Surgical treatment of pulmonary hydatid cysts: is capitonnage necessary?

BACKGROUND: Hydatid disease of the lung caused by Echinococcus granulosus is frequently encountered in Mediterranean countries. The ideal surgical method for treating this disease is still unknown. METHODS: Between 1994 and 2001, 71 patients with pulmonary hydatid cysts were treated surgically. There were 41 male and 30 female patients with a mean age of 30.2 years (range, 5 to 70 years). Cystotomy and closure of bronchial openings were performed in all patients. Obliteration of the residual cavity by imbricating sutures from within (capitonnage) was achieved in 39 patients (group 1). There were 34 patients with intact cysts and 37 patients with at least one complicated cyst. The average diameter of the cysts was 6.4 cm, and the mean number of cysts per patient was 1.4. The surgical outcome was assessed in group 1 patients and in patients who had undergone closure of bronchial openings without capitonnage (group 2; n = 32). The groups were comparable in regard to clinical characteristics. RESULTS: There was no mortality. The total hospitalization time (mean +/- standard error of the mean) was 5.0 +/- 5.0 days for group 1 and 5.9 +/- 6.9 days for group 2 (p = 0.91). Stay in the intensive care unit was 1.64 +/- 1.22 days in group 1 and 1.60 +/- 1.52 days in group 2 (p = 0.90). The duration of air leak was 2.56 +/- 4.73 days in group 1 and 2.38 +/- 4.74 days in group 2 (p = 0.87). There was no significant difference between groups in the development of empyema (1 patient in group 2 only) and prolonged air leak (5 patients in group 1 and 4 in group 2). There was also no significant difference in the rate of recurrence (3 patients in group 1 only). CONCLUSIONS: We conclude that capitonnage provides no advantage in operations for pulmonary hydatid cysts.     

Adrenal cavernous hemangioma with subclinical Cushing’s syndrome: report of a case

Cavernous hemangioma of the adrenal gland is a rare tumor, which does not usually have endocrinological function. We report to our knowledge, the third documented case of a functioning adrenal hemangioma. Interestingly, this tumor indicated glucocorticoid hypersecretion, whereas the two previous cases showed mineralocorticoid hypersecretion. The tumor was 5 cm in diameter with typical computed tomography and magnetic resonance imaging findings. Subclinical Cushing’s syndrome was diagnosed preoperatively, as there was insufficient suppression of cortisol by low-dose dexamethasone, a low adrenocorticotropic hormone (ACTH) concentration, and diminished ACTH and cortisol circadian rhythms without the typical clinical manifestation and symptoms of hypercortisolism. Intraoperative hypotension occurred immediately after tumor removal and following postoperative adrenal insufficiency, which support that the tumor was hyperfunctioning. The postoperative adrenal insufficiency had recovered completely by 12 months after the operation.     

Gitelman’s syndrome associated with chondrocalcinosis: a case report

Abstract

Gitelman’s syndrome (GS) is a rare disease with autosomal recessive trait, characterized by hypokalemia, hypomagnesemia, metabolic alkalosis, hypocalciuria and hyperkinemic hyperaldosteronism. While muscle weakness, tetany, stomachache, nausea and fever are very common, it could sometimes be completely asymptomatic as is the case in our patient. It is generally benign, but some severe complications like growth retardation and, though rare, paralysis and cardiac arrest could also be seen. A 57-year-old male patient sent to our hospital for further examination because of hypokalemia was diagnosed with GS as a result of clinical and laboratory assessments. Potassium and magnesium replacement was started. We are presenting our case seeing that GS is not a syndrome to be overlooked as it bears a risk of severe complications, although it might be asymptomatic until advanced ages.     

A case report of incarcerated inguinal hernia: Amyand’s hernia with adenocarcinoma tumor

IntroductionInguinal hernia is one of the most common surgical problems, often posing technical challenges even to expert surgeons. Amyand’s hernia (AH) is an inguinal hernia whose sac contains the vermiform appendix. Primary appendiceal neoplasms are rare. We report the case of an appendiceal adenocarcinoma within an Amyand’s hernia, presenting as an incarcerated right inguinal hernia.Presentation of caseA 87-year-old male presented in the emergency department due to a persistent right inguinal pain. Clinical examination revealed a tender right groin mass. Under the diagnosis of an right inguinal hernia, an operation was taken. Intraoperatively, an inflamed appendix and a part of the cecum were found in the hernia sac. The operation was completed with an ileocecal resection and a modified Bassini hernia repair. Histological examination revealed a adenocarcinoma of the appendix.DiscussionAmyand’s hernia is an inguinal hernia that contains vermiform appendix in its sac. It consists 1% of all inguinal hernias while appendicitis in an Amyand’s hernia accounts for 0.1% of all appendicitis cases. Adenocarcinomas of the appendix are even rarer, accounting for 0.2% to 0.5% of all intestinal malignancies, and 4%–6% of primary appendiceal neoplasms. Diagnosis is usually established intraoperatively.ConclusionA malignancy of the appendix should always be in the differential diagnosis of a right inguinal mass, in order to provide optimum surgical treatment.     

