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International Journal of Surgery Case... Jul 2024Midgut volvulus in adults based on congenital malrotation, which required emergency surgery, may occur under the stimulation of adverse factors and is rare and easy to...
INTRODUCTION
Midgut volvulus in adults based on congenital malrotation, which required emergency surgery, may occur under the stimulation of adverse factors and is rare and easy to be misdiagnosed.
PRESENTATION OF CASE
A young male was taken to the emergency room of a local hospital after six hours abdominal pain. Computed tomography (CT) shows intestinal volvulus and exploratory laparotomy was performed. Postoperative CT revealed remission of small intestinal torsion and congenital malrotation of the midgut. The patient vomited frequently within 48 h after the surgery, and was transferred to our hospital for conservative treatment. After 4 days of conservative treatment, the vomiting symptoms were relieved at first, but worsened again after a liquid diet. CT showed complete duodenal obstruction and exploratory laparotomy was performed again. Congenital malrotation was found, which resulted in midgut volvulus and duodenal obstruction due to anomalous fixation of the mesentery. The bowel was placed in normal anatomical position, and the mesentery was sutured to the posterior abdominal wall. The patient was followed up for 24 months with no complaints.
DISCUSSION
Due to the rare incidence and atypical pain clinical manifestations, it is difficult for the congenital malrotation in adults to be diagnosed. Midgut volvulus in adults with malrotation is even rarer and requires emergency operation, and may be misdiagnosed.
CONCLUSION
Midgut volvulus with midgut malrotation is very rare in adults. Exploratory laparotomy must be careful to reduce misdiagnosis and recurrence of volvulus.
PubMed: 38824740
DOI: 10.1016/j.ijscr.2024.109836 -
Frontiers in Medicine 2024Jejunal diverticulosis is a rare condition. Most of the time, it is asymptomatic; but it can cause severe complications such as intestinal perforation, mechanical... (Review)
Review
INTRODUCTION
Jejunal diverticulosis is a rare condition. Most of the time, it is asymptomatic; but it can cause severe complications such as intestinal perforation, mechanical occlusion, and hemorrhage.
CASE PRESENTATION
A patient aged 78 years, with a history of biological aortic valve prosthesis, atrial fibrillation, type 2 diabetes mellitus, and chronic obstructive pulmonary disease, presented in the emergency department for acute abdominal pain in the lower abdominal floor, nausea, and inappetence. Abdominal computed tomography revealed an inflammatory block in the hypogastrium, agglutinated small intestinal loops, fecal stasis, and air inclusions. Pulled mesentery and associated internal hernia are suspected. Exploratory laparotomy was performed, revealing an inflammatory block in the hypogastrium, whose dissection revealed inner purulent collection and the appearance of jejunal diverticulitis, a diagnosis confirmed by histopathological examination. Segmental resection of the jejunum with double-layer terminal-terminal enteroenteric anastomosis, lavage, and drainage was performed. The evolution was favorable.
CONCLUSION
Based on our brief review, the diagnosis of complicated jejunal diverticulosis is difficult and sometimes not accurately established, even by high-resolution imaging techniques, with diagnostic laparotomy being necessary for these situations. Surgical treatment should be considered before severe complications develop.
PubMed: 38818398
DOI: 10.3389/fmed.2024.1413254 -
The Medical Journal of Malaysia May 2024The complete mesocolic excision (CME) and central vascular ligation (CVL) is an advanced surgical technique used to treat colon cancer. It combines the removal of the... (Comparative Study)
Comparative Study
INTRODUCTION
The complete mesocolic excision (CME) and central vascular ligation (CVL) is an advanced surgical technique used to treat colon cancer. It combines the removal of the affected portion of the colon and surrounding lymph nodes with an improved method of controlling the vascular supply to the tumour.
MATERIALS AND METHODS
A retrospective study of patients with colon cancer underwent right hemicolectomy (either CME and CVL or conventional method) were operated by colorectal surgeons in a tertiary centre in Kuala Lumpur from 2018 to 2020. We review the data to compare the oncological, pathological and surgical outcomes of both techniques. Categorical variables were presented as frequencies and percentages. Continuous variables were compared using an independent t-test or Mann-Whitney Rank U test. The chi-square test was used to determine the association between categorical variables and mortality. Statistical analysis was conducted with IBM SPSS Statistics 25.0, and statistical significance was set at p<0.05.
