1
|
Marchegiani F, Schena CA, Luzzi AP, De'Angelis N. Robotic caecal atypical resection for an appendiceal mucocele - a video vignette. Colorectal Dis 2024; 26:573-574. [PMID: 38235941 DOI: 10.1111/codi.16869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 12/12/2023] [Indexed: 01/19/2024]
Affiliation(s)
- Francesco Marchegiani
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital (AP-HP), Clichy, France
- University Paris Cité, Paris, France
| | - Carlo Alberto Schena
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital (AP-HP), Clichy, France
- University Paris Cité, Paris, France
| | - Andrea-Pierre Luzzi
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital (AP-HP), Clichy, France
- University Paris Cité, Paris, France
| | - Nicola De'Angelis
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital (AP-HP), Clichy, France
- University Paris Cité, Paris, France
| |
Collapse
|
2
|
Almoguera González FJ, Muñoz Casares C, González de Pedro C, Galán Villamor L, Padillo Ruiz FJ. Malakoplakia of the appendix as a rare differential diagnosis of mucocele: a case report. Cir Esp 2024; 102:174. [PMID: 37730119 DOI: 10.1016/j.cireng.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 03/27/2023] [Indexed: 09/22/2023]
Affiliation(s)
| | - Cristóbal Muñoz Casares
- Unidad de Gestión Clínica Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Carlos González de Pedro
- Unidad de Gestión Clínica Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Lourdes Galán Villamor
- Unidad de Gestión Clínica Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Francisco Javier Padillo Ruiz
- Unidad de Gestión Clínica Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| |
Collapse
|
3
|
Kearsey CC, Dritsas S, Mathur M, Wild J. 'It's just a mucocele': a case report of a massive appendiceal mucocele presenting as a left upper quadrant mass. Ann R Coll Surg Engl 2024; 106:93-95. [PMID: 36622245 PMCID: PMC10757871 DOI: 10.1308/rcsann.2022.0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 01/10/2023] Open
Abstract
Tumours of the appendix are very rare tumours that can and often present with a mucocele. This is a case report highlighting the associated pathology of appendix tumours and the management of a large mucocele. Specifically, how a right hemicolectomy is very rarely needed in these cases regardless of size and local anatomical relationships and some important considerations for the practicing surgeon in the non-tertiary centre that encounters a case like this.
Collapse
Affiliation(s)
- CC Kearsey
- The Christie NHS Foundation Trust, UK
- Institute of Translational Medicine, University of Liverpool, UK
| | - S Dritsas
- The Christie NHS Foundation Trust, UK
| | - M Mathur
- The Christie NHS Foundation Trust, UK
| | - J Wild
- The Christie NHS Foundation Trust, UK
| |
Collapse
|
4
|
Bakula B, Belosic Halle Z, Bekic D, Karacic A. A case of an inverted appendiceal stump with dysplastic mucosa mimicking cecal polyp managed by a combined endoscopic laparoscopic approach. Rev Esp Enferm Dig 2023; 115:715-716. [PMID: 36263807 DOI: 10.17235/reed.2022.9237/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Endoscopic finding of invaginated appendiceal stump mimicking polyp is very rare. We present a case of patient with appendiceal stump mimicking cecal polyp covered with dysplastic mucosa which makes it even more rare. Polypoid lesions involving the appendiceal area represent a specific diagnostic-therapeutic dilemma. In these situations simple colonoscopic polypectomy poses increased risk for perforation. In our case biopsy of the polypoid cecal lesion revealed dysplastic mucosa. Due to the non-lifting sign and increased risk of perforation from simple polypectomy, polyp was removed by cecal wedge resection using combined endoscopic laparoscopic approach. Histopathology of the specimen confirmed medium dysplastic epithelium covering lymphoid follicles specific for appendix. In our case, decision on the need to remove the polyp, based on biopsy histology, was quite clear; however, the question is what should we have done if the biopsy finding was negative? In such a situation, conservative approach with endoscopic follow-up of the polyp and regular biopsy specimen analysis, or a more active approach of polyp removal should be considered. This issue can be discussed, however, we do believe that decision on approaching such patients should be made individually, based on the patient's age, comorbidities, general condition and operative risk.
Collapse
Affiliation(s)
| | | | - Dinko Bekic
- Gastroenterology, University Hospital Sveti Duh, Croatia
| | | |
Collapse
|
5
|
Notz-Heusler L, Burla L, Steinauer A, Misteli H. Internal hernia through the foramen of Winslow: a rare cause of intestinal obstruction with imminent ischaemia of the caecum. BMJ Case Rep 2023; 16:e257281. [PMID: 37940197 PMCID: PMC10632806 DOI: 10.1136/bcr-2023-257281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023] Open
Abstract
An internal hernia through the foramen of Winslow represents a rare surgical pathology. This report describes a case with incipient caecal ischaemia and discusses current diagnostic and therapeutic approaches. A patient in his early 60s presented at the emergency department with abdominal pain and last bowel movement three days prior. A CT scan of the abdomen suggested an internal hernia into the lesser sac. Intraoperatively, the suspected diagnosis could be confirmed laparoscopically with a twisted mobile caecum herniating through the foramen of Winslow. Due to a suspected ischaemia and laparoscopic frustrated reduction, a right open hemicolectomy was performed. The hernia gap was closed. The postoperative course was uneventful. Despite the rarity of internal hernias in patients without prior abdominal surgery, surgeons should be aware of this entity. The diagnosis can be difficult and sometimes only established intraoperatively. Open surgery is usually required. If the gap is clearly identified, the recommendations tend towards its closure.
Collapse
Affiliation(s)
| | - Laurin Burla
- Department of Surgery, Hospital Uster, Uster, Switzerland
| | | | - Heidi Misteli
- Department of Surgery, Hospital Uster, Uster, Switzerland
| |
Collapse
|
6
|
St John A, Murray R, Cooper L, Diaz J, Ghneim M. Cecal-Colon Intussusception due to Appendiceal Mucinous Adenocarcinoma. Am Surg 2023; 89:3822-3825. [PMID: 37222408 DOI: 10.1177/00031348231175489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Intussusception is a rare presentation in adults and describes when one portion of the intestine telescopes into another portion. Intussusception is associated with malignancies serving as the lead point in adults. Appendiceal mucinous neoplasms are uncommon tumors often incidentally discovered during appendectomy procedures to manage acute appendicitis. Here we present a case report of an instance of mucinous adenocarcinoma of the appendix that manifested as a large bowel obstruction with intussusception limited to the colon, underscoring the possibility of concurrent intussusception and mucinous neoplasms. The case highlights the importance of meticulous diagnostic evaluation and management, particularly without well-defined treatment protocols. Appropriate diagnostic workup and management, including surgical intervention, are critical for patient outcomes and overall prognosis. The study recommends that patients diagnosed with confirmed or suspected appendiceal neoplasms undergo upfront oncologic resection where aggressive malignancy is a concern. Colonoscopy should be performed postoperatively for all patients to identify synchronous lesions.
Collapse
Affiliation(s)
- Ace St John
- Department of Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Rhaya Murray
- Department of Pathology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Laura Cooper
- Department of Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Jose Diaz
- Department of Surgery, University of Maryland Medical Center, Baltimore, MD, USA
- Department of Trauma and Critical Care, R Adams Cowley Shock Trauma Center, Baltimore, MD, USA
| | - Mira Ghneim
- Department of Surgery, University of Maryland Medical Center, Baltimore, MD, USA
- Department of Trauma and Critical Care, R Adams Cowley Shock Trauma Center, Baltimore, MD, USA
| |
Collapse
|
7
|
Van Boeckel V, Arenas-Sanchez M, Legrand M, Maillart JF, Postal A. [Caecum hernia of foramen of Winslow]. Rev Med Liege 2023; 78:423-426. [PMID: 37560954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Winslow's foramen hernia, or Blandin's hernia, is a rare internal hernia with a non-specific clinical presentation and its diagnosis may be difficult. The hernia occurs across the omental hiatus, bounded by the inferior vena cava posteriorly and the portal triad anteriorly. CT imaging provides several diagnostic clues in this condition. Prompt surgical management allows reduction before complications arise. We present a case of caecal internal herniation through Winslow's foramen in a patient who underwent gastrojejunal bypass about ten years ago. Laparoscopy with reduction of the caecal bascule and closure of the foramen is performed successfully.
