共查询到20条相似文献,搜索用时 31 毫秒
1.
2.
Asra Hashmi Eitan Podgaetz Melanie L. Richards 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2010,14(3):426-430
Background:
Splenic tumors are rare. Malignant fibrous histiocytoma (MFH) of the spleen is one of the least common primary splenic tumors. Review of the literature shows that a laparoscopic resection has never been tried.Method:
We discuss the case of a 76-year-old man with a 7-cm MFH in the spleen and present a review of splenic sarcomas.Results:
The patient underwent a successful laparoscopic splenectomy; pathology revealed a rare undifferentiated pleomorphic sarcoma of the spleen. A review of the international literature identified 15 additional cases of primary splenic MFH. Survival was rarely longer than 15 months.Conclusion:
Malignant fibrous histiocytoma of the spleen is an exceedingly rare tumor with a poor prognosis. In experienced hands, laparoscopic splenectomy is a feasible operative choice for primary splenic sarcoma. 相似文献3.
Damiano Patrono Rosa Benvenga Francesco Moro Denis Rossato Renato Romagnoli Mauro Salizzoni 《International journal of surgery case reports》2014,5(10):652-655
INTRODUCTION
Left-sided portal hypertension is a rare clinical condition most often associated with a pancreatic disease. In case of hemorrhage from gastric fundus varices, splenectomy is indicated. Commonly, the operation is carried out by laparotomy, as portal hypertension is considered a relative contraindication to laparoscopic splenectomy (LS). Although some studies have reported the feasibility of the laparoscopic approach in the setting of cirrhosis-related portal hypertension, experience concerning LS in left-sided portal hypertension is lacking.PRESENTATION OF CASE
A 39-year-old man was admitted to the Emergency Department for haemorrhagic shock due to acute hemorrhage from gastric fundus varices. Diagnostic work up revealed a chronic pancreatitis-related splenic vein thrombosis causing left-sided portal hypertension with gastric fundus varices and splenic cavernoma. Following splenic artery embolization (SAE), the case was successfully managed by LS.DISCUSSION
The advantages of laparoscopic over open splenectomy include lower complication rate, quicker recovery and shorter hospital stay. Splenic artery embolization prior to LS has been used to reduce intraoperative blood losses and conversion rate, especially in complex cases of splenomegaly or cirrhosis-related portal hypertension. We report a case of complicated left-sided portal hypertension managed by LS following SAE. In spite of the presence of large varices at the splenic hilum, the operation was performed by laparoscopy without any major intraoperative complication, thanks to the reduced venous pressure achieved by SAE.CONCLUSION
Splenic artery embolization may be a valuable adjunct in case of left-sided portal hypertension requiring splenectomy, allowing a safe dissection of the splenic vessels even by laparoscopy. 相似文献4.
Skouras C Lalountas MA Triantafyllou A Angelidou S Ballas KD 《International journal of surgery case reports》2011,2(6):163-165
Introduction
Idiopathic spontaneous intra-abdominal haemorrhage is a rare, but challenging condition, associated with high mortality if not managed appropriately. The preoperative diagnosis is difficult, despite the recent advances in imaging. We present the clinical manifestations of this condition, as well as the available diagnostic and therapeutic modalities.Presentation of case
We report a case of a spontaneously ruptured dissecting aneurysm of the middle colic artery, which was managed with an emergency laparotomy and aneurysmatectomy. Interestingly, no evidence of vasculitis, infection or collagen disease was discovered during the histopathology examination of the specimen.Discussion
The treatment of idiopathic spontaneous intra-abdominal haemorrhage revolves around patient resuscitation and management of the source of bleeding. In case of a ruptured aneurysm of the middle colic artery, the surgical management includes emergency laparotomy, arterial ligation and resection of the aneurysm. Transarterial embolisation has been suggested as a safe and less invasive alternative approach.Conclusion
A ruptured middle colic artery aneurysm should be included in the differential diagnosis of any unexplained intra-abdominal haemorrhage. Aneurysmatectomy is the treatment of choice, with radiologic interventional techniques gaining ground in the management of this entity. 相似文献5.
