Left-sided acute appendicitis with situs inversus totalis: review of 63 published cases and report of two cases

BACKGROUND

Situs inversus (SI) and midgut malrotation (MM) are uncommon anatomic anomalies that complicate diagnosis and management of acute abdominal pain.

METHODS

We present two cases of left-sided acute appendicitis with situs inversus totalis and a literature review of studies published in English language on left-sided acute appendicitis, accessed via Pubmed and Google Scholar database.

RESULTS

Sixty-three published cases of left-sided acute appendicitis were evaluated, and two patients (M:16 yr, F:17 yr) who presented to our clinic with left lower quadrant pain caused by left-sided acute appendicitis were reported. Thirty-five of the patients were male and 30 were female (including our patients) with age range from 8 to 63 years and median age of 26.7 +/- 14.0 years. Fifty-three patients had situs inversus totalis (SIT), 8 had MM and two were with malrotation of the caecum. Thirty-eight patients had applied to the hospital with left lower quadrant pain, 12 with right and 6 with bilateral lower quadrant pain. Thirty patients were diagnosed as having SIT or MM, while the diagnosis in 12 patients was established during the intraoperative period. Eleven patients with SIT were aware of having this anomaly. Five of the patients underwent laparoscopic appendectomy and in two patients laparoscopic appendectomy and cholecystectomy were performed in one session. Preoperative diagnosis has been easier to achieve after 1985, when ultrasonography (USG) and computed tomography (CT) were introduced into the medical practice.

CONCLUSION

SIT and MM should be taken into consideration in patients with findings of the physical examination suspicious for left-sided acute appendicitis. X-ray, USG, CT and diagnostic laparoscopy are beneficial in developing the differential diagnosis.

A familial tendency for developing inguinal hernias: study of a single family

PURPOSE

Inguinal hernias are the most common abdominal wall rupture, and the predisposing factors to hernia formation include a familial tendency, connective tissue and lung diseases, smoking and prostatism. The aim of this study is to discuss the familial tendency for hernia in 5 members of a family of 11 people. To our knowledge, no other large family with inguinal hernias has been reported in the English literature.

METHODS

This study presents the surgical procedures and follow-up results of right inguinal hernias seen in 5 of 11 members from one family. Age, sex, body mass index (BMI), biochemical parameters, type of hernia and surgical procedure, and follow-up results were evaluated retrospectively.

RESULTS

This study included five patients (three males, two females) presenting with right direct inguinal hernias. The initial symptoms began at an average age of 18.2 years (range 15-22), and the mean BMI of the patients was 20.6 kg/m(2) (range 19.3-22.1). Three underwent hernia repairs with polypropylene surgical mesh and two with polyglactin-polypropylene composite mesh (Vypro II). The patients' blood vitamin C levels were lower than those of the other family members, while their 24-h urinary hydroxyproline levels were higher. The patients were followed for an average of 16.4 months (range 3-33 months). No complications developed during follow-up.

CONCLUSION

The occurrence of the same type of hernia in more than one family member and the altered biochemical results indicate that the hernias may have resulted from a familial connective tissue disease. In patients with hernias, if a familial tendency is suspected, a detailed examination for connective tissue diseases may help to confirm the diagnosis.

Primary retroperitoneal hydatid cyst: report of 2 cases and review of 41 published cases

This paper gives an overview of the literature between 2000 and 2010 on primary retroperitoneal hydatid cyst. We reported 2 cases of primary retroperitoneal hydatid cyst, and studies published in English literature on hydatid cyst developing in the retroperitoneal space were accessed via Pubmed and Google Scholar databases. Forty-one published primary retroperitoneal hydatid cyst cases were evaluated, and 2 patients (1 man, 78 years old; 1 woman, 75 years old) who presented with abdominal mass caused by retroperitoneal hydatid cyst were reported. Twenty-five of the patients were men (including our patient), and 18 were women; patients ranged in age from 3 to 80 years, and the median +/- standard deviation age was 41.37 +/- 20.4 years. On presentation, 72% of the patients complained of back or abdominal pain; 13.9% had urinary tract symptoms, and 65.1% were determined as having a palpable mass. Ultrasonography was performed on 93% of the patients, computed tomography was performed on 81.4%, magnetic resonance imaging was performed on 18.6%, and intravenous pyelography test was performed on 13.9%. The results of these tests showed a cystoid mass located on the left in 32.5% of the patients, on the right in 37.2%, and in the retrovesical area in 16.2%. Serologic tests determined 67.8% of the patients were indirect hemagglutination positive, and 71.4% were positive on enzyme-linked immunosorbent assay. As a surgical approach, total exision was performed on 55.8% of patients, partial cystectomy was performed on 39.5%, and 4.6% of patients underwent unroofing. If a cystic lesion is determined in the retroperitoneal area in a patient living in an area of endemic hydatid disease, a differential diagnosis of hydatid cyst should be considered. Clinical, radiologic, serologic, and histopathologic evaluations should be made for a differential diagnosis.