Dieulafoy’s disease of the lung: a report of three cases with review of pathological aspects

Dieulafoy’s disease of the lung is one of the causes of cryptogenic hemoptysis often massive and recurrent, caused by dysplastic superficially located arteries in the bronchial wall. Being a rare condition, available literature on this condition is limited to a few case reports and series. We report three such cases presenting with severe hemoptysis uncontrolled by bronchial artery embolization who subsequently underwent resection of the involved lobe of the lung. The clinical, radiological, bronchoscopic, and pathological features are discussed with emphasis on the gross and microscopic characteristics that aid in the pathological diagnosis in the resected specimens.     

Secretan’s syndrome: case report

Secretan's syndrome is a rare clinical condition with recurrent swelling of the forearm and dorsum of the hand, together with flexion contracture of the fingers and a thumb that is spared. The disease is associated with automutilation. We present a typical case of a 42-year old women with Secretan's syndrome.     

Magnetic resonance appearance of multiple intracranial epidermoid cysts: intrathecal seeding of the cysts? Case report

A 44-year-old man presented to the hospital with multiple intracranial epidermoid cysts. The clinical manifestations of his disease included chronic headaches and one seizurelike episode. Findings determined by magnetic resonance (MR) imaging, surgery, and histological analysis indicated intrathecal and intraventricular seeding of the cysts. Spontaneous (nontraumatic) seeding of multiple daughter cysts from intracranial epidermoid cysts is still very rare and their multiple appearances on MR imaging should be distinguished from the simple scattering of oily contents due to cyst rupture.     

Removal of a sex toy under general anaesthesia using a bimanual-technique and Magill’s forceps: A case report

IntroductionPhallic objects may cause large bowel obstruction if not promptly removed. A bi-manual technique with the aid of a Magill’s forceps is presented here.Presentation of caseA 68-year-old man presented to the emergency department with severe lower abdominal discomfort, distension and inability to pass urine, flatus or bowel motions. He had inserted a phallic object in the rectum 10 hours prior to presentation and had been unable to remove same. Abdominal examination was remarkable for distension with tenderness also elicited suprapubically and in the left iliac fossa. The foreign body was barely palpable per rectum. Plain radiographs showed prominent left-sided colonic segments. Following the trial of a manual attempt at removal in the emergency department, a decision was made to remove this under anaesthesia due to worsening symptoms. The phallic object was successfully removed under general anaesthesia using bi-manual manipulation assisted by a pair of Magill’s forceps.DiscussionThe method of removal of phallic objects varies from one individual case to another. In the presence of obstruction, a quick decision must be made for removal under general anaesthesia and the patient will also need to be consented for laparotomy. Previous literature described a “cork-in-bottle” technique using myomectomy screws as well as use of single-incision laparoscopic surgery (SILS) ports for removal of phallic objects.ConclusionExtraction of phallic objects requires ingenuity. We describe another minimally invasive technique of removal that adds to the literature, thereby limiting the need for laparotomy and open removal of foreign bodies.     

Treatment of perianal Paget’s disease using photodynamic therapy with assistance of fluorescence examination: case report

Our aim was to determine the usefulness of fluorescence examination and photodynamic therapy (PDT) for the management of perianal extramammary Paget’s disease. A 75-year-old woman underwent two courses of PDT. The first treatment was carried out with topically applied 5-aminolevulinic acid (ALA) to the affected area (2.5 × 2.5 cm²) 3 h before light treatment. We used ALA/protoporphyrin IX (PpIX)-mediated fluorescence to visualize the lesion and its margins. The lesion was treated with a 630 nm laser at 120 J/cm². Forty days later, the residual lesion was given a second treatment at the same light dose after topical application of ALA and intravenous injection of HiPorfin. ALA/PpIX-mediated fluorescence served as a useful tool to visualize the lesion’s location. Complete cure was achieved after the second course of PDT. During 7 months of follow up, no recurrence, scarring or functional loss was noticed. We concluded that ALA-assisted fluorescence examination can be a useful tool to determine the lesion and its margins. ALA-PDT is effective for superficial lesions, but, for thicker and deeper lesions, the systemic administration of photosensitizer is needed.     

