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Gynecologic Oncology Reports Jun 2024Cecal volvulus is a rare and life-threatening cause of intestinal obstruction with multiple risk factors including prior abdominal surgery and cecal hypermobility....
Cecal volvulus is a rare and life-threatening cause of intestinal obstruction with multiple risk factors including prior abdominal surgery and cecal hypermobility. Although its incidence has been reported after common procedures such as cholecystectomy and appendectomy, it has not been well studied after laparoscopy, especially in gynecological surgeries. If untreated, a cecal volvulus can result in serious complications such as intestinal strangulation, necrosis, or perforation. Therefore, early identification of risk factors and intervention is important in prevention of these sequelae. Here, we report a case of cecal volvulus in a patient with endometrial carcinoma after a staging robotic-assisted laparoscopic hysterectomy and the risk factors that may have led to her complication.
PubMed: 38765696
DOI: 10.1016/j.gore.2024.101404 -
Journal of Surgical Case Reports May 2024Postoperative pneumothorax is a well-known but relatively rare complication after laparoscopic surgery. Herein, we report a case of persistent pneumothorax after...
Persistent pneumothorax after laparoscopic appendectomy in a patient who had undergone radical esophagectomy 5 years before: possible relationship with vulnerability of the hiatus after esophagectomy: a case report.
Postoperative pneumothorax is a well-known but relatively rare complication after laparoscopic surgery. Herein, we report a case of persistent pneumothorax after laparoscopic appendectomy. A 57-year-old male, with a history of minimally invasive esophagectomy and intrathoracic gastric tube reconstruction 5 years before, underwent a laparoscopic appendectomy. A chest X-ray taken on postoperative Day 1 revealed the development of the right pneumothorax, which took more than 3 days to resolve spontaneously. Although the mechanism of postoperative pneumothorax was unclear, it seemed likely that the air that had replaced carbon dioxide in the peritoneal cavity migrated into the thoracic cavity through the esophageal hiatus, which was not covered by the peritoneum or pleura after surgical resection. The present case, together with our previous similar case, suggests that a history of esophageal cancer surgery increases the risk of pneumothorax after laparoscopic surgery, probably regardless of when this was performed.
PubMed: 38764740
DOI: 10.1093/jscr/rjae308 -
Journal of Surgical Case Reports May 2024Meckle's diverticulum is the most common embryological anomaly of the small bowel that is rarely seen in adults. It is caused by the incomplete closure of the vitelline...
Meckle's diverticulum is the most common embryological anomaly of the small bowel that is rarely seen in adults. It is caused by the incomplete closure of the vitelline or omphalomesenteric duct. Those who are symptomatic from Meckle's diverticulum have varied clinical presentations, which raise significant challenges with diagnostic and management options. We report a case of a 47-year-old male who presented to the hospital with clinical signs of appendicitis but was found to have perforated Meckle's diverticulitis with faecoliths on computed tomography imaging and laparoscopy. Furthermore, histopathology revealed an ectopic gastric tissue cell type, which is a rare finding. This was definitively managed surgically with laparoscopic resection of Meckle's diverticulum and appendicectomy.
PubMed: 38764737
DOI: 10.1093/jscr/rjae315 -
Surgery Open Science Jun 2024Closure of the appendix stump after appendectomy is considered one of the most important parts of laparoscopic appendectomy. Various techniques are used during this...
OBJECTIVE
Closure of the appendix stump after appendectomy is considered one of the most important parts of laparoscopic appendectomy. Various techniques are used during this surgery, commonly including endoclips and ligatures. Therefore, this study was conducted to compare endoclips with intra-corporeal ligatures in closing the appendix stump during laparoscopic appendectomy.
METHODS
This retrospective study was conducted using data from 50 patients with acute appendicitis who underwent uncomplicated laparoscopic appendectomy. The data from patients whose stumps were closed using endoclips in 25 patients (Group I) and with intra-corporeal ligatures in 25 patients (Group II) were extracted and compared regarding the occurrence of intraoperative and postoperative complications.
RESULTS
There were no differences between the two methods in terms of intraoperative and postoperative complications. The duration of surgery in the ligature group was significantly longer than in the clip group ( = 0.044). The hospital stay duration was clinically longer in the ligature group, but this difference was not statistically significant ( > 0.05).
CONCLUSION
Endoclips for closing the appendix stump are safer with a shorter operating time and also a simpler method. Therefore, they could be a reliable alternative to the method of closing the appendix stump with ligatures.
PubMed: 38764557
DOI: 10.1016/j.sopen.2024.04.007 -
Journal of Investigative Medicine High... 2024Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors in the digestive tract and arise from the interstitial cells of Cajal in the mesenteric...
