The SCARE Statement: Consensus-based surgical case report guidelines

Hepatolithiasis following hepaticojejunostomy successfully treated with right hepatectomy: A case report

Hepatolithiasis is a rare condition requiring multidisciplinary treatment approach. In this case report we present a case of multiple hepatolithiasis successfully treated with right hepatectomy. A 54 years-old asymptomatic female with previous history of hepaticojejunostomy for recurrent CBD stone was diagnosed with hepatolithiasis during routine follow-up. Hepatolithiasis has multifactorial causation one of which is thought to be previous biliary surgery. This case report highlights the importance of routine ultrasound imaging during follow-up of the patient with history of previous biliary surgery for early detection of hepatolithiasis thus, mitigating further complications.

A rare encounter - Unveiling the mysteries of biliary hamartoma: A case report

INTRODUCTION

Biliary hamartomas are rare congenital development anomaly of bile ducts, which are detected incidentally. They often present as multiple lesions on liver surface which resembles metastatic lesions. We report a case of acute calculous cholecystitis ultimately diagnosed to have asymptomatic multiple biliary hamartomas.

CASE DESCRIPTION

A 42-year-old male with no co-morbidities presented with pain in upper abdomen associated with fever and vomiting. Contrast enhanced computed tomography (CECT) of abdomen showed acute calculous cholecystitis, hepatomegaly with fatty changes in liver. On laparoscopy the liver was found to have grey-white nodular lesions of about 0.5 cm in diameter scattered on the surface of both the lobes. One of the lesion was biopsied along with cholecystectomy.

DISCUSSION

Biliary hamartoma commonly referred to as "von Meyenburg complexes" are uncommon lesions found in the liver which are usually asymptomatic. In this case the patient presented with symptoms of acute cholecystitis but the biopsy report from liver lesions proved to be benign biliary hamartoma which on initial impression looked like multiple liver secondaries.

CONCLUSION

We have described a case of an adult with multiple biliary hamartoma which was an incidental finding. Biliary hamartoma is a rare entity which can sometime mimic metastasis in the liver. Thus, histopathological confirmation is essential before planning any further treatment.

Histidine-Tryptophan-Ketoglutarate Cardioplegia Yields Different Results in Aortic Valve Surgery Depending on Patient Gender: A Pilot Study

BACKGROUND

Histidine-tryptophan-ketoglutarate (HTK) cardioplegia induces cardiac arrest through membrane hyperpolarization. Aortic valve pathology leads to pathophysiological changes in left ventricular vascularization that may prevent adequate cardioplegic distribution. The objective of the study was to ascertain whether the use of Bretschneider cardioplegia in aortic valve surgery yields different outcomes for male and female patients.

METHODOLOGY

Our study compares the perioperative data of 300 adult patients who underwent aortic valve replacement between June 2023 and June 2024 at the Emergency Cardiac Disease and Transplant Institute, Tîrgu Mures, Romania. Concomitant procedures, age under 18 years, retrograde or combined cardioplegia, and emergency surgery were excluded. The main outcome was operative mortality, and secondary outcomes were postoperative complications and paraclinical data such as ejection fraction and cardiac enzymes.

RESULTS

Male patients comprised 190 (62%) of the sample. The most common age group was 61-70 years in both groups. The mortality rate was 6 (5.4%) for women compared to 9 (4.7%) for men. Preoperative left ventricular ejection fraction was the primary covariate determining 30-day postoperative mortality. Left ventricular ejection fraction decreased by 2.2% in men and 1.1% in women 30 days after surgery.

CONCLUSIONS

The myocardial adaptation to aortic valve pathology exhibits gender-specific differences. However, the utilization of HTK cardioplegia obviates this disparity.

Evaluation of the appropriateness of nursing case studies using the CARE checklist

Case report is a narrative description of the problem of one or several patients. The CARE checklist (CAse REport) is the consensus document for reporting clinical case reports and through adaptations to the different CARE disciplines is used to define standards for authors in scientific journals; however, the specificity of the nursing process makes it difficult to adjust nursing case reports to CARE. The aim was to analyze the publications of clinical cases with a nursing perspective in scientific journals, as well as the quality standards and evaluation systems used. Few journals reviewed agreed to publish nursing case reports or stated standards for authors to adjust to CARE. Preliminary results indicated average or poor adherence to CARE, with the most reported elements being: Keywords, patient information and introduction. Adherence was lower for the elements: Timeline, therapeutic intervention, follow-up and outcomes, and patient perspective. The characteristics of the nursing process implies a low adherence to CARE, so it is necessary to unify criteria to guide researchers, authors, reviewers and editors of scientific journals, as well as to improve the rigor and quality of the reports. Currently, there are no specific guidelines for reporting clinical case reports with a nursing perspective available. These normative gaps could be solved by developing a CARE extension adapted to the methodological characteristics of the nursing process.

Autogenous, alloplastic, or hybrid for total mandibular reconstruction; is here an optimal path?

For less fit patients, total reconstruction of the mandible (TRM) is an elucidated alternative for severe maxillofacial defects. This study aimed to comprehensively review and analyze the existing evidence, irrespective of the underlying pathologies, to provide a consolidated overview of the current state of TRM. An electronic search was performed on PubMed, Embase, Scopus, and Google Scholar to identify studies reporting TRM without restrictions on patient age, type of pathology underlying the mandibular defect, and study type. Electronic search identified 390 studies; only 21 met the inclusion criteria, documenting 7 (33.3%) autogenous, 6 (28.6%) alloplastic, and 8 (38.1%) hybrid TRMs. All studies reported one clinical case, except for two studies that reported two patients treated with TRM. The mean age of the patients was 39.0 ± 19.4 years, and the mean follow-up was 22.3 ± 14.7 months. Osteomyelitis was the most common pathology. Bilateral condyles were preserved in only two cases. The TRM has been reported in clinical cases only and no large cohort study is available. Functional and aesthetic parameters have either not been reported or have been reported in heterogeneous formats, thus hampering comparisons of autogenous, alloplastic, and hybrid TRMs. Overall, TRM in patients presenting with severe maxillofacial defects achieved promising clinical outcomes endowed with acceptable function and aesthetics. Large cohort studies are needed to validate these results.

Venovenous bypass in adult liver transplant recipients: A single-center observational case series

BACKGROUND

Very little information is currently available on the use and outcomes of venovenous bypass (VVB) in liver transplantation (LT) in adults in Australia. In this study, we explored the indications, intraoperative course, and postoperative outcomes of patients who underwent VVB in a high-volume LT unit.

METHODS

The study was a single-center, retrospective observational case series of adult patients who underwent VVB during LT at Austin Health in Melbourne, Australia between March 2008 and March 2022. Information on baseline preoperative status and intraoperative variables, including specific VVB characteristics as well as postoperative and VVB-related complications was collected. The lengths of intensive care unit and hospital stays as well as intraoperative and in-hospital mortality were recorded.