RESULTS
A total of 30 patients (CME and CVL=15 or conventional colectomies=15) were included in this study with mean age of 65 years. There was no statistical difference between the mean age of the two groups (p=0.355). Most of the patients were Malays (46.7%) followed by Chinese (43.3 %) and Indians (10.0%). The mean (SD) = 19 (9) number of lymph nodes harvested is more in CME and CVL groups which however is not statistically significant compared to the mean (SD) = 16 (9), number of lymph nodes in conventional colectomies. The duration of surgery is longer in CME and CVL groups (214 minutes) compared to conventional colectomies (188 minutes) but with no significant statistical difference. Most of the perioperative complications were similar in both groups with no significant statistical differences.
CONCLUSION
CME and CVL are not inferior to conventional surgery in colon surgery in a tertiary centre. It should be considered since the advantages such as lymph node yield and median recurrence free survival are better with similar perioperative morbidity.
Topics: Humans; Colonic Neoplasms; Retrospective Studies; Male; Female; Ligation; Aged; Colectomy; Mesocolon; Middle Aged; Tertiary Care Centers; Malaysia; Treatment Outcome
PubMed: 38817066
DOI: No ID Found -
Scientific Reports May 2024Epithelial ovarian cancer is mostly discovered at the stage of peritoneal carcinosis. Complete cytoreductive surgery improves overall survival. The Fagotti score is a... (Observational Study)
Observational Study
Epithelial ovarian cancer is mostly discovered at the stage of peritoneal carcinosis. Complete cytoreductive surgery improves overall survival. The Fagotti score is a predictive score of resectability based on peritoneal laparoscopic exploratory. Our aim was to study the inter-observer concordance in an external validation of the Fagotti score. An observational, prospective, multicenter study was conducted using the Francogyn research network. The primary outcome was inter-observer concordance of the Fagotti score. 15 patients in which an ovarian mass was discovered were included. For each patient, the first exploratory laparoscopy before any treatment/chemotherapy was recorded. This bank of 15 videos was subject to blind review accompanied by a Fagotti score rating by 11 gynecological surgeons specializing in oncology. A total of 165 blind reviews were performed. Inter-observer concordance was very good for the Fagotti score with an intraclass correlation coefficient (ICC) of 0.83 [95% CI 0.71; 0.93]. Inter-observer concordance for the adjusted Fagotti score, which accounts for unexplorable areas with extensive carcinomatosis, resulted in an ICC of 0.64 [95% CI 0.46; 0.82]. According to the reviewers, the three least explorable parameters were mesentery involvement, stomach infiltration and liver damage. The ICC of the explorable Fagotti score, i.e. score with deletion of the parameters most often unexplored by laparoscopy, was 0.86 [0.75-0.94]. This study confirms the reproducibility of the Fagotti score during first assessment laparoscopies in cases of advanced ovarian cancer. The explorable Fagotti score has an equivalent or better inter-observer concordance than the Fagotti score.
Topics: Humans; Female; Ovarian Neoplasms; Middle Aged; Prospective Studies; Aged; Laparoscopy; Observer Variation; Cytoreduction Surgical Procedures; Carcinoma, Ovarian Epithelial; Adult; Reproducibility of Results
PubMed: 38802436
DOI: 10.1038/s41598-024-62568-0 -
Nature Communications May 2024Jamaican fruit bats (Artibeus jamaicensis) naturally harbor a wide range of viruses of human relevance. These infections are typically mild in bats, suggesting unique...
