A case of retroperitoneal venous aneurysm]

A case of retroperitoneal venous aneurysm is reported. A 73-year-old woman was referred to us with the chief complaint of left abdominal mass. A giant abdominal mass was palpable and diagnostic imaging examination including ultrasound tomography, excretory pyelography, computed tomography, magnetic resonance imaging and angiography revealed a giant cystic mass encircled by calcification in the left retroperitoneal space. Operation for this cystic mass was performed under the preoperative diagnosis of a giant left renal cyst. During operation the mass was located between the left kidney and the left adrenal gland. Because it was difficult to separate the mass from the left kidney the mass was removed with the left kidney. The extirpated tumor measured 15.5 x 15.0 x 9.5 cm and contained old blood clots and red-yellow colored fluid. A histological examination revealed that the tumor wall was composed of smooth muscle and elastic fibers. Therefore, pathological diagnosis was retroperitoneal venous aneurysm. Retroperitoneal venous aneurysm is very rare. To our knowledge, this is the 8th case of retroperitoneal venous aneurysm reported in Japan.     

Venous aneurysm of V. saphena accessoria--a case report

A 43-year-old male was admitted for subcutaneous mass of rt. inguinal lesion. Saccular dilatation of vein is a rare phenomenon and usually termed "venous aneurysm". Venous aneurysm has been reported in the following vein: face, neck, extremities, superior vena cava region, portal vein region and by-pass grafting vein. This is the 1st report of a venous aneurysm found in V. saphena accessories in Japan. The true etiology is unknown, but underlying causes which produce damage to the venous wall (trauma, inflammation, congenital weakness, and localized degenerative change) have been mentioned as possible causes. Rarely, thrombosed venous aneurysm may cause pulmonary emboli. Definitive diagnosis is established by venography. Venous aneurysm often increases or reduces in size according to the change of venous pressure by proximal vein compression postural change and Valsalva maneuver. In general, surgical resection of the aneurysm is the treatment of choice.     

Abdominal aortic aneurysm with aorta-left renal vein fistula with left varicocele

Abdominal aortic aneurysm with spontaneous aorto-left renal vein fistula is a rare but well-described clinical entity usually with abdominal pain, hematuria, and a nonfunctioning left kidney. This report describes a 44-year-old man with left-sided groin pain and varicocele who was treated with conservative measures only. The diagnosis was eventually made when he returned with microscopic hematuria, elevated serum creatinine level, and nonfunction of the left kidney; computed tomography scan demonstrated a 6-cm abdominal aortic aneurysm, a retroaortic left renal vein, and an enlargement of the left kidney. This patient represents the youngest to be reported with aorto-left renal vein fistula and the second case with a left-sided varicocele.     

Mycotic aortocoronary saphenous vein graft aneurysm presenting with unstable angina pectoris

We report the case of a 60-year-old man with a history of coronary bypass surgery 20 years prior who had a fever, chest pain, and a mediastinal mass develop after a complicated postoperative course of abdominal aortic aneurysm resection. A mycotic aneurysm of the saphenous vein graft to his left anterior descending coronary artery was diagnosed based on blood culture results and visualization of the aneurysm before resection. A summary of the saphenous vein graft aneurysm and pseudoaneurysm cause, diagnosis, and management is detailed.     

不孕症合并来源于下降不良卵巢的肿瘤两例并手术图文数据库和文献复习

目的由2例不孕症探查术中发现的特殊病例启发,回顾既往手术病例并检索复习文献,探讨卵巢下降不良的临床意义。方法报道2例原因不明腹腔包块或腹水合并不孕的病例,并回顾性分析2014年4月至2016年11月本院妇科内分泌组手术图文数据库中1 275例病例资料,结局指标包括不同手术指征病例中卵巢下降不良的发生率、不孕病例的妊娠结局等。结果因特发性不孕行腹腔镜检查的患者中,卵巢下降不良的发生率约为1.1%(11/988例)。其中,4例合并苗勒管畸形的患者中1例伴发Leydig细胞瘤,因肿瘤位于盆腔上方的卵巢上极,术前未能诊断;1例伴发不明原因腹水,术中方诊断粘液性囊腺瘤。4例合并子宫肌瘤、子宫内膜异位症、盆腔粘连、多囊卵巢综合征等不孕因素,3例除卵巢位置形态变异外无特殊发现。随诊至2017年4月,5例自然妊娠,1例IVF-ET妊娠,总体妊娠率54.5%。结论卵巢下降不良是一种罕见的先天性异常,最常见于不孕患者的手术检查中,不是导致不孕的独立因素。下降不良的卵巢和肿瘤之间的关系并不明确,其特殊的位置可能给术前诊断带来挑战。     