RESULTS

Of the 900 LTs performed at this center during the aforementioned 14-year period, 27 (3%) included a VVB procedure. VVB was performed electively in 16 of these 27 patients (59.3%) and as a rescue technique to control massive bleeding in the other 11 (40.1%). The median (interquartile range [IQR]) age of those who underwent VVB procedures was 48 (39-55) years; the median age was 56 (47-62) years in the non-VVB group (p<0.0001). The median model for end-stage liver disease (MELD) scores were similar between the two patient groups. Complete blood data was available for 622 non-VVB patients. Twenty-six VVB (96.3%) and 603 non-VVB (96.9%) patients required intraoperative blood transfusions. The median (IQR) number of units of packed red blood cells transfused was 7 (4.8-12.5) units in the VVB group compared to 3.0 units (1.0-6.0) in the non-VVB group (p<0.0001). Inpatient mortality was 18.5% and 1.1% for the VVB and non-VVB groups, respectively (p<0.0001). There were no significant differences in length of hospital stay or incidence of acute kidney injury, primary graft dysfunction, or long-term graft failure between the two groups. Patients in the VVB group experienced a higher rate of postoperative non-anastomotic biliary stricture compared to patients in the non-VVB group (33% and 7.9%, respectively; p = 0.0003).

CONCLUSIONS

VVB continues to play a vital role in LT. This case series highlights the heightened risk of major complications linked to VVB. However, the global transition to selective use of VVB underscores the urgent need for collaborative multi-center studies designed to address outstanding questions and parameters related to the safe implementation of this procedure.

Chylous ascites after associating liver partition and portal vein ligation for stage hepatectomy (ALPPS): overview and case report

Chylous ascites is an uncommon pathology with low incidence following hepato-pancreato-biliary surgery, there are no cases reported in the international literature following the associating liver partition and portal vein ligation for stage hepatectomy (ALPPS) procedure. It is caused by abnormal intraperitoneal accumulation of lymph fluid in the abdominal cavity secondary to obstruction or injury to the chyle cistern or its tributaries. We describe the case of a 49-year-old woman diagnosed with colon cancer and liver metastasis. ALPPS was performed, on a first and second stage, presenting a high drainage output as well as change in the characteristics of the drainage fluid. The diagnosis of chylous ascites was confirmed by finding triglyceride levels in the drainage fluid at 300 mg/dL. Medical treatment was started based on a hyper-protein diet and fat restriction, supplemented with medium-chain triglycerides and somatostatin analog, with fistula resolution. It can be managed with medical treatment.

Primary gastroduodenal tuberculosis presenting as gastric outlet obstruction: A case report and review of literature

BACKGROUND

Mycobacterium tuberculosis (TB) is the causative agent of TB, a chronic granulomatous illness. This disease is prevalent in low-income countries, posing a significant global health challenge. Gastrointestinal TB is one of the three forms. The disease can mimic other intra-abdominal conditions, leading to delayed diagnosis owing to the absence of specific symptoms. While gastric outlet obstruction (GOO) remains a frequent complication, its incidence has declined with the advent of proton pump inhibitors and Helicobacter pylori eradication therapy. Gastroduodenal TB can cause upper gastrointestinal hemorrhage, obstruction, and malignancy-like tumors.

CASE SUMMARY

A 23-year-old male presented with recurrent epigastric pain, distension, nausea, vomiting, and weight loss, prompting a referral to a gastroenterologist clinic. Endoscopic examination revealed distorted gastric mucosa and signs of chronic inflammation. However, treatment was interrupted, possibly owing to vomiting or comorbidities such as human immunodeficiency virus infection or diabetes. Subsequent surgical intervention revealed a dilated stomach and diffuse thickening of the duodenal wall. Resection revealed gastric wall effacement with TB.

CONCLUSION

Primary gastric TB is rare, frequently leading to GOO. Given its rarity, suspicions should be promptly raised when encountering relevant symptoms, often requiring surgical intervention for diagnosis and treatment.

Case Report: Robotic pylorus-preserving pancreatoduodenectomy for periampullary rhabdomyosarcoma in a 3-year-old patient

Periampullary neoplasm is rare in pediatric patients and has constituted a strict indication for pancreatoduodenectomy (PD), which is a procedure sporadically reported in the literature among children. Robotic PD has been routinely performed for periampullary neoplasm in periampullary neoplasm, but only a few cases in pediatric patients have been reported. Here, we report the case of a 3-year-old patient with periampullary rhabdomyosarcoma treated with robotic pylorus-preserving PD and share our experience with this procedure in pediatric patients. A 3-year-old patient presented with obstructive jaundice and a mass in the pancreatic head revealed by imaging. A laparoscopic biopsy was performed. Jaundice progressed with abdominal pain and elevated alpha-amylase leading to urgent robotic exploration in which a periampullary neoplasm was revealed and pathologically diagnosed as rhabdomyosarcoma by frozen section examination. After pylorus-preserving PD, we performed a conventional jejunal loop following a child reconstruction, including an end-to-end pancreaticojejunostomy, followed by end-to-side hepaticojejunostomy and duodenojejunostomy. Delayed gastric emptying (DGE) presented with increasing drain from the nasogastric tube (NGT) a week after the surgery and improved spontaneously within 10 days. In a 13-month follow-up until the present, our case patient recovered well without potentially fatal complications, such as pancreatic fistula. Robotic PD in pediatric patients was safe and effective without intra- or postoperative complications.

Alleviation of cadmium toxicity in pea (Pisum sativum L.) through Zn-Lys supplementation and its effects on growth and antioxidant defense

Cadmium significantly impacts plant growth and productivity by disrupting physiological, biochemical, and oxidative defenses, leading to severe damage. The application of Zn-Lys improves plant growth while reducing the stress caused by heavy metals on plants. By focusing on cadmium stress and potential of Zn-Lys on pea, we conducted a pot-based study, organized under completely randomized block design CRD-factorial at the Botanical Garden of Government College University, Faisalabad. Both pea cultivars were grown in several concentrations of cadmium @ 0, 50 and 100 μM, and Zn-Lys were exogenously applied @ 0 mg/L and 10 mg/L with three replicates for each treatment. Cd-toxicity potentially reduces plant growth, chlorophyll contents, osmoprotectants, and anthocyanin content; however, an increase in MDA, H2O2 initiation, enzymatic antioxidant activities as well as phenolic, flavonoid, proline was observed. Remarkably, exogenously applied Zn-Lys significantly enhanced the plant growth, biomass, photosynthetic attributes, osmoprotectants, and anthocyanin contents, while further increase in enzymatic antioxidant activities, total phenolic, flavonoid, and proline contents were noticed. However, application of Zn-Lys instigated a remarkable decrease in levels of MDA and H2O2. It can be suggested with recommendation to check the potential of Zn-Lys on plants under cadmium-based toxic soil.

Graves' disease with only unilateral involvement; a case report

INTRODUCTION

Graves' disease characteristically presents with a diffuse goiter secondary to the autoantibodies that target the thyrotropin receptors of the thyroid gland. Few cases have been reported of only one of the two lobes being affected. The cause of this phenomenon is still uncertain. Here we report on another case of unilateral Graves' disease.

