The SCARE 2018 statement: Updating consensus Surgical CAse REport (SCARE) guidelines

Solid pseudopapillary tumor of the pancreas in a 17-year-old girl

INTRODUCTION

Solid pseudopapillary tumor of the pancreas is a rare tumor of low malignant potential. The aim of this paper is to present and discuss a case of solid pseudopapillary tumor of the pancreas occurring in a 17-year-old female. A 17-year-old girl presented with dull aching poorly localized left hypochondrial pain for two years, she had no clinical findings on physical examination. Ultrasound of the abdomen showed well-defined 9 cm * 7 cm heterogeneous lesion with cystic contents in the region of the tail of the pancreas. Computed tomography scan (CT scan) of the abdomen showed a mass of 8 cm * 7 cm in the region of the tail of the pancreas; that could be pancreatic mass, left suprarenal mass, or lymphoma. Resection of the mass and histopathological examination confirmed the diagnosis of pseudopapillary tumor of the pancreas.

CONCLUSION

Pseudopapillary neoplasm of the pancreas is a rare condition, which needs surgical intervention. Close follow up is necessary to early detection of the recurrence and metastasis.

Tamoxifen-induced acute eosinophilic pneumonia in a breast cancer patient

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If a patient who is taking tamoxifen coughs, be aware of the possibility of pneumonia caused by Tamoxifen.

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Tamoxifen is one of the cause of drug-induced lung injury.

Introduction

Tamoxifen is often used as antihormonal therapy in patients with breast cancer. However, it has various side effects, of which pneumonia is a rare occurrence.

Presentation of case

A 46-year-old female patient with breast cancer underwent surgical treatment. Tamoxifen was administered as adjuvant therapy on post-operative day 14; 2 days after administration of tamoxifen, the patient developed high fever of more than 39 °C and cough with dyspnea. Based on chest computed tomography findings of ground glass opacity, interlobular septal thickening, and mild pleural effusion in both lungs, eosinophilic pneumonia was suspected. Tamoxifen was discontinued and methylprednisolone injection was administered; the patient showed improvement of symptoms and radiographic findings.

Discussion

Tamoxifen was suspected as the cause of eosinophilic pneumonia since the patient developed high-grade fever at the time of tamoxifen administration, which subsided after discontinuation of the treatment. Other factors considered as the cause of pneumonia were examined, but all showed negative results. In order to confirm tamoxifen as the cause of pneumonia, tamoxifen treatment was restarted at follow-up (post-operative day 47); however, after 1 month, regular administration was not possible due to the development of itching symptom and difficulty in obtaining the patient’s cooperation.

Conclusion

The study highlights that if the patient on tamoxifen develops high fever and cough with dyspnea at 2–3days after the first administration, tamoxifen-induced pneumonia should be suspected.

Simultaneous small and large bowel obstruction as a consequence of internal hernia: A case report

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There are no cardinal symptoms for internal hernia.

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Internal hernia must be kept as a differential diagnosis in the case of intestinal obstruction in both operated and non-operated abdomen.

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Early diagnosis both clinically and radiologically may prevent undesirable complications.

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Both patient status and surgeon's experience are essential to form the best surgical decision.

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Fine handling of bowel, assessment of viability, closure of defects and inspecting for other potential ones, and argumenting stoma formation are the main principles of surgery.

Introduction

Intestinal obstruction ascribed to internal hernia is quite rare, especially in adults. There are no differentiating features in the presentation of intestinal obstruction due to internal hernia as compared to other causes. Delay in the diagnosis of this condition carries a considerable risk especially in a virgin abdomen. We report a rare case of internal hernia which presented as acute small and large bowel obstruction.

Presented case

We report a 47- year- old male with generalized abdominal pain associated with vomiting and obstipation. The patient was in hypovolemic shock that only had a transient response to resuscitation. CT scans of the abdomen with contrast was done and showed both large and small bowel obstruction. Exploration laparotomy was done and revealed a concurrent nonviable portion of ileum and twisted sigmoid colon (volvulus) which protruded through a congenital transmesentric defect. Resection was mandatory, and repair of the defect was done.

Discussion

Incidence of internal hernia generally does not exceed 1%. The diagnosis of congenital internal hernia relies on absence history of trauma, inflammatory process and abdominal surgery. Protrusion of simultaneous small and large bowels together through transmesenteric congenital gate is uncommon.

Conclusion

Whether the patient presenting with intestinal obstruction has a history of undergoing previous surgeries (for any reason) or not, the diagnosis of internal hernia must be kept in mind. Coexisting involvement of both small and large bowels that need resection poses the question of the need for restoration of bowel continuity with either colostomy or ileostomy.

