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Journal of Neurological Surgery. Part... Aug 2022A case of a recurrent sphenocavernous meningioma is presented. The patient is a 42-year-old male who presented with an episode of transient right-sided numbness. A...
A case of a recurrent sphenocavernous meningioma is presented. The patient is a 42-year-old male who presented with an episode of transient right-sided numbness. A magnetic resonance imaging (MRI) revealed a large left sphenocavernous meningioma. The patient underwent a frontotemporal craniotomy for tumor resection. Near total resection was achieved with minimal residual in the left cavernous sinus (CS) and orbital apex. The pathology was consistent with meningioma, World Health Organization (WHO) grade I. A follow-up MRI was done 9 months after surgery and showed a growth of the residual tumor, which was treated with intensity modulated radiotherapy. Tumor growth was detected on serial imaging over a 4-year period. Surgical resection was offered. A left frontotemporal craniotomy with pretemporal transcavernous approach was performed. The bone flap was reopened and the dura was opened in a Y-shaped fashion. The roof of the optic canal was drilled off, and the falciform ligament was opened to decompress the optic nerve. The tumor was disconnected from the anterior clinoid region (the anterior clinoid process was eroded by the tumor) and reflected off the wall of the lateral CS. Tumor was adherent to the V2 fascicles (the lateral CS wall was resected in the first surgery) and was sharply dissected off. Gross total resection was achieved. The pathology was consistent with meningioma, WHO grade I. The patient had an unremarkable postoperative course without any new neurological deficits. The link to the video can be found at: https://youtu.be/KVBVw_86JqM .
PubMed: 36068907
DOI: 10.1055/s-0041-1725941 -
Cureus Jun 2021Internal hernias are rare, and a delayed diagnosis can lead to dangerous complications. A 75-year-old male with no previous surgical history presented with right upper...
Internal hernias are rare, and a delayed diagnosis can lead to dangerous complications. A 75-year-old male with no previous surgical history presented with right upper abdominal pain and vomiting. On examination, he had guarding in the right hypochondrium with a positive Murphy's sign. However, ultrasonography of the gall bladder was normal with dilated bowel loops. Contrast-enhanced CT (CECT) revealed a falciform hernia with evidence of obstruction. Segmental resection of the gangrenous ileum was done with a double-barrel stoma. Later on, stoma reversal was also done with no complications.
PubMed: 34322344
DOI: 10.7759/cureus.15898 -
The New England Journal of Medicine Nov 2017
Topics: Abdominal Pain; Aged, 80 and over; Duodenal Diseases; Female; Humans; Intestinal Perforation; Pneumoperitoneum; Radiography, Abdominal; Tomography, X-Ray Computed
PubMed: 29141173
DOI: 10.1056/NEJMicm1613914 -
Surgical Case Reports Jun 2022Falciform ligament abscess (FLA) is a rare disease, and its diagnosis can be challenging without typical image findings of an abscess. We report a patient with FLA that...
BACKGROUND
Falciform ligament abscess (FLA) is a rare disease, and its diagnosis can be challenging without typical image findings of an abscess. We report a patient with FLA that presented as a mass, with an indistinct border between it and the liver, in addition to disseminated foci within the liver. This made it difficult to determine whether it was FLA or a malignancy.
CASE PRESENTATION
A 69-year-old man presented with epigastric pain. Contrast-enhanced computed tomography revealed a 25-mm mass below the middle of the diaphragm. Based on an initial diagnosis of infection of the falciform ligament, we administered conservative antibiotic treatment and there was initial improvement in the patient's clinical condition and laboratory data. However, he continued to experience mild epigastric pain. A month later, imaging studies revealed enlargement of the falciform ligament mass and the emergence of a new nodule in the liver, whereas laboratory findings showed re-elevated C-reactive protein levels. Since conservative treatment had failed, we decided to perform surgery. Considering the imaging study findings, malignant disease could not be ruled out. Based on the operative findings, we performed combined resection of the falciform ligament, left liver, and gallbladder. Histopathological examination of the resected specimens revealed extensive neutrophil infiltration and the presence of giant cells and foam cells within the lesions. These findings were indicative of abscess. Pseudomonas aeruginosa was cultured from the pus in the falciform ligament mass and bile in the gallbladder. Although multiple abscesses postoperatively developed in the residual portion of the liver, they could be treated through antibiotic therapy.
CONCLUSIONS
FLA can spread to both adjacent and distant organs via its rich vascular and lymphatic networks. When FLA displays atypical image findings and/or an atypical clinical course, it can be difficult to distinguish it from malignant disease. In such cases, surgical treatment, with intraoperative pathological diagnosis, should be attempted.