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors in the digestive tract and arise from the interstitial cells of Cajal in the mesenteric plexus. These tumors can originate in any part of the GI tract; however, a higher burden has been observed in the stomach and small intestines. Mesenteric GISTs are exceedingly rare, with unique clinicopathological features and a poorer prognosis. Herein, we describe a unique case of a 66-year-old female with a remote history of appendectomy who presented to the emergency room complaining of severe abdominal pain and vomiting. On imaging, the patient was found to have a large inflammatory mass associated with small bowel loops, and the pathology confirmed a mesenteric GIST. The tumor was resected, and the genomic test results confirmed the KIT (exon 11) mutation. Although the tumor had a low mitotic rate, the tumor was large enough to warrant the initiation of adjuvant imatinib mesylate for 36 months with regular bloodwork and imaging.
Topics: Humans; Gastrointestinal Stromal Tumors; Female; Aged; Abdomen, Acute; Imatinib Mesylate; Mesentery; Proto-Oncogene Proteins c-kit; Tomography, X-Ray Computed; Mutation; Antineoplastic Agents
PubMed: 38757744
DOI: 10.1177/23247096241253348 -
Frontiers in Medicine 2024The objective of this study was to examine the impact of the introduction of the Universal Anaesthesia Machine (UAM), a device designed for use in clinical environments...
OBJECTIVE
The objective of this study was to examine the impact of the introduction of the Universal Anaesthesia Machine (UAM), a device designed for use in clinical environments with limited clinical perioperative resources, on the choice of general anesthesia technique and safe anesthesia practice in a tertiary-care hospital in Sierra Leone.
METHODS
We introduced an anesthesia machine (UAM) into Connaught Hospital, Freetown, Sierra Leone. We conducted a prospective observational study of anesthesia practice and an examination of perioperative clinical parameters among surgical patients at the hospital to determine the usability of the device, its impact on anesthesia capacity, and changes in general anesthesia technique.
FINDINGS
We observed a shift from the use of ketamine total intravenous anesthesia to inhalational anesthesia. This shift was most demonstrable in anesthesia care for appendectomies and surgical wound management. In 10 of 17 power outages that occurred during inhalational general anesthesia, anesthesia delivery was uninterrupted because inhalational anesthesia was being delivered with the UAM.
CONCLUSION
Anesthesia technologies tailored to overcome austere environmental conditions can support the delivery of safe anesthesia care while maintaining fidelity to recommended international anesthesia practice standards.
PubMed: 38756942
DOI: 10.3389/fmed.2024.1373593 -
Anesthesiology May 2024Observational studies of anesthetic neurotoxicity may be biased because children requiring anesthesia commonly have medical conditions associated with neurobehavioral...
BACKGROUND
Observational studies of anesthetic neurotoxicity may be biased because children requiring anesthesia commonly have medical conditions associated with neurobehavioral problems. This study takes advantage of a natural experiment associated with appendicitis, in order to determine if anesthesia and surgery in childhood were specifically associated with subsequent neurobehavioral outcomes.
METHODS
We identified 134,388 healthy children with appendectomy and examined the incidence of subsequent externalizing or behavioral disorders (conduct, impulse control, oppositional defiant, or attention-deficit/hyperactivity disorder); or internalizing or mood/anxiety disorders (depression, anxiety, or bipolar disorder) when compared to 671,940 matched healthy controls as identified in Medicaid data between 2001-2018. For comparison, we also examined 154,887 otherwise healthy children admitted to the hospital for pneumonia, cellulitis, and gastroenteritis, of which only 8% received anesthesia, and compared them to 774,435 matched healthy controls. We also examined the difference-in-differences between matched appendectomy patients and their controls and matched medical admission patients and their controls.
RESULTS
Compared to controls, children with appendectomy were more likely to have subsequent behavioral disorders (the hazard ratio (HR) was 1.04 (95% CI 1.01, 1.06), P = 0.0010), and mood/anxiety disorders (HR: 1.15 (95% CI 1.13, 1.17), P < 0.0001). Relative to controls, children with medical admissions were also more likely to have subsequent behavioral (HR: 1.20 (95% CI 1.18, 1.22), P < 0.0001), and mood/anxiety (HR: 1.25 (95% CI 1.23, 1.27), P < 0.0001) disorders. Comparing the difference between matched appendectomy patients and their matched controls to the difference between matched medical patients and their matched controls, medical patients had more subsequent neurobehavioral problems than appendectomy patients.
CONCLUSIONS
Although there is an association between neurobehavioral diagnoses and appendectomy, this association is not specific to anesthesia exposure, and is stronger in medical admissions. Medical admissions, generally without anesthesia exposure, displayed significantly higher rates of these disorders than appendectomy-exposed patients.