Situs inversus abdominalis, polysplenia, complex jejunal atresia and malrotation in a neonate: A rare association

INTRODUCTION

Situs inversus, polysplenia, complex jejuna atresia are rare anomalies in isolation. Their association in a single patient is even rarer with challenges in diagnosis and management.

PRESENTATION OF CASE

A 5 day old neonate presented with features of small bowel obstruction. Radiological investigations revealed situs inversus abdominalis with dilated proximal small bowel loops. At laparotomy, abdominal situs inversus, polysplenia, multiple jejunal atresias with apple peel appearance of the ileum with malrotation was seen.

CONCLUSIONS

The association of situs inversus, polysplenia and complex jejunal atresia is very rare. Pre-operative diagnosis of situs inversus is important for appropriate incision placement and surgical planning.

Inflammatory hepatocellular adenoma in a patient with Turner's syndrome: A case report

INTRODUCTION

Hepatocellular adenoma (HCA) is a rare benign tumor and is related to the use of an oral contraceptive pill. Turner's syndrome requires various hormone replacement therapies, including the pill which is used as a female hormone replacement therapy. Herein we report a case of Turner's syndrome with HCA treated by liver segmentectomy.

PRESENTATION OF CASE

A 36-year-old woman with Turner's syndrome was treated with oral contraceptive pills as a female hormone replacement therapy for 20 years. She presented with fatigue and liver tumor. Liver tumors in the posterior lobe measuring 60 mm and 10 mm in diameter were detected on CT; hence, she was referred to our department. Both the tumors showed high intensity in the arterial phase, iso-intensity in the portal and late phases, and low intensity in the hepatobiliary phase on Gb-EOB-MRI. She was diagnosed with multiple HCAs and underwent segmentectomy Section 7. Pathologically, both the tumors were diagnosed as HCAs, and inflammatory markers were detected by immunohistochemistry. Thirteen months postoperatively, she was doing well and there was no evidence of recurrence of HCA without the pill.

DISCUSSION

There is only one report of HCA in patients with TS (Espat et al., 2000). We reported a case of multiple HCAs in a patient with TS underwent hepatectomy.

CONCLUSION

With the use of the contraceptive pill as a long-term female hormone replacement therapy for Turner's syndrome, careful attention is required for HCA.

Sclerosing angiomatoid nodular transformation (SANT) of spleen mimicking a splenic abscess: Case report and review of the literature

INTRODUCTION

SANT of the spleen is a benign lesion that does not recur after splenectomy with unknown etiology.

PRESENTATION OF THE CASE

We report a case of sclerosing angiomatoid nodular transformation (SANT) of the spleen mimicking a splenic abscess in a patient with imaging studies that failed to differentiate this lesion from other splenic lesions.

DISCUSSION

SANT of the spleen is a rare condition, with only less than 100 cases reported in the literature. Clinically, SANT is only a kind of described pathological diagnostic conception. As in our case, these splenic lesions are often incidental findings on imaging studies performed for other reasons.

CONCLUSION

The patient was treated with splenectomy, which has proved to be both diagnostic and therapeutic. Although histology can lead to the diagnosis of vascular tumor, immunohistochemistry is the only way to confirm the diagnosis.

Tension pneumoperitoneum: Case report of a rare form of acute abdominal compartment syndrome

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Pneumoperitoneum is a rare cause of ACS.

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A defined approach has not been established.

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Whenever possible a minimally invasive approach should be attempted.

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Avoiding laparotomy may benefit certain patients.

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Reports are important in order to establish a treatment protocol.

Introduction: Tension pneumoperitoneum is a severe and rare form of pneumoperitoneum with concomitant hemodynamic instability and respiratory failure. It is a variant of abdominal compartment syndrome (ACS) causing an abrupt increase in intra-abdominal pressure.

Presentation of case: We present a case of pneumoperitoneum, after an endoscopic mucosal resection with the development of ACS. The patient was successfully treated with percutaneous decompression.

Discussion: Decompressive laparotomy is the first treatment option for both most forms of pneumoperitoneum and ACS; nevertheless, this issue is controversial. Recent reports have shown that some patients may be candidates for a minimally invasive catheter decompression avoiding major decompressive surgery. Identifying these patients is vital to avoiding unnecessary surgeries.

Conclusions: Tension pneumoperitoneum is a life-threatening event, early detection and intervention is critical in order to provide prompt and optimal treatment approaches.

Surgical outcome of collateral ligament injury with metacarpal head fracture in a near amputation after power saw injury: Case report

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Case report of collateral ligament injury with metacarpal head fracture in a near amputation after power saw injury.

