Migration of a GI Foreign Body into Retro Peritoneum Without Peritonitis

Reporting an unusual case of a GI foreign body migrating to retro peritoneum without peritonitis. A middle aged male patient presented to the outpatient department with low back pain, on evaluation there was long slender radio opaque foreign body present in the pelvis. Explarotary laparotomy done, surprisingly it was found to be a suction canula(metallic) used when undergoing tonsillectomy two years ago.     

Actualización en el manejo de sarcomas retroperitoneales y pélvicos; el papel de la cirugía compartimental

Surgery for retroperitoneal sarcomas should be “en bloc” compartmental, which involves resection of unaffected organs. Its upfront use is key, providing a high percentage of resections with negative margins, resulting in a better local control and increased survival in many patients. Preservation of organs should be done in an individualized manner, especially in the pelvic location, and adapted to the histological aggressiveness of the tumor. Preoperative biopsy is able to establish the diagnosis of sarcoma subtype and consequently an adequate perioperative strategy. These patients should be managed by expert surgeons at referral centers with multidisciplinary units and oncology committees. The use of chemotherapy and radiotherapy is not yet well defined, so it is only recommended at referral centers with clinical trials. Currently, this is the only option to offer the best morbidity and mortality rates, as well as possible improvements in the survival of these patients.     

Retroperitoneal paraganglioma—Is pre operative embolization useful?

IntroductionParagangliomas (PG) are rare tumors derived from chromaffin cells that are located outside the adrenal gland and are capable of producing catecholamines. The treatment is based on a surgical resection, and there is controversy regarding the usefulness of previously carrying out an embolization and what is the most adequate surgical approach.Clinical caseWe will present a 17-year-old woman with a retroperitoneal tumour in contact with the aorta and the inferior vena cava, treated with embolization prior to the surgical resection via laparotomy.DiscussionThe PG tumors are very infrequent and originate in the extra-adrenal chromaffin cells that exist in the vicinity of the components of the autonomic nervous system. Most of them (86%) produce catecholamines, are unique, sporadic, benign and more frequent in middle-aged women. Since they are radioresistant tumors, the only possibility for a cure is by a complete surgical excision. The preoperative embolization has been described mainly as the treatment of cervical PG, although its use in abdominal PG is more controversial and is not done in a systematic manner.ConclusionWe can conclude that the embolization of abdominal PG is not free of risks and that it has not been demonstrated that it significantly reduces the peri-operative bleeding or the surgical time. Probably, the embolization should be reserved for intensively hypervascularized and larger PGs.     

Retroperitoneal cystic lymphangioma in an adult: A case report and review of the literature

Lymphangiomas are rare benign cystic tumors of the lymphatic system. Retroperitoneal lymphangiomas account for 1% of all lymphangiomas, and approximately 186 cases have been reported. They may clinically present as a palpable abdominal mass and can cause diagnostic dilemmas with other retroperitoneal cystic tumors, including those arising from the liver, kidney and pancreas. This report describes the rare case of a cystic retroperitoneal lymphangioma in a 54-year-old male patient. The lymphangioma had progressed to the point of inducing clinical symptoms of abdominal distention, abdominal pain, anorexia, fever, nausea and diarrhea. Radiological imaging revealed a large multiloculated cystic abdominal mass with enhancing septations involving the upper retroperitoneum and extending into the pelvis. Surgical removal of the cyst was accomplished without incident. A benign cystic retroperitoneal lymphangioma was diagnosed on histology and confirmed with immunohistochemical stains.     