PubMed: 38753986
DOI: 10.1097/ALN.0000000000005075 -
Journal of Surgical Case Reports May 2024Acute appendicitis supposedly results from appendix obstruction caused by various conditions, including caecal cancer. Here, we report an adenocarcinoma found in the...
Acute appendicitis supposedly results from appendix obstruction caused by various conditions, including caecal cancer. Here, we report an adenocarcinoma found in the specimen of a 65-year-old man diagnosed with acute appendicitis. The adenocarcinoma was detected in the appendix stump after emergency laparoscopic appendectomy. The patient was diagnosed with caecal cancer based on post-operative lower endoscopy findings, and an additional laparoscopic right hemicolectomy was performed. Acute appendicitis can occur at any age and may require emergency surgery. It is a benign disease that can be cured entirely by appendectomy in most cases but may result from an underlying malignant disease in some cases, especially in patients >40 years of age. Thus, clinicians should consider the possibility of a malignancy while diagnosing and treating acute appendicitis.
PubMed: 38752150
DOI: 10.1093/jscr/rjae303 -
Annals of the Royal College of Surgeons... May 2024General Medical Council (GMC) guidelines dictate that reasonable alternatives to treatment should be disclosed during the consent process. We aimed to determine whether...
INTRODUCTION
General Medical Council (GMC) guidelines dictate that reasonable alternatives to treatment should be disclosed during the consent process. We aimed to determine whether GMC guidelines on disclosure of alternatives during consent are being followed in a real-world example which is disclosure of non-operative management as an alternative to appendicectomy in uncomplicated paediatric appendicitis.
METHODS
We undertook a retrospective single-centre observational study and national consultant specialist paediatric surgeon survey. Two groups of 50 consecutively treated children (<16 years) with acute uncomplicated appendicitis were included in the observational study during two periods. UK-based consultant surgeons who treat appendicitis were included in the national survey. The main outcomes were disclosure and use of non-operative management (NOM) as an alternative to appendicectomy.
RESULTS
Overall, in the observational study, NOM was disclosed in 30 (30%) children and 77% (23/30) opted for this treatment method when it was disclosed. There were 83 survey respondents representing all 25 eligible specialist paediatric surgery centres. Ten (12%) consultants reported routinely offering NOM, 39 (47%) offer it in select circumstances, and 34 (41%) never offer NOM. Only 25 (30%) respondents always disclose NOM as an alternative to appendicectomy, whereas 22 (27%) never do. Consultants who never disclose NOM are more likely to prefer appendicectomy over NOM compared with those who always disclose it (<0.001).
CONCLUSION
In this illustrative clinical scenario, observed and reported practice regarding disclosure of alternative treatments during the consent process do not meet GMC guidance. This risks depriving children and caregivers of a choice that they are entitled to.
PubMed: 38747064
DOI: 10.1308/rcsann.2024.0016 -
Frontiers in Psychiatry 2024Chronic and acute inflammation of the mucosa-associated lymphoid tissue have been positively linked to the development of psychiatric disorders in observational studies....
BACKGROUND
Chronic and acute inflammation of the mucosa-associated lymphoid tissue have been positively linked to the development of psychiatric disorders in observational studies. However, it remains unclear whether this association is causal. In the present study, we investigated this association, using as proxies genetically predicted tonsillectomy, appendectomy and appendicitis on psychiatric disorders including major depressive disorder (MDD), schizophrenia (SCZ), bipolar depression (BD) and anxiety (ANX) via a two-sample Mendelian randomization (MR) analysis.
METHODS
Genetic association summary statistics for tonsillectomy, appendectomy and appendicitis were sourced from FinnGen Consortium, comprising data from 342,000 participants. Genetic correlations between all exposures and outcome were calculated with Linkage Disequilibrium Score (LDSC) Regression analysis. MR estimates were then calculated to assess their impact on the risk of developing psychiatric disorders. Sensitivity analysis was employed to test for any directional pleiotropy.
RESULTS
Our results suggest that there is no direct causal association between tonsillectomy, appendectomy or appendicitis with a heightened risk for development of psychiatric disorders. The robustness of the results of the main MR analysis was further confirmed with additional sensitivity analyses. However, a moderate inverse genetic correlation was observed between tonsillectomy and MDD traits (r=-0.39, p-value (P)=7.5x10).
CONCLUSION
Our findings provide, for the first time, evidence that there is no causal association between tonsillectomy or appendectomy on subsequent vulnerability of developing psychiatric disorders. Future studies using larger sample size GWAS should focus on unraveling the confounding factors and mediators to investigate this relationship further.
PubMed: 38742127
DOI: 10.3389/fpsyt.2024.1379922