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Cureus Oct 2023This is the first reported case of lesser sac empyema secondary to a foreign body perforation in the posterior stomach. Although PubMed and Google Scholar...
This is the first reported case of lesser sac empyema secondary to a foreign body perforation in the posterior stomach. Although PubMed and Google Scholar search reports cases of lesser sac empyema alone and foreign body penetrations, there are currently no reported cases of a lesser sac abscess secondary to a foreign body. Patients with a lesser sac empyema present atypically with an insidious onset. The lesser sac should be examined in patients with peritonitis without a clear source. A 48-year-old female presented to the emergency department with acute onset epigastric pain. The patient was tender in the epigastrium and left upper quadrant with associated guarding. The patient had elevated white cell count and C-reactive protein, with a computed tomography scan identifying a foreign body posterior gastric wall perforation. The patient was managed with endoscopic drainage of the lesser sac empyema and surgical washout of the abdomen. Foreign bodies are investigated using different imaging modalities, with computed tomography being able to further evaluate the size, shape, and complications. Intra-abdominal collections can be managed through three different methods: percutaneous drainage, endoscopic drainage, and surgery. Patients with peritonitis would require a laparoscopic or open surgical washout of the abdomen and inspection of the lesser sac would be necessary if no obvious source is identified. Foreign body ingestion requires careful history taking and assessment. Patients with lesser sac empyema present atypically, and this can lead to delayed surgical referral and management. Contained intra-abdominal collections can be drained percutaneously or endoscopically.
PubMed: 38021889
DOI: 10.7759/cureus.47186 -
Cureus Oct 2023During a routine anatomical dissection of an 81-year-old male cadaver received through the Gift Body Program of Saint Louis University School of Medicine (SLU SOM), a...
During a routine anatomical dissection of an 81-year-old male cadaver received through the Gift Body Program of Saint Louis University School of Medicine (SLU SOM), a massive bulging in the abdominal area was observed that was consistent with numerous hernia repairs noted in the donor's self-reported medical history. Gross anatomical dissection of the cadaveric body revealed extensive herniation of portions of the small intestine and peritoneal sac along the costal margin and extending to the left aspect of the abdomen. Additionally, an uncircumcised phallus was buried within the suprapubic fat pad and demonstrated simple, grade III penoscrotal webbing (PSW), creating an impression of micropenis presence. To gain additional insights into the current case, analysis of the coding regions (exomes) of DNA procured from the body for putative genetic variants was performed using next-generation sequencing (NGS) technology. This analysis revealed 110 rare (minor allele frequency (MAF) ≤ 0.01), pathologic/deleterious genetic mutations. The most relevant variants to this case were the ones associated with male sexual development, and ; connective tissue development, and ; cilia morphogenesis and function, and ; as well as hormonal homeostasis, . Direct involvement of both in male sexual development and hernia genesis makes it a strong candidate for linking the two pathologies, PSW and multiple hernias, observed in the present case. Yet the presence of a group of mutated genes linked to myopathies (, , , , ) and muscular dystrophy () raises a question about the involvement of these muscular pathologies in hernia genesis and unsuccessful hernia repairs associated with the current case.
PubMed: 38021525
DOI: 10.7759/cureus.47375 -
Surgical Neurology International 2023Dandy-Walker syndrome (DWS) is a well-known developmental anomaly. An occipital meningocele (OMC) is recognized as a malformation that is relatively often associated...
BACKGROUND
Dandy-Walker syndrome (DWS) is a well-known developmental anomaly. An occipital meningocele (OMC) is recognized as a malformation that is relatively often associated with DWS, but the association of DWS with OMC has been reported in approximately 40 cases. We present herein a rare clinical course of DWS with OMC, in which the sac was small at birth and became progressively larger.
CASE DESCRIPTION
A 5-day-old baby boy was referred to our hospital due to OMC. He was born at 33 gestational weeks due to premature rupture of the membranes. He was diagnosed as having DWS associated with OMC. The OMC was covered with skin and its maximum diameter at birth was 3 cm. Magnetic resonance imaging showed an occipital bone defect and continuity of the fourth ventricle, posterior fossa cyst, and OMC sac. The aqueduct was patent, and no hydrocephalus was found. The OMC sac increased progressively with moderate hydrocephalus and reached 7 cm at the age of 54 days when his weight was 2508 g. A cystoperitoneal shunt and repair were performed after sinus venography by contrast computed tomography (CT). At the age of 1 year and 8 months, he had moderate developmental disabilities.
CONCLUSION
In most cases reported, the OMC was relatively small, and large and giant sizes were reported in only six cases. Almost all cases remained the same size as at birth and underwent surgical intervention as early as possible. It was possible to understand the relationship between the occipital bone defect and abnormal running of sinuses such as the superior sagittal sinus, torcular Herophili, and transverse sinus preoperatively from the CT venography (CTV) image. CTV may be an effective and important method for safely performing repair and shunt.