Sean McPhillips Randall Friese Gary Vercruysse 《International journal of surgery case reports》2014,5(12):951-953
INTRODUCTION
Splenic abscesses associated with leukemia are rare. Most reported cases of splenic abscesses occur after chemotherapy and are related to the immunosuppressive effects of the chemotherapy. Their etiology is most frequently fungal.PRESENTATION OF CASE
A 58-year-old male presented with splenomegaly and scrotal swelling secondary to a multibacterial splenic abscess which required a splenectomy. Upon investigation he was found to suffer from chronic myeloid leukemia (CML) and epididymitis.DISCUSSION
Splenic abscesses are rarely found in leukemic patients. Reported cases are fungal and commonly occur after chemotherapy due to immunosuppression. Scrotal swelling with concurrent splenomegaly can be found in other pathologies including brucellosis, Lyme disease and even non-Hodgkin primary testicular lymphoma. Scrotal swelling in our case was likely secondary to epididymitis and exacerbated by the effects of splenomegaly upon the systemic circulation promoting venous congestion.CONCLUSION
This case illustrated an unusual presentation of CML because the patient presented with splenomegaly, a multibacterial splenic abscess, and scrotal swelling. 相似文献6.
Oliver Varban 《International journal of surgery case reports》2014,5(6):315-318
INTRODUCTION
Splenic cyst during pregnancy is rare and may result in spontaneous rupture during the third trimester, which increases perinatal morality.PRESENTATION OF CASE
We present a 27-year-old healthy Caucasian female who presented at 18 weeks gestation with left flank pain, early satiety and weight loss. Imaging studies demonstrated a large complex multiloculated splenic cyst. The patient underwent a successful laparoscopic splenectomy and delivered a healthy child at term without complication.DISCUSSION
Spontaneous rupture of a splenic cyst during the third trimester incurs a perinatal mortality rate as high as 70%. Surgical management includes open or laparoscopic splenectomy or fenestration and preservation of the spleen.CONCLUSION
Laparoscopic splenectomy during the second trimester appears to be safe and offers definitive management of a large symptomatic splenic cyst during pregnancy. 相似文献7.
Tharwat Saad Kandil Mohamed El Sorogy Yousef Naiem Wagdi Fawzi Elkashef 《International journal of surgery case reports》2014,5(11):877-878
INTRODUCTION
Defined as heterotrophic autotransplantation of splenic tissue after splenic trauma or surgery.PRESENTATION OF CASE
We present a case of 45 years old female patient with past history of splenectomy for haemolyticanaemia. Complaining of abdominal pain the patient was investigated by abdominal CT scan which revealed a focal lesion in the left lateral section of the liver suspicious to be hepatocellular carcinoma and gall bladder stones. Serum α-fetoprotein was within normal range. Exploration revealed a well encapsulated lesion completely separable from the liver and the diaphragm. Histopathological examination confirmed the diagnosis of splenosis. Although it is a rare condition, we recommend that the diagnosis of splenosis should be put in consideration in every patient with past history of splenectomy for proper management.DISCUSSION
Although several cases of hepatic splenosis have been reported in the literature, supra-hepatic splenosis as our case has been rarely described.CONCLUSION
Considering patients past history of splenectomy or splenic trauma should add splenosis to the list of possible differential diagnosis to avoid unnecessary surgical intervention. 相似文献8.
Lance Burns Douglas P. Slakey 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2009,13(1):60-63
Background:
Intrahepatic arterial aneurysms are rare and typically related to trauma, transplantation, iatrogenic injury, or infection. They account for approximately 10% of clinically significant hemobilia.Case Report:
We present the case of a 49-year-old man with an intraparenchymal hepatic artery aneurysm that presented as massive hemobilia following a laparoscopic cholecystectomy. The aneurysm could not be managed by interventional embolization and required a left hepatic lobectomy, which was performed laparoscopically.Discussion:
Evaluation of hemobilia requires a multidisciplinary team approach. The diagnosis of hepatic artery aneurysm can be most readily made by MRI or CT scan. Interventional embolization of the aneurysm may be effective treatment but is not always possible due to anatomic considerations. Where indicated, surgical resection in a manner that preserves a maximal amount of normal hepatic parenchyma is the treatment of choice.Conclusion:
This is the first report of laparoscopic liver resection performed for bleeding from a hepatic artery aneurysm and adds an effective treatment modality to the surgical armamentarium. 相似文献9.