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Special attention for treatment. The early reparation, reconstruction and fixation with screws in a convergent system procedure was the treatment of choice in this condition.

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Intra-articulation union of a metacarpal head fracture and the good function of metacarpophalangeal joints (MCP) joint at the 1-year follow-up.

Introduction

The incidence of thumb amputation is high in developing and industrialized countries. A power saw injury is very traumatic to the soft tissue and neurovascular system, and thus difficult for orthopedic and plastic surgeons to treat.

Presentation of case

A 41 year old male injured his right hand with a power saw. The poor condition of the soft tissue and collateral ligament damage to the head of the metacarpal fracture meant that near amputation was a possibility. The patient received adequate antibiotic and was taken to the operating room for fixation with convergent screws system, repaired and reconstructed collateral ligament complex. At 3 month follow up, author saw the union of the intraarticular fracture and the metacarpophalangeal joint (MCP). The patient was followed up at 1 year, the sensory and function was full recovered. The patient was extremely satisfied with this treatment and can now work normally again.

Discussion

The collateral ligament complex injury with metacarpal head fracture in a near amputation after power saw injury; it is a very unstable injury. In this case, author performed an early adequate intravenous antibiotics in the emergency room and was taken to the operating room for repair and reconstruction. Neurological status and hand function were recovered that patient was extremely satisfied in this surgical planning.

Conclusion

The power saw injury is a severe injury which requires special attention for treatment. Furthermore, the early reparation, reconstruction and fixation with screws in a convergent system is the treatment of choice in this condition.

Long-term survival with stable disease after multidisciplinary treatment for synchronous liver metastases from gastric cancer: A case report

INTRODUCTION

The liver is one of the most common sites of hematogenous metastases of gastric cancer. The 5-year overall survival rate of synchronous liver metastases from gastric cancer was less than 27%. We report a rare case of patient with synchronous liver metastases from gastric cancer who experienced stable disease for 7 years and 3 months following multidisciplinary modalities.

THE PRESENTATION OF A CASE

A 33-year-old woman was admitted to our institute because of abdominal pain lasting for a day. Haemoglobin level was 68 g/L. Computed tomography (CT) scan revealed hemoperitoneum, multiple round lesions within liver parenchyma. The pathological diagnosis was gastric cancer with liver metastases. Following multidisciplinary treatment, she experienced stable disease for7 years and 3 months. Currently, the patient remains alive with no recurrence.

CONCLUSION

We report a rare case of patient with synchronous liver metastases from gastric cancer who experienced stable disease for 7 years and 3 months following multidisciplinary modalities. Future trials are required to prospectively investigate the established regimen of multidisciplinary treatment.

Bronchogenic cyst removal via thoracoscopic surgery in the prone position: A case report and literature review

INTRODUCTION

Mediastinal bronchogenic cysts are encountered relatively often, but in many cases, diagnosis using imaging modalities, is difficult. Early surgical excision of bronchogenic cysts is recommended as a diagnostic and therapeutic measure. Here, we report the case of patient with a lower mediastinal bronchogenic cyst, who was treated using thoracoscopic surgery with prone positioning and include a review of literature on diagnosis and treatment of this condition.

PRESENTATION OF CASE

The patient was a 66-year-old woman with an asymptomatic cystic lesion in the posterior, lower mediastinum. The lesion was diagnosed as an esophageal cyst using preoperative imaging and was scheduled for thoracoscopic removal with the patient in the prone position. Intraoperatively, the lesion was found to have no continuity with the esophageal wall and was easily separated from it. Moreover, a cord extending to the lesion, appeared to arise from the crura of the diaphragm. On histopathological examination of the extracted mass, the lesion was diagnosed as a bronchogenic cyst. Postoperatively, the patient recovered uneventfully and was discharged after 7 days.

CONCLUSION

Thoracoscopic mediastinal cystectomy with the patient in the prone position may be an optimal surgical strategy for the treatment of bronchogenic cysts in the posterior, lower mediastinum.

Unusual localization of bleeding under acenocoumarol: Spinal subdural hematoma

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The spinal subdural hematoma is a rare situation which should be evoked in any patient treated by vitamin K antagonists with signs of spinal cord compression.

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Magnetic resonance imaging is the imaging exam of choice to establish the diagnosis.

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Rapid correction of bleeding disorders is required.

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Sometimes, emergent surgical evacuation of the hematoma is the only therapeutic option to ensure optimal neurological prognosis.

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The procedures for resuming anticoagulation should be subject to a multidisciplinary consultation.

