Meckel’s cocoon: A rare case of abdominal cocoon with Meckel’s diverticulum

Abdominal cocoon syndrome (ACS), also known as sclerosing encapsulating peritonitis, is a rare cause of intestinal obstruction in which there is partial or total encapsulation of abdominal viscera within a dense fibrous membrane. It was first described by Foo et al. [1] in 1978. This condition was thought to be related to retrograde menstruation. However, sporadic cases have been reported in both children and men, hence the exact aetiology remains unknown. This disease is characterized as either primary (idiopathic) or secondary to other causes. It is often confused with peritoneal encapsulation (PE) which is a congenital anomaly. It invariably presents as an acute or subacute intestinal obstruction with or without a mass. Diagnosis is mostly made after exploratory laparotomy and histopathological analysis of the sac. Herein, we present the case of a 38-year-old male who presented with features of acute intestinal obstruction. At laparotomy, small bowel loops were found encased in a cocoon with a tight ring at the base which resulted in bowel wall necrosis; Meckel’s diverticulum was also present within the cocoon. Resection of the cocoon and anastomosis was performed. A better awareness of these conditions will facilitate proper management when encountered as an emergency.     

Medical teleconferencing with high-definition video presentation on the ‘usual’ Internet

Although medical teleconferences on advanced academic networks have been common (Telemed J E Health 15:112–117, 1; Asian J Endosc Surg 3:185–188, 2; Surg Today 41:1579–1581, 3; Telemedicine development center of Asia. http://www.aqua.med.kyushu-u.ac.jp/eg/index.html. Accessed 6 March 2013, 4), reports regarding ‘usual’ Internet teleconferences or tele-lectures employing a telecommunication system for business use are very rare. Medical teleconferences and tele-lectures on the Internet were held three times between our institutions and other institutions, using the ‘HD Com’ made by Panasonic (HD Com. http://panasonic.biz/com/visual/. Accessed 6 March 2013, 5), which is a high-definition telecommunication system for business tele-meeting. All of our medical telecommunications were successfully completed without any troubles. This system allows for all kinds of presentations using personal computers to be made from each station, so that discussions with high-definition surgical video presentation, which has recently been developed, could be effortlessly established despite the distance between institutions. Unlike telecommunication using advanced academic networks, this system can run without any need for specific engineering support, on the usual Internet. Medical telecommunication employing this system is likely to become common among ordinary hospitals in the near future.     

Tibial hemimelia with ‘mirror foot’

Mirror foot anomalies are extremely rare forms of duplications of toes. They can be associated with several other anomalies such as mirror hands, fibular dimelia, tibial hypoplasia/aplasia or facial deformities. A case of a mirror foot anomaly in association with an extremely rare variant of tibial hemimelia is presented. Other similar cases in the literature and modern theories regarding the aetiology are also presented.     

The effect of case-based discussion of topics with experts on learners’ opinions: implications for spinal education and training

Purpose

This investigation aimed to examine the extent to which case-based discussion with experts could influence the audience’s opinions on the treatment of patients during a continuing medical education event for spine surgeons.

Methods

We conducted a prospective controlled crossover study of 90 surgeons. During a continuing medical education activity using case-based discussion, quiz questions were used which asked participants (attendants and faculty group) their opinions on the best choices about diagnosis and treatment in a number of cases. No answer was considered correct, but we evaluated the number of participants choosing each specific answer among a number of valid options. Quiz questions were collected with an automated response system at the entry and at the end of each case discussion. Change in participant’s opinions was estimated from the change in the preferred answers between the entry and exit quizzes. Chi-square analysis was performed to determine significance.

Results

Sixty-two attendants out of eighty three (75%) and six faculties out of twelve (50%) responded to the survey. After the case discussion, 68.2% (p < 0.04, Chi-square test) of the attendants changed their opinion on the appropriate treatment. The faculty answers, however, showed no significant change in opinions regarding the identification of the appropriate treatment.

Conclusions

On the basis of our results, case-based discussion driven by experts, as a form of teaching, has a measurable effect in terms of changes in the learners’ opinions.

     

Evaluation of visible spinal arteries on computed tomography angiography before and after branched stent graft repair for thoracoabdominal aortic aneurysm

Objective

The aim of this study was to evaluate the impact of intercostal and lumbar segmental arteries (SAs) detectable on computed tomography angiography (CTA) on the risk of spinal cord ischemia (SCI) in patients undergoing single-step or two-staged branched endovascular aneurysm repair (BEVAR).