Collapse
Affiliation(s)
| | | | - Marc Legrand
- Service de Chirurgie abdominale, CHR de Huy, Belgique
| | | | - Alain Postal
- Service de Chirurgie abdominale, CHR de Huy, Belgique
| |
Collapse
|
8
|
Ramos-Cruz I, Sanjuan-Sánchez C, Castillo S, Leyva-Bohórquez P, Cruz-Lucas CF. Acute purulent diverticulitis in the cecum: case report. CIR CIR 2023; 91:716-718. [PMID: 37844895 DOI: 10.24875/ciru.21000794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 11/17/2021] [Indexed: 10/18/2023]
Abstract
A 40-year-old female with a 24-hour course of abdominal pain suggestive of acute appendicitis. An emergency laparotomy was performed, finding plastron in the cecum and ascending colon, color changes, with purulent liquid and 5 cm in diameter, fixed to Toldt's. It was decided to perform a right hemicolectomy with an ileotransverse end-to-side anastomosis with adequate postsurgical evolution. The histopathological report showed acute purulent diverticulitis of the cecum, which is very low incidence in the Mexican population, that's why this case report is carried out.
Collapse
Affiliation(s)
- Iván Ramos-Cruz
- Servicio de Coloproctología, Clínica Imagen y Diagnóstico Médico, Oaxaca de Juárez, Oaxaca, México
| | - Carlos Sanjuan-Sánchez
- Servicio de Coloproctología, Clínica Imagen y Diagnóstico Médico, Oaxaca de Juárez, Oaxaca, México
| | - Selene Castillo
- Servicio de Coloproctología, Clínica Imagen y Diagnóstico Médico, Oaxaca de Juárez, Oaxaca, México
| | - Paulina Leyva-Bohórquez
- Servicio de Coloproctología, Clínica Imagen y Diagnóstico Médico, Oaxaca de Juárez, Oaxaca, México
| | - Claudia F Cruz-Lucas
- Servicio de Coloproctología, Clínica Imagen y Diagnóstico Médico, Oaxaca de Juárez, Oaxaca, México
| |
Collapse
|
9
|
Abdulmuttaleb AT, Al-Habbal Z, Ahmed F. Caecal volvulus in a 35-year-old man: a case report. Pan Afr Med J 2023; 44:37. [PMID: 37034486 PMCID: PMC10080308 DOI: 10.11604/pamj.2023.44.37.37403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/17/2023] [Indexed: 01/21/2023] Open
Abstract
Caecal volvulus is a rare cause of mechanical bowel obstruction (1-1.5%) that carries a high mortality rate if diagnosis or surgical intervention is delayed. We report a 35-year-old man who presented with acute colicky abdominal pain, vomiting, and constipation for the past 18 hours. A plain abdominal X-ray showed distended large bowel loops with two large well-defined air-fluid levels superimposed on each other, suggestive of caecal volvulus. The patient underwent emergency laparotomy, and the intraoperative finding confirmed the diagnosis of gangrenous extended caecal volvulus, which involves the terminal ileum, cecum, and the whole of the ascending colon. A right hemicolectomy was performed, and bowel continuity was restored by primary ileotransverse anastomosis. The patient recovered without complications and was discharged on postoperative day 6. In conclusion, caecal volvulus is a rare cause of adult intestinal obstruction. Early diagnosis and surgical intervention can prevent perforation and reduce morbidity related to volvulus perforation.
Collapse
Affiliation(s)
- Abdulrahman Tawfeeq Abdulmuttaleb
- Department of Surgery, Al-Thawra Private Hospital, Taiz, Yemen
- Corresponding author: Abdulrahman Tawfeeq Abdulmuttaleb, Department of Surgery, Al-Thawra Private Hospital, Taiz, Yemen.
| | - Zakareya Al-Habbal
- Department of Surgery, School of Medicine, University of Kurdistan, Erbil, Iraq
| | - Faisal Ahmed
- Department of Urology, School of Medicine, Ibb University of Medical Sciences, Ibb, Yemen
| |
Collapse
|
10
|
Zmora O, Indursky A, Klin B, Mendlovic S. Rare Pediatric Cecal Anomalies: A Lesson in Pediatric Surgery. Isr Med Assoc J 2022; 24:634-637. [PMID: 36309857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Rare incidence cases are part of the routine work of pediatric surgeons. Cecal anomalies in children are an example of such cases. Objectives: To describe the presentation, workup, management and outcome of rare cecal anomalies in children and to analyze the skills needed for their successful treatment. METHODS A retrospective chart review was conducted of all cases of cecal anomalies managed by the pediatric surgical service at a tertiary hospital from June 2017 to January 2020. Data regarding demographics, clinical presentation, radiological studies, surgical treatment, pathology, complications, and outcome were collected. RESULTS Five cases of cecal anomalies were encountered over a period of 32 months, including a cecal volvulus, cecal duplication, cecal intussusception, and two cecal masses (one ulcerated lipoma and one polyp). All patients, except the patient with cecal duplication, presented acutely and were managed surgically. Long-term follow-up of 17-24 months was unremarkable in all cases. CONCLUSIONS A wide knowledge base, careful judgment, and creativity enable pediatric surgeons to successfully treat rare conditions such as rare cecal anomalies. These skills should be part of the education of pediatric surgery trainees.
Collapse
Affiliation(s)
- Osnat Zmora
- Pediatric Surgery, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Atara Indursky
- Pediatric Surgery, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Baruch Klin
- Pediatric Surgery, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sonia Mendlovic
- Pathology, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
11
|
Reeves JM, Jayasekara JH, Mumme A. A real kick in the guts: small bowel herniation through the foramen of Winslow in a child. ANZ J Surg 2022; 92:2718-2719. [PMID: 35195325 DOI: 10.1111/ans.17578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Jenna M Reeves
- Department of General Surgery, Lismore Base Hospital, Lismore, New South Wales, Australia
| | - Jayani H Jayasekara
- Department of General Surgery, Lismore Base Hospital, Lismore, New South Wales, Australia
- Department of General Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Alison Mumme
- Department of General Surgery, Lismore Base Hospital, Lismore, New South Wales, Australia
| |
Collapse
|
12
|
Camacho-Aguilera JF, Calderón-Vieyra A. [Cecal volvulus: one case and literature review]. Rev Med Inst Mex Seguro Soc 2022; 60:591-598. [PMID: 36049083 PMCID: PMC10395989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/01/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Cecal volvulus is a rare disease that causes intestinal obstruction. It has various congenital and acquired risk factors. It is frequently associated with abnormal cecal fixation, and it is caused by torsion of the cecum in one of its three axes. It is not different from other causes of intestinal obstruction, but a delay in its diagnosis can lead to ischemia, necrosis and colon perforation. Its management depends on the viability of the tissues, ranging from untwisting and cecopexy to hemicolectomy with or without anastomosis. We present a case of caecal volvulus (caecal bascule) and review the literature as well. CLINICAL CASE 43-year-old female, who was admitted to an emergency department with data of intestinal obstruction. A simple tomography of the abdomen was performed, where a dilated colon and an image that resembles an inverted coffee bean were identified. An exploratory laparotomy was performed, identifying a bascule-type cecal volvulus, without vascular compromise. Devolvulation, decompression through appendectomy, and caecopexy were performed. After the surgical event, the patient recovered without incident and was discharged with adequate controls by external consultation. CONCLUSIONS Cecal volvulus is a cause of intestinal obstruction with a low incidence, which is why early recognition and treatment are key to avoiding the complications that its evolution entails. This type of disease should be among our differential diagnoses, since treatment is surgical and delay leads to a high mortality rate.
Collapse
Affiliation(s)
- José Francisco Camacho-Aguilera
- Instituto Mexicano del Seguro Social, Hospital General de Zona No. 3, Servicio de Cirugía General. San Juan del Río, Querétaro, México
| | | |
Collapse
|
13
|
Bolukbasi H. Cecal Diverticulitis: A Diagnosis to Keep in Mind When Evaluating Acute Appendicitis. J Coll Physicians Surg Pak 2022; 32:1067-1069. [PMID: 35932136 DOI: 10.29271/jcpsp.2022.08.1067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/13/2020] [Indexed: 06/15/2023]
Abstract
Cecal diverticulitis is a rare cause of right lower-quadrant abdominal pain. As its symptoms mimic those of acute appendicitis, the final diagnosis in the patients is generally confirmed after surgery. Herein, we report a 45-year man who was admitted to the department of emergency with lower right abdominal pain. Cecal diverticulitis was diagnosed on computed tomography (CT) images, and a conservative treatment approach was recommended. He was hospitalised, and intravenous antibiotics and hydration were administered immediately. Oral feeding was interrupted. After five days of intensive medical care, the patient was discharged without any further complications. Based on my experience, I advise that CT can be used to differentiate cecal diverticulitis from the acute appendicitis. In uncomplicated cases, conservative approaches are advised. Key Words: Cecal diverticulitis, Computed tomography, Acute appendicitis, Conservative treatment.
