Post-splenectomy splenosis presenting as hepatocellular carcinoma in the left lateral section of the liver: A case report

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.     

Complete colonic duplication--a case report

Duplications of the entire colon are very rare. An 18-month-old boy presented with symptoms of chronic constipation and was noted with a complete colonic duplication. The presentation and management are discussed.     

A case of duodenal intramural metastasis from gastric cancer

INTRODUCTIONHere, we report a case of duodenal intramural metastasis from gastric cancer, which is extremely rare.PRESENTATION OF CASEA 72-year-old man was admitted to our hospital with a chief complaint of lack of appetite in 2010. An endoscopic evaluation detected a Borrmann type 2 tumor occupying the lesser curvature of the gastric body and antrum, and pyloric stenosis. The patient underwent total gastrectomy. In an examination of the resected specimen, a type 2 tumor was identified in the middle gastric body and antrum, and a submucosal tumor was detected in the duodenal bulb. A histopathological examination demonstrated that the gastric tumor was not contiguous with the duodenal submucosal tumor. A microscopic examination demonstrated that the gastric tumor was a moderately to poorly differentiated adenocarcinoma and displayed lymphatic permeation. The duodenal submucosal tumor was also found to be an adenocarcinoma and was similar to the gastric tumor; therefore, we diagnosed the duodenal tumor as an intramural metastasis from gastric cancer.DISCUSSIONThe most common route of metastasis from gastric cancer involves hematogenous metastasis, lymph node metastasis, and peritoneal metastasis. Intramural metastasis from gastric cancer is rare and has been reported to be a variant of lymphogenic metastasis. The clinicopathological features of patients with duodenal intramural metastasis from gastric cancer are unclear because only one case of the condition has been reported.CONCLUSIONDuodenal intramural metastasis from gastric cancer is an advanced form of cancer, and we suggest that it should be treated with surgical resection followed by adjuvant therapy.     

腹腔镜下外伤性脾破裂切除加自体脾移植术的临床研究(附7例报告)

目的:探讨腹腔镜下外伤性脾破裂切除加自体脾移植术的临床意义及并发症的预防。方法:回顾分析7例经腹腔镜行腹腔探查并实施外伤性脾脏切除,同时腔镜下行自体脾移植术的资料。结果:术后1例出现脾窝积液、胸腔积液、胰漏,经过抗感染及抑酶和胸穿抽胸水治疗后痊愈,1个月后拔上腹引流管。其余6例术后均无脾窝积液、脾热及切口感染,术后第2天离床活动,住院7~30d。结论:只要把握好适应证,腹腔镜下外伤性脾破裂切除加自体脾移植术是一种理想的保脾术式,创伤小,康复快,手术效果理想。     

肝内异位脾种植6例报告并文献复习

背景与目的：肝内异位脾种植（ES）在临床上较为罕见,患者多在体检中偶然发现肝内病灶,极易误诊为肝脏的良性或恶性肿瘤而影响治疗。因此,本研究探讨肝内ES的临床特点及其诊治方法。方法：回顾性分析总结2015年1月—2022年1月上海东方肝胆外科医院收治的肝内ES患者的临床资料,并行相关文献复习。结果：6例肝内ES患者中,男性4例,女性2例;年龄39～78岁,中位年龄51岁。均有外伤致脾破裂出血行脾切除手术史,脾切除术后至初诊肝内ES时间为20～33年,中位时间27年;4例为单纯肝内ES,2例为肝脏合并膈肌多发ES;伴有右上腹不适者1例,其余5例均在体检中发现;术前MRI或CT检查5例拟诊为肝癌,1例拟诊为血管平滑肌脂肪瘤。6例患者均行肝切除手术。术后病理均证实为异位脾组织,肝内ES灶大小为1.5～5.9 cm,中位直径3.2 cm,其中1例肝内2个病灶病理结果分别为肝内ES和肝细胞癌。6例患者术后恢复顺利,随访半年均未发现新发ES病灶。文献复习结果显示,脾外伤或脾切除术后,90%的ES发生于腹腔内,以小肠浆膜、大网膜、壁层腹膜、肠系膜及盆腔多见,而发生于肝脏、膈肌或其他远隔器官较为罕见。结...     