Left Renal Vein Anomaly Associated with Abdominal Aortic Aneurysm Surgery: Report of a Case

Retroaortic left renal vein occurs infrequently and poses potential hazards to the surgeon during abdominal aortic surgery. We herein report the case of a 77-year-old man with a retroaortic left renal vein who underwent an abdominal aortic aneurysm (AAA) repair. The retroaortic left renal vein was diagnosed preoperatively by contrast-enhanced computed tomography (CT). The patient underwent a successful abdominal aortic replacement with an uneventful postoperative course without any renal complications. The CT scan was useful for both evaluating the AAA and for establishing the presence of the venous anomaly. Major venous anomalies (retroaortic left renal vein, left renal vein collar, left-sided inferior vena cava, and caval duplication) should thus be taken into consideration in AAA operations.     

Heparin-induced thrombocytopenia with thrombosis after endovascular aneurysm repair

Heparin-induced thrombocytopenia is an immune-mediated syndrome that results from unfractionated heparin or low molecular weight heparin exposure. It often remains unrecognized and undertreated and can cause limb and/or life-threatening thrombosis. The authors present 2 cases of thrombosis: one arterial and the other venous that occurred following endovascular abdominal aortic aneurysm repair. To the authors' knowledge, this is only the second report of arterial thrombosis and the first of deep vein thrombosis as a result of heparin-induced thrombocytopenia developing following endovascular abdominal aortic aneurysm repair. This underscores the importance of considering heparin-induced thrombocytopenia as a potential cause for postendovascular thrombotic complications in the patient who develops thrombocytopenia following this procedure.     

Iliofemoral venous obstruction without thrombosis

Nonthrombotic iliofemoral venous obstruction, masquerading as deep vein thrombosis, was diagnosed in four patients. In each instance the patient was hospitalized and intravenous heparin therapy was started. Phlebography demonstrated venous outflow obstruction without thrombosis; subsequent CT scanning revealed an obstructing lesion in each case. At surgical exploration, (1) endoaneurysmorrhaphy of a hypogastric artery aneurysm decompressed an obstructed right iliac vein; (2) a primary iliac vein leiomyosarcoma was extirpated; (3) a synovial cyst arising from the right hip joint, which obstructed the femoral vein, was excised; and, (4) a postherniorrhaphy inflammatory mass obstructing the left iliofemoral vein junction was confirmed with biopsy results. Improved diagnostic accuracy with its attendant specific therapy is achieved in suspected cases of iliofemoral vein thrombosis if, in addition to noninvasive venous studies or phlebography, CT scanning of the abdomen and pelvis is performed.     

Laparoscopic treatment of ovarian vein syndrome.

BACKGROUND: Ovarian vein syndrome is a rare cause of teral obstruction. In this report, we describe an unusual presentation of the syndrome successfully treated with laparoscopic techniques. METHODS: The patient presented with a 12-month history of right flank pain and a right abdominal mass. The preoperative evaluation revealed renal malrotation, hydronephrosis, decreased renal function, and presumed ureteropelvic junction obstruction. RESULTS: By using a transperitoneal laparoscopic approach, an enlarged ovarian vein was identified as the cause of the ureteral obstruction. The ovarian vein was divided with a laparoscopic stapler. The patient's postoperative course was unremarkable, and she was discharged from the hospital on the second postoperative day. At 3-months follow-up, the patient was completely asymptomatic without evidence of obstruction. DISCUSSION: Ovarian vein syndrome remains a rare diagnosis of exclusion. A careful preoperative evaluation is required to exclude other causes of ureteral obstruction. By using a laparoscopic approach, the ureter and obstructing vessel were readily identified to effectively treat the patient. With the minimally invasive approach, postoperative recovery and patient quality of life were improved.     

