Preoperatively diagnosed mucocele of the appendix.

Mucocele of the appendix is an infrequent entity, characterized by distension of the lumen due to accumulation of mucoid substance and is rarely diagnosed preoperatively. If untreated, mucocele may rupture producing a potentially fatal entity known as pseudomyxoma peritonei. The type of surgical treatment is related to the dimensions and the histology of the mucocele. Appendectomy is used for simple mucocele or for cystadenoma. Right hemi-colectomy is recommended for cystadeno carcinoma. In this paper, we report a case of an asymptomatic 37-year-old woman in whom mucocele was found on a routine ultrasound examination and preoperative computed tomography scan. Surgery revealed a big appendix measuring 84 mm in length and 40 mm in diameter. The final pathologic diagnosis was simple mucocele.

Spontaneous diaphragmatic rupture: case report and literature review.

Spontaneous diaphragm rupture is extremely rare. Usually a diaphragm rupture is trauma induced. We describe a case of an 18-year old patient admitted 2 hours after onset, presenting severe epigastric and left sided chest pain without any trauma history. Upright chest x-ray revealed displaced stomach and colon into the left pleural cavity with a collapsed left lung. Surgery for a left-sided diaphragm rupture with stomach, spleen and colon splenic flexure herniation was undertaken. We present a brief review regarding the aetiology, diagnostic and treatment policy of spontaneous diaphragmatic rupture.

Duodenal gastrointestinal stromal tumor.

BACKGROUND: Gastrointestinal stromal tumors (GISTs) are low-grade malignant tumors that may arise anywhere in the alimentary tract, and in the past, most of them were diagnosed as intestinal leiomyoma or leiomyosarcoma. GISTs of the duodenum make up only 4.5% of all GISTs. MATERIALS AND METHODS: We report a patient presented with upper GI bleeding who exhibited radiological findings of a tumor in the third portion of the duodenum. The patient underwent a segmental duodenectomy. Pathological examination concluded in a GIST. RESULTS: The patient is free of recurrence for one year after surgery. CONCLUSIONS: Our case report, along with other, highlights that surgical resection remains the cornerstone of treatment for patients with localized disease. Along with others, we agree that from oncologic point of view, partial resection of the duodenum is an alternative to a duodenopancreatectomy.

Pseudomyxoma peritonei presenting with inguinal hernia.

Pseudomyxoma peritonei (PMP) is rare being characterized by intraperitoneal accumulation of mucinous ascites produced by neoplastic cells, mostly originating from a perforated appendiceal adenoma. The clinical signs of the disease are variable, and preoperative diagnosis is often difficult. We describe the clinical case of a 67-year-old patient referred to our unit one month after a left inguinal hernia repair, presenting clinical signs compliant with PMP. Surgical cytoreduction, peritonectomy, appendectomy, and greater omentectomy with perioperative intraperitoneal chemotherapy were performed. The patient was disease free for a 15 month period when he died apparently due to a cardiac event. We advocate that in all cases of gelatinous fluid in a hernia sac PMP must be suspected, thus histological investigation is mandatory as well as abdominal computed tomography (CT) in order to confirm the diagnosis.

Implantation of self-expanding metal stent in the treatment of severe bleeding from esophageal ulcer after endoscopic band ligation.

Endoscopic variceal ligation is superior to sclerotherapy because of its lower rebleeding and complication rates. However, ligation may be associated with life-threatening bleeding from postbanding esophageal ulcer. We report a case of a 49-year-old male with massive hemorrhage from esophageal ulcer on 8th day after successful band ligation of bleeding esophageal varices caused by postviral liver cirrhosis (Child-Pugh class C). A removable polyurethane membrane-covered self-expanding metal stent (SX-ELLA stent Danis, 135 mm × 25 mm, ELLA-CS, Hradec-Kralove, Czech Republic) was inserted in ICU for preventing fatal hemorrhage. Complete hemostasis was achieved and stent was removed after 8 days without rebleeding or any complications. To the best of our knowledge, this is the first report in English literature regarding life-threatening hemorrhage from postbanding esophageal ulcer successfully treated by self-expanding metal stent in a patient with portal hypertension.

Sporadic retroperitoneal aggressive fibromatosis: report of a case.

We describe herein a case of sporadic retroperitoneal aggressive fibromatosis. A 54-year-old man with a palpable abdominal mass was referred to our hospital for investigation and treatment. Abdominal ultrasonography and computed tomography revealed a solid mass with relatively well-defined borders in the left abdominal retroperitoneum. At surgery, a large tumor (14 x 13 x 11 cm) was found, arising from the retroperitoneal space and involving the wall of jejunum. Complete removal was achieved. Histological examination of the resected specimen revealed the presence of changes consistent with aggressive fibromatosis. The patient was not scheduled for any further treatment. Two years after surgery, the patient is without any signs of recurrent disease. Although extremely rare, aggressive fibromatosis should be considered in the differential diagnosis of retroperitoneal masses. Complete surgical resection with negative pathological margins remains the first line management of these neoplasms. Careful follow-up is indicated because recurrence may occur every time after surgery.

Ruptured duodenal varices successfully treated by mini-loop ligation: report of a case.

Bleeding from duodenal varices is a rare, but often fatal manifestation of portal hypertension and these ectopic varices are more common in extrahepatic portal venous obstruction. There are over 160 cases of duodenal varices reported in the English literature. A 47-year-old female presented with massive hematemesis and prolonged shock. Initial endoscopy revealed non-bleeding small esophageal varices and large varices in the first portion of the duodenum with spurting bleeding. Endoscopic hemostasis was obtained with 5 detachable nylon loops. Portal hypertension was caused by liver cirrhosis and postthrombotic portal cavernoma. To the best of our knowledge this is the first case of successful mini-loop ligation of bleeding duodenal varices reported in the literature.

Primary retroperitoneal mucinous cystadenoma. A case report and brief review of the literature.

Retroperitoneal mucinous cystadenomas are extremely rare tumors found exclusively in women. An additional case of retroperitoneal mucinous cystadenoma histologically confirmed in a 41-year- old woman is reported herein. Computed tomographic (CT) scanning showed a cystic mass, 21 x 16 cm in size, in the right retroperitoneal space. Removal of the cystic tumor was performed without any other additional procedures, and further histological diagnosis was confirmed as primary mucinous cystadenoma of borderline type. Histologic findings suggested that the tumor developed from mucinous metaplasia of the coelomic mesothelium. Clinicopathological features, diagnostic findings, therapeutic options and the outcome are analyzed in this paper having reviewed the cases reported in world literature.

[The specific aspects of portal hemodynamics and surgical correction of liver cirrhosis complications in Cruveilhier-Baumgarten syndrome]. / Osobennosti portal'noi gemodinamiki i khirurgicheskaia korrektsiia oslozhnenii tsirroza pecheni v sochetanii s sindromom Kriuvel'e- Baumgartena.

Cruveilhier--Baumgarten syndrome (CBS) was revealed in 6 of 35 patients with portal hypertension. Esophageal veins varicosis was revealed in 5 patients with CBS, in 4 of them the hemorrhage have occurred. The portal system encephalopathy was not observed. The peculiarities of blood flow in a portal vein system while CBS were studied according to data obtained by ultrasonic dopplerography. The authors do not recommend the umbilical vein usage while portocaval anastomosis forming.