CASE PRESENTATION

A 43-year-old female patient presented with a history of weight loss, palpitations and right sided neck swelling for 4 months. Clinical examination showed an enlarged right thyroid lobe. Laboratory investigations yielded evidence of thyrotoxicosis with suppressed thyroid stimulating hormone. In addition, anti-TSH receptor and anti-thyroperoxidase antibodies were positive. Neck Ultrasound showed an enlarged right thyroid lobe with increased vascularization. The isthmus and left lobe were both normal in size. A Tc99m pertechnetate thyroid scan demonstrated enlargement of the right thyroid lobe with diffuse intense uptake, whereas the left lobe was suppressed. A diagnosis of unilateral Graves' disease was made. The thyrotoxicosis was treated and maintained with methimazole.

DISCUSSION

Unilateral Graves' disease is a rare manifestation of Graves' disease, sharing the same autoimmune background and the symptoms of thyrotoxicosis. Enlargement of only one lobe was evident on clinical examination. The distinctive feature was unilateral uptake during thyroid scintigraphy. The exact pathophysiology of this condition has yet to be elucidated. Management options and responses are similar to those of classical Graves' disease.

CONCLUSION

Unilateral uptake during thyroid scintigraphy and/or unilateral lobar goiter in the setting of hyperthyroidism can be the presentation of unilateral Graves' disease.

Delayed Presenting Gastric Duplication Cyst Mimicking a Left Adrenal Cyst in a Young Female: A Case Report with a Literature Review

Introduction

Gastric duplication cyst (GDC) is a rare congenital anomaly of the gastrointestinal tract. Though GDC is often misdiagnosed, misidentification as an adrenal cyst has rarely been reported. Herein, we report a case of GDC in a young female mimicking an adrenal cyst.

Case Presentation

A 17-year-old female presented with chronic epigastric pain, nausea, and intermittent vomiting. Physical examinations revealed mild tenderness in the epigastric region. Esophagogastroduodenoscopy showed no abnormality. Ultrasound, contrast-enhanced computed tomography scan, and MRI of the abdomen and pelvis showed an oval-shaped left adrenal cystic lesion measuring 33 × 26 mm. Preoperative blood investigations and hormonal assessments were normal. Laparoscopy showed that the cyst originated from the greater curvature of the stomach. The left adrenal gland was normal. After an intraoperative consultation with a gastrointestinal surgeon, a wedge resection of the cyst was performed. Histopathology confirmed the gastric duplication cyst.

Conclusion

GDCs are rare congenital malformations that may become symptomatic during adulthood. They can mimic adrenal cysts and lead to misdiagnosis.

Pathological unstable dislocation of shoulder secondary to septic arthritis: A case report

INTRODUCTION

Pathological unstable dislocation of the glenohumeral joint following septic arthritis is a rare condition. We report a case of 40 years old patient with pathological shoulder dislocation secondary to septic arthritis.

CASE PRESENTATION

A 40 years old male patient presented to the Department of Orthopedics with chief complain of swelling and pain of Right upper extremity for 6 days. He had history of IV canula insertion to give fluids. Then he developed swelling of hand which progressively increased up to right shoulder. He also complained of severe pain over that region. X-ray showed anteromedial dislocation of humeral head. Aspiration of joint was done and the aspirate was sent for culture and sensitivity, which revealed Staphylococcus aureus. Incision and drainage was performed, about 500 ml of straw-colored pus mixed with synovial fluid extending up to sternum, posteriorly up to clavicle and laterally up to deltoid was estimated. Then we planned for open reduction and percutaneous pinning with K-wire. The intervention led to substantial loss of disability and regain of limited range of motion.

DISCUSSION

Septic Arthritis in adults is uncommon and complete dislocation of the glenohumeral joint associated with it is rare. Septicemia was a common complication among all treatment groups, with cultures most frequently indicating Staphylococcus aureus as the causative organism. Septic arthritis is most commonly caused by hematogenous but recently, the incidence of hematogenous septic arthritis has decreased, while local injection-induced septic arthritis has been increased specially in shoulder.

CONCLUSION

Septic arthritis of the glenohumeral joint is rare condition in comparison with knee and hip joints. Therefore, the diagnosis requires a high index of suspicion, early evaluation and treatment of the affected shoulder. Our case is a good example of how we can use simple surgery techniques like open reduction and percutaneous fixation with K-wire in low and middle income countries where patient is not economically sound to afford arthroplasty.

Gastroblastoma without GLI1 and EWSR1 gene breaks

OBJECTIVE

To report a rare gastroblastoma; discuss its clinical features, histopathological morphology, diagnosis, differential diagnosis, treatment, and prognosis; and so as to improve the understanding on this disease and provide reference for its diagnosis, treatment, and prognosis.

METHODS

The diagnosis and treatment, imaging examination, pathological, and genetic data of a 19-year-old young female patient with gastroblastoma were analyzed retrospectively, and the relevant literature was reviewed and summarized.

RESULTS

The patient was found to have a "gastrointestinal stromal tumor" for 3 days by physical examination in another hospital. Abdominal CT and MRI considered "solid pseudopapilloma of pancreas" and clinically planned to perform "radical pancreatoduodenectomy." During the operation, the tumor was observed to bulge from the posterior wall of the gastric antrum, and the root was located in the gastric antrum, so it was changed to "partial gastrectomy + Ronx-y gastrojejunal anastomosis." The postoperative pathology showed that the tumor was bi-differentiated between gastric epithelium and mesenchymal. Combined with the results of IHC and the opinions of several consultation units, the diagnosis of gastric blastoma (low-grade malignancy) was supported. However, the fracture rearrangement of GLI1 and EWSR1 genes was not detected by FISH. After 19 months of follow-up, no signs of tumor recurrence and metastasis were found.

CONCLUSION

Combined with existing literature reports, gastroblastoma occurs in young people, equally in men and women, and tends to occur in the gastric antrum. The biological behavior of the tumor tends to be inert, and the prognosis of most cases is good. Postoperative pathology and IHC are reliable methods for the diagnosis of gastric blastoma, and surgical resection of the lesion is the preferred treatment.

Short Peptide Nanofiber Biomaterials Ameliorate Local Hemostatic Capacity of Surgical Materials and Intraoperative Hemostatic Applications in Clinics

Short designer self-assembling peptide (dSAP) biomaterials are a new addition to the hemostat group. It may provide a diverse and robust toolbox for surgeons to integrate wound microenvironment with much safer and stronger hemostatic capacity than conventional materials and hemostatic agents. Especially in noncompressible torso hemorrhage (NCTH), diffuse mucosal surface bleeding, and internal medical bleeding (IMB), with respect to the optimal hemostatic formulation, dSAP biomaterials are the ingenious nanofiber alternatives to make bioactive neural scaffold, nasal packing, large mucosal surface coverage in gastrointestinal surgery (esophagus, gastric lesion, duodenum, and lower digestive tract), epicardiac cell-delivery carrier, transparent matrix barrier, and so on. Herein, in multiple surgical specialties, dSAP-biomaterial-based nano-hemostats achieve safe, effective, and immediate hemostasis, facile wound healing, and potentially reduce the risks in delayed bleeding, rebleeding, post-operative bleeding, or related complications. The biosafety in vivo, bleeding indications, tissue-sealing quality, surgical feasibility, and local usability are addressed comprehensively and sequentially and pursued to develop useful surgical techniques with better hemostatic performance. Here, the state of the art and all-round advancements of nano-hemostatic approaches in surgery are provided. Relevant critical insights will inspire exciting investigations on peptide nanotechnology, next-generation biomaterials, and better promising prospects in clinics.