Collapse
Affiliation(s)
- Hakan Bolukbasi
- Department of General Surgery, Ministry of Health, University of Health Science, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
14
|
Abbassi I, Triki W, Trigui R, Ben Salah R, Itaimi A, Ayed K, Sebri H, Baraket O, Bouchoucha S. Case Report: Caecal volvulus management from diagnosis to treatment in a young patient. F1000Res 2022; 11:781. [PMID: 35999844 PMCID: PMC9360906 DOI: 10.12688/f1000research.121789.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 09/23/2023] Open
Abstract
Caecal volvulus (CV) is a rare cause of intestinal obstruction, defined by an axial torsion of the caecum, ascending colon, and terminal ileum around the mesenteric vascular pedicles, leading to ischemia and bowel necrosis. A 20-year-old woman, with no significant medical history, was admitted for generalized abdominal pain evolving for three days, along with constipation and abdominal distension, but with no vomiting. Physical examination showed a generalized abdominal tenderness with no rigidity or rebound tenderness, associated with abdominal distension and tympanic upon percussion. Laboratory findings were within normal limits. An abdominal computed tomography scan revealed distension of a loop of the large bowel with its long axis extending from the right lower quadrant to the epigastrium or left upper quadrant. Colonic haustral pattern was absent. An abdominal computed tomography scan showed a rounded focal collection of air-distended bowel with haustral creases in the upper left quadrant. In addition, spiraled loops of the collapsed cecum (giving a whirl sign) were noted, along with low-attenuating fatty mesentery from the twisted bowel. The patient underwent an emergency laparotomy and caecectomy using GEA 80 charges. The patient had no complaints post-operation. CV is a rare cause of bowel obstruction, mainly caused by an exceedingly mobile caecum. Despite its rareness, CV represents the second most common cause of large bowel volvulus, behind sigmoid volvulus. For acute obstruction by CV, it is hard to differentiate it clinically from obstruction of the small bowel; therefore, radiological exams are needed. Surgery is the gold standard treatment for CV. We report a rare case of CV to highlight the rarity of this pathology, specify its diagnostic and therapeutic means, and its clinical and biological evolution.
Collapse
Affiliation(s)
- Imed Abbassi
- General Surgery Department, Hôpital Universitaire Bougatfa of Bizerte, Bizerte, 7000, Tunisia
| | - Wissem Triki
- General Surgery Department, Hôpital Universitaire Bougatfa of Bizerte, Bizerte, 7000, Tunisia
| | - Racem Trigui
- General Surgery Department, Hôpital Universitaire Bougatfa of Bizerte, Bizerte, 7000, Tunisia
| | - Ramy Ben Salah
- Plastic and Reconstructive Department, Hospital Habib Bougatfa of Bizerte, Bizerte, 7000, Tunisia
| | - Ahmed Itaimi
- General Surgery Department, Hôpital Universitaire Bougatfa of Bizerte, Bizerte, 7000, Tunisia
| | - Karim Ayed
- General Surgery Department, Hôpital Universitaire Bougatfa of Bizerte, Bizerte, 7000, Tunisia
| | - Hajer Sebri
- Gynecology and Obstetric Department, Hospital Mongi Slim of La Marsa, Tunis, 1000, Tunisia
| | - Oussema Baraket
- General Surgery Department, Hôpital Universitaire Bougatfa of Bizerte, Bizerte, 7000, Tunisia
| | - Sami Bouchoucha
- General Surgery Department, Hôpital Universitaire Bougatfa of Bizerte, Bizerte, 7000, Tunisia
| |
Collapse
|
15
|
Terada I, Hashimoto M, Zaimoku R, Takei R, Terakawa H, Tsukioka Y, Kiriyama M. [A Case of Cecal Burkitt's Lymphoma with Intussusception]. Gan To Kagaku Ryoho 2022; 49:220-222. [PMID: 35249067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
We report a case of ileocecal intussusception due to Burkitt's lymphoma(BL). A 14-year-old boy was admitted to our hospital for abdominal pain and diarrhea. He was diagnosed an intussusception by the ultrasonography and the CT scan. Laparoscopic ileocecal resection was performed. A diagnosis of BL was made on basis of pathological examination. He was transferred for the chemotherapy on postoperative day 8. We conclude that, if the intussusception associated with malignant lymphoma is assumed from the preoperative findings, we have to keep minimal surgical invasion and start postoperative chemotherapy immediately.
Collapse
|
16
|
Kasetani T, Hirata H, Morita T, Furukawa H. [A Case of Appendiceal Intussusception Induced by Early Appendiceal Carcinoma]. Gan To Kagaku Ryoho 2021; 48:1728-1730. [PMID: 35046311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Appendiceal intussusception is an uncommon pathologic condition. We report herein a case of appendiceal intussusception induced by appendiceal carcinoma. A 76-year-old woman was admitted to hospital because of epigastric pain. CT scan showed multiple concentric ring sign in ascending colon and enhanced tumor in transverse colon. Colonoscopy showed invagination of polypoid lesion which was pushed back to cecum endoscopically. Laparoscopy-assisted ileocecal resection with regional lymph node dissection was performed for cecal cancer. During surgery, the appendix was found to be inverted completely into the cecum. The tumor was 70×35 mm in size in the cecal cavity, and the appendix had completely invaginated into the cecum at its base. Histopathologic examination revealed early appendiceal carcinoma. The patient is healthy without recurrence.
Collapse
|
17
|
Alavi K, Poylin V, Davids JS, Patel SV, Felder S, Valente MA, Paquette IM, Feingold DL. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Colonic Volvulus and Acute Colonic Pseudo-Obstruction. Dis Colon Rectum 2021; 64:1046-1057. [PMID: 34016826 DOI: 10.1097/dcr.0000000000002159] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Karim Alavi
- University of Massachusetts Medical School, Worcester, Massachusetts
| | | | - Jennifer S Davids
- University of Massachusetts Medical School, Worcester, Massachusetts
| | | | | | | | | | | |
Collapse
|
18
|
Fujiwara S, Yamashita H. Refractory epigastric pain secondary to intussusception caused by cecal endometriosis. BMJ Case Rep 2021; 14:e246160. [PMID: 34413051 PMCID: PMC8378380 DOI: 10.1136/bcr-2021-246160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 11/03/2022] Open
Affiliation(s)
- Sho Fujiwara
- Department of Surgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan
| | - Hiroshi Yamashita
- Department of Surgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan
| |
Collapse
|
19
|
Tonelli G, Soricelli E, Vannucchi M, Lucchese M. A rare case of epidermoid cyst of the cecum. Clin J Gastroenterol 2021; 14:1746-1748. [PMID: 34403033 DOI: 10.1007/s12328-021-01496-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 07/31/2021] [Indexed: 11/27/2022]
Abstract
Epidermoid cysts of the gastrointestinal tract are very uncommon and the published literature on this subject is anecdotal. We report the case of a 51-year-old man who was diagnosed with a cystic neoplasm located close to the cecum and the appendix. Given the strong suspicion of an appendiceal mucocele, the patient underwent a laparoscopic exploration. During the operation, a semisolid mass appearing to originate from the cecal wall was identified and a laparoscopic ileo-cecal resection was performed. The pathological diagnosis was an epidermoid cyst of the cecum. An epidermoid cyst of the cecum is a rare entity that usually has a mild and aspecific clinical picture. However, it should be included in the differential diagnosis of an occasionally diagnosed peri-cecal cystic lesion.
Collapse
Affiliation(s)
- Giovanni Tonelli
- Department of Surgery, General and Bariatric Surgical Unit, Santa Maria Nuova Hospital, Piazza Santa Maria Nuova, 1, 50122, Florence, Italy
| | - Emanuele Soricelli
- Department of Surgery, General and Bariatric Surgical Unit, Santa Maria Nuova Hospital, Piazza Santa Maria Nuova, 1, 50122, Florence, Italy.
| | | | - Marcello Lucchese
- Department of Surgery, General and Bariatric Surgical Unit, Santa Maria Nuova Hospital, Piazza Santa Maria Nuova, 1, 50122, Florence, Italy
| |
Collapse
|
20
|
Kunishi Y, Tsukamoto M, Yanagibashi T, Sodani Y, Niwa K, Yoshie K, Kato Y, Maeda S. Cecal Volvulus Resolved Spontaneously. Intern Med 2021; 60:851-854. [PMID: 33055481 PMCID: PMC8024960 DOI: 10.2169/internalmedicine.5532-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/24/2020] [Indexed: 11/06/2022] Open
Abstract
Cecal volvulus is an uncommon cause of colonic obstruction. First-line treatment for cecal volvulus is surgery, as nonoperative management is rarely achievable. We herein report an extremely rare case of a patient with spontaneously resolved cecal volvulus; no recurrence occurred without elective surgery. A 47-year-old woman presented with acute lower abdominal pain. She was misdiagnosed with small bowel obstruction and treated conservatively. A few hours later, she was correctly diagnosed with cecal volvulus. Subsequently, her symptoms and computed tomography findings of cecal volvulus completely disappeared. She refused elective surgery, but no recurrence occurred during five months of follow-up.