Vein compression by arterial aneurysms

This study was done to emphasize the importance of early, accurate diagnosis of arterial aneurysms that show the symptoms of venous obstruction. Fourteen patients were identified as having atherosclerotic aneurysms producing venous compression. Nine patients had popliteal aneurysms, causing popliteal vein thrombosis in three patients and vein compression without thrombosis in six patients. Five patients had iliac artery aneurysms, producing left iliac vein thrombosis in one patient and venous compression without thrombosis in four patients. In 10 patients the cause of the venous compression symptoms was correctly identified and appropriate revascularization was performed with successful results. In four patients, two with iliac artery aneurysms and two with popliteal artery aneurysms, the associated aneurysm was not identified. One patient died of a ruptured aneurysm and three patients had below-knee amputations because of untreatable distal ischemia. Inappropriate treatment of patients with venous obstruction from unrecognized arterial aneurysms is associated with unacceptable morbidity and mortality. Accurate diagnosis with timely aneurysm repair eliminates the risk of aneurysm rupture or thrombosis and simultaneously alleviates venous compression symptoms.     

Abdominal actinomycosis: a report of two cases

Actinomyces spp. cause a chronic suppurative, granulomatous disease which is characterized clinically by extensive abscess formation, recurrent draining of sinuses and fistulae and histologically by the presence of the so-called "sulphur granules". Colonic actinomycosis is a relatively rare infection and its diagnosis is difficult. We report the case of a female patient who was operated on for ovarian cyst and the case of another female patient operated on for a mass in the transverse colon. In both cases the pathology of the excised tissues revealed actinomycosis. Actinomycosis must be considered in the differential diagnosis of patients who present with abdominal pain, fever, leucocytosis and intestinal wall thickness and/or abdominal mass.     

Two types of major venous anomalies associated with abdominal aneurysmectomy: A report of two cases

We report herein the cases of two patients with major venous anomalies associated with abdominal aneurysmectomy, one being an isolated left-sided vena cava and the other, a retroaortic left renal vein, and discuss the clinical significance of such anomalies. In the first patient, an isolated left-sided vena cava was correctly diagnosed preoperatively by contrast-enhanced computed tomography (CE-CT) and digital subtraction angiography (DSA) which revealed that the vena cava crossed the normal portion of the aorta and the right renal vein ran cephalad. In the second patient, a retroaortic left renal vein was also preoperatively diagnosed with CE-CT and DSA. In both patients, dissection was performed, taking care to avoid injury to anomalous venous tributaries, and graft replacement for abdominal aneurysm was successfully carried out. Thus, careful preoperative evaluations using such imaging techniques as CE-CT, DSA, and venographic studies, are important for establishing the presence of an associated venous anomaly preoperatively to ensure the success of abdominal aneurysmal surgery.     

Lymphoepithelial cysts of the pancreas: Case report and review of the literature

The aim of this report was to describe the clinical and pathologic features of lymphoepithelial cysts of the pancreas, establish the differential diagnosis of other pancreatic cysts, and review the literature.A 53-year-old man was incidentally diagnosed with a pancreatic lesion after an abdominal CT scan. This study showed a solid mass in the tail of the pancreas not enhanced by helical CT. Endoscopic ultrasound examination revealed a low-density tissue mass on the surface of the pancreas, less echogenic than the surrounding parenchyma. Distal pancreatectomy and splenectomy were performed with a suspected diagnosis of mucinous cystic tumor. The patient has had an uneventful postoperative period, and the pathologic finding was a lymphoepithelial cyst of the pancreas. Lymphoepithelial cyst of the pancreas is an unusual and benign entity that must be taken into consideration when evaluating a cystic lesion of the pancreas because a different therapeutic approach may be required.     

Saphenous vein graft aneurysm: potential for mistaken identity

We report the unusual presentation of a saphenous vein graft aneurysm in a 72-year-old man who had undergone coronary artery bypass surgery 15 years prior to admission. The patient presented with a large mass on the anterior wall of the right ventricle and chest discomfort; initially believed to be a cardiac tumor. The patient underwent reoperative coronary surgery with excision of the saphenous vein graft aneurysm, followed by an uneventful postoperative course. Aortocoronary saphenous vein graft aneurysms are rare and their presentation may be mistaken for pulmonary or chest wall lesions. Complications include rupture, and therefore require attentive diagnosis and surgical therapy.     

A case of urachal xanthogranuloma suspected to be a urachal tumor

A 47-year-old female consulted our hospital with the chief complaints of lower abdominal pain and fever. There was a palpable mass in the lower abdomen. The patient had undergone oophorectomy by lower abdominal median incision. Ultrasonography, computed tomography, and magnetic resonance imaging (MRI) demonstrated a cystic mass above the bladder dome extending to the umbilicus, which was strongly suspected to be a urachal tumor. Enhanced T1 weighted MRI showed a mass enhanced by contrast media. Partial cystectomy with urachal resection was performed by lower abdominal median incision. The histological diagnosis was xanthogranuloma. This is the thirteenth case report of xanthogranuloma of the urachus in the Japanese literature.     

