ABSTRACT
Afferent loop syndrome is a relatively rare complication after subtotal gastrectomy. We present a late onset of afferent loop obstruction, in a patient who underwent Billroth II gastrectomy with Roux-Y reconstruction for a gastric ulcer 27 years ago. A 60-year-old male was admitted to the hospital with an 8-hour history of acute epigastric pain, associated with vomiting, fever and signs of sepsis. Laboratory tests revealed leukocytosis, elevated liver function tests and high serum amylase. An obstructed afferent loop appeared on CT as a fluid filled tubular mass, crossing the middle line between the aorta and the mesenteric vessels. Advanced sepsis was also seen in the peripancreatic and retroperitoneal region. Although the patient was operated on immediately after diagnosis with reconstruction of Roux-Y anastomosis, he died 12 hours later. Afferent loop syndrome is quite uncommon, and must be suspected in patients who have undergone subtotal gastrectomy. Clinical manifestations of the syndrome are usually non-specific. CT is the examination of choice and surgery the first choice treatment.
Subject(s)
Afferent Loop Syndrome/surgery , Gastrectomy/adverse effects , Abdominal Pain/etiology , Acute Disease , Afferent Loop Syndrome/complications , Afferent Loop Syndrome/diagnosis , Afferent Loop Syndrome/etiology , Dilatation, Pathologic , Duodenum/diagnostic imaging , Duodenum/pathology , Emergencies , Fatal Outcome , Humans , Male , Middle Aged , Peptic Ulcer/complications , Postprandial Period , Time Factors , Tomography, X-Ray ComputedABSTRACT
Malakoplakia represents a chronic inflammatory disease associated with a broad spectrum of bacterial infections. On histopathology, Michaelis-Gutmann bodies are considered as pathognomonic histopathological findings. Rarity of the disease and wide variety of clinical presentation makes its diagnosis very challenging. We report herein the case of a 66-year-old woman who, having undergone lower anterior resection for rectal adenocarcinoma 3 and a half years ago, presented with urinary frequency and dull abdominal pain. CT scan revealed a soft tissue tumour infiltrating the preperitoneal fat over the urinary bladder, which was considered as recurrence of the rectal carcinoma. On laparotomy, a tumour invading the bladder, small intestine and the anterior abdominal wall was resected and the patient recovered uneventfully. On histopathology, malakoplakia of urinary bladder was revealed. Overstaging of patients' malignancy due to malakoplakia is not uncommon, so its early identification can help avoid incorrect treatment.
Subject(s)
Adenocarcinoma/surgery , Malacoplakia/diagnosis , Neoplasm Recurrence, Local/diagnosis , Pelvis/pathology , Rectal Neoplasms/surgery , Adenocarcinoma/diagnosis , Aged , Colonoscopy , Diagnosis, Differential , Female , Humans , Rectal Neoplasms/diagnosis , Tomography, X-Ray ComputedABSTRACT
Epidermoid splenic cysts are very rare. Symptoms emerge because of enlargement, infection, haemorrhage or rupture. Although splenectomy is indicated for large cysts, minimally invasive and preservation procedures, such as partial splenectomy or total cystectomy with splenorrhaphy, have been increasingly used during the last decade. We report herein the case of a 16-year old female presented with left upper abdominal quadrant pain, fever and abdominal distention treated in our department.
Subject(s)
Abscess/microbiology , Abscess/pathology , Epidermal Cyst/pathology , Splenic Diseases/microbiology , Splenic Diseases/pathology , Abscess/surgery , Adolescent , Collagen/metabolism , Epidermal Cyst/metabolism , Epidermal Cyst/surgery , Female , Humans , Splenic Diseases/surgery , Splenomegaly/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
Traumatic lymphoceles are usually the result of surgical injuries or blunt trauma. Although usually described in the pelvis after radical pelvic node dissection or kidney transplantation, traumatic lymphoceles are rare. Diagnosis is based on CT scan and confirmed by fine needle aspiration with biochemical analysis. Treatment modalities are not standardized and different techniques have been described. We report herein a case of anterior thoracic wall lymphocele due to blunt trauma treated in our department.