Background

The spinal subdural hematoma (SSH) is an extremely rare entity which represents only 4.1% of all spinal hematomas. It needs accurate diagnosis and rapid intervention because of the major neurological risk induced by spinal compression. Several etiologies have been reported: anticoagulant treatments, haematological disorders, arterio-venous malformation, repeated attempts at lumbar punctures and tumors. We report the case of an 82-year-old patient under acenocoumarol for atrial fibrillation who presented with paraplegia secondary to SSH.

Case report

An 82-year-old patient with a history of ischemic heart disease and atrial fibrillation under acenocoumarol was admitted to emergency department with sudden onset of paraplegia and intense back pain associated with urinary incontinence and anal sphincter disorder. On examination his lower limb power was MRC grade 0 out of 5 in all ranges of movement bilaterally and a complete bilateral anesthesia reaching the T12 dermatome was noted. Biological test results showed an International Normalized Ratio at 10. Magnetic resonance imaging revealed a posteriorly located spinal hematoma at T12 level, measuring 36 mm with spinal cord compression. After correction of hemostasis disorders the patient was admitted to the operating room for a T11-L1 laminectomy with evacuation of the subdural hematoma. Muscle power showed a gradual improvement in the lower limbs estimated at 3/5 with regression of sphincter disorders but unfortunately a sequellar sensory impairment persisted.

Conclusion

SSH is a rare situation of acenocoumarol bleeding incident, it should be evoked in any patient treated by this molecule with signs of spinal cord compression.

Cytomegalovirus enterocolitis in a patient with dihydropyrimidine dehydrogenase deficiency after capecitabine treatment: A case report

INTRODUCTION

5-Fluorouracil (5-FU) is widely used for cancer treatment. The reduced activity of dihydropyrimidine dehydrogenase (DPD), the key enzyme in 5-FU inactivation, increases a patient's risk of developing severe 5-FU related toxicity. However, screening for DPD deficiency is rarely performed before 5-FU administration.

PRESENTATION OF CASE

Our patient was a 69-year-old man with rectal cancer (T2N1bM0 stage IIIA) who underwent laparoscopic low anterior resection. He developed severe neutropenia and diarrhea 15 days after the administration of capecitabine for adjuvant chemotherapy, and was admitted to our hospital. Four days after admission, he was transferred to the intensive care unit for sepsis. DPD protein screening revealed DPD deficiency. On day 27, massive melena suddenly appeared. He died of continual bleeding 41 days after admission. Pathological autopsy revealed cytomegalovirus enterocolitis.

DISCUSSION

The administration of 5-FU to patients with DPD deficiency is lethal. Genotypic and phenotypic assessments are reliable tests for DPD deficiency. A genetic study can effectively screen for DPD deficiency; however, its use has not been established in the national insurance system. Patients with DPD deficiency tend to develop severe neutropenia, so clinicians should pay attention to opportunistic infections such as cytomegalovirus enterocolitis.

CONCLUSION

Screening for DPD deficiency is necessary prior to 5-FU administration.

Pilomatrix carcinoma of the right postauricular region: A case report and literature review

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Pilomatrix carcinoma is a very rare locally aggressive tumor.

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A well-defined gold standard for surgical management has not been established.

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Currently wide local excision with safe margins is recommended.

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Regional lymph node dissection is performed when metastasis is suspected.

Introduction

Pilomatrix carcinoma is a rare aggressive tumor with a high rate of local recurrence after surgical excision. Diagnosis is made by histopathology and when discovered, wide local excision has been shown to have the best results.

Presentation of case

We report a case of a 74-year-old male incidentally found to have a large right postauricular mass and regional lymphadenopathy. The mass was biopsied and proven to be a malignant pilomatrixoma. Wide local excision and level II and III neck dissection with reconstruction using a right supraclavicular flap was performed.

Discussion

Pilomatrix carcinoma is a lesion first described in 1880 by Malherbe and Chenantais. It is unknown if these tumors arise de novo or arise through malignant transformation of a benign pilomatrixoma. There are similarities between the benign lesion and its malignant counterpart in terms of activating mutations in signaling pathways. A well-defined gold standard for surgical management has not been established, but currently wide local excision with safe margins is recommended along with regional lymph node dissection when metastasis is suspected. Currently, no chemotherapy regimen has been shown to be effective in local control or in preventing metastatic spread.

Conclusion

Pilomatrix carcinoma, given its aggressive nature, has a high propensity for recurrence after excision. It is important to perform wide local excision to avoid an incomplete resection and higher recurrence rates. Further studies will be needed to create a more defined standard of treatment and to evaluate the role of adjuvant chemotherapy and radiation therapy.