Twists and turns: A case report of cecal volvulus

We present a case of a 22-year-old male presenting in the emergency room with colicky abdominal pain, vomiting, and abdominal distension for which an early computed tomography scan was done and diagnosed as cecal volvulus. Following diagnosis case was managed promptly by laparotomy with right hemicolectomy and primary anastomosis.

Laparoscopic treatment of Mirizzi syndrome with subtotal cholecystectomy and electrohydraulic lithotripsy: A case report

Mirizzi syndrome is a rare chronic cholecystitis complication. However, the current consensus on managing this condition remains controversial, especially through laparoscopic surgery. This report describes the feasibility of treating type I Mirizzi syndrome with laparoscopic subtotal cholecystectomy and electrohydraulic lithotripsic gallstone removal. A 53-year-old woman presented with dark urine and right upper quadrant pain for 1 month. On examination, she was jaundiced. Blood tests showed highly elevated liver and biliary enzyme levels. Abdominal ultrasound showed a slightly dilated common bile duct with suspicion of choledocholithiasis. However, endoscopic retrograde cholangiopancreatography showed a narrowed common bile duct extrinsically compressed by a gallstone in the cystic duct, establishing a Mirizzi syndrome diagnosis. Elective laparoscopic cholecystectomy was planned. At operation, the trans-infundibulum approach was used since dissection around the cystic duct was difficult due to severe local inflammation of Calot's triangle. The gallbladder's neck was opened, and the stone was removed by lithotripsy via a flexible choledochoscope. Common bile duct exploration through the cystic duct was normal. The fundus and body of the gallbladder were resected, followed by T-tube drainage and suturing of the gallbladder's neck. The patient's postoperative clinical course was uneventful. Treating Mirizzi syndrome remains a major challenge for hepatobiliary specialists even with open surgery due to high complication rates, including bile duct injuries. Treatment is primarily to clear out the responsible stone and necrotic tissue. Due to advances in endoscopic surgery and equipment, subtotal cholecystectomy with laparoscopic gallstone extraction provides a safe and effective option for patients with Mirizzi syndrome. Laparoscopic subtotal cholecystectomy with electrohydraulic lithotripsy is a feasible and useful approach for treating Mirizzi syndrome that avoids iatrogenic bile duct injury.

Superior Sternoclavicular Dislocation Treated with Costoclavicular Ligament Reconstruction Using Autograft: A Case Report

CASE

We describe a case of a traumatic superior dislocation of the sternoclavicular joint (SCJ) due to an isolated rupture of the costoclavicular ligament (CCL). A magnetic resonance imaging (MRI) scan demonstrated the CCL rupture with preservation of the anterior and posterior SCJ ligaments. This was successfully treated with an isolated hamstring tendon reconstruction of the CCL, resulting in a satisfactory outcome at 1 year after the procedure.

CONCLUSION

Isolated CCL reconstruction with a hamstring tendon in a patient with a superior SCJ dislocation provided a satisfactory outcome.

Do Case Reports on Total Mandibular, Extended, and Bilateral Total Temporomandibular Joint Reconstruction Prostheses Adhere to the Surgical CAse REport Guidelines?

PURPOSE

The Surgical CAse REport (SCARE) guidelines are a standardized format for reporting surgical cases. The aim of this study was to evaluate the completeness of case reports documenting alloplastic reconstruction of large craniomaxillofacial defects involving total mandibular, bilateral, and extended temporomandibular joint in major high-quality craniomaxillofacial journals, based on the SCARE guidelines.

METHODS

An extensive online search was performed according to the Priority Reporting Items for Systematic Reviews and Meta-Analyses statement in PubMed, Embase, Scopus, Google Scholar, and Dimensions databases to identify relevant case reports. Each selected case report was assessed on 16 topics (38 items) of the SCARE guidelines, using a scoring scale of "0" (No/noncompliance), "1" (Yes/compliance), and 2" (unclear). The completeness of reporting (COR) score was calculated as the ratio of "yes" responses to "total" (ie, yes + no + unclear) responses. Adequacy of case reporting was denoted by a COR score of 70% or more.

RESULTS

A total of 35 case reports were selected, where the male to female patients ratio was 3:4 cases, mean ± standard deviation (SD) age: 34.9 ± 16.7 years, mean ± SD follow-up duration: 17.0 ± 12.9 months, and number of patients with left, right, and bilateral temporomandibular joint reconstruction prostheses were 16, 10, and 09, respectively. The mean ± SD COR score for all 35 case reports and the individual item of the SCARE guidelines was 70.2 ± 10.5% and 66.5 ± 31.2%, respectively. The minimum and maximum COR score was found for "Keywords" (0.0%) and "Introduction" (100%) and "Clinical Findings" (100%), respectively. Adequate reporting was found for 20/35 (57%) case reports.

CONCLUSIONS

This study revealed that case reports in major high-quality craniomaxillofacial journals suffer from insufficient reporting. Widespread adoption of available standards, such as SCARE guidelines, is proposed to improve the quality and robustness of case reporting.

The SCARE 2023 guideline: updating consensus Surgical CAse REport (SCARE) guidelines

BACKGROUND

The Surgical CAse REport (SCARE) guidelines were first published in 2016 as a tool for surgeons to document and report their surgical cases in a standardised and comprehensive manner. However, with advances in technology and changes in the healthcare landscape, it is important to revise and update these guidelines to ensure they remain relevant and valuable for surgeons.

MATERIALS AND METHODS

The updated guidelines were produced through a Delphi consensus exercise. Members of the SCARE 2020 guidelines Delphi group, editorial board members, and peer reviewers were invited to participate. Potential contributors were contacted by e-mail. An online survey was completed to indicate their agreement with the proposed changes to the guideline items.

RESULTS

A total of 54 participants were invited to participate and 44 (81.5%) completed the survey. There was a high degree of agreement among reviewers, with 36 items (83.7%) meeting the threshold for inclusion.

CONCLUSION

Through a completed Delphi consensus exercise we present the SCARE 2023 guidelines. This will provide surgeons with a comprehensive and up-to-date tool for documenting and reporting their surgical cases while highlighting the importance of patient-centred care.

Incomplete common mesentery with Ladd's band and Meckel's diverticulum: A rare cause of small bowel obstruction

INTRODUCTION AND IMPORTANCE

The common mesentery is an abnormal rotation of the primitive intestinal loop or omphalomesenteric loop. It is not necessarily symptomatic, but a clinical presentation of acute bowel obstruction on the band or volvulus can reveal it. We report a case of small bowel obstruction due to Ladd's band and Meckel's diverticulum on the incomplete common mesentery.

PRESENTATION OF CASE

We report a case of a 54-year-old man with no previous abdominal surgery who experienced periumbilical abdominal pain and vomiting. Physical examination revealed a diffusely tender and distended abdomen. Laboratory data showed a biological inflammatory syndrome. An abdominal CT scan revealed a small bowel mechanical obstruction with a double transitional level under the umbilical without a loop enhancement. An emergent laparotomy was performed. We found an incomplete common mesentery. The small bowel obstruction was due to a Ladd's band attrapping the Meckel's diverticulum. This association was responsible for dilating ileal loops at the superior part of the mechanical obstruction with necrosis of 30 cm of the small bowel. We have sectioned the congenital band and resected the necrotic segment, followed by an intestinal anastomosis. The postoperative follow-up was uneventful.