Scar endometriosis in the abdominal wall: a predictable condition for experienced surgeons

PURPOSE

Endometriosis in surgical scars develops in 0.1% of those women who undergo Caesarean section or other obstetric surgery. Herein we analyse and discuss the clinico-pathological characteristics of 15 patients with scar endometriosis in the abdominal wall.

METHODS

Fifteen cases of scar endometriosis in the abdominal wall that were treated surgically in our department between 2003 and 2009 were examined retrospectively. Age, parity, complaint, medical or surgical history, pre/postoperative hormonotherapy, size of the mass, surgical procedure, follow-up and disease recurrence were analysed.

RESULTS

This retrospective study included 15 patients presenting with 17 postoperative abdominal wall masses. The mean age of the patients was 32.1 +/- 6.0 years (range, 23-48). Eleven of the patients had a painful mass that became bigger before menstruation, two had palpable masses only, and two were hospitalised because of a mass with persistent pain. The locations of the masses were as follows: eight were close to the right side and three were close to the left side; two were in the middle of the Pfanenstiel incision and two were in trocar tracts. The patients' surgical histories included Caesarean section in thirteen, bilateral laparoscopic ovarian cyst excision in one, and laparoscopic appendectomy in one.

CONCLUSIONS

If a patient presents with incision pain and a palpable mass after gynaecologic surgery, an incisional endometrioma should be considered. Surgical excision and hormone therapy are effective treatment approaches in these patients.

Radical vs conservative surgery for hydatid liver cysts: Experience from single center

AIM: To compare the efficacy and safety of radical and conservative surgical interventions for liver hydatid disease.

METHODS: The study comprised 59 patients in two groups who had undergone radical and conservative surgical procedures for liver hydatid disease in our department between 2004 and 2009. Preoperative diagnostic tools, medical treatments, demographic and clinical characteristics, postoperative follow-up, and recurrence were compared in both groups.

RESULTS: This non-randomized retrospective study included 59 patients who had undergone liver hydatid disease surgery. The radical technique was used in 18 patients (mean age: 42.1 ± 13.5 years, seven male, 11 female), and the conservative technique was used in 41 patients (mean age: 43.5 ± 13.9 years, 17 male, 24 female). The follow-up period ranged from 3 to 58 mo. Although operative time was significantly shorter in the conservative group (P < 0.001), recurrence was significantly reduced in the radical group (P = 0.045). No statistically significant differences were found in terms of hospitalization duration, cyst count and size, location, postoperative complications, scolicidal solution usage, or follow-up duration between the two groups.

CONCLUSION: The more effective method for preventing postoperative recurrence is radical surgery. Endoscopic retrograde cholangiopancreatography for bile leakage in the early postoperative period may decrease the requirement for repeat surgery.

Giant renal oncocytoma: a case report and review of the literature

INTRODUCTION

Renal oncocytomas are benign neoplasms derived from cells of the distal renal tubule, and comprise 5% to 7% of primary renal neoplasms. Oncocytomas are mostly asymptomatic, and the majority of tumors are discovered incidentally. In this case report, we present a case of a patient with a giant oncocytoma arising from her left kidney.