Low probability of Significant Intra-Abdominal Injury in Stable Patients with Abdominal ‘‘Seat Belt Sign’’

Abstract Study Objective:   Our aim was to determine the diagnostic significance of the association between the abdominal skin bruise from a seat belt and the presence of intraabdominal injury. Methods:   This was an observational analysis of prospectively collected data on 45 patients who presented with an abdominal seat belt sign to a level 1 trauma center following a motor vehicle accident between July 2004 and December 2007. The patients were evaluated by computed tomography (CT) scans or ultrasonography (FAST), depending on their hemodynamic stability. They were then hospitalized for treatment or observation. Results:   Forty-five patients [23 males (51.1%) and 22 females (48.9%)], with a mean age of 32.2 years (range 16–80 years), fulfilled entry criteria and were enrolled. Of these, 44 (97.8%) underwent CT, and one (2.2%) underwent FAST due to hemodynamic instability. two patients (4.4%) had intraabdominal injuries: one required surgery for bowel injury, and the other had a minor liver laceration, which was managed expectantly. Sixteen patients (35.5%) had concomitant injuries. The length of hospital stay ranged from 1–23 days (median 2.2 days). Conclusions:   Despite the widely accepted view that patients with an abdominal seat belt sign are more likely to have serious intraabdominal injuries, the results of our investigation showed no such association in a group of hemodynamically stable patients.     

The prevalence of chronic low back pain and lumbar deformities in patients with Parkinson’s disease: implications on spinal surgery

Purpose

This observational study was aimed at quantification of low back pain (LBP) in Parkinsonian patients and its morphological correlation.

Background

Parkinson’s disease (PD) is a common disabling condition in the elderly population. Parkinsonian patients frequently are troubled by LBP. Causes for LBP in PD are muscular imbalances by the movement disorder itself and skeletal degeneration.

Methods

Ninety-seven PD patients and 97 controls were inquired about low back pain through the Oswestry Low Back Pain Disability Questionnaire and visual analogue scales. Fifty-four patients with LBP underwent X-ray of the lumbar spine in two planes and flexion–extension views. Parkinson’s disease was characterized by stage, disease duration, motor score, lateralization of symptoms and dosage of medication.

Results

LBP occurred significantly more frequent in PD (87.6%) compared to controls (62.6%) with longer duration and higher pain intensity. Pain intensity and disability scores were associated with higher PD stages and higher motor scores. Patients with the hypokinetic PD subtype experienced more pain intensity. X-ray of the lumbar spine revealed lumbar arthrosis in 79.6%, scoliosis in 38.8% and spondylolisthesis in 24.1% of PD patients with LBP. Lateralization of scoliosis and PD symptoms were significantly correlated. Only a small portion of PD patients with LBP received specialized orthopaedic treatment.

Conclusion

LBP and lumbar degeneration are common in PD. Both are related to movement disorder symptoms. The knowledge about musculoskeletal conditions in Parkinson’s disease is important for an interdisciplinary conservative or operative treatment decision of LBP.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

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A South Indian cadaveric study on obturator neurovascular bundle with a special emphasis on high prevalence of ‘venous corona mortis’

Surgical procedures in the pelvic region are very challenging because of the complex anatomy of this region. “Corona mortis” is a term used to describe retro-pubic anastomosis between the obturator and external iliac vessels. It is considered as a key structure as significant haemorrhage may occur if the vessels are cut accidentally during pelvic surgeries. Earlier studies have documented a high frequency of venous anastomosis compared to its arterial counterpart. The objective of our study was to document the prevalence of venous corona mortis in South Indian human adult cadaveric pelvises. We conducted this study on 73 cadaveric pelvic halves. Out of the 73 hemi pelvises, 36 were normal without any variations of the obturator vessels while 37 hemi pelvises (51%) showed the presence of abnormal obturator vessels which proves to be a very high incidence in terms of variations. Out of the 37 hemi pelvises, 25 (68%) showed the presence of 2 obturator veins, out of which 1 was normal and the other was an abnormal obturator vein. 8 hemi pelvises (22%) had only abnormal obturator vein. Most of the abnormal obturator veins drained into the external iliac vein, while two veins drained into inferior epigastric veins. Venous corona mortis is said to be frequently encountered during surgery and is considered to be as important as arterial corona mortis in its clinical implications. Individual evaluation of this risky anatomical structure should be done prior to any surgical interventions.