Differentiating Chilaiditi’s Syndrome with hollow viscus perforation: A case report

IntroductionChilaiditi‘s syndrome is a rare condition accounting for only 0.25%–0.28% of all abdominal imaging worldwide. To rule out Chilaiditi‘s syndrome from other acute abdominal emergencies is very important to avoid unnecessary treatment or surgical procedure.Presentation of caseA 25-year-old female presented in the emergency room with 1 week history of abdominal discomfort. At time of examination, she had a mild shortness of breath that was not related with rigorous activities. A plain abdominal x-ray was suggested the presence of an air-filled bowel tract within the right subphrenic space (Fig. 1). Abdominal computed tomography suggested colonic loop present between the right hemi-diaphragm and liver. The absence of abdominal free air confirmed an isolated pseudo-pneumoperitoneum due to colonic interposition between the liver and diaphragm.DiscussionChilaiditi sign is radiolucency in the subdiaphragmatic space as a result of bowel interposition between a diaphragm and the liver. If gastrointestinal symptoms present, the condition is known as Chilaiditi's syndrome. The abdominal symptoms including severe pain, anorexia, diarrhea, nausea, vomiting, bloating and constipation might mislead physicians or surgeons with diaphragmatic hernia, subdiaphragmatic abscess, bowel perforation, infected hydatid cyst and liver tumor. Thorough physical examination, imaging, and timely follow up is very important to avoid unnecessary exploratory laparotomies.ConclusionChilaiditi’s Syndrome is often misdiagnosed with bowel perforation because the presence of pseudopneumoperitoneum in the plain X-Rays. It is important to understand the unique characteristics of the sign, symptoms and findings of Chilaiditi’s Syndrome to prevent unnecessary surgical procedures.     

Case report: Remodeling of the tibia after grafting of a large cavity with particulate bioactive glass-hydroxylapatiteon treatment of fibrous dysplasia with 13 years’ follow-up

No Abstract available     

Case report - Bouveret’s syndrome with pancreatitis: A rare combination

Introduction and importanceBouveret’s syndrome is characterised by gastric outlet obstruction due to impaction of gallstone in the duodenum through a cholecystoduodenal fistula, having concurrent pancreatitis makes it an even rarer presentation.Case presentationWe present an 82-year-old woman who presented with acute pancreatitis which she described 2 days of right upper quadrant pain with nausea and vomiting. Biliary obstruction signs were not present. She was known to have cholelithiasis but was for non-operative management due to significant cardiac history and multiple comorbilities.Clinical findings and investigationsOn initial examination, abdomen was soft with mild right upper quadrant tenderness. Murphy sign was negative. Lipase level was raised at 64,261U/L with cholestasis appearance on liver function test. Bouveret’s syndrome was later diagnosed on CT after symptoms of gastric outlet obstruction surfaced during her admission.Interventions and outcomeAn on-table endoscopic stone retrieval was done as first-line treatment. After multiple attempts of stone retrieval via endoscopy, surgical extraction of the impacted gallstone was required. Patient’s post-operative care was further challenged by effects from pancreatitis. Patient eventually recovered well and was discharged from hospital.Relevance and impactWhen managing patients with gallstone pancreatitis, presence of persistent vomiting should raise suspicion of Bouveret’s syndrome. Bouveret’s syndrome can be diagnosed in these patients with aid of CT imaging or endoscopy. Stone extraction is required to treat Bouveret’s syndrome, endoscopic retrieval is first-line therapy as surgery has mortality risk of 12–30%. Prolonged recovery period can be expected due to concurrent inflammatory effects from acute pancreatitis.     

Mesenteric Meckel’s diverticulum or intestinal duplication cyst: A case report with review of literature

IntroductionA Meckel’s diverticulum (MD) is the most common congenital anomaly of the gastrointestinal (GI) tract. They arise from the middle-to-distal ileum. Contrary to MD, intestinal duplication cyst (IDC) is uncommon congenital anomaly of GI, but can occur anywhere from the tongue to the anus.Presentation of caseHere we report an 18-year-old male who presented to the department of abdominal surgery with chronic abdominal pain, frequent vomiting and mild abdominal distension. Following radiological investigation, a laparotomy was performed with the preoperative diagnosis of a mesenteric cyst. Intraoperativelly it became apparent that the cystic mass was on the mesenteric aspect of the small bowel without intestinal communication. Resection of the cyst was performed. Histological examination of the specimen revealed the presence of gastric tissue, which resembles MD. Although, the exact diagnosis of this cystic mass is ambiguous between MD and IDC, because of similar clinical signs, their complications and presence of gastric mucosa, however surgical treatment is gold standard of both.ConclusionThis case report underlines the necessity of how to differentiate between MD and IDC, although, surgical management is recommended for both.     

Esophageal adenocarcinoma after Nissen’s fundoplication for Barrett’s esophagus: report of a case

It remains unclear whether surgical treatment of gastro-esophageal reflux disease (GERD) and Barrett’s esophagus (BE) decreases the long-term risk of lower esophagus malignancy; yet, proposed reductions in Barrett’s epithelial transformation have been used as a rationale for antireflux surgery. We report the case of a 63-year-old woman with a 40-year history of GERD, whose symptoms returned after a Nissen fundoplication. A gastroscopy done 3 years later revealed BE. Despite close surveillance, adenocarcinoma of the lower esophagus was diagnosed 8 years after the original surgery. Thus far, there is insufficient evidence to convince practitioners that surgery should be the first line of treatment to prevent malignant change in BE. Further well-standardized, prospective trials are required. Our case demonstrates that antireflux surgery in a patient with GERD and BE cannot be relied upon to prevent adenocarcinoma.