腹部反麦氏点穿刺法在胸室—腹腔分流手术中的应用

目的 以自制穿刺针行腹腔反麦氏点穿刺方法改良脑室腹腔分流术。方法 回顾性分析49例接受改良脑室腹腔分流术治疗的脑积水患者临床资料。结果 所有病例经术后随访示分流管阻塞和术后感染发生率均为4．08％，较文献报道少。结论 以腹部反麦氏点穿刺替代开腹手术置管具有创伤小、恢复快，感染机会小，不易被网膜包裹及腹部并发症少等优点。     

Transoral migration of the inferior end of a ventriculoperitoneal shunt: A case report with literature review

Ventriculoperitoneal (VP) shunt surgery is the most widely used technique for the treatment of hydrocephalus. However, it can incur certain complications. Beside frequent complications (infection, obstruction), migration of the peritoneal catheter is a rare but dangerous complication. This report presents the case of a 4-year-old boy who had undergone VP shunt for hydrocephalus. One month later, the patient presented with protrusion of the peritoneal catheter through his mouth. He underwent another procedure to remove the peritoneal catheter, retaining the original ventricular catheter and valve chamber. Progression was favorable. To the best of our knowledge, only 7 cases of VP shunt transoral extrusion were reported, but many risk factors were identified. Bowel perforation is a serious complication of VP shunt surgery, sometimes leading to fatal outcome.     

Early postoperative colonic ventriculoperitoneal shunt migration with trans-anal protrusion: A unique case report

Introduction and importanceColonic ventriculoperitoneal shunt (VPS) migration with trans-anal protrusion remains uncommon. Patients may be asymptomatic, and diagnosis may only be made on visualization of the prolapsed catheter from the anus. This unique case of early post-operative trans-anal shunt protrusion highlight the possibility of this rare complication specially when shunt revision accompanies bowel surgery.Case presentationThe authors present a case of early postoperative colonic shunt migration in a thirteen-year-old female with who underwent Malone Antegrade Continence Enema (MACE) with concomitant revision of the distal part of the peritoneal catheter. She presented two weeks post operatively with shunt catheter protruding from the anus. This was noticed by her carer and she was asymptomatic on her presentation.Clinical discussionDelayed post-operative shunt related bowel perforation and trans-anal shunt protrusion is an uncommon complication after ventriculoperitoneal shunting. Most cases present months after surgery and majority are asymptomatic on presentation. The exact pathophysiology is not established, and mechanisms have been proposed. Early post -operative trans-anal shunt protrusion is rare and suggests inadvertent occult bowel injury especially when shunt placement or revision accompanies extensive bowel surgery.ConclusionThe authors recommended shunt imaging within the first two to three weeks after shunt revision in patient who undergo concomitant bowel surgery with risk of inadvertent bowel injury to identify early colonic migration and avoid its potentially fatal sequelae.     

Metachronous mediastinal lymph node metastasis from ascending colon cancer: A case report and literature review

IntroductionMetachronous mediastinal lymph node metastasis without pulmonary metastasis is extremely rare in colorectal cancer, which makes the clinical diagnosis difficult and treatment strategy unclear.Prsentation of caseA case was a 59-year-old man, who had undergone right hemicolectomy for ascending colon cancer 2 years and 8 months previously, presented with enlarged mediastinal lymph nodes. ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography revealed FDG was accumulated only into the mediastinal lymph nodes. Serum carcinoembryonic antigen (CEA) level was within the normal range. Six months later, the size and FDG uptake of the mediastinal lymph nodes had increased. We assumed a possibility that the mediastinal lymph nodes were metastasized from ascending colon cancer and so performed thoracoscopic-assisted resection of the mediastinal lymph nodes. Histopathological analysis revealed the resected lymph nodes were filled with moderately differentiated adenocarcinoma and a diagnosis of mediastinal lymph nodes metastasis from previously-resected ascending colon cancer was made. The patient was postoperatively followed for more than 1 year and 8 months without any sign of recurrence.DiscussionOnly 7 cases of metachronous mediastinal lymph node metastasis from colorectal cancer, including our case, have been reported in the English literature. It is difficult to clinically diagnose mediastinal lymph node metastasis.ConclusionWe report a rare case of metachronous mediastinal lymph node metastasis from ascending colon cancer with literature review. If the mediastinal lymph nodes are enlarged after colorectal cancer resection, we need to make a treatment strategy as well as a diagnostic approach considering the possibility of mediastinal lymph node metastasis.     

Chest wall metastasis of endometrial cancer: case report and review of the literature

Introduction: Endometrial cancer is the fourth most common female cancer and also distant metastases to the chest wall associated with these tumors are seen less common. Surgical treatment options for metastases of endometrial cancer are limited.