Intramural colonic splenosis: a rare case of lower gastrointestinal bleeding

BACKGROUND: A 41-year-old man had left upper quadrant abdominal pain, constipation, and melena. About 6?years previously, he received a single gunshot wound to the abdomen, which required partial gastrectomy and small bowel resection. He subsequently developed bleeding gastric varices for which he underwent a splenectomy 2?years before the current admission. DISCUSSION: A CT scan identified a 6.5?×?2.5?cm left upper quadrant mass. Upper endoscopy was unremarkable, but on colonoscopy, a 3-cm polypoid mass partially obstructed the descending colon. A left hemicolectomy was performed with a primary colonic anastomosis and incidental appendectomy. The mass involved the muscularis of the colon and caused ulceration of the mucosa was ectopic hyperplasic splenic tissue, indicating intramural colonic splenosis. We hypothesize that after the patient's splenectomy, a colonic focus of heterotrophic spleen became hyperplastic and led to a clinically apparent lesion.     

Occult gastrointestinal bleeding and abdominal pain due to entero-enteric intussusception caused by splenosis

Intussusception is rare in adults. We report the first known case of adult intussusception caused by splenosis. The patient had chronic gastrointestinal bleeding and intermittent abdominal pain. The diagnosis of entero-enteric intussusception was made by CT scan. A laparoscopic-assisted small bowel resection was performed, leading to resolution of the symptoms.     

A case of colonic gas explosion caused by electrocautery

Journal of Anesthesia -     

An unusual case of primary colonic dedifferentiated liposarcoma

INTRODUCTION

İn this paper, we present a rare case of primary dedifferantiated liposarcoma (DDLS) of the colon, management of which is unclear and difficult to cope with.

PRESENTATION OF CASE

71 year old female patient with complaints of abdominal pain and swelling was referred to our clinic with the diagnosis of intraabdominal mass. 23 cm × 19 cm × 18 cm tumor starting from the neighborhood of left liver lobe and extending toward pelvic floor was detected on computed tomography. At laparotomy, a multilobulated, soft and yellowish mass was arising from transvers colon and invading greater curvature of stomach. En-bloc removal of the tumor including segmental colon and gastric wedge resection was performed. Postoperative histopathological diagnosis was consistent with dedifferentiated liposarcoma.

DISCUSSION

Liposarcomas are rarely encountered in the gastrointestinal tract. Previously, only ten cases of primary liposarcoma of the colon have been reported worldwide and to our knowledge DDLS of transverse colon is the first case reported in the literature. DDLS is a high-grade aggressive tumor carrying the ability to metastasize. Despite complete removal of tumor recurrence is common in DDLS.

CONCLUSION

The constellation of findings in our patient demonstrates that liposarcomas which histologically exhibit dedifferentiation are associated with a poor clinical prognosis and advocating surgery alone is not recommended.     

不同术式治疗结肠慢传输型便秘的疗效比较

目的对比观察结肠慢传输型便秘的4种外科术式治疗效果.方法回顾性总结1990年10月至2002年11月施行的89例94例次的手术治疗资料,数据处理采用t检验.结果行结肠全切除术6例,术后短期内腹泻6例（100%）,难治性腹泻1例（16.7%）,无便秘复发;结肠次全切除术73例,短期内腹泻19例（26%）,明显低于结肠全切除术（t=1.90,P＜0.05）,无难治性腹泻,复发1例,出现吻合处梗阻1例,切口感染2例;盲直肠端侧吻合术12例,疗效与结肠次全切除术相同,但手术时间和失血量均明显少于结肠次全切除术（t=2.849和10.455,P＜0.01）;结肠部分切除术3例,均于短期内复发.本组病例无手术死亡、吻合口瘘发生.结论结肠次全切除、结肠全切除和盲直肠端侧吻合术对结肠慢传输型便秘均有满意的疗效,应根据患者的具体病情选择术式,但结肠全切除术后腹泻发生率高,结肠部分切除术疗效不肯定.     

Acute colonic occlusion over endometriosis: About a case

The gastrointestinal tract is the most common site of extra pelvic endometriosis, with the rectum and sigmoid colon being the most frequently affected areas. Its diagnosis is still very difficult, especially when it manifests itself as an acute occlusion. We report the case of a patient admitted to the emergency room for an occlusive syndrome on a sigmoid process and who was operated on with colorectal resection and it was the anatomopathological examination that led to the diagnosis of endometriosis.     

Surgical management of colonic perforation due to ulcerative colitis during pregnancy: Report of a case

This report describes a young female in her secondtrimester of pregnancy with known ulcerative colitis onmaintenance medical therapy. She was admitted forabdominal pain, and workup revealed a colonic stric-ture and ulceration with contained perforation. Aftermultidisciplinary discussion she was managed withcolectomy and end ileostomy. She delivered a healthynewborn 18 wk after surgery. Only a few prior reportsdescribed surgical management of inflammatory boweldisease during pregnancy, with recent results indicatinglow risk of adverse outcomes.     

