Replacement of the Inferior Vena Cava and Hepatic Auto-Transplantation after Ex Situ Excision of a Leiomyosarcoma Extending from the Bifurcation of the Common Iliac Vein to the Suprahepatic Vena Cava

Ex situ resection and hepatic auto-transplantation as devised by Pichlmayr may be an answer for a lesion that has close proximity to or has invade the major hepatic veins. We report here on a 31-year-old female patient with a leiomyosarcoma extending from the suprahepatic vena cava to the bifurcation of the common iliac vein, and this tumor was deemed not accessible by the conventional in situ surgical techniques. The liver and retrohepatic inferior vena cava was removed en bloc and taken to the back-table where the neoplasm invading the cava wall was removed together with the inferior vena cava. The inferior vena cava was then replaced by a 26-mm Dacron graft proximally and a 20-mm ringed polytetrafluoroethylene (PTFE) graft distally, and the outflows of the liver was reconstructed to a single opening with using longitudinallyopened autogenous great saphenous vein fencing. The liver was then autotransplanted by the Piggyback technique. Both renal veins were not reconstructed because both gonadal veins were preserved during the operation. The postoperative course was uneventful and the patient is in good health until now.

Urinary Bladder Injury during Pediatric Inguinal Herniorrhaphy

An inguinal hernia is common in pediatric age. However, an in injury to the bladder during hernia repair is quite rare, which may be related to the lack of awareness of the inguinal canal anatomy or inadequate exposure. Gross hematuria and voiding difficulty after herniorrhaphy may indicate a possible injury. Cystography can define the presence and type of injury. An extraperitoneal bladder injury can be managed safely by catheter drainage, antibiotics, and close clinical observations. An intraperitoneal injury requires surgical exploration and bladder closure. We report a case of a urinary bladder injury that was detected after the completion of herniorrhaphy in an eight-year-old girl.

Necrotizing Fasciitis Secondary to Perforated Appendicitis

Necrotizing fasciitis is a rapidly progressing soft-tissue infection that affects the subcutaneous fascia and dermis, and characteristically spares the underlying muscle. Most cases represent a synergistic or mixed bacterial infection of aerobes and anaerobes. A variety of etiologies have been reported. Herein, two cases of necrotizing fasciitis of the right thigh secondary to perforated appendicitis, an extremely rare complication, are reported. Both cases recovered following aggressive surgical and medical therapies. The delay in diagnosis and radical surgical excision are frequent and significant contributory factors in the high reported mortality rate. A high index of suspicion, followed by prompt surgical intervention with broad-spectrum antibiotic therapy, seems to be the most important prognostic factor in these difficult cases.