Alessandro Perin Roberto Cola Franco Favretti 《International journal of surgery case reports》2014,5(12):887-889
INTRODUCTION
Accessory wandering spleen is a rare but dangerous condition. Abnormalities of the ligamentous apparatus of an accessory spleen may evolve into torsion of its vascular axis, which can lead to a splenic infarct making surgery necessary. Patients are often asymptomatic and the diagnosis can be accidental. An early diagnosis and a correct treatment are fundamental.PRESENTATION OF CASE
In this case report a young woman underwent laparoscopic surgery after an incidental finding at a Pelvic Ultrasound of an accessory wandering spleen.DISCUSSION
In literature are reported cases of asymptomatic patients with an accessory wandering spleen treated with a conservative approach. However, a torsion or infarct of the accessory wandering spleen leads to emergency surgery. The presence of an independent vascular axis of the accessory spleen reduces the risk of postoperative complications (e.g. thrombocytosis) and the administration of low molecular weight heparin should prevent the risk of portal thrombosis.CONCLUSION
We suggest performing surgery with a laparoscopic approach in patients with accessory wandering spleen, though asymptomatic, because of the risk of serious complications in case of accessory spleen torsion. 相似文献10.
INTRODUCTION
Persistent sciatic artery (PSA) is a rare vascular anomaly associated with a higher rate of aneurysm formation or thromboembolic complications causing lower extremity ischemia.PRESENTATION Of Case
A 15-year-old female patient with bilateral PSA presented with lower extremity ischemia. Considering the age and symptoms of the patient, we did not perform any intervention, but continued surveillance with duplex ultrasonography in case of the high incidence of aneurysmal formation or thromboembolic event.DISCUSSION
Epidemiology, development, anatomical structure, diagnosis and treatments of PSAs are discussed.CONCLUSION
PSAs, are prone to early atheromatous degeneration and aneurysm formation. Treatment of a PSA mainly dependent on the symptoms is either by surgical procedures or by endovascular interventions. 相似文献11.
Bryan G. Garber Jean-Denis Yelle Robin Fairfull-Smith John W. Lorimer Cathy Carson 《Canadian journal of surgery》1996,39(6):474-480
Objectives
To document the current practice pattern for the treatment of splenic injuries in one Canadian trauma centre and to identify factors that determined which method was employed.Design
A cohort study.Setting
A Canadian lead trauma centre.Patients
A cohort of 100 patients with splenic injury treated at one trauma hospital over 5 years was identified from a prospective trauma database.Main Outcome Measures
The success rate and failure rate for splenic salvage by splenectomy, splenorrhaphy or observation. Volume of blood transfused, injury severity score (ISS) and method of diagnosis.Results
The median ISS for the cohort was 34 (36 for splenectomy, 38 for splenorrhaphy and 35 for observation). A blunt mechanism of injury was present in 96%. The diagnosis was made by computed tomography (CT) in 55%. Splenic salvage was accomplished in 51 patients; of these, 44 (86%) were in the observation group, and the success rate was 90% (within the range reported in the literature). Only seven patients underwent splenorrhaphy. CT was performed more frequently in the observation group than in the splenectomy group (82% v. 25%, p < 0.0001). The splenectomy group had more blood tranfused than the successful observation group (mean units 15 v. 3, p = 0.0001) and had a higher median ISS (36 v. 29, p = 0.02). Multivariate analysis revealed that the method of diagnosis (CT v. diagnostic peritoneal lavage) was the strongest factor associated with how the splenic injury was treated.Conclusions
The finding in this report of an increase in observational treatment of splenic injuries represents a shift in practice from a previous Canadian report and is in keeping with recent published trends from the United States. Future studies are needed to assess whether any strong regional practice pattern variations in the management of blunt splenic injuries exists in other trauma centres across Canada. 相似文献12.