CLINICAL DISCUSSION

Incomplete common mesentery with Ladd's band and Meckel's diverticulum is an extremely rare association. Causing a small bowel obstruction remains an uncommon complication and circumstance of discovery. This complication presents a life-threatening condition. An abdominal CT scan could help for the diagnosis in some cases. Surgery is the standard treatment in most cases.

CONCLUSION

The association of incomplete common mesentery with Ladd's band and Meckel's diverticulum is uncommon and should be known to avoid intraoperative misdiagnose.

Neck Sinus Post-Thyroidectomy Secondary to Retained Oxidized Regenerated Cellulose: A Case Report

The present study aims to report the first case of chronic neck sinus post-thyroidectomy caused by oxidized regenerated cellulose (ORC). A 55-year-old female patient underwent a total thyroidectomy operation. Three months after the surgery, the patient presented with persistent purulent discharge and sinus at the site of the drain. A CT scan of the neck showed a fistula tract, deep-neck fluid collection, and bilateral paratracheal high-density lesions at the thyroid bed, suggesting infected foreign bodies. The patient underwent surgery, during which the mesh of the ORC was found nonresorbed at the paratracheal space. The treatment involved neck exploration with the removal of all retained material and excision of the sinus tract. The patient had a favorable outcome following the surgical excision of the sinus tract and the removal of retained hemostatic materials. Further research is needed to explore the risk factors and preventive measures for neck sinus formation to enhance the safety and outcomes of thyroidectomy.

The Impact of the Preferred Reporting Items for Case Reports in Endodontics (PRICE) 2020 Guidelines on the Reporting of Endodontic Case Reports

Aim The aim of this study is to evaluate the impact of the Preferred Reporting Items for Case reports in Endodontics (PRICE) 2020 guideline on the reporting of published endodontic case reports (CRs). Methodology All case reports published in the International Endodontic Journal, European Endodontic Journal, Journal of Endodontics and Restorative Dentistry and Endodontics, in the year before and after the release of PRICE 2020, were included for analysis. Two panels comprising dentists scored case reports against a scoring system adapted from the guideline. Individual items were scored up to a maximum of 1; scores were then summated to provide an overall maximum of 47 for each CR. Each report provided an overall percentage adherence, and panel agreement was calculated using the intraclass correlation coefficient (ICC). Disagreement on scoring was discussed until a consensus was reached. Scores before and after PRICE guideline publication were compared using an unpaired two-tailed t test. Results A total 19 CRs were identified in both the pre- and post-PRICE guideline publication. Mean adherence to PRICE 2020 increased by 7.9% (p=0.003) from 70.0%±8.89 to 77.9%±6.23 following its publication. Agreement between panels was moderate (ICC pre-PRICE: 0.673 {p=0.011}; ICC post-PRICE: 0.742 {p=0.003}). Items 1a, 6c, 6e, 6f, 6g, 6j, 6q, 6s, 7a, 9a, 11a, 12c and 12d experienced a fall in compliance. Conclusion The PRICE 2020 guideline has resulted in a modest improvement in the reporting of endodontic case reports. Greater awareness and a wider acceptance and implementation of the guideline in endodontic journals are needed to improve adherence to the novel guideline.

Laparoscopic Sleeve Gastrectomy in Monozygotic Twins: Report of the First Case

Obesity is an epidemic disease that is believed to link to other pathologies as well as life-threatening cardiovascular pathology. Here we report a case of monozygotic twins who successfully lost weight following laparoscopic sleeve gastrectomy at the end of the 18-month follow-up period. We aimed to determine the factors affecting the weight loss outcome after sleeve gastrectomy in monozygotic twins. The twins' initial BMIs were 37.1 kg/m2 and 40.2 kg/m2, respectively. Twin A's excess weight loss was 48.4%, 61.3%, 80.6%, 96.8%, and 112.9% at three, six, nine, 12 and 18 months, while Twin B's in the third, sixth, ninth, 12th and 18th months was 23.1%, 41%, 51.3%, 61.5% and 71.8%. On the third, sixth, ninth, 12th, and 18th months of Twin A, the total weight loss was 15.8%, 20%, 26.3%, 31.6%, and 36.8%. In Twin B in the third, sixth, ninth, 12th, and 18th months, it was 8.7%, 15.5%, 19.4%, 23.3%, and 27.2%. When the twins were compared in terms of excess weight loss and total weight loss at 18 months, Twin A was more successful than Twin B. Especially at this point, Twin B's having a child (three years old) at a young age, her low compliance with the recommendations in the post-operative period and her difficulty in changing her lifestyle, environmental factors are as important as hereditary factors in achieving weight loss and a healthy body mass index (BMI) range.

Bile Leakage From the Luschka Duct After Laparoscopic Sleeve Gastrectomy and Cholecystectomy: A Case Report

Bile leakage may develop as a result of traumatic or iatrogenic injuries of bile ducts during laparoscopic cholecystectomy (LC). The frequency of Luschka duct injuries during LC is extremely rare. In this case, we present a case of bile leakage due to Luschka duct injury during sleeve gastrectomy (SG) and LC. The leakage was not noticed during the surgery, and on postoperative day 2, bilious drainage was seen from the drain. Magnetic resonance imaging (MRI) was helpful to determine Luschka duct injury. Biliary leakage resolved after endoscopic retrograde cholangiopancreatography (ERCP) with stent placement.

The value of case reports in diagnostic radiography

OBJECTIVE

- This paper sought to explore the value of case reports in diagnostic radiography with regards to current usage, relevance to evidence-based radiography, and educational benefits.

KEY FINDINGS

Case reports are short accounts of novel pathologies, trauma or treatment with a critical review of relevant literature. Examples within diagnostic radiography include the appearances of COVID-19 alongside examination-level scenarios involving image artefacts, equipment failure and patient incidents in radiology. With greatest risk of bias and lowest generalisability, they are considered as low-quality evidence with generally poor citation rates. Despite this, there are examples of significant discoveries or developments initiated with case reports with important patient care implications. Furthermore, they offer educational development for both reader and author alike. Whereas the former learns about an unusual clinical scenario, the latter develops scholarly writing skills, reflective practice and may generate further, more complex, research. Radiography-specific case reports could capture the diverse imaging skills and technological expertise currently under-represented in traditional case reports. Potential avenues for cases are broad and may include any imaging modality where patient care or safety of other persons may illicit a teaching point. This encapsulates all stages of the imaging process, before, during and after patient interaction.

CONCLUSION

Despite being low-quality evidence, case reports contribute to evidence-based radiography, add to the knowledge base, and foster a research culture. However, this is contingent upon rigorous peer-review and adherence to ethical treatment of patient data.

IMPLICATIONS FOR PRACTICE

With the drive to increase research engagement and output at all levels in radiography (student to consultant), case reports may act as a realistic grass-root activity for a burdened workforce with limited time and resources.