Case: A 57-year-old patient who underwent total abdominal hysterectomy?+?bilateral salpingo oophorectomy and received adjuvant chemotherapy for endometrioid-type adenocarcinoma of the endometrium and tuba is presented. The patient initially presented with pleural effusion 8 years ago and the tumor was detected while during etiologic screening. The patient had no problems after adjuvant chemotherapy and had been living in another city when she presented with a mass on the chest wall measuring 20?×?15?×?12?cm 8 years after the initial diagnosis and distant organ metastasis due to the first surgery was detected. The mass was first thought to be a sarcoma and the tru-cut biopsy revealed a metastatic lesion that was immunohistochemically similar to the first surgical specimen. The mass was resected with a wide radical excision and ‘no touch’ technique. The patient was then discharged with no postoperative complications.

Conclusion: Here in, a case with a distant organ metastasis due to an endometrioid-type adenocarcinoma is presented accompanied by literature data.     

The solitary cutaneous metastasis of asymptomatic colon cancer to an operative scar

Although umbilical or cutaneous metastases from asymptomatic internal malignancies are occasionally documented, the literature contains no report of a solitary cutaneous metastasis to an old operative scar from an asymptomatic internal malignancy. A rare case of colonic cancer presenting as a solitary subcutaneous metastasis to a lower abdominal scar resulting from an open prostatectomy is described in this communication. It was impossible to distinguish this subcutaneous metastasis from a pyogenic granuloma caused by residual sutures without histological evidence. Thus, a granuloma that persists despite repeated treatment may be a possible sign of asymptomatic internal malignancy.     

Extraneural metastasis of the pineal germinoma via ventriculoperitoneal shunt

Extraneural metastasis of pineal germinoma is an infrequent event. We report a case of a 19‐year‐old boy who had pineal germinoma and was successfully treated with irradiation. He was diagnosed with abdominal metastasis of pineal germinoma via ventricuolperitoneal shunt 6 years afterwards. The disease was controlled with surgery and systemic chemotherapy.      

Mediastinal lymph node metastasis of colon cancer: Report of a case

We herein describe a patient with mediastinal lymph node metastases which occurred after both a primary sigmoid colon cancer and metachronous ovarian metastasis had been resected. The most likely route of metastases to the mediastinum in this case is the paravertebral venous plexus probably connected to the ovarian metastasis, or so-called remetastasis. This case illustrates that the mediastinum is thus a possible metastatic site in patients with colon cancer. Surgeons should therefore pay attention to the mediastinum as well as the lung fields when checking chest X-ray films during a follow-up of patients after a resection of colon cancer.     

结肠癌肝转移外科治疗的临床与病理分析(附25例报告)

目的　探讨结肠癌肝转移的外科治疗方法及其病理因素对预后的影响。方法　本组79例结肠癌肝转移患者中共有 2 5例接受原发灶根治术以及肝转移灶切除术或射频消融术。其中 14例进行了原发灶根治术及肝脏转移灶切除术 ,11例进行了肝脏转移灶射频消融术。结果　本组结肠癌肝转移患者术后 1年、3年生存率分别为 84 %、4 8%。分化程度高以及单个转移灶的患者预后较好。肝脏肿瘤切除与肝脏肿瘤射频消融术后患者生存时间无明显差异。结论　结肠癌肝转移患者原发肿瘤的分化程度、肝脏转移灶的数量对预测患者的预后有一定的作用。手术切除及射频消融术对治疗结肠癌肝转移能够达到较为接近的治疗效果。     

