Concurrent rectal perforation and obstruction following neoadjuvant chemoradiation for locally advanced rectal cancer: A case report.

INTRODUCTION: Locally advanced rectal cancer (LARC) is commonly managed with neoadjuvant chemoradiation (neoCRT) followed by surgery, though not without complications. The anatomical exposure of the colon and rectum and pelvic radiotherapy poses risk, with rectal perforation and bowel obstruction, though rare, carrying life-threatening potential. PRESENTATION OF CASE: This case highlights an exceptionally rare occurrence of concurrent rectal perforation and rectal obstruction in a 77-year-old male with LARC, just two months post neoCRT. Initial symptoms included rectal bleeding, and diagnostic procedures confirmed rectal T1N3adenocarcinoma with no metastasis. Emergency admission, prompted by complete bowel obstruction symptoms, led to discovery of rectal perforation during laparotomy, sealed by the bladder. Pathological analysis attributed the cause to radiation proctitis, reporting complete response to neoCRT with no residual tumor. DISCUSSION: The rarity of both bowel obstruction and perforation as neoCRT complications, particularly in the acute phase of radiation proctitis, is noteworthy in this case. The absence of tumoral cells at the affected sites emphasizes the exceptional nature of this case. CONCLUSION: This case underscores the importance of recognizing acute post neoCRT injuries as potentially life-threatening complications, emphasizing the need for heightened awareness and consideration in clinical management.

Aortic Pseudoaneurysm following Ventricular Septal Defect Closure in a Pediatric Patient: A Case Report and Literature Review.

Aortic pseudoaneurysm, a rare condition characterized by localized transmural disruption and dilatation of the aorta, is very rare in the pediatric population. It is primarily caused by previous cardiovascular procedures such as aortic coarctation repair, aortic valve replacement, and subaortic membrane resection. We present a unique case of aortic pseudoaneurysm following surgery to repair a perimembranous ventricular septal defect in a 19-month-old boy who presented with fever as the sole symptom. The fever started on the 30th day after the surgery, and the patient exhibited abnormal laboratory results, including a white blood cell (WBC) count of 28.3 × 109/L, neutrophil percentage of 68%, platelet count of 880 × 109/L, erythrocyte sedimentation rate (ESR) of 200 mm/hour, and 3+ positive C-reactive protein. Echocardiogram revealed a large cystic mass (5 × 4.8 cm) in the ascending aorta, compressing the superior vena cava. Based on this finding, a diagnosis of aortic pseudoaneurysm was suspected. The diagnosis was confirmed through cardiac computed tomographic angiography, and the patient underwent emergent surgery for the repair of the aortic pseudoaneurysm under deep hypothermia and circulatory arrest. Unfortunately, our patient died shortly after the surgery.

Meat bezoar due to inadequate mastication leading partial bowel obstruction: A case report.

INTRODUCTION: Gastrointestinal bezoars may occur in individuals with a normal gastrointestinal tract structure or as a result of gastrointestinal defects and disease. This rare condition initially presents with general abdominal pain, mimicking appendicitis in later stages. Recognizing this condition as a differential diagnosis in patients with abdominal pain can prevent delays in diagnosis and serious complications. PRESENTATION OF CASE: We report a rare case of a meat bezoar in a 52-year-old man presenting with acute and generalized abdominal pain at an emergency department. DISCUSSION: We discuss gastrointestinal bezoars as a rare differential diagnosis of abdominal pain and acute abdomen in people with no pre-existing medical history, and the challenges that might be faced during diagnosis and treatment. CONCLUSION: Gastrointestinal bezoars are rare which makes the diagnosis challenging. Obtaining a complete history and a full examination with appropriate imaging could help the diagnosis.

Ileo-sigmoid knotting- an unusual cause of intestinal obstruction: A case report.

INTRODUCTION AND IMPORTANCE: Ileosigmoid knotting is an unusual cause of intestinal obstruction in which the ileum wraps around the base of the sigmoid colon and its mesentery, which leads to a closed loop intestinal obstruction. PRESENTATION OF CASE: A 59-year-old male patient was referred to our center with acute abdominal pain, obstipation and a few episodes of vomiting. On physical examination, he had hypotension and tachycardia as well as distension, diffused tenderness, guarding and rebound tenderness of the abdomen. Bowel sounds were absent. Abdominal Plain X-ray showed dilatation of the large bowel associated with the distended small bowel. After resuscitation with aggressive intravenous fluid therapy, the patient underwent an emergency laparotomy. Exploration revealed gangrene of the intestinal loops, including the jejunum and ileum, which was secondary to a 360° clockwise twisting of the ileal loops around the sigmoid colon. Gangrene of the sigmoid colon along with torsion of the superior mesenteric arteries was also obvious. Resection of the gangrenous loops of the small bowel as well as a sigmoidopexy was carried out and a primary anastomosis of the small intestine and colon was performed. He did well post-operatively. CLINICAL DISCUSSION: It is crucial to distinguish Ileosigmoid knotting from sigmoid volvulus because it can rapidly, even within hours, progress to bowel gangrene and peritonitis; moreover, in this situation the endoscopic reduction is contraindicated. CONCLUSION: Ileosegmoid knotting is an unusual cause of bowel obstruction which has relatively high mortality rates and should be considered in patients with acute abdominal pain and presentations of bowel obstruction.

The effect of fibrin glue on the postoperative lymphatic leakage after D2-lymphadenectomy and gastrectomy in patients with gastric cancer.

INTRODUCTION: Disturbance in the lymphatic drainage during D2 dissection is associated with significant morbidity. We aimed to assess the effect of fibrin glue on the reduction of postoperative lymphatic leakage. METHODS: Prospective double-blinded randomized clinical trial with forty patients in each study arm was conducted. All patients diagnosed, staged, and became a candidate for D2 dissection based on NCCN 2019 guideline for gastric cancer. The intervention group received 1 cc of IFABOND® applied to the surgical bed. RESULTS: The difference between study groups regarding age, gender, tumor stage was insignificant. (All p-values > 0.05). The median daily drainage volume was 120 ml with the first and the third interquartile being 75 and 210 ml, respectively for the intervention group. The control group had median, the first, and the third interquartile of 350, 290, and 420 ml. The difference between daily drainage volumes was statistically significant (p-value < 0.001). The length of hospital stay was significantly different between the two groups. Notably, the intervention group was discharged sooner (median of 7 Vs 9 days, p-value: 0.001). CONCLUSION: This study showed the possible role of fibrin glue in reducing postoperative lymphatic leakage after gastrectomy and D2 dissection. Registration trial number: IRCT20200710048071N1, 2020.08.16.