Collapse
Affiliation(s)
- Yosuke Kunishi
- Department of Gastroenterology, Kanagawa Prefectural Ashigarakami Hospital, Japan
| | - Megumi Tsukamoto
- Department of Gastroenterology, Kanagawa Prefectural Ashigarakami Hospital, Japan
| | - Takafumi Yanagibashi
- Department of Gastroenterology, Kanagawa Prefectural Ashigarakami Hospital, Japan
| | - Yuki Sodani
- Department of Gastroenterology, Kanagawa Prefectural Ashigarakami Hospital, Japan
| | - Kazuhiro Niwa
- Department of Gastroenterology, Kanagawa Prefectural Ashigarakami Hospital, Japan
| | - Koichiro Yoshie
- Department of Internal Medicine, Kanagawa Prefectural Ashigarakami Hospital, Japan
| | - Yoshio Kato
- Department of Gastroenterology, Kanagawa Prefectural Ashigarakami Hospital, Japan
| | - Shin Maeda
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Japan
| |
Collapse
|
21
|
Abstract
Caecal volvulus is an infrequent cause of acute surgical abdomen, where an abnormally mobile cecum twists on its own axis. It can lead to the development of closed-loop obstruction, small bowel ischaemia and perforation. Early recognition and prompt treatment is key; however, due to the rarity of this pathology, it is seldom listed as a differential diagnosis. Here, we present a single-centre case series of two patients presenting with caecal volvulus to an Emergency Surgery Unit at a University Hospital.
Collapse
Affiliation(s)
- Martha Sara Kedrzycki
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- General Surgery Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Hammersmith, London, UK
| | - Jaya Roy Choudhury
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- General Surgery Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Hammersmith, London, UK
| | - Sherif Hakky
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- General Surgery Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Hammersmith, London, UK
| |
Collapse
|
22
|
Fiordaliso M, Panaccio P, Costantini R, De Marco AF. Comparison between children and adults intussusception. Description of two cases and review of literature. Ann Ital Chir 2021; 92:268-276. [PMID: 34031279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Intussusception is a common condition in children, it is rare in adults. Adult intussusception differs from pediatric intussusception in various respects, including etiology clinical characteristics and therapy. METHODS We present and discuss a new case of intussusception in children and adults. RESULTS In child the Barium Enema x-ray examination is identified an endoluminal filling defect to refer to the apex of the invaginated loop at the rectal level, with slow ascent during the progressive injection of the radiopaque contrast medium. At the end of the procedure, incomplete reduction of the picture is documented. The patient undergoes emergency surgery where the presence of an ileo-ceco-colic invagination is documented. Intussusception is reduced by taxis. In the adult laparoscopic right hemicolectomy was performed. High-grade B-cell Burkitt's lymphoma was confirmed by immunohistochemistry. DISCUSSION In contrast to intussusceptions in children, in the adult population, a demonstrable etiology is found in most of the cases. In adults surgery is always indicated. The non-invasive resolutive intervention most commonly used in the child and best known consists in the rectal introduction of a radiopaque contrast medium (air or barium) at controlled pressure until. CONCLUSIONS Although intussusceptions occur at all ages, there are major differences in the clinical presentation, diagnostic approach, and management between pediatric and adult populations. Intussusception is remarkably different in these two age groups and it must be approached from a different clinical perspective. KEY WORDS Intussusception in children, Intussusception in adults, Intussusception symptoms, Radiology and treatment.
Collapse
|
23
|
Abstract
RATIONALE Appendiceal intussusception is a rare disease. The definite preoperative diagnosis of appendiceal intussusception is rare and challenging. Here, we present a case of McSwain type V appendiceal intussusception in a 10-year-old boy. To our best knowledge, this is the first case report of a type V appendiceal intussusception that was preoperatively confirmed with sonography. Here, we have described in detail the ultrasound features and differential diagnosis of this rare disease. PATIENT CONCERNS A 10-year-old boy presented with 3 days of recurrent intermittent mild abdominal pain. The result of ultrasonography suggested an ileocolic intussusception and a therapeutic air-contrast enema was requested to reduce the intussusception but failed at a local hospital. DIAGNOSES Physical exam revealed mild tenderness in the lower right quadrant of the abdomen. However, ultrasonography showed a target-sign in cross section and a finger-like appearance in the longitudinal view. A diagnosis of McSwain type V appendiceal intussusception was made. INTERVENTIONS The patient underwent an appendectomy after successful manual reduction on laparotomy. The appendix was successfully resected. OUTCOMES Intraoperatively, the appendix was completely inverted in the cecum, and the preoperative sonographic findings were confirmed. During follow-up, there were no signs of recurrence. LESSONS Pre-operatively, on ultrasound a type V appendiceal intussusception is usually misdiagnosed as an ileocolic intussusception. Radiologists must execute caution to avoid over reliance on the sonographic findings of intussusception, especially when there is a mismatch with clinical symptoms. It is especially important to accurately understand the surgical-anatomic configuration of type V appendiceal intussusception that creates a "target-sign" and a "finger-like" layout on ultrasonography.
Collapse
Affiliation(s)
| | | | | | | | - Xiang-lian Tang
- Department of paediatric surgery, Hunan Children's Hospital, Changsha, Hunan Province, China
| |
Collapse
|
24
|
Jonas L, Bombil I, Mannell A. Unusual histopathologies of the appendix. S AFR J SURG 2020; 58:160. [PMID: 33231010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Appendicitis is the most common surgical emergency. Most commonly it is a result of luminal occlusion that leads to ischaemia and eventually to perforation with resultant localised or diffuse peritonitis. Unusual causes have been documented including viral infections, parasites, tuberculosis and neoplasms. These conditions are important to recognise, as they may need additional specific management. This study endeavours to identify the incidence and type of unusual histopathology of appendicitis. METHOD A retrospective review of histopathological reports of appendix specimens obtained during appendectomies done between January 2012 and December 2014 in the three academic hospitals of Johannesburg - Chris Hani Baragwanath Academic Hospital (CHBAH), Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), and Helen Joseph Hospital (HJH). All specimens were examined by pathologists of the National Health Laboratory Services (NHLS). RESULTS A total of 2 408 histopathology results were obtained from the NHLS. 164 specimens were excluded because they were part of colonic resection for unrelated conditions. Of the 2 244 specimens included, 8.1% were normal, 52.7% showed acute appendicitis and 30.1% showed complicated appendicitis. Unusual pathology comprised 5.3% (119/2 244). The median age of all patients was 25.6 years (0-88yrs) and the gender distribution was 61.9% males and 38.1% females. The most common unusual causes were parasites (37%), mainly schistosomiasis (24.3%), followed by neoplasm (20%) and fibrous obliteration (14.2%). CONCLUSION All appendectomy specimens must be submitted to the pathologist for histological diagnosis. It is important that the result be checked before the patient is discharged as further specific treatment may be indicated.
Collapse
Affiliation(s)
- L Jonas
- Department of Surgery, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - I Bombil
- Department of Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - A Mannell
- Department of Surgery, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
25
|
Montorfano L, Miret R, Rahman AU, Alonso M, Maron DJ, Roy M, Ferri F, Bejarano P, Wexner SD. Colorectal surgery obesity-related morbidity during COVID-19. Surg Obes Relat Dis 2020; 16:1372-1375. [PMID: 32723601 PMCID: PMC7346794 DOI: 10.1016/j.soard.2020.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/05/2020] [Indexed: 01/16/2023]
Abstract
Tocilizumab, a monoclonal antiinterluekin-6 receptor antibody, has been empirically used in the treatment of cytokine release syndrome associated with severe coronavirus disease 2019 infections. The efficacy and safety of these medications for these patients is unknown. The purpose of this report was to present a case of acute large bowel perforation in a morbidly obese patient with coronavirus disease 2019 pneumonia who received empiric Tocilizumab. This case report analyzes the risks of acute large bowel perforation after using this medication empirically and discusses the appropriate management of this adverse event.