Case report: Diverticulitis complicating a giant Meckel’s divertuculum

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Meckel’s diverticulitis is a rare condition which may need surgical approach.

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It is uncommon that Meckel’s diverticulum causes symptomatic disease in adults.

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Although early detection is often challenging, an abdominal CT-scan may establish a certain diagnosis in giant diverticula.

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Emergency surgery is mandatory in patients with complicated Meckel’s diverticulum.

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Segmental resection is the approach of choice when a giant diverticulum has inflammatory signs.

Introduction

In this paper, we discuss a unique case of diverticulitis in which the patient presented a giant Meckel’s diverticulum.

Presentation of case

The patient was a 44 year old male whose medical history included a laparoscopic gastric bypass four years before the finding, and chronical high blood pressure. The patient came to the emergency department with an abdominal pain and elevated acute-phase reactants. An abdominal CT revealed a 17 cm long Meckel’s diverticulum with signs of severe inflammation. The patient was then taken to the operating room, and subjected to a 4 cm ileum resection, including the entire diverticulum, with a manual end-to-end anastomosis.

Discussion

Although Meckel’s diverticulum is the most common congenital abnormality of the intestinal tract, it is unusual for it to cause symptoms in adults. However, when a patient arrives at the emergency department with a complicated Meckel’s diverticulum, an early diagnosis is essential to prevent serious complications, such as perforation of the diverticulum and subsequent peritonitis. The presence of a giant diverticulum is an extremely rare condition. There are few publications to date, but these diverticula are associated with more complications, presenting a higher risk of torsion, volvulus or intestinal obstruction.

This paper include a bibliographic review of existing studies on etiopathogenesis, and the diagnosis and treatment of complicated Meckel’s diverticulum, particularly in its giant variant.

Conclusion

Although Meckel’s diverticulitis is a rare entity, it can appear as an acute abdomen. An early diagnosis and treatment to prevent subsequent complications is essential to ensure an optimal recovery.

Twenty-year survival of gastric cancer with peritoneal metastases using long-term normothermic intraperitoneal 5-fluorouracil and systemic mitomycin C: A case report

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Primary gastric cancer presenting with peritoneal metastases has limited successful treatment options.

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Treatments utilize aggressive systemic cancer chemotherapy with profound negative impact on quality of life.

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A simplified management plan using gastrectomy, HIPEC, and long-term intraperitoneal and systemic chemotherapy was used.

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Her quality of life throughout treatment was excellent and resulted in a 20-year survivor of these treatments.

Background

Methods

Results

Conclusions

Paediatric case of gastrointestinal basidiobolomycosis mimicking appendicitis – Case report

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Basidiobolomycosis is a rare fungal infection that leads to subcutaneous infection.

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Gastrointestinal basidiobolomycosis is difficult to diagnose primarily due to its non-specific clinical presentation.

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Gastrointestinal basidiobolomycosis should be a differential especially in paediatric patients present with abdominal mass and eosinophilia.

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Optimal way to manage gastrointestinal basidiobolomycosis is by surgical resection followed by 3 months of antifungal treatment.

Introduction

Basidiobolomycosis is a rare fungal infection caused by Basidiobolus ranarum that normally leads to subcutaneous infection and, rarely, to involvement in the gastrointestinal tract.

Presentation of case

A 6-year-old boy presented to the Emergency department (ED) complaining of abdominal pain of a few weeks’ duration in the right lower quadrant, associated with fever and vomiting. A computed tomography (CT) of the abdomen was done. It showed an enlarged tubular structure in the right iliac fossa, a suspected appendicular lesion, and free fluid collection, as well as multiple enlarged mesenteric and right iliac lymph nodes. Based on these results, the decision was made to do surgical exploration on the patient. After two weeks, the patient developed tachycardia, abdominal distention, constipation, and spikes of fever. Two days later, re-exploration was performed. An ileostomy and colostomy were performed and drains inserted. Post-operative, the patient was pushed to paediatric intensive care unit (PICU), while still intubated and hemodynamically stable. However, he developed cardiac arrest on the same day and cardiopulmonary resuscitation (CPR) was performed, but he couldn't be resuscitated.

Discussion

The patient presented with severe abdominal pain in the right lower quadrant, as well as fever and vomiting. These complaints may have been misdiagnosed as appendicitis. The diagnosis of gastrointestinal basidiobolomycosis was confirmed by histopathology, based on a surgical specimen taken during the primary exploration. The management was a combination between surgical intervention and medical treatment.