How to mimic a type A intramural hematoma: A case of IgG4-related aortitis associated with cerebral hemorrhage

IgG4-related aortitis is an inflammatory condition of the aorta, characterized by aortic wall thickening and periaortic soft-tissue involvement. Therefore, this condition can mimic an aortic intramural hematoma (IMH), due to similar radiological findings. We hereby report the case of an IgG4-related aortitis misdiagnosed as an IMH, associated with cerebral hemorrhage, possibly due to cerebral vascular system involvement.     

Imaging in colonic cancer

Whilst the diagnosis of colonic cancer is always based on visually guided flexible colonoscopy, which is the only technique that provides a histological diagnosis, the pre-treatment assessment of the cancer involves computed tomography. This can determine the exact site of the cancer in the colon, its dimensions and juxta-colonic extension and is used to investigate for liver, mesenteric or lung metastases.     

The effect of diverticular disease on the colonic J pouch

OBJECTIVE: The aim of this study was to assess the impact of the diverticular disease (DD) on function and on postoperative complications of the colonic J-pouch (CJP) with pouch-anal anastomosis. METHODS: Patients who underwent a CJP between December 1990 and August 2001, were retrospectively reviewed. The presence of DD in the CJP was assessed on pouchogram prior to ileostomy closure. A questionnaire designed to evaluate the degree of continence (total incontinence score (IS): 0 = worst, 20 = best) and pouch evacuation (total evacuation score (ES): 0 = worst, 28 = best) was used for comparison between patients with DD and those without DD (NDD). RESULTS: Sixty-six patients (47 males; 19 females) with a median age of 68 years (range 28-87 years) were included. The median follow-up period was 22 months (range 2-106 months). Twenty-four patients comprised the DD group and 42 were in the NDD group. The two groups were comparable for age, gender and time from ileostomy closure; all patients with postoperative chemoradiation therapy were in the NDD group. The total ES and IS total did not significantly differ between the two groups with a P-value of 0.11 and 0.09 respectively. Furthermore, there was no significant difference in the total incidence of pouch complications between the two groups (3 strictures, 1 leak, 1 fistula in the NDD group vs. 1 pelvic sepsis in the DD group; P = 0.4). CONCLUSIONS: The presence of DD in a CJP does not seem to impact pouch function or the postoperative complication rate.     

Hirschsprung's disease in an infant with colonic atresia and normal fixation of the distal colon

The coexistence of colonic atresia and Hirschsprung's disease presents a diagnostic and therapeutic challenge. Colonic atresia is quickly recognized, and the majority of patients are diverted shortly after birth. The diagnosis of coincident Hirschsprung's disease usually is made after anastomotic failure after restoration of intestinal continuity. A recent compilation of these patients has suggested that Hirschsprung's disease may be predicted on the basis of nonfixation of the colon distal to the atresia. However, we recently cared for an infant with transverse colonic atresia and total colonic aganglionosis associated with normal orientation and fixation of the distal colon.     

食管胃壁内吻合术对抗反流作用的临床研究

目的 探讨食管胃壁内吻合术重建贲门功能对预防食管下段癌、食管胃交界癌术后反流性食管炎的作用.方法 回顾性分析2002年1月至2008年10月西安交通大学医学院第二附属医院对66例食管下段癌、食管胃交界癌患者(研究组)施行胸腔食管胃壁内吻合术的临床资料.同期行器械吻合的65例患者为对照组.两组术后情况进行比较,采用X~2和t检验统计分析.结果 (1)反流程度:研究组3例为Ⅰ度,63例为0度;对照组16例为0度,23例为Ⅰ度,19例为Ⅱ度,7例为Ⅲ度.两组比较差异有统计学意义(X~2=137.3,P<0.05).(2)钡餐透视:研究组12例有少量钡剂反流,对照组有41例钡剂反流,两组比较差异有统计学意义(X~2=27.4,P<0.05).(3)胃镜检查:研究组9例黏膜改变,对照组46例黏膜改变,两组比较差异有统计学意义(X~2=43.5,P<0.05).(4)食管括约肌压力:研究组食管下括约肌压力为(3.4±0.8)kPa,食管上括约肌压力为(7.4±1.7)kPa;对照组分别为(2.5±0.6)kPa、(4.2±0.8)kPa.两组比较差异有统计学意义(t=4.98,11.59,P<0.05).结论 食管胃壁内吻合术能够部分达到贲门功能重建的作用,可较好预防反流性食管炎的发生.