CASE PRESENTATION

We describe a 25-year-old Turkish woman who was admitted to our hospital with abdominal pain and a 3-year palpable abdominal mass, which was found present since her second pregnancy. Examination revealed a 15 x 20-cm mass in her abdominal cavity. Computed tomography revealed a mass with regular outlines, measuring 18 x 11 x 12 cm, associated with the left kidney, and causing marked hydroureteronephrosis. We excised the mass and performed a left nephrectomy on our patient. The immunohistopathology of the mass was consistent with renal oncocytoma. No local or distant metastasis was seen at 6 months postoperatively.

CONCLUSION

To the best of our knowledge, this is the second largest renal oncocytoma described in the English language literature. This is also the first reported giant oncocytoma that presented during pregnancy.

Unusual presentation of eosinophilic fasciitis: two case reports and a review of the literature

INTRODUCTION

Eosinophilic fasciitis is an uncommon disorder with unknown etiology and a poorly understood pathogenesis. We present the cases of two patients with eosinophilic fasciitis with unusual presentation, and describe the clinical characteristics and laboratory findings related to them.

CASE PRESENTATION

The first case involves a 29-year-old Turkish man admitted with pain, edema and induration of his right-upper and left-lower limbs. Unilateral edema and stiffness with prominent pretibial edema was noted upon physical examination. A high eosinophil count was found on the peripheral smear. The second case involves a 63-year-old Turkish man who had pain, edema, erythema, and itching on his upper and lower extremities, which developed after strenuous physical activity. He had cervical lymphadenopathy and polyarthritis upon physical examination, and rheumatoid factor and antinuclear antibody upon laboratory examination.

CONCLUSION

Eosinophilic fasciitis can present with various symptoms. When patients exhibit eosinophilia, arthralgia and myalgia, eosinophilic fasciitis should be considered as a possible diagnosis.

Rhabdomyolysis-induced acute renal failure following fenofibrate therapy: a case report and literature review

Fenofibrate, a fibric acid derivative, is used to treat diabetic dyslipidemia, hypertriglyceridemia, and combined hyperlipidemia, administered alone or in combination with statins. Rhabdomyolysis is defined as a pathological condition involving skeletal muscle cell damage leading to the release of toxic intracellular material into circulation. Its major causes include muscle compression or overexertion; trauma; ischemia; toxins; cocaine, alcohol, and drug use; metabolic disorders; infections. However, rhabdomyolysis associated with fenofibrate is extremely rare. Herein we report a 45-year-old female patient who was referred to our department because of generalized muscle pain, fatigue, weakness, and oliguria over the preceding 3 weeks. On the basis of the pathogenesis and clinical and laboratory examinations, a diagnosis of acute renal failure secondary to fenofibrate-induced rhabdomyolysis was made. Weekly followups for patients who are administered fenofibrate are the most important way to prevent possible complications.

Acute appendicitis together with chylous ascites: is it a coincidence?

Acute chylous ascites is a rarely seen clinical picture, therefore, examination findings are often confused with acute appendicitis. To the best of our knowledge, there is no publication to date showing the occurrence of them together. This study presents the treatment plan for a 25-year-old male patient with both acute chylous ascites and appendicitis. Surgical findings were retrocaecal appendicitis, evident lymphangiectasia in the proximal segment of jejunum, and approximately 3 lt of chylous fluid. An appendectomy was performed and drainage was applied. Low-fat total parenteral nutrition (TPN) and octreotide treatment were administered for 7 days postoperatively. We also present a general review of some studies on chylous ascites, which have been published in the English language medical literature since 1910.

A rare cause of severe dyspareunia: a case report and literature review

Gastrointestinal stromal tumors (GISTs) of the rectum are rare, and their clinical manifestations are variable. We report the case of a 23-year-old woman who was referred complaining of dyspareunia during coitus. We performed digital vaginal and rectal investigations, ultrasound, colonoscopy, and computed tomography. These examinations confirmed the presence of a lesion measuring about 6 × 5 × 5 cm in size attached to the posterolateral left rectum wall. We performed a circumanal excision, then arrived at the mass between the muscles of the pelvic floor. Pathological studies indicated that the tumor was a high-grade GIST, and was clear at the surgical margins. On follow-up, a GIST was found at the gastric fundus via an endoscopic biopsy. Imatinib treatment was initiated because the patient refused a second operation. The gastric lesion disappeared 6 months after imatinib treatment. Dyspareunia disappeared 1 month after operation.