Study design methodology in neurosurgical research

Background

Medical research has evolved from individual expert-described opinions and techniques to scientifically designed methodology-based studies. There are different study designs, and selecting an appropriate study design is critical to appropriately answer the research question being investigated.

Main body

A research question may be addressed using different approaches that can be descriptive, analytical, or experimental. The choice of study design is influenced by features as that related to exposure (intervention) and disease (outcome); considerations related to time, resources, ethics and gaps in scientific knowledge that remain to be filled. The purpose of this review is to provide an overview of the basic study designs as it is the foundation of neurosurgical research to provide valid scientific evidence.

Conclusion

Quality in scientific research begins with a clear hypothesis and a well-formulated design. This entails a thorough understanding of the different study designs to choose the best suited to answer the investigated research question.

Oesophageal neuroendocrine tumours-case series of a rare malignancy

Oesophageal neuroendocrine neoplasms (NENs) are rare tumours. Neuroendocrine carcinomas (NECs) are the highest grade of NENs, with aggressive biological behaviour and poor outcomes. No standardized treatment pathways exist for these tumours, with management being individualized based on patient and tumour factors. We present five cases, four men and one women between 63 and 68 years old, who were diagnosed with symptomatic primary oesophageal NECs. Three were diagnosed with localized disease, and two were diagnosed with metastatic disease. Endoscopy, biopsy and staging scan results are outlined. Two patients received neoadjuvant chemotherapy. Three patients with localized disease underwent oesophagectomy. Two of these patients received neoadjuvant chemotherapy. Four patients have succumbed to their disease, with a median survival following a diagnosis of 18 months (5-34 months). This case series highlights the variability of presentation and stage at diagnosis of oesophageal NECs. Multimodal treatment is commonly utilized; however, outcomes are universally poor. Further research is required to determine the optimal treatment regimen for oesophageal NENS.

A rare presentation of appendicitis contained within an incisional hernia post loop ileostomy reversal - A case report

INTRODUCTION AND IMPORTANCE

Appendicitis within an incisional hernia is rare, with current literature describing a small number of cases, occurring through a variety of surgical incisions. We describe a case of appendicitis contained within an incisional hernia following reversal of a loop ileostomy, on a background of previous sigmoid cancer resection. This is the second such case we were able to identify on literature review.

CASE PRESENTATION

A 45 year old man presented with one day of migratory abdominal pain, predominantly focused at a tender, irreducible lump in his right lower quadrant, underlying the scar from previous reversal of loop ileostomy. CT on admission revealed an incisional hernia, containing an inflamed appendiceal tip. He underwent an uncomplicated laparoscopic appendicectomy and primary suture closure of the hernia defect, and was discharged the following day. Acute appendicitis was confirmed on histopathology.

DISCUSSION

Placement of a defunctioning ileostomy is common in the management of colonic cancers, and incisional hernias are a common complication. It is however rare for an appendix to be contained within a hernia sac, and even rarer for appendicitis to develop in this setting. As a result, the presentation of this condition may mimic that of an incarcerated or strangulated incisional hernia, with pre-operative diagnosis typically relying on diagnostic imaging.

CONCLUSION

Incisional hernia appendicitis is rare and presents a diagnostic challenge. Early recognition of this dual pathology is necessary to allow for prompt surgical management of both the appendicitis and hernia, as well as guiding the approach for hernia repair.

Cutaneous Blastomycosis Presenting as a Nonhealing Wound in the Northeast United States: A Case Report

Primary cutaneous blastomycosis is a rare presentation of infection caused by direct inoculation of a wound. We present a 61-year-old male with an extensive history of wound dehiscence and wound care noncompliance after a bite from a brown recluse spider on the left thigh while on vacation in Cape Cod in September of 2020. After antibiotic therapy and culture, treatment involved debridement, split thickness skin grafting, strict wound vacuum-assisted closure care, and oral itraconazole. This brief demonstrates a case of blastomycosis arising from trauma in a non-endemic region for infection and serves as an example of successful management of the longstanding wound.

Retroperitoneal paraganglioma in a young patient presenting with hypertensive crisis and transient loss of sight; a rare case report and literature review

INTRODUCTION

Catecholamine secreting tumors are a rare type of neuroendocrine tumors whose embryological origin is neural crest cells. 80 % to 90 % arise from the chromaffin cells of adrenal medulla while 10 % to 20 % arise from sympathetic and parasympathetic ganglia. Paragangliomas can be symptomatic due to excess catecholamine secretion or can be asymptomatic. Definitive treatment of paragangliomas is surgical resection.

CASE

A 16 yr old male who presented with right iliac fossa pain and hypertension associated with headache and transient loss of sight. Contrasted CT scan of the abdomen revealed a para-aortic retroperitoneal mass, 24 h urine Normetanephrines were significantly elevated. Pre-operative patient preparation included administration of alpha blockers then later beta blockers with adequate hydration. Intra operative blood pressure elevation during tumor manipulation managed with intravenous beta blockers. Post operatively patient required no inotropic support or anti hypertensives. Histopathology revealed features suggestive of a paraganglioma and immunohistochemistry s100 (+) Chromogranin A (+).

DISCUSSION

Functional paragangliomas are manifested by symptoms that result from catecholamine hypersecretion. Biochemical confirmation and functional localization of the tumors is recommended. Definitive management is surgical resection with a pre requisite of adequate patient preparation which includes blood pressure control and volume replacement.

CONCLUSION

Tumor localisation and adequate patient preparation with alpha blockers and adequate hydration is an important prerequisite to surgical resection.

Spontaneous cessation of postpancreatectomy hemorrhage in a patient with celiac artery stenosis

Postpancreatectomy hemorrhage (PPH) is a severe complication of pancreatic surgery. This condition often develops on the background of pancreatic fistula. In our report, we demonstrate an unusual case of spontaneous cessation of severe postpancreatectomy common hepatic artery (СHA) hemorrhage after distal pancreatectomy in a patient with celiac artery stenosis (CAS). A 64-year-old male diagnosed with pancreatic tail tumor underwent extended distal pancreatectomy. He developed pancreatic fistula and was discharged with an abdominal drain, and was readmitted with severe postpancreatectomy hemorrhage from a pseudoaneurysm of the CHA. The bleeding stopped spontaneously due to CHA thrombosis. The patient developed no ischemic symptoms. Spontaneous severe postpancreatectomy hemorrhage cessation is an extremely rare phenomenon. Vascular anomalies must be considered when attempting interventional radiology treatment. CHA probably may be sacrificed with no ischemic consequences in case of severe hemorrhage in patients with CAS.