PubMed: 35699804
DOI: 10.1186/s40792-022-01466-x -
Cureus Nov 2023The falciform ligament is a double peritoneal fold that separates the left and right hepatic lobes anatomically. Fatty-falciform ligament appendage torsion (F-FLAT) is...
The falciform ligament is a double peritoneal fold that separates the left and right hepatic lobes anatomically. Fatty-falciform ligament appendage torsion (F-FLAT) is defined as torsion of the extraperitoneal fat within the falciform ligament causing fat infarction, which is an uncommon surgical presentation, scarcely documented within the current literature. The objective of presenting this case report and reviewing the literature on F-FLAT is to discuss the clinical presentation, possible associated factors and management strategies in regard to this rare pathology. A 72-year-old female patient presented to the emergency department with a seven-day history of epigastric pain, reduced appetite and nausea. On admission, the patient was stable and apyrexial with abdominal examination highlighting she was tender in her right upper quadrant and epigastric region. Due to the patient's unremitting abdominal pain despite appropriate analgesia, CT of the abdomen and pelvis (CTAP) with intravenous contrast was done and a diagnosis of F-FLAT was made. The patient was treated with antibiotics and analgesia, had a negative abdominal ultrasound (US) result and due to her symptoms settling by the second day of admission, she was discharged the same afternoon. A literature review into falciform ligament infarction was conducted by two independent reviewers across four different databases: PubMed, Medline, Embase and the Cochrane Library. Search terms included "falciform ligament" OR "falciform" AND "infarction" (likewise with Medical Subject Headings, or MeSH, terms in the Cochrane Library). Eligibility criteria and our subsequent inclusion criteria were based on studies specifically discussing falciform ligament infarction and published in English. Study types were by majority case reports, but also included one literature review and a book source as well as two pictorial radiological reviews. All 13 patients presented with abdominal pain, but only 53% presented with raised infective/inflammatory markers. The majority of patients had abdominal US as a first-line investigation with 9 of 13 patients also having a CTAP with contrast, which classically showed fat stranding in the falciform ligament. Two patients had no evidence of any radiological investigation. Initially all cases were managed conservatively with non-steroidal anti-inflammatory drugs and analgesia, but in 62% of the cases (8/13), surgical intervention was needed due to unresolving abdominal pain. All eight of the excised falciform ligaments showed evidence of infarction and necrosis histologically. In conclusion, F-FLAT is a relatively rare condition making it difficult to build higher level evidence studies. The current literature has revealed some evidence of incomplete and inconsistent data, for example, in the biochemical results and management techniques presented, yet contrast-enhanced CT seems moderately sensitive for detection in the reviewed literature. Though F-FLAT is rare and unfamiliar, it is vital we exclude common acute surgical pathologies that F-FLAT mimics and monitor for unsettling symptoms that could change the management trajectory.
PubMed: 37937182
DOI: 10.7759/cureus.48361 -
World Journal of Gastrointestinal... Oct 2018Liver resection surgery can be associated with significant perioperative mortality and morbidity. Extensive knowledge of the vascular anatomy is essential for... (Review)
Review
Liver resection surgery can be associated with significant perioperative mortality and morbidity. Extensive knowledge of the vascular anatomy is essential for successful, uncomplicated liver surgeries. Various imaging techniques like multidetector computed tomographic and magnetic resonance angiography are used to provide information about hepatic vasculature. Linear endoscopic ultrasound (EUS) can offer a detailed evaluation of hepatic veins, help in assessment of liver segments and can offer a possible route for EUS guided vascular endotherapy involving hepatic veins. A standard technique for visualization of hepatic veins by linear EUS has not been described. This review paper describes the normal EUS anatomy of hepatic veins and a standard technique for visualization of hepatic veins from four stations. With practice an imaging of all the hepatic veins is possible from four stations. The imaging from fundus of stomach is the easiest and most convenient method of imaging of hepatic veins. EUS of hepatic vein and the tributaries is an operator dependent technique and in expert hands may give a mapping comparable to computed tomographic and magnetic resonance imaging. EUS of hepatic veins can help in identification of individual sectors and segments of liver. EUS guided interventions involving hepatic veins may require approach from different stations.
PubMed: 30364872
DOI: 10.4253/wjge.v10.i10.283 -
Scientific Reports Jul 2020Whether sealing the hepatic resection surface after liver surgery decreases morbidity is still unclear. Nevertheless, various methods and materials are currently in use...