Collapse
Affiliation(s)
| | - Rafael Miret
- Department of General Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Asad Ur Rahman
- Department of Gastroenterology, Cleveland Clinic Florida, Weston, Florida
| | - Mileydis Alonso
- Department of General Surgery, Cleveland Clinic Florida, Weston, Florida
| | - David J Maron
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Mayank Roy
- Department of General Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Francisco Ferri
- Department of General Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Pablo Bejarano
- Department of Laboratory Medicine, Cleveland Clinic Florida, Weston, Florida
| | - Steven D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida.
| |
Collapse
|
26
|
Rincon-Sanchez RAM, Ramirez-Barranco R. [Intestinal malrotation in adults diagnosed after presentation of post polypectomy syndrome in the cecum: report of a case]. Rev Gastroenterol Peru 2020; 40:185-187. [PMID: 32876637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Intestinal malrotation is a congenital anomaly of intestinal rotation and fixation, diagnosed infrequently in adulthood. We report the presence of intestinal malrotation in a previously asymptomatic adult patient with changes in bowel habit in the last 6 months after a colonoscopy is performed with evidence of a polyp in the cecum, after resection presenting acute abdominal pain in the left iliac fossa that allows imaging to confirm the diagnostic.
Collapse
|
27
|
Abstract
RATIONALE Large bowel perforations by a foreign body are rarely diagnosed pre-operatively due to non-specific clinical symptoms. The safety and efficacy of foreign body removal via upper endoscopy is well-established and strongly recommended. There is far less experience of endoscopic treatment of sharp foreign bodies impacted in lower parts of gastrointestinal tract. PATIENT CONCERNS The patient was 78-year-old female with abdominal pain and nausea. Symptoms had begun 48 hours prior to hospital admission. She had lost over 10 kg of body weight in the previous couple of months DIAGNOSIS:: A multidetector-row computed tomography (MDCT) examination of the abdomen revealed mural thickening and enhancement of the cecum with haziness and linear areas of high attenuation in the pericecal fat tissue. A colonoscopy showed, the clear presence of a sharp 5.5-cm-long chicken bone perforating the cecal wall at the antemesenteric site close to the Bauchini valve. INTERVENTIONS A quarter of the bone that had penetrated the cecal wall was pulled out with a flexible colonoscopy using a polypectomy snare. Due to the form and length of the bone, it was withdrawn through the entire colon, using pointed end trailing. OUTCOMES The patient was discharged three days after colonoscopy with normal laboratory results and without any pain. LESSONS In cases where sharp foreign bodies stuck into the large bowel, it is highly advisable to try to remove them via colonoscopy, before deciding to resolve the issue through a surgical intervention.
Collapse
|
28
|
Joly MA, Aime A, Souraud JB, Malgras B. Appendicular myxoglobulosis; a rare form of appendicular mucocele. J Visc Surg 2019; 157:359-361. [PMID: 31711958 DOI: 10.1016/j.jviscsurg.2019.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Myxoglobulosis is a particular, rare, form of appendicular mucocele, characterized by the presence of numerous, occasionally calcified, globules that are grouped together like grapes, and look like pearls or fish eggs, in the appendicular lumen. The diagnosis of myxoglobulosis is most often fortuitous, but sometimes, can be made in the face of acute appendicitis or another setting of abdominal pain. Imaging (sonography or computerized tomography (CT)) is highly suggestive when it shows a cystic, encapsulated, oblong, well-delineated mass, containing (heterogeneous, liquid, and viscous) mucus with calcified globules. In contrast to acute appendicitis, the wall of the appendix is thin (<6mm) and there is no peri-appendicular inflammation. Long-term complications are similar to other appendicular mucoceles, including invagination, bleeding, perforation, peritonitis and peritoneal pseudomyxoma.
Collapse
Affiliation(s)
- M A Joly
- Service de chirurgie digestive, HIA Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
| | - A Aime
- Service de chirurgie digestive, HIA Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
| | - J-B Souraud
- Service d'anatomopathologie, HIA Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
| | - B Malgras
- Service de chirurgie digestive, HIA Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France; École du Val-de-Grâce, 1, place Alphonse Laveran, 75230 Paris cedex 05, France.
| |
Collapse
|
29
|
Korotkaya Y, Dunn E, Aybar A, Crino J, Alaish S, Scheimann A. Cecal Duplication Presenting With Hematochezia in an Infant. Clin Pediatr (Phila) 2019; 58:1338-1340. [PMID: 31402694 DOI: 10.1177/0009922819867456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Yelena Korotkaya
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Emily Dunn
- Division of Pediatric Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ahmet Aybar
- Annapolis Pediatric Gastroenterology and Nutrition, Annapolis, MD, USA
| | - Jude Crino
- Department of Obstetrics and Gynecology, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Samuel Alaish
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ann Scheimann
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
30
|
Abstract
Internal hernias through the foramen of Winslow are very rare. An 80-year-old female patient presented with epigastric and right upper quadrant pain associated with abdominal distention, nausea and vomiting for 1 day. A CT scan showed an internal hernia with terminal ileum and caecum identified within the lesser sac. The diagnosis was confirmed by laparotomy. A right hemicolectomy was performed to prevent further recurrence. We reviewed case reports with the same presentation by searching the Pubmed database using the keywords: 'foramen Winslow hernia, cecum'. We identified 23 publications. Our review extracted the following information: presentation, anatomical findings, pathological causes and surgical management. Misdiagnosis was common due to the limitations of plain abdominal X-rays. Abdominal CT scan is now the preferred radiological study and is more effective in establishing a diagnosis. Surgical treatment options varied. Right hemicolectomy has emerged as the preferred procedure to decrease the rate of recurrence.
Collapse
Affiliation(s)
- Faez Ayoob
- General Surgery, Staten Island University Hospital, Staten Island, New York, USA
| | - Rami Michael
- General Surgery, Staten Island University Hospital, Staten Island, New York, USA
| | - Zachary Chadnick
- General Surgery, Staten Island University Hospital, Staten Island, New York, USA
| | - Charles Fasanya
- General Surgery, Staten Island University Hospital, Staten Island, New York, USA
| |
Collapse
|
31
|
Ion D, Serban MB, Păduraru DN, Nica AE, Rahim AM, Andronic O. Appendiceal Mass - Dilemmas Regarding Extension of the Resection. Chirurgia (Bucur) 2019; 114:126-130. [PMID: 30830855 DOI: 10.21614/chirurgia.114.1.126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2019] [Indexed: 11/23/2022]
Abstract
Starting from a typical case, we try to highlight the main critical elements, both in the diagnostic algorithm and in the therapeutic one. We hereby present a 54-year old patient, known with hepatic steatosis and renal microlithiasis, which undergoes an ultrasonography in ambulatory, on the background of unsystematised abdominal discomfort; the ultrasound reveals the presence of a tumoral mass in the right iliac fossa.
Collapse
|
32
|
Agne GF, Stockler RM, Passler T, Maxwell H, Cole R. Successful surgical resolution of a ceco-cecal intussusception in a 15-month-old Angus heifer. Can Vet J 2018; 59:1071-1074. [PMID: 30510310 PMCID: PMC6135298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A 15-month-old Angus heifer was presented for anorexia and abdominal discomfort. Transabdominal ultrasound was suggestive of a ceco-cecal intussusception. Exploratory laparotomy confirmed the diagnosis and a cecectomy was performed. The heifer recovered well and continued to gain weight after discharge. This is the first report of a heifer with ceco-cecal intussusception in North America.
Collapse
Affiliation(s)
- Gustavo Ferlini Agne
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, Alabama 36849, USA
| | - Ricardo M Stockler
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, Alabama 36849, USA
| | - Thomas Passler
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, Alabama 36849, USA
| | - Herris Maxwell
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, Alabama 36849, USA
| | - Robert Cole
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, Alabama 36849, USA
| |
Collapse
|
33
|
Bailey KS, Lundstrom E, Borgstrom D. Cecal Volvulus: An Evolving Disease. Am Surg 2018; 84:e418-e419. [PMID: 30454520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
|
34
|
Tsukamoto R, Sakamoto K, Honjo K, Niwa K, Sugimoto K, Ishiyama S, Kamiyama H, Takahashi M, Okuzawa A. Case of idiopathic and complete appendiceal intussusception. Asian J Endosc Surg 2018; 11:256-258. [PMID: 29214746 PMCID: PMC6099467 DOI: 10.1111/ases.12442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/16/2017] [Accepted: 10/04/2017] [Indexed: 11/30/2022]
Abstract
Appendiceal intussusception is a rare disease in which the appendix invaginates into the cecum. It is often caused by organic diseases. The present case involved an appendiceal intussusception without an organic disease, and laparoscopic resection of part of the cecum was performed. Appendiceal intussusception has various causes, including malignant diseases. Therefore, diagnosis and selection of operative method are complex and could potentially lead to an excessively invasive option. By performing SILS with a multiuse single-site port, we were able to provide an appropriate, non-invasive treatment that had a good esthetic outcome.