A Case Report of Necrotizing Neutrophilic Dermatosis: A Sheep in Wolf's Clothing

Neutrophilic dermatosis (ND) is a category of diseases characterized by trauma-induced, autoinflammatory cutaneous eruption. Comorbid systemic disease is common with a predilection for malignancy, inflammatory bowel disease, and rheumatologic disease. Rarely, it can manifest with aseptic shock, an entity referred to as necrotizing neutrophilic dermatosis (NND). NND may occur in the postoperative setting and is often misdiagnosed as a necrotizing soft tissue infection. Unfortunately, the treatment for a necrotizing soft tissue infection, namely, wide debridement, is often detrimental in the setting of NND. We present the case of a woman with underlying myelodysplastic syndrome who developed episodic postoperative hemodynamic collapse followed by delayed necrotic peristomal ulceration following colonic diversion for complicated diverticulitis. Infectious workup and operative re-exploration were unrevealing. Pathologic assessment of affected skin tissue showed changes consistent with ND, ultimately leading to the diagnosis of NND. Her clinical course dramatically improved with the initiation of immunosuppressive therapy. The mimicry of NND to a potentially lethal necrotizing soft-tissue infection creates a grave diagnostic dilemma in the postoperative period. A general lack of knowledge of NND among non-dermatologic specialists produces an opportunity for misdiagnosis and inappropriate surgical interventions, namely, serial debridement. Several clinical cues may aid in the earlier recognition of NND. The cornerstone of treatment involves systemic corticosteroid therapy with adjunctive therapy for refractory cases. NND must be considered in the differential diagnosis of necrotizing soft tissue infection as early recognition may result in the avoidance of deleterious surgical interventions.

Minimally invasive treatment of an amebic empyema secondary to the transdiaphragmatic rupture of a liver abscess: a case report

Liver abscesses are a common complication in patients with amebiasis. Rarely, these will rupture across the diaphragm causing life-threatening empyemas. Evidence justifies performing surgical debridement or decortication for their treatment, given the better overall performance in comparison to open surgeries. However, no current guideline specifies which is the best approach. This report presents the case of a 39-year-old male with clinical, radiographical and microbiological evidence of an amebic empyema secondary to an amebic liver abscess, who received treatment by video-assisted thoracoscopy. The case description highlights the surgical technique, findings and operative outcomes that could be taken into consideration by other physicians to timely manage similar cases. The latter is especially relevant in underdeveloped and developing countries, where the burden of amebiasis appears to be greater. To the best of the authors’ knowledge, this is the first description of a transdiaphragmatic amebic infection treated in a minimally invasive fashion.

Giant uterus in a patient with Klippel-Trenaunay syndrome. Report of a case

INTRODUCTION

Klippel-Trenaunay syndrome is an uncommon congenital disease also called angio-osteodystrophy syndrome for its typical disorders characterized by abnormal growth of the soft tissues and bones and vascular malformations.

CASE REPORT

In this report, we present a rare case of a 46-year-old nulliparous woman with Klippel-Trenaunay syndrome. She suffered from an abnormal uterine bleeding accompanied by severe anemia with need for multiple blood transfusions. At the time of admission, physical examination revealed port-wine stains and varicose veins on her lower limbs and hypertrophy of left lower extremity. We carried out an open bilateral hysteroannexectomy. Histopathology examination revealed a uterus weighing 6300 g with diffuse abnormal vasculature, leiomyomatosis and diffuse venous malformation.

DISCUSSION

Klippel-Trenaunay syndrome is considered a rare disease as it has an incidence of 2-5 on 100,000 with no differences between the both sexes. The clinical manifestations are related to the organs involved in the pathological angiogenesis therefore patients may also present cerebral, retinal, gastrointestinal and genitourinary anomalies with consequent occult or significant bleeding. Uterine involvement is very rare. The main clinical manifestations are represented by irregular episodes of hematuria and/or menometrorrhagia associated with important anatomical anomalies of the female reproductive system.

CONCLUSION

Uterine involvement in patients with Klippel-Trenaunay syndrome, althought rare and with extremely variable clinical manifestations, is actually a relevant event that not only significantly affects the reproductive capacity of the woman but which potentially puts patients' lives at risk because of an unpredictable bleeding.

Recurrent appendicitis of vermiform appendix after a prior appendectomy: A case report and review of the literature

Introduction

Acute appendicitis is one of the leading causes of acute abdominal pain and surgical emergency. Stump appendicitis is a known complication of appendectomy whereby a retained appendiceal tip serves as a nidus for recurrent bouts of inflammation. Nevertheless, full-blown appendicitis of the vermiform appendix after a prior appendectomy remains a diagnostic conundrum.

Case presentation

A 45-year-old woman presented with a six-month history of right iliac fossa pain. Pertinently, she had undergone a prior open appendectomy twelve years ago. Further investigative workup revealed full-blown appendicitis, which was not attributable to a retained appendiceal stump. A subsequent laparoscopic appendectomy was performed, and the resultant specimen was sent for further evaluation, confirming the diagnosis of recurrent appendicitis.

Clinical discussion

Acute appendicitis is one of the most common life-threatening abdominal surgical emergencies worldwide, with 300000 appendectomies performed annually in the United States alone. Stump and chronic appendicitis are two separate and exceedingly rare clinical entities that may present simultaneously and develop serious complications unless promptly recognized and appropriately managed. The present paper prompts the clinicians to distinguish amongst the two at the initial surgery in order to thwart further exacerbations.

Conclusion

While stump appendicitis is a rare but well-characterized complication of a prior appendectomy, full-blown appendicitis of vermiform appendix remains elusive. It is therefore imperative to distinguish between a duplicated and a recurrent appendix at the initial operative procedure to facilitate optimal patient management.

Olecranon With Concomitant Radial Head Fracture: A Case Series of Fifteen Patients

Introduction

Simultaneous olecranon and radial head fractures are rare injuries and due to this factor, the outcome of the selected therapy is not widely studied. The aim of this study is to report and evaluate the functional outcome of the surgical treatment of simultaneous olecranon and radial head fractures.

Materials and Methods

This is a retrospective study of fifteen patients with concomitant olecranon and radial head fractures presenting to our orthopedic department between 2015 and 2020. Olecranon fractures were classified by Mayo classification and radial head fractures by Mason classification and were managed appropriately. Main outcome measures include range of elbow extension-flexion, pronation-supination, Broberg and Morrey rating system score, and quickDASH score.

Results

Our study included 6 females and 9 males with a mean age of 50 (r, 25-73). The mean of follow-up was 31 months (r, 3-51). Olecranon fractures were fixed with tension band with K-Wires or intramedullary compression screw or locking plate. Radial head fractures were fixed with headless compression screws or mini plate or replaced (radial head arthroplasty). Postoperatively, an average 115° extension-flexion arc and 135° pronation-supination arc was noted. The mean Broberg and Morrey rating system score was 78 and the mean quick DASH score was 25, indicating a good result. Two cases of heterotopic ossification were present and no nonunion was noted.

Conclusion

Surgical management of concomitant olecranon and radial head fractures with appropriate technique can result in the restoration of a functional movement arc and a satisfactory outcome.

Solitary Cecal Ulcer: A Case Report

Background

Solitary cecal ulcer is a rare disease. Its etiology is unknown and there are no pathognomonic symptoms. There are rare reports mimicking carcinoma as seen in this case.

Case Presentation

A 64 year-old woman presented with a history of intermittent right lower abdominal pain for 20 years and worsening for 1 year. Colonoscopy revealed an enormous cecal ulcer. The PET-CT showed increased metabolism of the lesion. She underwent a right hemicolectomy. Histopathological examination revealed chronic non-specific inflammation. A rare diagnosis of the solitary cecal ulcer was ultimately made.