Retroperitoneal disorders associated with IgG4-related autoimmune pancreatitis

Ig G4-related autoimmune pancreatitis is frequently accompanied by relevant lesions in the genitourinary tract and retroperitoneal organs, which cause various clinical problems, ranging from non-specific back pain or bladder outlet obstruction to renal failure. The diagnosis of Ig G4-related retroperitoneal fibrosis requires a multidisciplinary approach, including serological tests, histological examination, imaging analysis, and susceptibility to steroid therapy. Radiological examinations are helpful to diagnose this condition, but surgical resection is occasionally unavoidable to exclude malignancy, particularly for patients with isolated retroperitoneal involvement. Steroid therapy is the treatment of choice for this condition, the same as for other manifestationsof Ig G4-related disease.For patients with severe ureteral obstruction,additional ureteral stenting needs to be considered prior to steroid therapy to preserve the renal function.Some papers have suggested that Ig G4-related disease can affect male reproductive organs including the prostate and testis.Ig G4-related prostatitis usually causes lower urinary tract symptoms,such as dysuria and pollakisuria.Patients sometimes state that corticosteroids given for Ig G4-related disease at other sites relieve their lower urinary tract symptoms,which leads us to suspect prostatic involvement in this condition.Because of the limited number of publications available,further studies are warranted to better characterize Ig G4-related disease in male reproductive organs.     

Postoperative retroperitoneal desmoid tumor mimics recurrent gastrointestinal stromal tumor: A case report

Desmoid tumor is a locally invasive, myofibroblastic, nonmetastatic tumor. Its pathogenesis remains unclear and it may involve genetic abnormalities, sex hormones and traumatic injury, including surgery. Postoperative intra-abdominal desmoid tumor is rare, especially in the retroperitoneum. We report a case of postoperative retroperitoneal desmoid tumor that developed 29 mo after the first excision of a gastrointestinal stromal tumor. Sporadic trauma-related intra-abdominal desmoid tumors reported in the English literature are also reviewed. Despite an extremely low incidence, postoperative desmoid tumor should be considered in the differential diagnosis when a recurrent neoplasm is found at least one year after operation. However, it is a clinical challenge to distinguish recurrent malignant neoplasms from desmoid tumors, and surgical resection is the treatment option depending on the anatomic location.     

腹膜后孤立性纤维瘤的CT表现(附2例报道并文献复习)

目的探讨腹膜后孤立性纤维瘤的CT影像学特征。方法回顾性分析2例经病理证实的腹膜后孤立性纤维瘤的CT影像学表现,并与病理组织学结果作对照分析。结果腹膜后孤立性纤维瘤的CT表现为巨大的境界清楚的肿块,由两种不同密度的实质成分组成,增强扫描显著强化,动脉期瘤内可见肿瘤血管影,静脉期肿瘤持续强化,并可见强化的包膜。病理学检查肿瘤细胞呈梭形,间质为增生的胶原纤维,肿瘤由细胞密集区和细胞疏松区组成,免疫组化示CD34阳性。结论腹膜后孤立性纤维瘤的CT影像学表现具有一定的特征性,病理形态学及免疫组织化学检查可以明确诊断。     

Primary retroperitoneal mature cystic teratoma in an adult: A case report

BackgroundMature cystic teratoma is one of the most common tumors of the ovaries; however, primary retroperitoneal lesions are rare entities in adults.Case summaryWe report a case of a 33 year-old woman noticing a mass in her epigastric and left upper abdominal region without any specific signs and symptoms. Radiological evaluation revealed a retroperitoneal mass with extension from the posterior aspect of the pancreas to the pelvic cavity, composed of calcifications and cystic elements.ConclusionThe tumor was resected through a midline laparotomy and the pathology report confirmed the diagnosis of a mature cystic teratoma with no evidence of malignancy or immature components.     

Laparoscopic treatment of retroperitoneal cystic mesothelioma. Two cases reported

Retroperitoneal cystic mesothelioma is a very rare lesion. The pathogeny is unclear and establishing a preoperative diagnosis versus others retroperitoneal cystic lesions is difficult.Thus, with increasing experience in laparoscopic retroperitoneal surgery, the use of this approach for exploration of a retroperitoneal mass of unknown origin may provide an alternative to classic open surgery and all the benefits of laparoscopy. We present two cases treated laparoscopycally and review the literature.