Jamaican fruit bats (Artibeus jamaicensis) naturally harbor a wide range of viruses of human relevance. These infections are typically mild in bats, suggesting unique features of their immune system. To better understand the immune response to viral infections in bats, we infected male Jamaican fruit bats with the bat-derived influenza A virus (IAV) H18N11. Using comparative single-cell RNA sequencing, we generated single-cell atlases of the Jamaican fruit bat intestine and mesentery. Gene expression profiling showed that H18N11 infection resulted in a moderate induction of interferon-stimulated genes and transcriptional activation of immune cells. H18N11 infection was predominant in various leukocytes, including macrophages, B cells, and NK/T cells. Confirming these findings, human leukocytes, particularly macrophages, were also susceptible to H18N11, highlighting the zoonotic potential of this bat-derived IAV. Our study provides insight into a natural virus-host relationship and thus serves as a fundamental resource for future in-depth characterization of bat immunology.
Topics: Animals; Chiroptera; Male; Single-Cell Analysis; Humans; Orthomyxoviridae Infections; Macrophages; Influenza A virus; Gene Expression Profiling
PubMed: 38802391
DOI: 10.1038/s41467-024-48934-6 -
Journal of Surgical Case Reports May 2024Lymphangiomas in the peritoneal cavity are rare in adults, with most cases occurring in children. We present the case of a 49-year-old woman who was admitted with severe...
Lymphangiomas in the peritoneal cavity are rare in adults, with most cases occurring in children. We present the case of a 49-year-old woman who was admitted with severe lower abdominal pain. The diagnostic assessment revealed a multiloculated cystic structure in the mesentery of the distal ileum, suggesting a lymphangioma. The patient underwent laparotomy and resection, with successful removal of the mass. Histopathological examination confirmed the diagnosis of intestinal lymphangioma, a rare benign vascular neoplasm of the small bowel. Postoperatively, the patient experienced resolution of postoperative ileus and mild back and abdominal pain, with no complaints during follow-up. Awareness of this uncommon condition is crucial for accurate diagnosis and appropriate treatment. Surgical resection, supported by radiological and histopathological investigations, is the primary treatment modality for symptomatic lymphangioma. Regular follow-up with imaging may be necessary to monitor recurrence.
PubMed: 38800506
DOI: 10.1093/jscr/rjae322 -
Frontiers in Oncology 2024Desmoid tumor (DT) is a rare locally aggressive but non-metastatic mesenchymal soft tissue neoplasm that predominantly occurs in the abdominal wall, abdominal cavity,...
Case report: Rapidly progressive desmoid tumor after surgery for esophagogastric junction cancer and slowly progressive primary desmoid tumor: a report of two cases and literature review.
BACKGROUND
Desmoid tumor (DT) is a rare locally aggressive but non-metastatic mesenchymal soft tissue neoplasm that predominantly occurs in the abdominal wall, abdominal cavity, and extremities. Its occurrence in the mesentery is relatively uncommon.
CASE REPORTS
This article reports two cases of desmoid tumor treated at the Department of Gastrointestinal Surgery, Weifang People's Hospital. The first case was a 59-year-old male patient who had previously undergone surgery for esophagogastric junction cancer. Postoperatively, he developed an intra-abdominal mass that rapidly increased in size within three months. The second case was a 60-year-old male patient who incidentally discovered a mass in the left lower abdomen. Both patients underwent surgical treatment, and the postoperative pathological diagnosis was mesenteric desmoid tumor.
CONCLUSION
The treatment of desmoid tumor remains challenging. Simple surgical resection often yields unsatisfactory outcomes, and the efficacy of adjuvant radiotherapy and chemotherapy is also limited. Further research and clinical practice are necessary to improve diagnostic and therapeutic strategies, aiming to enhance patient survival and quality of life.
PubMed: 38800396
DOI: 10.3389/fonc.2024.1401839 -
International Journal of Surgery Case... Jul 2024Cecal volvulus is a rare cause of obstruction in pregnancy. It accounts for ∼1.5 % of all intestinal obstructions. The diagnosis is challenging and causes increased...
INTRODUCTION AND IMPORTANCE
Cecal volvulus is a rare cause of obstruction in pregnancy. It accounts for ∼1.5 % of all intestinal obstructions. The diagnosis is challenging and causes increased morbidity and mortality to the mother and fetus. This case report will highlight the life-threatening nature of this condition and emphasize the critical importance of early diagnosis and intervention.
