Insulinoma: a rare neuroendocrine pancreatic tumor

Insulinomas are functional endocrine tumors originating from the pancreatic b-cells. In 1902 Nicholls described the first adenoma of pancreatic islets, while the first insulinoma was described in 1927 in Mayo Clinic, which was dissected two years later in 1929 in Toronto. The first enucleation of insulinoma took place in a St. Jouis hospital in 1931, and after four years, in 1935, Whipple described the classic diagnostic triad: symptoms of fasting hypoglycemia or fatigue, blood glucose levels under 50 mg/dl and disappearance of symptoms after glucose administration.

Primary adenocarcinoma of the appendix: an update

Adenocarcinoid arising in the vermiform appendix is a rarity. The diagnosis of appendiceal adenocarcinoma has never been made preoperatively and is frequently an incidental finding at the time of operation for unrelated conditions. Because of the rarity of the disease, its natural history is poorly understood. Benefits from adjuvant radiation, chemotherapy, or a combination have not been reported. Most studies emphasize survival outcome based on surgical technique. There are few data and, consequently, much debate on the appropriate management of these lesions. The aim of this article is to review this entity and to assess and report new data, through a study of the literature.

Hydatid disease of the urinary tract: an update

Hydatid disease constitutes an endemic zoonosis caused by different species of the cestode Echinococcus. The main organs affected are the liver and the lungs. Echinococcosis of the urinary tract is an extremely rare medical condition, met in 2-4% of cases. This pathologic entity has to be included in the differential diagnosis of occupying lesions of the urinary tract at any age, especially among patients in endemic areas. Meticulous laboratory and imaging control when taking into consideration the suspicion for the disease, can guarantee an accurate diagnosis and successful outcome.

Superficial parotidectomy under local anaesthesia

The modern tendency of surgery is to perform a constantly rising number of operations under local anaesthesia. Superficial parotidectomy under local anaesthesia has not been widely attempted. However only few reports show that this kind of procedure could be feasible. If this is the case, standard assessment of benign parotid tumors will change radically.

Evaluation and surgical management of the gallstone ileus. A single center experience

Gallstone ileus representing 1-4% of all bowel obstructions cholelithiasis. Impaction of a gallstone in the human of the bowel is a surgical emergency. Relief of the obstruction is the treatment of choice, but controversy exists regarding the repair of the fistula and cholecystectomy. Our experience in the management of gallstone ileus is presented in the following article.

Adrenal rupture after blunt abdominal trauma

The case of a patient, victim of a car accident, with rupture of the left adrenal gland associated with splenic rupture and liver laceration is reported. Injury of the adrenal glands is most frequently caused by blunt abdominal trauma and is usually associated with injuries of other abdominal organs. Careful exploration of the upper retroperitoneal space where adrenals are located is considered necessary during laparotomy for severe blunt abdominal trauma. If adrenal lesion has been overlooked continuous hemorrhage may occur, which could be lethal if not promptly treated.

Echinococcal cyst of the subcutaneous tissue: a rare case report

Hydatid disease is an endemic zoonosis caused by the cestode Echinococcus granulosus. The most common affected organs are the liver and the lungs. Echinococcal cyst located in the subcutaneous tissue constitutes an extremely rare manifestation of the hydatid disease. Here we present a case report with a cystic mass in the subcutaneous tissue of the left gluteal area, diagnosed as being a hydatid cyst.

Abdominal compartment syndrome: effects on organ function

Abdominal compartment syndrome (ACS) constitutes a critical clinical situation presenting a remarkable incidence being the causal factor of variable abdominal and extra-abdominal pathology, thus a rising issue of interest in intensive medical care over the past decade. Moreover, ACS as a condition potentially leading to Multiple Organ Failure (MOF), its better understanding could provide more effective management resulting to limitation of MOF incidence and mortality.

Spigelian hernia. A rare case of bilateral hernia and presentation of our experience

Spigelian hernia is a relatively rare defect of the abdominal wall. Due to its unspecific and variable clinical presentation, presents a difficult diagnostic challenge. We present a rare case of bilateral Spigelian hernia that was diagnosed and successfully treated with open surgery and hernioplasty. Also we present our experience in management of the disease. In our department the last fifteen years, 12 cases of Spigelian hernia have been treated surgically, using direct reconstruction with excellent results.

Choledochoduodenal anastomosis: a technical tip to ensure the impermeability of the anastomosis

In 1891 O. Sprengel described a successful side-to-side choledochoduodenostomy and since then this has been a method frequently used in dealing with the problem of constriction of the lower third-portion of the bile duct, due to malignant or benign causes. Taking in consideration that the first choledochoduodenostomy was performed by H. Riedel in 1888 and the patient died 9 hours after surgery due to leakage of the anastomosis (disclosed in autopsy), it is evident to conclude that hermetic anastomosis is the main factor for fast and uncomplicated recovery of the patient. In order to ensure intraoperatively a hermetic "bile-proof" anastomosis, we have applied a technical tip, which has been proved to be efficient.