Vyacheslav Bard Natalie Goldberg Hanoch Kashtan 《International journal of surgery case reports》2014,5(2):67-69
INTRODUCTION
Accessory spleen is a rare condition. Torsion of accessory spleen can lead to acute abdomen.PRESENTATION OF CASE
We describe a young woman with an acute abdomen caused by torsion of accessory spleen. Abdominal computed tomography angiography (CTA) demonstrated an ischemic giant accessory spleen with a twisted vascular pedicle. An emergency laparotomy was performed with resection of the infarcted accessory spleen.DISCUSSION
Accessory spleen is a rare and asymptomatic condition. Torsion of accessory spleen is also uncommon. Abdominal pain is the main symptom. CTA is effective in reaching a diagnosis. Definitive treatment of an acute abdomen due to accessory splenic torsion is emergency accessory splenectomy.CONCLUSION
Elective accessory splenectomy should be recommended for known giant accessory spleen to prevent complications in future. 相似文献13.
Introduction
We report a case of IEA false aneurysm following a mesh repair of a large incisional hernia. We emphasize the importance to consider the diagnosis to help avoid inappropriate interventions which could increase patient morbidity.Case report
A 68-year-old male patient, who 4 weeks previously had had a mesh repair of a large incisional hernia, presented with a painful left iliac fossa swelling. This was found to be an IEA false aneurysm. This was treated successfully with percutaneous thrombin injection.Conclusions
We feel an inferior epigastric artery false aneurysm must be included in the differential diagnosis when investigating the cause of any lateral swelling following incisional hernia repair. This would help reduce the chance of a missed diagnosis and avoid any inappropriate interventions which may cause increased patient morbidity. 相似文献14.
Objective:
To detail the case of a 79 year-old female who presented with sudden bilateral neurological deficits of the lower extremities and was later diagnosed with non-traumatic conus medullaris infarction. The purpose of this case report is to inform primary contact practitioners of the presentation, diagnosis and the associated risk factors of this condition in order to facilitate prompt management.Clinical Features:
Spinal cord infarction presenting as low back pain with a high degree of bilateral loss of motor strength, sensation and reflexes in the lower extremities and bowel/bladder dysfunction, in a patient with previous coronary artery bypass graft surgery and renal insufficiency.Intervention and Outcome:
Referral to emergency within hours of symptom onset allowed for immediate assessment, management and relatively favourable partial recovery.Summary:
Although rare, conus medullaris infarction is potentially devastating and requires an appropriate clinical index of suspicion for timely diagnosis, treatment and optimal neurological recovery. 相似文献15.
Kaundinya Kiran Bharatam C. Kaliyappa Raja Raghavendra Reddy 《International journal of surgery case reports》2014,5(12):1154-1157
INTRODUCTION
Transmesenteric mesocolic hernias are a rare cause of acute abdomen in adults with few reported cases in published literature.PRESENTATION OF CASE
We report a rare case of a 30-year-old male with right-sided transmesenteric hernia of ileum due to a congenital mesocolic defect resulting in acute abdomen, presenting as acute abdomen. The hernia was reduced, small bowel inspected for gangrene and mesenteric hernia repaired, following which the patient made a good recovery and was discharged 5 days later.DISCUSSION
The insidious onset of transmesenteric herniae and lack of specific radiological or laboratory investigations reaffirms the importance of surgeons maintaining a high index of suspicion for this surgical emergency.CONCLUSION
Transmesentric hernia though rare can present as a case of acute abdomen in an emergency. The diagnosis is purely by a CT scan and close monitoring of the patient''s general condition in cases of non-specific abdominal pain is essential to identify the rare deteriorating patient for early surgical intervention and optimal outcome. 相似文献16.