Collapse
Affiliation(s)
- Ryoichi Tsukamoto
- Department of Coloproctological Surgery, Faculty of MedicineJuntendo UniversityTokyoJapan
| | - Kazuhiro Sakamoto
- Department of Coloproctological Surgery, Faculty of MedicineJuntendo UniversityTokyoJapan
| | - Kumpei Honjo
- Department of Coloproctological Surgery, Faculty of MedicineJuntendo UniversityTokyoJapan
| | - Koichiro Niwa
- Department of Coloproctological Surgery, Faculty of MedicineJuntendo UniversityTokyoJapan
| | - Kiichi Sugimoto
- Department of Coloproctological Surgery, Faculty of MedicineJuntendo UniversityTokyoJapan
| | - Shun Ishiyama
- Department of Coloproctological Surgery, Faculty of MedicineJuntendo UniversityTokyoJapan
| | - Hirohiko Kamiyama
- Department of Coloproctological Surgery, Faculty of MedicineJuntendo UniversityTokyoJapan
| | - Makoto Takahashi
- Department of Coloproctological Surgery, Faculty of MedicineJuntendo UniversityTokyoJapan
| | - Atsushi Okuzawa
- Department of Coloproctological Surgery, Faculty of MedicineJuntendo UniversityTokyoJapan
| |
Collapse
|
35
|
Park BS, Shin DH, Kim DI, Son GM, Kim HS. Appendiceal intussusception requiring an ileocecectomy: a case report and comment on the optimal surgery. BMC Surg 2018; 18:48. [PMID: 30068337 PMCID: PMC6090942 DOI: 10.1186/s12893-018-0380-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 07/17/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Appendiceal intussusception is very rare condition with an estimated incidence of 0.01%. Therefore, it is likely to be overlooked. In addition, making the diagnosis before or during surgery is very difficult. CASE PRESENTATION A 60-year-old male who was referred to our gastroenterology center with cecal inflammation found during a colonoscopy. An abdominal computed tomography (CT) following endoscopy revealed a 5 × 2.5 × 4 cm mass-like lesion in the cecum around the ileocolic (IC) valve and appendiceal orifice. The main lesion seemed to be an inflammatory mass rather than a malignancy because it appeared to be an extraluminal or extramucosal lesion. Ultrasonography revealed diffuse wall thickening of the cecum around the appendiceal orifice that was suspicious for an inflammatory mass or a benign mass. A diagnosis was uncertain. The differential diagnosis included chronic appendicitis, appendiceal neoplasm such as appendiceal mucocele, low grade appendiceal mucinous neoplasm. The patient underwent a laparoscopic partial cecectomy. In the surgical field, there was a large mass in the appendiceal orifice. The cecum was partially resected, with care taken to preserve the IC valve. Final histopathological analysis of the surgical specimen revealed an appendiceal intussusception without any mucosal lesion of the appendix. Narrowing of the terminal ileum with a small bowel obstruction and stenosis of the IC valve occurred postoperatively. Therefore, ileocecectomy was performed via a laparoscopic approach. The patient was discharged 11 days after the second surgery without another significant postoperative complication. CONCLUSIONS We report a rare case of appendiceal intussusception that required reoperation due to ileocolic valve stenosis. If the correct diagnosis of appendiceal intussusception is made, we can select an appropriate surgical treatment based on the classification of appendiceal intussusceptions.
Collapse
Affiliation(s)
- Byung-Soo Park
- Department of Surgery, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan, Gyungsangnam-do, 50612, Republic of Korea
| | - Dong Hoon Shin
- Department of Pathology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Dong-Il Kim
- Department of Surgery, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan, Gyungsangnam-do, 50612, Republic of Korea
| | - Gyung Mo Son
- Department of Surgery, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan, Gyungsangnam-do, 50612, Republic of Korea
| | - Hyun Sung Kim
- Department of Surgery, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan, Gyungsangnam-do, 50612, Republic of Korea.
| |
Collapse
|
36
|
Ruan XJ, Ye BL, Zheng ZH, Zhou HH, Zheng XF, Zhou ZX. Laparoscopic surgery assisted by colonoscopy for a submucosal cecal fecalith presenting as acute appendicitis: A case report. Medicine (Baltimore) 2017; 96:e8872. [PMID: 29382008 PMCID: PMC5709007 DOI: 10.1097/md.0000000000008872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE A cecal submucosal fecalith is extremely rare and is likely to be misdiagnosed as appendicitis with an incarcerated fecalith. PATIENT CONCERNS This review presents the case of a female patient complaining of recurrent abdominal pain in the right lower quadrant, similar to the clinical symptoms of appendicitis. Physical examination revealed an abdominal tenderness in the right lower quadrant without rebound tenderness or muscular tension. An ultrasound examination found a mass located in the right lower abdomen. Computed tomography showed a high-density shadow in the cecal cavity. DIAGNOSES A fecalith was detected in the submucosal cecal wall. The postoperative pathologic examination showed that the fecalith was located in the submucosa. INTERVENTIONS A partial cecal excision was performed under laparoscopic surgery assisted by colonoscopy. OUTCOMES The patient was discharged 1 week after surgery without postoperative complications. LESSONS Fecaliths should be considered in the differential diagnosis of submucosal occupying lesions of the cecum.
Collapse
|
37
|
Yamamoto T, Tajima Y, Hyakudomi R, Hirayama T, Taniura T, Ishitobi K, Hirahara N. Case of colonic intussusception secondary to mobile cecum syndrome repaired by laparoscopic cecopexy using a barbed wound suture device. World J Gastroenterol 2017; 23:6534-6539. [PMID: 29085202 PMCID: PMC5643278 DOI: 10.3748/wjg.v23.i35.6534] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 06/20/2017] [Accepted: 07/12/2017] [Indexed: 02/06/2023] Open
Abstract
A 27-year-old man with recurrent right lower quadrant pain was admitted to our hospital. Ultrasonography and computed tomography examination of the abdomen revealed a target sign in the ascending colon, which was compatible with the diagnosis of cecal intussusception. The intussusception was spontaneously resolved at that time, but it relapsed 6 mo later. The patient underwent a successful colonoscopic disinvagination; there was no evidence of neoplastic or inflammatory lesions in the colon and terminal ileum. The patient underwent laparoscopic surgery for recurring cecal intussusception. During laparoscopy, we observed an unfixed cecum on the posterior peritoneum (i.e. a mobile cecum). Thus, we performed laparoscopic appendectomy and cecopexy with a lateral peritoneal flap using a barbed wound suture device. The patient’s post-operative course was uneventful, and he continued to do well without recurrence at 10 mo after surgery. Laparoscopic cecopexy using a barbed wound suture device is a simple and reliable procedure that can be the treatment of choice for recurrent cecal intussusception associated with a mobile cecum.
Collapse
Affiliation(s)
- Tetsu Yamamoto
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane 693-8501, Japan
| | - Yoshitsugu Tajima
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane 693-8501, Japan
| | - Ryoji Hyakudomi
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane 693-8501, Japan
| | - Takanori Hirayama
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane 693-8501, Japan
| | - Takahito Taniura
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane 693-8501, Japan
| | - Kazunari Ishitobi
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane 693-8501, Japan
| | - Noriyuki Hirahara
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane 693-8501, Japan
| |
Collapse
|
38
|
Samo KA, Khalid M, Kaleem S. Post-Appendectomy Cecal Prolapse. J Coll Physicians Surg Pak 2017; 27:385-386. [PMID: 28689535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 01/24/2017] [Indexed: 06/07/2023]
Affiliation(s)
| | - Muneeb Khalid
- Department of Surgical Unit III, Civil Hospital, Karachi
| | | |
Collapse
|
39
|
Bhatti S, Khan MA, Farooka W, Butt UI, Rehman UA, Malik AA. An Unusual Case of Caecal Volvulus due to Appendicitis, Successfully Managed by Caecopexy. J Coll Physicians Surg Pak 2017; 27:S18-S20. [PMID: 28302233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 12/26/2016] [Indexed: 06/06/2023]
Abstract
Caecal volvulus is a rare cause of intestinal obstruction. Caecal volvulus precipitated by acute appendicitis is even rarer. We report an unusual case of caecal volvulus with acute appendicitis as a cause. A 55-year female presented in surgical emergency with 3 days history of abdominal pain, distension and absolute constipation; and 2 days history of vomiting. Her past surgical history was significant for hysterectomy 5 years back. On examination, abdomen was distended and bowel sounds exaggerated. X-ray abdomen erect showed a single large air fluid level in the right hemiabdomen. A preoperative diagnosis of intestinal obstruction due to adhesions was made and patient prepared for exploratory laparotomy. On exploration, a huge caecum was lying in the midline and was twisted around a band arising from the appendix and attached deep into the pelvis. The appendix was densely inflammed. The volvulus was de-twisted in a counter clockwise manner. Viability of the caecum was confirmed and appendectomy was done. Caecopexy was performed and abdomen was closed. Postoperative recovery of the patient was uneventful and she was safely discharged on 5th postoperative day.