PubMed: 37941619
DOI: 10.25259/SNI_585_2023 -
Annals of Medicine and Surgery (2012) Nov 2023Congenital peritoneal encapsulation (CPE) is a rare condition in which the small intestine is encased within a mesothelial-lined sac. The following case is an extremely...
INTRODUCTION AND IMPORTANCE
Congenital peritoneal encapsulation (CPE) is a rare condition in which the small intestine is encased within a mesothelial-lined sac. The following case is an extremely rare description of the co-existence of both colon cancer and peritoneal encapsulation, highlighting the potential role of this co-existence in preventing the spread of metastases and tumor implantation.
CASE-PRESENTATION
A 60-year-old female was diagnosed with metastatic colon cancer. During the operation, a thin fibrous membrane was found covering the small intestine, which suggested CPE. The tumor was removed, and the additional membrane was totally excised. The patient is currently receiving chemotherapy for metastatic treatment and is in good health.
CLINICAL DISCUSSION
CPE is a medical condition that results from abnormal peritoneal development, and it is often confused with other differential diagnoses resulting from inflammatory causes. It can occur at different ages and remains asymptomatic for the majority of cases. However, it can be a potential cause of bowel obstruction. An intraoperative diagnosis can easily differentiate the case. The co-existence with colon cancer has been described only once in the literature.
CONCLUSION
Peritoneal encapsulation is a rare, mostly asymptomatic condition. However, it may play a protective role in preventing metastatic colon cancer from affecting the small intestine, thus potentially opening up new avenues for the treatment of cancer metastases.
PubMed: 37915706
DOI: 10.1097/MS9.0000000000001218 -
Asian Journal of Surgery Feb 2024
Topics: Humans; Hernia, Inguinal; Herniorrhaphy; Peritoneum; Laparoscopy; Peritoneal Neoplasms; Mesothelioma; Retrospective Studies; Treatment Outcome
PubMed: 37914647
DOI: 10.1016/j.asjsur.2023.10.082 -
Cureus Sep 2023Malignant pericardial effusion (MPE) is a slowly progressive and potentially clinically silent condition. Pericardial effusion can arise in oncology patients due to...
Malignant pericardial effusion (MPE) is a slowly progressive and potentially clinically silent condition. Pericardial effusion can arise in oncology patients due to several factors, including disease spreading directly or metastatically, anticancer therapy side effects, or both. Solid and hematological malignancy metastasis more frequently involves the pericardium than primary tumors, with lung cancer being the most common metastatic tumor to involve the pericardium. While 5%-20% of all patients with metastatic neoplasms have pericardial involvement, MPE rarely appears with hemodynamic instability. Occasionally, MPE constitutes the initial manifestation of an underlying malignancy. Diagnosis and treatment require a multidisciplinary approach and a high degree of clinical suspicion. We present a case of a 59-year-old female with a history of peritoneal carcinoma who presented with persistent dyspnea on exertion following an episode of pneumonia that was treated with antibiotics. Physical examination and bedside point-of-care ultrasound (POCUS) revealed fluid in the pericardial sac. The cytological examination of the fluid revealed it to be of malignant origin, resulting from metastasis from gynecologic adenocarcinoma. Pericardiocentesis was done, and symptoms improved after fluid drainage.
PubMed: 37900376
DOI: 10.7759/cureus.46059 -
International Journal of Surgery Case... Nov 2023Meckel's diverticulum is a common congenital abnormality. In this study, we reported a case of small bowel occlusion due to Meckel's diverticulum causing a small bowel...
INTRODUCTION AND IMPORTANCE
Meckel's diverticulum is a common congenital abnormality. In this study, we reported a case of small bowel occlusion due to Meckel's diverticulum causing a small bowel obstruction and a life-threatening condition.
CASE PRESENTATION
28-year-old man complaining of abdominal pain for 3 days. The physical examination found the patient appeared profusely unwell with a blood pressure of 80/40 mmHg. The abdominal examination found abdominal rigidity suggesting peritonitis. The patient's C-reactive protein was 210 mg/l with normal white blood cell count. Consequently, the patient was operated on using a laparotomy. A mechanical bowel obstruction due to a gangrenous Meckel's diverticulum was confirmed during the operation. Meckel's diverticulitis with the tip attached to the ileal mesentery through a band. A section of the band was performed followed by a resection of the Meckel's diverticulum and an ileo-ileal anastomosis. The postoperative follow-up was uneventful.
CASE DISCUSSION
Meckel's diverticulum results from yolk sac persistence during embryonic development, often remaining asymptomatic. However, it can lead to symptoms like abdominal pain, diarrhoea, and fever when inflamed or infected. Treatment involves surgery (diverticulectomy) for severe cases with complications, with good prognosis but associated surgical risks.
CONCLUSION
The diverticulum can present a life-threatening condition. The treatment is essentially surgical. This surgery should be performed emergently to enhance the prognosis.
