A Rare Cause of Duodenal Obstruction: Spontaneous Intramural Duodenal Hematoma Caused by a Hemangioma

Small bowel hemangioma is a rare benign lesion, and it usually presents with bleeding or as a leading point of an intussusception. However, obstruction due to intramural hematoma by this lesion is unusual. Intramural hematoma of the duodenum is also an uncommon lesion, and it is usually a complication of blunt abdominal trauma in children and young adults. We present here a case of an intramural hematoma that was caused by spontaneous bleeding of a hemangioma, and this caused duodenal obstruction.

Hydrocele of the Canal of Nuck

In females, a small evagination of parietal peritoneum accompanies the round ligament through the inguinal ring into the inguinal canal and is called the canal of Nuck; it is homologous to the process vaginalis in males. If it fails to undergo complete obliteration, an indirect inguinal hernia or a hydrocele of the canal of Nuck can occur. We report three cases of this rare developmental disorder, discuss the CT findings and its use in the diagnosis of a hydrocele of the canal of Nuck.

The Comparison of Laparoscopic Adrenalectomy with Open Adrenalectomy

PURPOSE: The purpose of our study was to compare the outcomes of patients who had undergone a conventional open adrenalectomy (OA) with those who had undergone a laparoscopic adrenalectomy (LA). METHODS: We retrospectively reviewed 66 patients who underwent an adrenalectomy between 1990 and 2005. The study group was comprised of 41 laparoscopic cases with 25 open adrenalectomy cases comprising the control group. The parameters studied included the operating times, transfusion volumes, time to resumption of a soft diet, total frequency of analgesics, time to return to free ambulation and length of hospital stay in both the OA and LA groups. RESULTS: No mortality was observed in either the OA or LA groups. The operating times were, on average, 203.1+/-64.5 and 158.2+/-76.4 minutes in the OA and LA group, respectively (P=0.011). 10 cases in the OA group needed a transfusion (average: 438.52+/-687.57 ml), but two cases including one require conversion to a celiotomy, due to a right renal vein injury, needed a transfusion (average: 23.41+/-110.63 ml)(P=0.004). The patients of the OA and LA groups began soft diets on the 4.8+/-1.1 (3~7 days) and 2.7+/-1.5 postoperative days (1~8 days), respectively (P=0.004). Total frequencies of analgesics were 9.5+/-6.5 and 4.4+/-4.7 in the OA and LA groups, respectively (P=0.001). The times needed to return to free ambulation were 7.6+/-3.8 and 4.3+/-2.3 days in the OA and LA groups, respectively (P= 0.000). Postoperative hospital stays were 16.3+/-7.5 and 7.3+/-2.3 days in the OA and LA groups, respectively (P=0.000). CONCLUSION: An LA appears to be a safe and effective approach for patients with various adrenal pathologies and large sized adrenal lesions. We expect the indications for an LA may be extended to large adrenal tumors as well as primary or metastatic malignant adrenal lesions if the oncologic principles are obeyed.

Portal Vein and Superior Mesenteric Vein Thrombosis following Cholecystectomy and Choledochostomy

Acute thrombosis of the portal and superior mesenteric vein (SMV) due to inflammation of abdominal organs is a rare condition, but delayed diagnosis causes severe problems and serious long term complications. Therefore the early diagnosis and adequate management of the underlying disease and thrombus is very important. Here a case of an 84-year-old man with portal vein and SMV thrombosis on Doppler ultrasonography and computed tomography (CT) after cholecystectomy and choledochostomy by the 10th day is reported. The patient's condition improved without complication after the treatments with an anticoagulant regimen and antimicrobials. In the follow up, there was no thrombus on the CT or sign of a recurrent disease.