Recurrent Large Extrauterine Lipoleiomyoma in a Postmenopausal Woman: A Case Report.

Lipoleiomyoma is a type of tumor usually found in the uterine corpus. The pathophysiology is unclear; however, it is commonly seen in obese perimenopausal and postmenopausal women. While intrauterine lipoleiomyoma may be surveilled, there is less information about the management of extrauterine lipoleiomyoma, especially significantly large tumors.  This is a case involving a 51-year-old female who was incidentally found to have a 23-cm extrauterine lipoleiomyoma emanating from the peritoneum between uterosacral ligaments. She underwent hand-assisted laparoscopic removal of an intra-abdominal tumor, which was found to be an extrauterine lipoleiomyoma. Six months later, she was found to have a recurrent mass on a follow-up computed tomography (CT) of the abdomen and pelvis. She underwent a robotic-assisted total abdominal hysterectomy, bilateral salpingo-oophorectomy, and removal of the recurrent tumor.  While the mass is benign in nature, the mass effect that it may cause prompts a discussion about the best course of management and an investigation into recurrence rates, specifically in similar extrauterine presentations.

A Rare Case of Aortoenteric Graft Erosion Presenting as Candida glabrata Fungemia.

BACKGROUND: An aortoenteric fistula (AEF) describes a communication of the aorta or aortic graft with an adjacent loop of the bowel. Aortic graft erosion is a rare complication of abdominal aortic aneurysm repair. We describe a case of a patient presenting with sepsis from Candida glabrata fungemia secondary to aortoenteric erosion without any symptoms or signs of gastrointestinal bleeding. This is a unique case of Candida glabrata fungemia from aortoenteric graft erosion. Case Summary. This patient is a 75-year-old male with a history of a prior aortobifemoral bypass graft in 2005. He presented with complaints of right paraspinal pain and chills. He had no symptoms of gastrointestinal bleeding or abdominal pain. His white blood cell count was 25,600/mcl (4,000-11,000/mcL) with left shift. The erythrocyte sedimentation rate was 11 mm/hr (0-38 mm/hr), and C-reactive protein was 95.5 mg/L (<=10.0 mg/L). Blood cultures were obtained and eventually grew Candida glabrata. A computed tomography angiogram (CTA) of abdomen and pelvis demonstrated inflammation surrounding the graft concerning for graft infection with additional inflammatory changes tracking down both femoral limbs. He underwent staged bilateral femoralaxillary bypass followed by the excision of aortobifemoral bypass. CONCLUSION: Patients with aortoenteric erosion can present with sepsis in absence of gastrointestinal bleeding. Emergent computed tomography angiogram (CTA) of abdomen and pelvis should be performed to assess for aortic graft erosion or fistula. Empiric treatment with antibiotics should include antifungal agent like micafungin until the final culture is reported. The definite management is an extra anatomic bypass, followed by graft excision.

Nontraumatic liver herniation mimicking a right lower lobe lung mass.

Nontraumatic liver herniation through diaphragm is a rare condition. We present a case of a 54-year-old female presenting with nontraumatic liver herniation mimicking a right lower lobe mass. Patient was noted to have growth of two right lower lobe lung nodules from 1.5 cm × 2.8 cm and 0.9 cm × 1.3 in August 2009 to 2.8 cm × 4.1 cm and 1.1 cm × 1.4 cm in March 2019 on computerized tomography (CT) scan. PET scan as well as the growth pattern was consistent with low-grade malignancy likely carcinoid tumor. CT-guided biopsy was not feasible because of location of the mass. We performed robotic thoracoscopy with plan for wedge resection, however gross inspection of the thoracic cavity revealed two masses on the dome of the diaphragm with appearance like liver and correlating with nodules seen on CT scan. A core needle biopsy showed that it was benign liver tissue.

Splenic trauma from colonoscopy: A case series.

INTRODUCTION: Splenic trauma is quite rare after colonoscopy and can be overlooked as a complication when a patient presents with severe abdominal pain. It can be difficult to diagnose without appropriate imaging, but it should be considered as part of the differential in a patient arriving for evaluation of left upper quadrant abdominal pain. PRESENTATION OF CASE: In this case series, we discuss four patients who presented to our institution with splenic trauma specifically after colonoscopy. These patients were diagnosed with splenic trauma utilizing computed tomography (CT) scans of the abdomen and pelvis. They were all immediately transferred to our surgical intensive care unit (SICU) for close monitoring and serial hemoglobin checks. Two of the four patients had decreasing hemoglobin levels and were monitored until they underwent interventional radiology (IR) angiography and angioembolization. The other two patients had significant transfusion requirements and ultimately went to the operating room for an open splenectomy. All four of these patients did well after their interventions, although one of them required longer hospitalization while on the ventilator secondary to Haemophilus infection. DISCUSSION: This case series recognizes that there is potential for quite severe splenic trauma after colonoscopy. While one of the four patients did have a history of prior splenic trauma, the other three had no history of trauma. CONCLUSION: These cases demonstrate that this complication should be managed similarly to traumatic splenic injury unrelated to colonoscopy, and that non-operative treatment remain a possibility. Certainly, non-operative management requires a SICU and IR capabilities to be successful. If the patient becomes unstable, they should undergo the appropriate operative intervention.