Spontaneous abdominal wall endometrioma: A case report

IntroductionThe abdominal wall is the commonest site of extra pelvic endometriosis (endometrioma), defined as the presence of functional endometrial gland and stroma outside the uterine cavity. Spontaneous abdominal wall endometriosis (AWE) represents an ectopic functional endometrial tissue situated superficial to peritoneum in a scar less abdomen. Spontaneous AWE is rare, accounting for 20% of all abdominal wall endometriosis. It is unfamiliar to general surgeons because of a large number of potential pitfalls in its diagnosis.Clinical presentation and interventionWe report a case of spontaneous abdominal wall endometriosis (endometrioma) presenting to our general surgery clinic with a painful nodular mass in hypogastric area below umbilicus. The initial diagnosis was a desmoid tumour of the anterior abdominal wall. Pain was a remarkable complaint in our patient. Abdominal wall endometrioma was diagnosed by histopathology postoperatively. Excision planned, during operation, one mass was spotted and excised within healthy limits. Histopathology revealed: endometrial glands surrounded by mantle of endometrial stroma, few scattered hemosiderin laden macrophages and fibrous scar tissues. Our patient had no previous scar. She was discharged from hospital on 5th postoperative day uneventfully. (On account of uncontrolled DM and Hypertension). One year of follow up after the surgery, she is free from disease and no recurrence has been observed.DiscussionEndometriosis is characterised by the presence of endometrial glands and stroma outside the uterine cavity with the maximum prevalence reported in the 4th decade of life. Most cases of spontaneous endometriosis occur in a scar less abdomen. Multiple imaging techniques have been used and described for its diagnosis. The alleged aetiopathogenesis of spontaneous endometrioma is still debatable. It is usually diagnosed by the histopathology and the preferential treatment in cases of endometrioma is total excision of the mass. The hormonal therapy can be added to surgical excision if there is proven pelvic endometriosis. The surgical excision should be wide enough to prevent its recurrence.ConclusionSpontaneous abdominal wall endometriosis is an extremely rare gynaecological entity, accounts for 18–20% of all abdominal wall endometriosis. The diagnosis of abdominal wall endometrioma is hardly established prior to surgery. The triad: mass, pain and cyclic symptom aids in diagnosis, unfortunately cyclic symptom is not present in all cases (as in our case). Spontaneous abdominal wall endometrioma is usually diagnosed by high index of clinical suspicion and histopathology. The results of imaging techniques are nonspecific. It may pose a diagnostic dilemma due to its rarity and atypical presentation. The preferential treatment of choice is wide excision.     

Ventriculocholecystic shunt. A mortality report

Ventriculocholecystic shunts are not commonly used for the treatment of hydrocephalus. We present a case of a child who underwent such a procedure and died of unusual complications. This case represents a unique juxtaposition of uncommon neurosurgical entities and complications including acquired communicating hydrocephalus, bilious ventriculitis secondary to a ventriculocholecystic shunt, and pulmonary edema. The unusual features of this case are discussed and emphasis is placed on the pathophysiologic findings.     

Umbilical CSF fistula: a rare complication of ventriculoperitoneal shunt

Summary An umbilical CSF fistula following a ventriculoperitoneal shunt is an extremely rare complication. We report a 28-year-old man who presented with leak of clear fluid from the umbilicus, one month after a ventriculo-peritoneal shunt revision. Shuntogram revealed communication between umbilicus and abdominal end of the catheter. He was managed successfully with shunt exteriorization, antimeningitic treatment, and later shunt re-insertion.     

Acute appendicitis presenting as an abdominal wall abscess: A case report

IntroductionAmyand hernia (AH) is a rare type of hernia characterized by the presence of appendix vermiformis in the inguinal hernial sac. It is rarely reported in women.Presentation of caseWe presented a case of a 60- year old woman who was admitted initially with an abdominal wall abscess and found to have perforated appendix in the right inguinal hernia. The patient underwent standard open appendectomy and the post-operative course was uneventful.DiscussionThe initial presentation of our case as an abdominal wall abscess is rare in the contemporary literature.ConclusionsA high index of suspicious, early diagnosis and timely surgical intervention are the keys to have favorable outcome in amyand hernia. The management should follow general guidelines of appendectomy, hernia repair and dealing with the associated pathology if present.     

Rare complication of ventriculoperitoneal shunt. Early onset of distal catheter migration into scrotum in an adult male: Case report and literature review

IntroductionThe role of shunt placement is to divert cerebrospinal fluid from within the ventricles to an alternative location in the setting of hydrocephalus. One of the rare shunt complications is distal catheter migration, and various body sites have been reported, including the scrotum. Although cases of scrotal migration of distal catheter have been reported in pediatric patients, cases in adult patients are rare due to obliterated processus vaginalis. Furthermore, there has not been a case reported for scrotal migration in an adult at an early onset.Presentation of case65-year-old male underwent shunt placement for normal-pressure hydrocephalus-like symptoms. On post-operative day seven patient developed right testicular edema, for which ultrasound was performed, revealing hydrocele along with the presence of distal catheter in the scrotum. On post-operative day nine patient underwent distal catheter trimming via laparoscopic approach with general surgery, with post-operative imaging showing satisfactory location of distal catheter in the peritoneal cavity.Discussion/ConclusionEarly onset of distal catheter migration into scrotum in an adult male is a unique case, as most cases are reported in pediatric patients, and it is the first case reported in the English literature to have occurrence at an early onset during the peri-operative period. As our case demonstrates, early occurrence and detection of scrotal migration of the distal catheter prevent shunt malfunction. Prompt surgical management of catheter repositioning is therefore recommended to avoid the risk of further complications.     

A case report: Renal metastasis of prostate cancer

In this report, a rare case of renal metastasis of prostate cancer in a 55-year-old man is presented.