Retroperitoneal fibrosis and obstructive uropathy due to actinomycosis: case report of a treatment approach

An actinomycotic retroperitoneal infection usually occurs in the presence of an intrauterine device (IUD). It can result in pelvic inflammatory disease and diffuse retroperitoneal fibrosis. A 39-year-old patient was admitted to the emergency unit with left flank pain. A computed tomography scan of the abdomen showed bilateral hydroureteronephrosis and a retroperitoneal malignant mass. Other tumors were excluded with a colonoscopy and an upper gastrointestinal endoscopy. Results of a fine needle aspiration biopsy showed fibrosis compatible with retroperitoneal mesenteritis. Double-J stents were placed in both ureters, and immunosuppressive therapy was started. The patient had clinical and radiologic responses to the therapy. A bilateral ureterolysis and sigmoid colon resection were done. The pathology report showed fibrosis and Actinomyces israelii infection. Parenteral and oral penicillins were administered. The probability of an Actinomyces infection in patients with retroperitoneal fibrosis should be kept in mind, especially in cases in which the patient has an intrauterine device.

Careless use of turban pins: a possible problem for turbaned patients

INTRODUCTION

Foreign body ingestion is rare in adults. In recent years, however, ingestion of the pins that are used for securing turbans has frequently been observed among young Islamic women. This article reviews the patients who were admitted to our emergency unit for turban pin ingestion.

METHODS

Between 2005 and 2009, 42 patients were admitted to our emergency unit with problems involving turban pins. The patients' characteristics were analyzed, including age; marital status; career; type, number, and location of pins; and history of gastrointestinal surgery.

RESULTS

The patients ranged in age between 11 and 48 years. Of the patients, 22 were single, and 20 were married; 19 were students, and 23 were housewives. The patients visited the emergency unit within 1 to 12 h after they had ingested the pins. Eight of the patients had ingested two pins each, while the others had ingested one pin each. The pins ingested most frequently were those with ball heads. Spontaneous excretion took 3 to 16 days. Of the patients who did not pass the pins spontaneously with feces, the pins were extracted at endoscopy in three and at laparotomy in one. The patients were followed up for 4 to 49 months. No pathological problems were noted during follow-up.

CONCLUSIONS

Turban pin ingestion is common in Islamic populations, and the treatment requires a systemic approach and careful follow-up. Pin ingestion can be prevented by increasing public awareness and avoiding holding pins in the mouth when fixing a turban or wearing a type of turban that does not require pins.

Appendiceal endometriosis presenting as perforated appendicitis: report of a case and review of the literature

While endometriosis is a common disorder in women of reproductive age, appendiceal endometriosis accounts for less than 1% of all pelvic endometriotic lesions. Involvement at this site may present as acute appendicitis and be diagnosed only upon postoperative histopathologic examination. We report such an occurrence of appendiceal endometriosis in a 40-year-old woman who presented with acute perforated appendicitis.

Preemptive living donor renal transplantation: a single-center experience

Renal transplantation is considered preemptive if it occurs before initiation of dialysis. In our experience and in the literature, preemptive transplantation has been shown not only to reduce the costs of renal replacement therapy but also to avoid the long-term adverse effects of dialysis. Preemptive renal transplantation therefore is associated with better survival of both the allograft and the recipient. Our aim was to evaluate the outcomes of preemptive renal transplantation experience at our center. Since 1985, 1385 renal transplantations have been performed at our center. We retrospectively analyzed the 16/1385 recipients (11 male, 5 female) of overall mean age of 28.5 +/- 15 years who underwent preemptive procedures. The causes of end-stage renal failure were focal segmental glomerulosclerosis (n = 5), vesicular ureteral reflux (n = 4), Berger disease (n = 2), polycystic renal disease (n = 2), and others (n = 3). Ten patients were adults, the remaining six, children. The mean creatinine clearance and plasma creatinine levels of the recipients before renal transplantation were 13.5 +/- 8.5 mL/min and 6.7 +/- 2.4 mg/dL, respectively. All renal transplantations were performed from living related donors. The mean preoperative serum creatinine levels, mean glomerular filtration rate, and creatinine clearance rates of the donors were 0.8 +/- 0.1 mg/dL, 61.6 +/- 6.5 mL/min, and 112.5 12 mL/min, respectively. Two episodes of acute cellular rejection and one of humoral rejection occurred during a mean follow-up of 48.7 +/- 14 months (range = 25-76 months). The two patients who experienced graft losses due to humoral rejection or chronic rejection were retransplanted 2 and 48 months thereafter, respectively. At this time all patients are alive with good renal function. In conclusion, our single-center results are promising for preemptive renal transplantation as the optimal, least-expensive mode of treatment for end-stage renal disease.