Subject(s)
Lymphocele/diagnosis , Thoracic Diseases/diagnosis , Thoracic Wall/pathology , Adult , Female , Humans , Lymphocele/etiology , Lymphocele/surgery , Thoracic Diseases/etiology , Thoracic Diseases/surgery , Thoracic Wall/surgery , Wounds, Nonpenetrating/complicationsABSTRACT
A case of false aneurysm of the radial proper palmar digital artery located in the tip of the right index finger is presented. The aneurysm was the result of blunt trauma and the diagnosis was made by contrast enhanced magnetic resonance angiography. The patient was treated by ligation and resection of the aneurysm.
Subject(s)
Aneurysm, False/etiology , Finger Injuries/complications , Fingers/blood supply , Wounds, Nonpenetrating/complications , Adult , Aneurysm, False/pathology , Aneurysm, False/surgery , Hemophilia A/complications , Humans , Magnetic Resonance Imaging , MaleABSTRACT
Parastomal hernia represents a common complication of colostomy formation. Surgical techniques such as facial repair and stoma relocation have almost been abandoned because of high recurrence rates. Extraperitoneal prosthetic mesh repair had better results but was accompanied by high rates of mesh contamination. A new technique, with intraperitoneal onlay position of expanded polytetrafluoroethylene (ePTFE) was therefore established. We report herein two cases of symptomatic large parastomal hernias treated in our department.
Subject(s)
Colostomy , Hernia/etiology , Herniorrhaphy , Surgical Mesh , Female , Humans , Middle Aged , Polytetrafluoroethylene , Postoperative ComplicationsABSTRACT
Peutz-Jeghers type polyps of the stomach are rare and almost always associated with intestinal polyposis and mucocutaneous pigmentation; a condition known as Peutz-Jeghers syndrome. The case presented in this report refers to a woman found to have a large solitary Peutz-Jeghers type polyp of the stomach, with a maximal diameter of 7cm. Extended investigation did not reveal intestinal polyposis or any other sign of Peutz-Jeghers syndrome. Because of the size of the polyp, a partial gastrectomy was performed. To the best of our knowledge, there are only three other reports in the literature of a solitary Peutz-Jeghers type gastric polyp occurring in the absence of Peutz-Jeghers syndrome. This patient is scheduled to undergo a follow-up examination every 2 years to detect any sign of the development of Peutz-Jeghers syndrome or malignancies commonly associated with it.
Subject(s)
Peutz-Jeghers Syndrome/pathology , Female , Gastrectomy , Humans , Middle Aged , Peutz-Jeghers Syndrome/diagnostic imaging , Peutz-Jeghers Syndrome/surgery , Tomography, X-Ray ComputedABSTRACT
In an effort to develop a reproducible model of liver cirrhosis and esophageal varices, we administered phenobarbital (PhB) and carbon tetrachloride (CCl4) in 32 rats that had previously undergone complete devascularization of the left renal vein (DLRV). The operation was conducted to enhance the development of cephalad collaterals mainly responsible for the induction of esophageal varices. Thirty-two rats underwent sham operation and PhB and CCl4 administration, and 24 only sham-operated rats comprised the control group. After the induction of liver cirrhosis, histopathologic examination and morphometric analysis of the lower esophagus were performed to study the submucosal veins. We separately studied number of vessels in the submucosa, mean vessel area, percentage of submucosa occupied by vessels, and area of the single most dilated vein. All variables except the number of vessels were significantly higher in cirrhotic rats that had undergone DLRV (P<0.001). We conclude that induction of liver cirrhosis in rats that previously undergo complete DLRV could present a reproducible and reliable model for the induction of liver cirrhosis and esophageal varices.