Conclusion

Solitary cecal ulcer is a rare, idiopathic entity. It mimics inflammatory bowel disease, malignancy, infection, etc. The comprehensive images of this case describe the characteristics of the disease.

Is It a "Colon Perforation"? A Case Report and Review of the Literature

Background

Intrauterine devices (IUDs) are commonly used as a contraceptive method. IUD migration and colon perforation are rare but serious complications occurring sometimes years after insertion.

Case

A 42-year-old woman with complaints of slight abdominal pain underwent a colonoscopy. Colonoscopy showed that a "nail" had penetrated the ascending colon wall and that an arm of the "nail" was embedded in the colon wall. We did not remove the "nail" rashly under colonoscopy. Considering the safety and effectiveness of the patient's operation, we were able to remove the "nail" easily by performing laparoscopic-endoscopic cooperative surgery (LECS) combined with hysteroscopy at the same time.

Conclusion

We report a case of successful removal of a colonic perforation device by colonoscopy, laparoscopy, and hysteroscopy, which is the first method used.

Primary hepatic neuroendocrine neoplasm diagnosed by somatostatin receptor scintigraphy: A case report

BACKGROUND

Primary hepatic neuroendocrine neoplasm (NEN) is a rare condition, and it is difficult to differentiate between primary and metastatic hepatic NENs. Herein, we report a case of primary hepatic NEN that initially mimicked a hemangioma but showed a gradual increase in size on long-term careful observation.

CASE SUMMARY

A 47-year-old woman was incidentally diagnosed with a 12-mm liver mass, suspected to be a hemangioma. Since then, regular follow-up had been carried out. Ten years later, she was referred to our institute due to the tumor (located in segment 4) having increased to 20 mm. Several imaging studies depicted no apparent extrahepatic lesion. Positron emission tomography (PET)/computed tomography exhibited significant accumulation in the mass lesion, which made us consider the possibility of malignancy. Left hepatectomy was performed. The histopathological diagnosis was neuroendocrine tumor grade 2, with somatostatin receptor 2a/5 positivity. Postoperative somatostatin receptor scintigraphy (SRS) showed no other site, leading to the diagnosis of NEN of primary hepatic origin. The gradual growth of the hepatic NEN over 10 years suggested that it was likely to be a primary liver tumor.

CONCLUSION

In this case, positivity on PET and postoperative SRS may have helped determine whether the tumor was primary or metastatic.

Xanthogranulomatous cholangitis mimicking cholangiocarcinoma: Case report and review of literature

Introduction

Xanthogranulomatous cholangitis is an extremely rare diagnosis and is believed to be an extension of xanthogranulomatous cholecystitis, a benign inflammatory process characterized by lipid-laden foamy macrophages (called “xanthoma cells”) occurring in a background of chronic inflammation consisting of lymphocytes, plasma cells, and eosinophils. Here, we report a case of xanthogranulomatous cholangitis mimicking cholangiocarcinoma.

Case presentation

A 72 year old male with history of recurrent cholangitis had preoperative workup highly suggestive of intrahepatic cholangiocarcinoma. He underwent right hepatectomy and portal lymphadenectomy, with pathology showing xanthogranulomatous cholangitis, with no evidence of malignancy. Interestingly, the patient did not have xanthogranulomatous cholecystitis.

Discussion

We reviewed the current literature on xanthogranulomatous cholangitis, and identified only 14 previously reported cases. In our case series, there were six female and eight male patients. Among the 14 patients, 11 presented to the hospital with jaundice. Twelve patients had preoperative workup concerning for malignancy. The diagnosis of xanthogranulomatous cholangitis was confirmed through pathology in 13 patients, and through endoscopic ultrasound biopsy in one patient. In our review, seven patients had associated xanthogranulomatous cholecystitis, three patients had an isolated case of xanthogranulomatous cholangitis, and four patients had unknown status. Our patient is the fourth case of isolated xanthogranulomatous cholangitis without xanthogranulomatous cholecystitis.

Conclusion

Xanthogranulomatous cholangitis is a very rare phenomenon that can lead to benign strictures of the bile ducts, especially in the setting of recurrent cholangitis. It can mimic malignancies, such as cholangiocarcinoma, and should be considered in the differential diagnosis.

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Xanthogranulomatous cholangitis is an extremely rare inflammatory process.

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It involves lipid-laden macrophages of the bile duct.

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Patients with xanthogranulomatous cholangitis frequently present with jaundice.

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It can mimic malignancies, including bile duct, liver, gallbladder, and pancreatic cancers.

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It should be included in the differential diagnosis of biliary abnormalities

Transcutaneous ventriculo-peritoneal shunt catheter extrusion with silent bowel perforation following digestive surgery: a case report

This case report provides an account of transcutaneous ventriculo-peritoneal (VP) shunt extrusion with silent bowel perforation occurring 2 years post digestive surgery. A 22-year-old man treated since childhood for post-infectious hydrocephalus was referred to our neurosurgery department for an inflammatory wound to the right hypochondrium caused by an abandoned calcified VP shunt. This VP shunt was surgically removed without complications. The perforated bowel required no direct repair. Progress is favorable at 1 year follow-up.

Multivesicular hepatic human hydatid cyst from Iran: First genotyping-based confirmation

Cystic echinococcosis is one of the most important zoonotic parasitic diseases caused by the tapeworm Echinococcus granulosus. To date, the genotype of multivesicular CE has not been identified. In this regard, the genotyping of multivesicular types of CE could help clinicians understand and manage the disease effectively.

Difficulties in Diagnosing Extraperitoneal Ureteroinguinal Hernias: A Review of the Literature and Clinical Experience of a Rare Encounter in Acute Surgical Care Settings

Although inguinal hernia repair is one of the most common surgical procedures, finding a retroperitoneal structure, such as the ureter, is a rather rare occurrence. Ureteroinguinal hernias may arise in the presence or absence of obstructive uropathy, the latter raising difficulties in diagnosis for the general surgeon performing a regular inguinal hernia surgery. This study aims to collect the relevant literature describing the diagnosis and management of ureteroinguinal hernias and update it with a case encountered in our clinic. The following study was reported following the SCARE guidelines. The relevant literature describes less than 150 cases of ureteroinguinal hernias overall, considering the 1.7% prevalence of inguinal hernias in the general population. With only 20% of these hernias being described as extraperitoneal, such an encounter becomes an extremely rare finding. Our clinical experience brings a case of a 75-year-old male with frequent urinary tract infections and a large irreducible inguinoscrotal hernia of about 20/12 cm located at the right scrotum. The patient underwent an open inguinal hernia repair technique under general anesthesia, incidentally finding an extraperitoneal ureteral herniation. Segmental ureterectomy was performed with uneventful recovery. Intraoperatively, finding an incidental ureteroinguinal hernia raises concerns about probable urinary tract complications during regular hernia repair surgery and whether the diagnosis is likely to happen prior to surgical intervention. Although imaging is rarely indicated in inguinal hernias, the case reports show that a pelvic CT scan with urography in symptomatic patients with urinary symptoms will provide accurate confirmation of the diagnosis. The relevant literature is limited due to the rarity of respective cases, thus making standardized management of such cases unlikely.