Giant vesical diverticulum: A rare cause of defecation disturbance

Vesical diverticula frequently result from bladder outlet obstructions. However, giant vesical diverticula which cause acute abdomen or intestinal obstruction are very rare. Our review of the English medical literature found 3 cases of bladder diverticula which caused gastrointestinal symptoms. Here, we present a 57-year-old man with a giant diverticulum of the urinary bladder who complained of abdominal pain, nausea and vomiting, constipation, no passage of gas or feces, and abdominal distension for 3 d. A 20 cm × 15 cm diverticulum was observed upon laparotomy. The colonic obstruction was secondary to external compression of the rectum against the sacrum by a distended vesical diverticulum. We performed a diverticulectomy and primary closure. Twelve months postoperatively, the patient had no difficulty with voiding or defecation.

Giant inflammatory fibroid polyp of ileum causing intussusception: a case report

Inflammatory fibroid polyps are rare, localized, non-neoplastic lesions originating in the submucosa of the gastrointestinal tract. Intussusception due to inflammatory fibroid polyps is uncommon; moreover, ileo-ileal intussusception has only rarely been reported. Here, we report an 11 x 7 cm giant inflammatory fibroid polyp of the small bowel that presented as intussusception in a 73-year-old woman. Ultrasonography demonstrated a solid, homogeneous, echogenic mass surrounded by the typical mural layers of an invaginated ileum. The immunohistopathological diagnosis after segmental ileal resection was an ileal inflammatory fibroid polyp. Although encountered rarely in adults, physicians should be aware of invagination and consider it in each case of acute abdomen because of the wide spectrum of clinical settings.

Castleman's disease as cervical mass: a report of three cases and review of the literature

Castleman disease is a rare disorder characterized by benign lymph node hyperplasia involving lymphatic tissue in the neck, mediastinum, abdomen and other areas. Disease was described for the first time in 1956 by Castleman. The etiopathogenesis of the disease is unknown. The disorder can be classified into three histopathological types: hyalin-vascular, plasma-cell and mixed. We report three cases of the Castleman's disease (hyaline-vascular type) in three female patients with unilateral swelling of the neck. None of the patients developed any local or distant recurrence in postoperative follow-up.

Transmural migration of a surgical compress into the stomach after splenectomy: a case report

A surgical compress retained in the abdominal cavity following surgery is a serious problem. Here, we describe a 33-year-old female who was admitted with abdominal pain, vomiting, no passage of gas or feces, and abdominal distension for 3 days. She had a splenectomy at another medical center 4 years previously. An upright plain abdominal film revealed small bowel obstruction with marked small bowel air-fluid levels. The physical examination revealed muscular guarding and rebound tenderness in the periumbilical region. Therefore, a laparotomy was performed. A surgical compress was removed at enterotomy and the final diagnosis was gossypiboma. Because a retained surgical compress may lead to medicolegal problems, it is important to count the material used before and after a surgical procedure to reduce the risk of this problem.

An unusual cause of ileal perforation: Report of a case and literature review

An ileal perforation resulting from a migrated biliary stent is a rare complication of endoscopic stent placement for benign or malignant biliary tract disease. We describe the case of a 59-year-old woman with a history of abdominal surgery in which a migrated biliary stent resulted in an ileal perforation. Patients with comorbid abdominal pathologies, including colonic diverticuli, parastomal hernia, or abdominal hernia, may be at increased risk of perforation from migrated stents.