Large external iliac vein aneurysm in a patient with a post-traumatic femoral arteriovenous fistula

We report about a young patient with a large aneurysm of the left external iliac vein associated with a traumatic arteriovenous fistula between the left superficial femoral artery and the femoral vein after a stab wound 20 years ago. The patient presented with swelling of the left leg, which developed during the past years and worsened after saphenectomy 12 months before hospital admission. The chronically hyperperfused common iliac artery proximal to the arteriovenous fistula was compressing the common iliac vein. The venous outflow obstruction and subsequent venous hypertension render a possible explanation for the formation of the iliac vein aneurysm. Surgical repair of the venous aneurysm by interposition grafting and closure of the arteriovenous fistula was successful. A postoperative computed tomography scan showed a 50% size reduction of the feeding artery, underlining the ability of the arterial system to normalize arterial diameter in response to flow reduction, even after a high flow situation had existed for probably >20 years.     

Abdominal aortic and iliac aneurysm presented as lower limb deep vein thrombosis: case report

Abstract

Introduction: We report a rare case of a symptomatic abdominal aneurysm presented as a lower limb deep vein thrombosis (DVT).

Case presentation: A 63-year old male presented to our hospital with a recent progressive onset of the right lower limb swelling and pain. The patient had a history of a previous cardiovascular disease. A Duplex ultrasound was performed, which confirmed a right lower limb DVT extending to the right iliac vein. The patient had a pulsatile abdominal mass. Computed tomography scan of the abdomen showed an abdominal aortic and a right iliac artery aneurysm compressing the thrombosed inferior caval and the right iliac vein. The patient was treated with low molecular weight heparin. After resolution of the DVT on day 3 of hospitalization, a surgery on the abdominal and iliac artery aneurysm was performed. The aneurysm was resected and an aortobifemoral bypass was placed using a Dacron prosthesis. The patient remained to be asymptomatic for 6 months after the surgery. Follow up computed tomography demonstrated a fully patent inferior caval and iliac vein and the absence of the aneurysmal disease.

Conclusion: Although rare, our case confirms that the DVT should be considered as a possible symptom of an abdominal aneurysm in selected patients.     

Abdominal Actinomycosis: a Report of Two Cases

Actinomyces spp. cause a chronic suppurative, granulomatous disease which is characterized clinically by extensive abscess formation, recurrent draining of sinuses and fistulae and histologically by the presence of the so-called “sulphur granules”. Colonic actinomycosis is a relatively rare infection and its diagnosis is difficult. We report the case of a female patient who was operated on for ovarian cyst and the case of another female patient operated on for a mass in the transverse colon. In both cases the pathology of the excised tissues revealed actinomycosis. Actinomycosis must be considered in the differential diagnosis of patients who present with abdominal pain, fever, leu-cocytosis and intestinal wall thickness and /or abdominal mass.     

Saphenous Vein Graft Aneurysm: Potential for Mistaken Identity

Abstract We report the unusual presentation of a saphenous vein graft aneurysm in a 72‐year‐old man who had undergone coronary artery bypass surgery 15 years prior to admission. The patient presented with a large mass on the anterior wall of the right ventricle and chest discomfort; initially believed to be a cardiac tumor. The patient underwent reoperative coronary surgery with excision of the saphenous vein graft aneurysm, followed by an uneventful postoperative course. Aortocoronary saphenous vein graft aneurysms are rare and their presentation may be mistaken for pulmonary or chest wall lesions. Complications include rupture, and therefore require attentive diagnosis and surgical therapy.     

A case of mediastinal thoracic duct cyst]

This is a rare case of thoracic duct cyst in 34-year-old woman. She complained of a left supraclavicular mass and admitted our hospital. A clinical examinations were all within normal limit. The chest X-ray and the magnetic resonance imaging examinations revealed a round tumor 65 x 40 mm in diameter with clear margin located at the left upper mediastinum. The slightly dilated thoracic duct was connected to the tumor. The left supraclavicular vein was compressed by the tumor. The cystectomy was performed under diagnosis of thoracic duct cyst by Trap door method on September, 17, 1999. Macroscopically, thin-capsulated elastic soft tumor contained chyle, and it was connected to the thoracic duct and the left jugular vein. The histological diagnosis was thoracic duct cyst. The postoperative course was uneventful, and the patient was discharged 9 days after operation. The patient remains disease-free at 8 months after the operation.