Collapse
|
40
|
Motsumi MJ, Motlaleselelo P, Ayane G, Sesay SO, Valdes JR. A case report of a giant appendiceal mucocele and literature review. Pan Afr Med J 2017; 28:106. [PMID: 29515724 PMCID: PMC5837178 DOI: 10.11604/pamj.2017.28.106.13832] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 09/25/2017] [Indexed: 02/05/2023] Open
Abstract
A 43-year-old female presented at the accident and emergency department of Princess Marina Hospital, Gaborone, Botswana. She reported a deep dull aching pain of two years duration in the right iliac fossa that has been progressively becoming worse. Ultrasound revealed a large sausage like cystic mass extending from the pelvis up to the medial aspect of the ascending colon. CT scan showed a large sausage like cystic mass extending from the pelvis up to the hepatic flexure of the colon with the cecum displaced. No metastatic features were seen. We made an impression of appendiceal mucocele. A semi-elective laparotomy was scheduled. Intraoperative findings: a giant intact cystic distended appendix with involved base, displacing the cecum cranially. A right hemicolectomy was performed. The histopathological results revealed a low-grade appendicular mucinous neoplasm with no lymph node involvement. The surgical margins were free. The patient recovered uneventfully.
Collapse
Affiliation(s)
- Mpapho Joseph Motsumi
- University of Botswana, Department of Surgery, Sir Ketumile Masire University Hospital, PO Box, Mogoditshane, Botswana
| | - Pako Motlaleselelo
- Department of Surgery, Ministry of Health, Princess Marina Hospital, Mogoditshane, Botswana
| | - Gezahen Ayane
- Department of Surgery, University of Botswana, Sir Ketumile Masire University Hospital, Mogoditshane, Botswana
| | - Sheikh Omar Sesay
- Ministry of Health, Department of Radiol, Princess Marina Hospital, Mogoditshane, Botswana
| | - Johamel Ramos Valdes
- Department of Pathology, University of Botswana, Sir Ketumile Masire University Hospital, Mogoditshane, Botswana
| |
Collapse
|
41
|
Gimonet H, Laigle-Quérat V, Ploteau S, Veluppillai C, Leclère B, Frampas E. Is pelvic MRI in women presenting with pelvic endometriosis suggestive of associated ileal, appendicular, or cecal involvement? Abdom Radiol (NY) 2016; 41:2404-2410. [PMID: 27590068 DOI: 10.1007/s00261-016-0884-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE To evaluate whether deep pelvic endometriosis or endometriomas diagnosed at pelvic MRI are associated with extrapelvic bowel endometriosis (EPBE) (ileal, appendicular, or cecal involvement) in order to suggest criteria for performing an additional imaging examination dedicated to the assessment of EPBE. METHODS Ninety-six patients operated on for deep pelvic endometriosis were retrospectively included. They were classified in two groups according to the presence of surgically and histologically proven EPBE. According to pelvic endometriotic lesions described on the preoperative pelvic MRI, a logistic regression analysis was performed to evaluate a possible association between EPBE and pelvic endometriosis. RESULTS Eleven patients had EPBE (5 appendicular, 2 cecal, and 4 ileocecal lesions) at surgery. In adjusted models, involvement of the right ureter, rectosigmoid, and sigmoid localizations were statistically associated with EPBE with adjusted OR of 9.13 (95% CI 1.98-42.19), 5.8 (95% CI 1.12-30.07), and 6.74 (95% CI 1.23-36.77), respectively. CONCLUSIONS Further imaging evaluation to assess ileal, appendicular, or cecal endometriosis should be proposed in case of sigmoid or rectosigmoid endometriosis diagnosed at pelvic MRI. A right ureteral lesion diagnosed preoperatively should be considered carefully as its association with EPBE is not described so far.
Collapse
Affiliation(s)
- Hélène Gimonet
- Service de radiologie et imagerie médicale, Hôtel-Dieu, CHU de Nantes, 1 place Alexis-Ricordeau, 44093, Nantes, France.
| | - Valérie Laigle-Quérat
- Service de radiologie et imagerie médicale, Hôtel-Dieu, CHU de Nantes, 1 place Alexis-Ricordeau, 44093, Nantes, France
| | - Stéphane Ploteau
- Service de gynécologie-obstétrique, Hôpital Femme-enfant-adolescent, CHU de Nantes, 38 boulevard Jean-Monnet, 44093, Nantes, France
| | - Cergika Veluppillai
- Service de gynécologie-obstétrique, Hôpital Femme-enfant-adolescent, CHU de Nantes, 38 boulevard Jean-Monnet, 44093, Nantes, France
| | - Brice Leclère
- Service d'évaluation médicale et d'épidémiologie, Hôpital St Jacques, CHU de Nantes, 85 rue St Jacques, 44093, Nantes, France
| | - Eric Frampas
- Service de radiologie et imagerie médicale, Hôtel-Dieu, CHU de Nantes, 1 place Alexis-Ricordeau, 44093, Nantes, France
| |
Collapse
|
42
|
Fox C, Stewart M, King SK, Patel N. Acute gastrointestinal compromise in neonates with congenital diaphragmatic hernia prior to repair. J Pediatr Surg 2016; 51:1917-1920. [PMID: 27712890 DOI: 10.1016/j.jpedsurg.2016.09.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 09/12/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Congenital diaphragmatic hernia (CDH) affects 1 in 3000 live births. Modern management strategies include delayed repair of the diaphragm to permit pre-operative optimization of cardiorespiratory status. We describe a cohort of neonates in whom early emergency operative intervention was required for potentially fatal intestinal compromise. METHODS A retrospective review was performed of all neonatal CDH patients managed at a tertiary center in an 8-year period (2005-2012). RESULTS A total of 126 CDH patients were managed during the 8-year period. Five neonates (male - 1; gestation 37+4-39+7; birth weight 2.9-3.7kg; left CDH - 5) required emergency operative intervention for presumed gastrointestinal compromise. All five neonates demonstrated systemic hypotension despite inotropic support, raised serum lactate (>2mmol/L), and abnormal radiographic findings. Operative intervention occurred within 3days of birth (1-3days). Findings included gastric volvulus, jejunal volvulus, and perforated caecum. All patients underwent primary diaphragmatic repair without a patch. Temporary ileostomy was required in 1 patient. All patients remain alive. CONCLUSION Gastrointestinal compromise is a rare, but potentially catastrophic, complication of CDH. Emergency operative intervention may be required in a select cohort of patients. Early deterioration following birth should alert clinicians to the possibility of significant intestinal pathology. LEVEL OF EVIDENCE Level IV case series with no comparison group.
Collapse
Affiliation(s)
- Catherine Fox
- Paediatric Infant Perinatal Emergency Retrieval Service, The Royal Children's Hospital, Melbourne, Victoria, Australia.
| | - Michael Stewart
- Paediatric Infant Perinatal Emergency Retrieval Service, The Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Neonatal Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Neonatal Services, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Sebastian K King
- Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia; Surgical Research Department, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Neil Patel
- Department of Neonatology, Royal Hospital for Children, Glasgow, United Kingdom
| |
Collapse
|
43
|
Tsukiyama G, Tanaka H, Yabuki S, Hasegawa M, Tanahashi C. [A Case of Mantle Cell Lymphoma Diagnosed after Surgery for Ileocecal Intussusception]. Gan To Kagaku Ryoho 2016; 43:2163-2165. [PMID: 28133256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A 63-year-old woman visited our hospital complaining of abdominal pain and bloody discharge in November 2015. Abdominal CT revealed ileocecal intussusception. After hospitalization, a right colectomy was performed. Pathological diagnosis of the resected specimen was Mantle cell lymphoma. After this diagnosis, chemotherapy was initially administered. Following this, peripheral stem cell transplantation was carried out. We discovered this case of Mantle cell lymphoma by chance; therefore, here, we consider and introduce how this type of disease should be treated. We also introduce a rare case of Mantle cell lymphoma with intussusception at the cecum.