CASE PRESENTATION
A 30-year-old gravida-3 para-2 patient presented with colicky abdominal pain of 24 h duration. She had associated abdominal distension, vomiting and fever. She had amenorrhea of 05-months. The past medical and surgical histories were negative. Her vital signs were deranged and had tenderness all over the abdomen. Ultrasound showed gaseous abdomen and viable fetus in the uterus. Laparotomy has revealed gangrenous cecal volvulus. A right hemicolectomy and end-to-side ileo-transverse colon anastomosis were performed. She expelled a dead fetus after 12 h. She was discharged in good clinical status.
DISCUSSION
Cecal volvulus involves axial rotation of the ascending colon, cecum, and terminal ileum about associated mesentery. Pregnancy is among the pre-disposing factor for cecal volvulus. The diagnosis is often challenging because of non-specific presentations. Radiologic procedures are helpful in the diagnosis. The primary treatment is surgical intervention.
CONCLUSION
Cecal volvulus is a rare life-threatening cause of obstruction in pregnancy. It is an emergency situation, and early diagnosis and intervention are crucial to decreasing morbidity and mortality. The most effective treatment is surgical resection.
PubMed: 38796939
DOI: 10.1016/j.ijscr.2024.109803 -
Microorganisms Apr 2024Cysticercus pisiformis is a kind of tapeworm larvae of , which parasitizes the liver envelope, omentum, mesentery, and rectum of rodents such as rabbits. Cysteine...
Cysticercus pisiformis is a kind of tapeworm larvae of , which parasitizes the liver envelope, omentum, mesentery, and rectum of rodents such as rabbits. Cysteine protease inhibitors derived from helminth were immunoregulatory molecules of intermediate hosts and had an immunomodulatory function that regulates the production of inflammatory factors. Thus, in the present research, the recombinant Stefin of was confirmed to have the potential to fight inflammation in LPS-Mediated RAW264.7 murine macrophages. CCK8 test showed that rCpStefin below 50 μg/mL concentration did not affect cellular viability. Moreover, the NO production level determined by the Griess test was decreased. In addition, the secretion levels of IL-1β, IL-6, and TNF-α as measured by ELISA were decreased. Furthermore, it exerted anti-inflammatory activity by decreasing the production of proinflammatory cytokines and proinflammatory mediators, including IL-1β, IL-6, TNF-α, iNOS, and COX-2 at the gene transcription level, as measured by qRT-PCR. Therefore, Type I cystatin derived from suppresses the LPS-Mediated inflammatory response of the intermediate host and is a potential candidate for the treatment of inflammatory diseases.
PubMed: 38792680
DOI: 10.3390/microorganisms12050850 -
Journal of Clinical Medicine May 2024Chyloperitoneum arises from lymph leakage into the abdominal cavity, leading to an accumulation of milky fluid rich in triglycerides. Diagnosis can be challenging, and... (Review)
Review
Chyloperitoneum arises from lymph leakage into the abdominal cavity, leading to an accumulation of milky fluid rich in triglycerides. Diagnosis can be challenging, and mortality rates vary depending on the underlying cause, with intestinal volvulus being just one potential acute cause. Despite its rarity, our case series highlights chyloperitoneum associated with non-ischemic small bowel volvulus. The aims of our study include assessing the incidence of this association and evaluating diagnostic and therapeutic approaches. We present two cases of acute abdominal peritonitis with suspected small bowel volvulus identified via contrast-enhanced computed tomography (CT). Emergency laparotomy revealed milky-free fluid and bowel volvulus. Additionally, we conducted a systematic review up to 31 October 2023, identifying 15 previously reported cases of small bowel volvulus and chyloperitoneum in adults (via the PRISMA scheme). Clarifying the etiopathogenetic mechanism of chyloperitoneum requires specific diagnostic tools. Magnetic resonance imaging (MRI) may be useful in non-emergency situations, while contrast-enhanced CT is employed in emergencies. Although small bowel volvulus infrequently causes chyloperitoneum, prompt treatment is necessary. The volvulus determines lymphatic flow obstruction at the base of the mesentery, with exudation and chyle accumulation in the abdominal cavity. Derotation of the volvulus alone may resolve chyloperitoneum without intestinal ischemia.
PubMed: 38792360
DOI: 10.3390/jcm13102816