Diabetic foot ulcers combination with lower limb lymphedema treated by staged charles procedure: case report and literature review

Primary or secondary, lymphedema is lymphatic dysfunction which results in protein-rich interstitial fluid accumulated in the skin and subcutaneous tissue. In developed countries, surgical resection of regional lymph nodes or chronic inflammation process is the most common etiology of lymphedema instead of parasite infection seen in developing countries. Patients with lymphedema sustain either cosmetic or functional problems, and several studies have indicated the potential risk, though not high, transforming lymphedema to lymphangiosarcoma. Here we introduce a simple idea with staged Charles procedure by a case report to decrease the size of wound healing in each procedure and decreasing the rate of surgical complication

Obstructive jaundice caused by metastatic lymph node of Colon Cancer

Obstructive jaundice poses an important clinical challenge in diagnosis due to asymptomatic signs early in their course. Proper imaging studies should be obtained immediately to make an early diagnosis to prevent further complications and prolonged hospitalization. We report an unusual case of silent colon cancer presenting with obstructive jaundice mimicking acute cholangitis due to lymph node metastasis by external compressing the common bile duct. Abdominal computed tomographic scan [CT] is efficient to make an early diagnosis, although there is still controversy about the benefit of performing an early abdominal CT in patients with acute abdomen. With surgical intervention exploratory laparotomy with right hemi-colectomy and lymph node dissection, the patient was discharged with normal total bilirubin level on the postoperative day 10.

Surgical treatment of sclerosing encapsulating peritonitis

We report a patient with end stage renal failure [ESRD] with chronic ambulatory peritoneal dialysis [CAPD] who suffered from chronic peritonitis due to repeat dialytic tube infection. She also had surgery for exploratory laparotomy because of gastric ulcer bleeding, and finally dialytic tube had removed. Abdominal cocoon formed one year later with severe adhesion of abdomen wall, peritoneum and intestine. Urgent surgical intervention secondary to intestinal obstruction was performed after failure of conservative treatment. To avoid the previous surgical adhesion, we performed the surgery with a horizontal incision, where ablation is most easily performed. With careful dissection and excision of the thick capsule, the patient is doing well without further incident at 12 months follow-up

Co-existing acute appendicitis and segmental infarction: report of a case and review of the literature

Omental infarction is a rare entity in children, especially coexisting with acute appendicitis. We present a case of a 6-year old child presenting with abdominal pain with fever, anorexia, and leukocytosis. The child underwent surgery with preoperative diagnosis of acute appendicitis according to the findings of sonography. The definitive diagnosis of an infarcted segment of right side of the greater omentum and acute appendicitis was made intraoperatively and confirmed pathologically. As the etiology is unknown, we surgeons should be aware of the coincident intraperitoneal pathological condition of acute appendicitis and segmental infarction to avoid further complications

Co-existing perforated duodenal ulcer and ruptured gastroduodenal artery aneurysm

Gastroduodenal artery [GDA] aneurysm is a rare and life threatening visceral artery aneurysms. We report a case of perforated duodenal ulcer accompanied with ruptured aneurysm of gastroduodenal artery. To our knowledge, this case is not yet reported in the literature with presentation of postoperative shock due to ruptured GDA aneurysm after perforated duodenal ulcer operation. Moreover, with awareness of ruptured GDA aneurysm and early treatment with transarterial embolization, the patient leads a good result after treatment