Collapse
|
44
|
Tsukui H, Koinuma K, Morimoto M, Horie H, Lefor AK, Kagaya Y, Takahashi H, Yano T, Matsubara D, Yamamoto H, Sata N. Crohn's disease presenting as a ceco-urachal fistula. Clin J Gastroenterol 2016; 10:32-36. [PMID: 27766543 DOI: 10.1007/s12328-016-0691-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 10/02/2016] [Indexed: 01/06/2023]
Abstract
We report the case of a patient with Crohn's disease who initially presented with a ceco-urachal fistula. The patient was a 31-year-old female who underwent an appendectomy 6 years before presenting to our institution. She had a one-year history of diarrhea, and had recently developed polyuria and a sensation of residual urine. She was admitted with fever and lower abdominal pain. Endoscopy and computed tomography revealed a ceco-urachal fistula, which was consistent with Crohn's disease. An urachal resection was performed, which included partial cystectomy and ileocecal resection. A ceco-urachal fistula is a rare initial symptom of Crohn's disease. During the surgical management of such cases, it is necessary to resect the urachus, the affected portion of the bladder, the fistula, and the affected part of the digestive tract in order to avoid recurrence.
Collapse
Affiliation(s)
- Hidenori Tsukui
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Koji Koinuma
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Mitsuaki Morimoto
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Hisanaga Horie
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Alan Kawarai Lefor
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Yuka Kagaya
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Haruo Takahashi
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Tomonori Yano
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | | | - Hironori Yamamoto
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Naohiro Sata
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| |
Collapse
|
45
|
Kılıç MÖ, Güldoğan CE, Balamir İ, Tez M. Ischemia-modified albumin as a predictor of the severity of acute appendicitis. Am J Emerg Med 2016; 35:92-95. [PMID: 27769665 DOI: 10.1016/j.ajem.2016.10.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 10/04/2016] [Accepted: 10/04/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The early prediction of gangrenous/perforated appendicitis is of great importance for the surgical planning, further treatments, and predicting the course of disease. Ischemia-modified albumin (IMA) was previously reported as a biomarker of various ischemia-based diseases. Our aim is to determine the predictive value of serum IMA in the severity of acute appendicitis. METHODS Sixty-two patients who underwent urgent appendectomy were included in the study. Plasma level of IMA was measured after diagnosis and before treatment. All patients were classified as noncomplicated (acute) appendicitis and complicated (gangrenous/perforated) appendicitis according to histopathological findings, and comparisons were made between the groups. RESULTS The data of 62 patients with a mean age of 30.1 years were statistically evaluated. The pathological diagnoses were acute appendicitis in 33 (53.2%), and gangrenous/perforated appendicitis in 29 (46.8%) patients. There were significant differences in computed tomography (CT) findings (P = .031) and IMA (P = .012) levels between the groups. A strong positive correlation between IMA levels and CT findings was also found (Spearman ρ = +0.688, P = .003). CONCLUSIONS The IMA can be considered as a novel and useful marker to distinguish gangrenous/perforated appendicitis from noncomplicated appendicitis. The correlation of IMA with CT findings also enhances the predictive value of IMA.
Collapse
Affiliation(s)
- Murat Özgür Kılıç
- Department of General Surgery, Numune Training and Research Hospital, Ankara, Turkey.
| | - Cem Emir Güldoğan
- Department of General Surgery, Numune Training and Research Hospital, Ankara, Turkey
| | - İlhan Balamir
- Department of Biochemistry, Numune Training and Research Hospital, Ankara, Turkey
| | - Mesut Tez
- Department of General Surgery, Numune Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
46
|
Bettenworth D, Lopez R, Hindryckx P, Levesque BG, Rieder F. Heterogeneity in endoscopic treatment of Crohn's disease-associated strictures: An international inflammatory bowel disease specialist survey. J Gastroenterol 2016; 51:939-48. [PMID: 26831355 DOI: 10.1007/s00535-016-1172-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 01/17/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Crohn's disease (CD) is frequently complicated by intestinal strictures, which are commonly treated by endoscopic balloon dilation (EBD). However, available data on this area of treatment is limited. The aim of this study was to depict the heterogeneity of endoscopic management of CD-associated strictures among international CD specialists to identify common treatment standards. METHODS IBD experts of the International Organization for the Study of Inflammatory Bowel Disease (IOIBD), the European Crohn's and Colitis Organization (ECCO), and from the Prospective Value In IBD trials (PROVIT) completed a web-based questionnaire to evaluate their endoscopic experience, practice setting, and number of EBDs performed annually. Additionally, two case scenarios and technical practice parameters were investigated. RESULTS A total of 126 subjects from 15 countries completed the survey. The maximal length of dilated stricture was 4.5 ± 1.7 cm. The most commonly used maximal balloon size was graded as 15-18 mm. While 87.2 % of the participants favored EBD for anastomotic strictures, only 58.6 % did so in the case of naïve strictures. Only 35.7 % of physicians dilated actively inflamed strictures. Interventional endoscopists were more likely to dilate only clinically symptomatic strictures (p = 0.046). Surgeons favored surgical treatment of de novo ileocecal strictures compared to gastroenterologists (p = 0.026), reported a shorter stricture length being amendable by EBD (p = 0.045), and more frequently used concomitant therapies (p = 0.001). Operator experience increased the likelihood of EBD use in actively inflamed strictures (p = 0.002), maximum length of stricture, and maximum balloon size (p = 0.001). CONCLUSIONS EBD is a widely used treatment approach for stricturing CD. Individual approaches differ significantly based on background of the operator, experience level, and practice setting.
Collapse
Affiliation(s)
- Dominik Bettenworth
- Department of Medicine B, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.
| | - Rocio Lopez
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Pieter Hindryckx
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
| | - Barrett G Levesque
- Division of Gastroenterology, University of California San Diego, La Jolla, CA, USA
| | - Florian Rieder
- Department of Gastroenterology, Hepatology & Nutrition, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
- Department of Pathobiology, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| |
Collapse
|
47
|
Abstract
The classification of mucinous tumors of the vermiform appendix is quite controversial, and includes a spectrum of neoplastic lesions ranging from benign proliferations, intraluminal, to invasive adenocarcinomas. Among the complications of appendicular mucinous neoplasms we should mention the "pseudomyxoma peritonei", a condition caused by cancerous cells (mucinous adenocarcinoma) that produce abundant mucin or gelationous ascites. Mucinous neoplasms of the appendix are rare diseases of unknown etiology. The diagnosis is difficult because of poorly specific clinical, biochemical and imaging parameters, and their detection can be occasional. Most of the reported cases involving women of reproductive age (with a history of endometriosis, abdominal surgery or pelvic inflammatory disease). The definitive diagnosis requires histology and immunohistochemistry. Cytoredutive surgery combined with hyperthermic intraperitoneal chemoterapy (HIPEC) is now considered the best treatment for this disease. We present two cases treated with surgery and HIPEC.
Collapse
|
48
|
Abstract
Inflammatory pseudotumors of the caecum are uncommon. They pose problems with diagnosis. We report on a 35 year old female who presented with clinical signs of acute appendicitis. Intra-operatively, a caecal tumour was found with normal appendix and multiple enlarged mesenteric lymph nodes. A right hemicolectomy was performed. Histopathology findings revealed an inflammatory mass with abundant fibroblast proliferation with associated collagen formation, infiltrating bowel wall and pericaecal adipose tissue. She recovered well and was discharged home 5 days post-operatively. A t present, she is free of symptoms.
Collapse
Affiliation(s)
- U Ihedioha
- Department of General Surgery, Monklands Hospital, Airdrie.
| | | | | |
Collapse
|
49
|
Hardy JM, Freer SR. What Is Your Diagnosis?: Neoplasia, intussusception, abscess, granuloma, hematoma, and cyst. J Am Vet Med Assoc 2016; 248:373-5. [PMID: 26829266 DOI: 10.2460/javma.248.4.373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
50
|
Lejeune B, Kramer A, Meylan M. [Ceco-cecal intussusception in a Simmental heifer]. SCHWEIZ ARCH TIERH 2016; 157:401-5. [PMID: 26753359 DOI: 10.17236/sat00027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This report describes the clinical, laboratory and ultrasonographic findings in a Simmental heifer with a ceco-cecal intussusception. The general condition of the heifer was moderately reduced and it showed mild colic signs. Physical examination revealed a firm longish mass visible and palpable in the right flank. Findings upon rectal examination, fecal output und defecation were normal. Ultrasound examination of the mass revealed features typical for an intussusception. Based on the slow development of symptoms, normal fecal output and ultrasonography findings, a ceco-cecal intussusception was diagnosed. Right flank laparatomy was performed under general anaesthesia, and an end-to-side anastomosis between the jejunum and the spiral colon was made after resection of the intussuscepted intestines. Recovery was uneventful.
Collapse
|