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 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

Incidentally Detected Enhancing Breast Lesions on Chest Computed Tomography

OBJECTIVE: To evaluate the nature and imaging appearance of incidental enhancing breast lesions detected on a routine contrast-enhanced chest CT. MATERIALS AND METHODS: Twenty-three patients with incidental enhancing breast lesions on contrast-enhanced chest CT were retrospectively reviewed. The breast lesions were reviewed by unenhanced and enhanced CT, and evaluated by observing the shapes, margins, enhancement patterns and backgrounds of breast lesions. A histopathologic diagnosis or long-term follow-up served as reference standard. RESULTS: Sixteen (70%) patients had malignant breast lesions and seven (30%) had benign lesions. In 10 patients, the breast lesions were exclusively detected on contrast-enhanced CT. Using unenhanced CT, breast lesions with fibroglandular backgrounds were prone to be obscured (p < 0.001). Incidental primary breast cancer showed an non-significant trend of a higher percentage irregular margin (p = 0.056). All of the four incidental breast lesions with non-mass-like enhancement were proven to be malignant. CONCLUSION: Routine contrast-enhanced chest CT can reveal sufficient details to allow for the detection of unsuspected breast lesions, in which some cases may be proven as malignant. An irregular margin of incidental enhancing breast lesion can be considered a suggestive sign of malignancy.