tubal, Salpingectomy, Laparoscopic salpingo-neostomy