Jason Porr Karen Chrobak Brad Muir 《The Journal of the Canadian Chiropractic Association》2013,57(4):341-349
Objective:
To present 2 cases of entrapment of the saphenous nerve at the adductor canal affecting the infrapatellar branch, and to provide insight into the utilization of nerve tension testing for the diagnosis of nerve entrapments in a clinical setting.Rationale:
Saphenous nerve entrapments are a very rare condition within today’s body of literature, and the diagnosis remains controversial.Clinical Features:
Two cases of chronic knee pain that were unresponsive to previous treatment. The patients were diagnosed with an entrapment of the saphenous nerve at the adductor canal affecting the infrapatellar branch using nerve tension techniques along with a full clinical examination.Intervention and Outcome:
Manual therapy and rehabilitation programs were initiated including soft tissue therapy, nerve gliding techniques and gait retraining which resulted in 90% improvement in one case and complete resolution of symptoms in the second.Conclusion:
Nerve tension testing may prove to be an aid in the diagnosis of saphenous nerve entrapments within a clinical setting in order to decrease time to diagnosis and proper treatment. 相似文献17.
George Galyfos Zisis Touloumis Konstantinos Palogos Konstantinos Stergios Maria Chalasti Nikolaos Kavouras Laurant Lavant 《International journal of surgery case reports》2014,5(2):104-107
INTRODUCTION
Pseudocysts of the spleen are usually asymptomatic and associated with a history of trauma, infection or infarction. In this report, we present two uncommon cases of solitary, oversized pseudocysts of the spleen.PRESENTATION OF CASE
Two patients (cases A and B), with symptoms of abdominal pain, were investigated. The laboratory and ultrasound examination confirmed the diagnosis of a large, non-parasitic splenic cyst in both cases. Computed tomography described an oversized pseudocyst occupying almost the entire splenic parenchyma in both cases and in patient A, the cyst was located in the splenic hilum. The medical history revealed a previous abdominal injury only in case A. The two patients underwent an open total splenectomy. The pathology examination verified the diagnosis of a non-parasitic splenic pseudocyst.DISCUSSION
Both patients presented with symptoms, in contrast to the majority of patients with splenic cysts. The medical history of patients with splenic pseudocysts does not always reveal the cause of the pseudocyst formation. Any type of spleen-sparing procedure is not easy to perform in cases of surgical and anatomical difficulty, because of recurrence and the risk of intractable bleeding from the spleen.CONCLUSION
Partial splenectomy is the recommended method for parenchymal preservation, but total splenectomy is preferred when the splenic cyst is oversized or cannot be excised with safety. 相似文献18.
Jason D. Fraser Shawn D. St. Peter Jenevieve H. Hughes James M. Swain 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2009,13(2):254-259
Background:
Superior mesenteric artery (SMA) syndrome, also called Wilkie''s syndrome, is a rare clinical phenomenon believed to be caused by compression of the third portion of the duodenum by the overlying superior mesenteric artery. We present the case of a 32-year-old female who presented with epigastric pain, weight loss, and vomiting.Methods:
Her workup included a normal upper endoscopy as well as an abdominal CT scan and upper GI contrast study that confirmed the diagnosis of superior mesenteric artery syndrome. The patient was taken to the operating room and underwent successful treatment with laparoscopic duodenojejunostomy.Results:
The patient achieved complete relief of her symptoms and is able to eat a regular diet without difficulty. SMA syndrome is a real anatomic clinical pathology resulting in chronic, consistent obstructive symptoms. An upper GI series and CT scan with contrast can confirm the diagnosis.Conclusion:
Laparoscopic duodenojejunostomy should be considered the treatment of choice for these patients, because it offers a high likelihood of excellent outcome based on the current literature. 相似文献19.
Naruhiko Ikoma Casey L. Anderson Maro Ohanian Harinder S. Juneja Bruce V. MacFadyen Shinil K. Shah Kulvinder S. Bajwa 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2014,18(1):125-127
Introduction:
Portal vein thrombosis (PVT) is a relatively uncommon complication after abdominal surgery.Case Report:
We report an even more unusual case of PVT 10 days after an uncomplicated laparoscopic cholecystectomy, believed to be only the fourth reported case in the literature of this rare complication.Conclusion:
Albeit extremely rare, PVT should be included in the differential diagnosis for abdominal symptoms and/or elevated hepatic function tests after laparoscopic cholecystectomy. 相似文献20.