PubMed: 37883867
DOI: 10.1016/j.ijscr.2023.108982 -
Journal of Minimal Access Surgery Sep 2023The popularity of endolaparoscopic extraperitoneal repairs has been on the rise due to advantages such as sublay mesh placement and early return to daily activities....
INTRODUCTION
The popularity of endolaparoscopic extraperitoneal repairs has been on the rise due to advantages such as sublay mesh placement and early return to daily activities. However, the procedure requires overcoming a learning curve, and with increased adoption, new complications have emerged. One significant complication is the rupture of the posterior rectus sheath (PRS). In this article, we present our modifications of the technique to reduce tension during PRS closure.
PATIENTS AND METHODS
The study included 105 patients who underwent endolaparoscopic extraperitoneal repairs for ventral hernias using two different techniques. Group A (n = 68) underwent the original technique, whereas Group B (n = 37) underwent the modified technique. The modifications in Group B included preserving the peritoneal bridge between the two PRS and the hernia sac, conducting a complete dissection of the space of Bogros and adopting a transverse or oblique closure of PRS along the lines of least tension. To assess the efficacy of these modifications in preventing PRS rupture, we compared the results of both groups.
RESULTS
Our findings indicate that following all the technical steps of the modified technique resulted in a reduced need for transversus abdominis release for PRS closure and a lower incidence of PRS rupture in the postoperative period. However, to further validate the effectiveness of these modifications, a larger follow-up period and a bigger sample size are required.
CONCLUSIONS
The adoption of the modified technique can help achieve a tension-free PRS closure.
PubMed: 37843159
DOI: 10.4103/jmas.jmas_177_23 -
International Journal of Surgery Case... Oct 2023Sclerosing encapsulating peritonitis (SEP), or abdominal cocoon, is a remarkably rare entity. It consists of a fibrous layer or cocoon-like sac encasing, in most cases,...
INTRODUCTION
Sclerosing encapsulating peritonitis (SEP), or abdominal cocoon, is a remarkably rare entity. It consists of a fibrous layer or cocoon-like sac encasing, in most cases, the small bowel. The lack of specific symptoms makes preoperative diagnosis challenging.
CASE PRESENTATION
A 50-year-old patient, with no history of abdominal surgery or medical diseases, was admitted for symptoms of small bowel obstruction. On examination, the patient was underweight with a BMI of 18 kg/m. Vital signs were stable. His abdomen was mildly distended and soft. Abdominal CT scan showed signs in favor of a left paraduodenal hernia with incarcerated small bowel loops. Intraoperatively, the small bowels were encapsulated in a cocoon-like structure formed by thick fibrous tissue associated with multiple adhesions. Careful adhesiolysis with complete resection of the membrane was performed. The postoperative course was uneventful. One year later, the patient was symptom-free.
DISCUSSION
SEP is thought to be a persistent inflammatory disorder due to a cause that remains unidentified. It is divided into two categories based on its etiology: primary and secondary. The most common mode of SEP revelation is bowel obstruction. Because there is no clear consensus on SEP management, the therapeutic approach typically follows the management strategy of bowel obstruction.
CONCLUSION
SEP is an uncommon cause of bowel obstruction. Preoperative detection can be challenging in the absence of pathognomonic signs. Treatment is based on surgery, specifically entailing complete excision of the cocoon and adhesiolysis.
PubMed: 37793231
DOI: 10.1016/j.ijscr.2023.108897 -
Chirurgia (Bucharest, Romania : 1990)Amyand's hernia (AH) is a rare type of inguinal hernia, containing the appendix in the hernia sac irrespective of the presence of appendicitis. Appendiceal mucocele...
Amyand's hernia (AH) is a rare type of inguinal hernia, containing the appendix in the hernia sac irrespective of the presence of appendicitis. Appendiceal mucocele represents a dilation of the appendix with an accumulation of mucinous material and could be either a benign or a malignant process. Herein we report an exceptionally rare case of a perforated appendiceal mucocele within an AH. Case report: A 77-year-old male patient, underwent surgery for right incarcerated inguinoscrotal hernia. He was found to have a perforated, phlegmonous, and dilated appendix dislocated from the caecum, with peri-appendicular purulent content with fibrin deposits within the hernia sac. Also, the last ileal loop, caecum, ascendant colon, and the right testicle within the hernia sac, were compromised due to the septic process around. A right hemicolectomy and orchiectomy, followed by a herniorrhaphy without using a synthetic mesh, was performed. Histopathological examination revealed a perforated benign appendiceal mucocele associated with phlegmonous appendicitis and fibrinous peritonitis. This case report describes a rare combination of entities: an AH that presented as an incarcerated hernia and was diagnosed intraoperatively with a perforated, phlegmonous, and dilated appendix, proving to be an appendiceal mucocele.
PubMed: 37750318
DOI: 10.21614/chirurgia.118.eC.2740