Whether sealing the hepatic resection surface after liver surgery decreases morbidity is still unclear. Nevertheless, various methods and materials are currently in use for this procedure. Here, we describe our experience with a simple technique using a mobilized falciform ligament flap in minimally invasive liver surgery (MILS). We retrospectively analyzed the charts from 46 patients who received minor MILS between 2011 and 2019 from the same surgical team in a university hospital setting in Germany. Twenty-four patients underwent laparoscopic liver resection, and 22 patients received robotic-assisted liver resection. Sixteen patients in the laparoscopic group and fourteen in the robotic group received a falciform ligament flap (FLF) to cover the resection surface after liver surgery. Our cohort was thus divided into two groups: laparoscopic and robotic patients with (MILS + FLF) and without an FLF (MILS-FLF). Twenty-eight patients (60.9%) in our cohort were male. The overall mean age was 56.8 years (SD 16.8). The mean operating time was 249 min in the MILS + FLF group vs. 235 min in the MILS-FLF group (p = 0.682). The mean blood loss was 301 ml in the MILS + FLF group vs. 318 ml in the MILS-FLF group (p = 0.859). Overall morbidity was 3.3% in the MILS + FLF group vs. 18.8% in the MILS-FLF group (p = 0.114). One patient in the MILS-FLF group (overall 2.2%), who underwent robotic liver surgery, developed bile leakage, but this did not occur in the MILS + FLF group. Covering the resection surface of the liver after minor minimally invasive liver resection with an FLF is a simple and cost-effective technique that does not prolong surgical time or negatively affect other perioperative parameters. In fact, it is a safe add-on step during MILS that may reduce postoperative morbidity. Further studies with larger cohorts will be needed to substantiate our proof of concept and results.
Topics: Adult; Aged; Female; Humans; Laparoscopy; Length of Stay; Liver Neoplasms; Male; Middle Aged; Minimally Invasive Surgical Procedures; Operative Time; Postoperative Complications; Retrospective Studies; Robotic Surgical Procedures; Surgical Flaps
PubMed: 32699283
DOI: 10.1038/s41598-020-69211-8 -
Journal of Clinical Medicine Feb 2022Umbilical endometriosis represents 30-40% of abdominal wall endometriosis and around 0.5-1.0% of all cases of endometriosis. The aim of this systematic review is to... (Review)
Review
Umbilical endometriosis represents 30-40% of abdominal wall endometriosis and around 0.5-1.0% of all cases of endometriosis. The aim of this systematic review is to revisit the epidemiology, signs, and symptoms and to formulate a pathogenic theory based on literature data. We performed a systematic literature review using the PubMed and Embase databases from 1 January 1950 to 7 February 2021, according to the PRISMA guidelines. The review was registered at PROSPERO (CRD42021239670). Studies were selected if they reported original data on umbilical endometriosis nodule defined at histopathological examination and described as the presence of endometrial glands and/or stromal cells in the connective tissue. A total of 11 studies (10 retrospective and one prospective), and 14 case series were included in the present review. Overall, 232 umbilical endometriosis cases were reported, with the number per study ranging from 1 to 96. Umbilical endometriosis was observed in 76 (20.9%; 95% CI 17.1-25.4) of the women included in studies reporting information on the total number of cases of abdominal wall endometriosis. Umbilical endometriosis was considered a primary form in 68.4% (158/231, 95% CI 62.1-74.1) of cases. A history of endometriosis and previous abdominal surgery were reported in 37.9% (25/66, 95% CI 27.2-49.9) and 31.0% (72/232, 95% CI 25.4-37.3) of cases, respectively. Pain was described in 83% of the women (137/165, 95% CI 76.6-88.0), followed by catamenial symptoms in 83.5% (142/170, 95% CI, 77.2-88.4) and bleeding in 50.9% (89/175, 95% CI 43.5-58.2). In the 148 women followed for a period ranging from three to 92.5 months, seven (4.7%, 95% CI 2.3-9.4) recurrences were observed. The results of this analysis show that umbilical endometriosis represents about 20% of all the abdominal wall endometriotic lesions and that over two thirds of cases are primary umbilical endometriosis forms. Pain and catamenial symptoms are the most common complaints that suggest the diagnosis. Primary umbilical endometriosis may originate from implantation of regurgitated endometrial cells conveyed by the clockwise peritoneal circulation up to the right hemidiaphragm and funneled toward the umbilicus by the falciform and round liver ligaments.
PubMed: 35207266
DOI: 10.3390/jcm11040995