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Retroperitoneal chyloma is a rare entity that presents with non-specific symptoms. Although benign, it can cause complications due to the mass effect. In this case report, we present the case of a 24-year-old woman who presented with a complaint of left-sided colicky abdominal pain and mild dysuria for one year. On physical examination, there was only mild abdominal tenderness. Computed tomography (CT) revealed a thick-walled cystic retroperitoneal mass with a small amount of fat in the superior part and a displaced left hydronephrotic kidney. Magnetic resonance imaging (MRI) confirmed the findings and also revealed a fat-fluid level in the cyst. A laparotomy was performed, and the cystic mass, containing milky fluid, was excised. Histopathology showed a pseudocyst with chronic inflammation and a xanthomatous reaction, with no evidence of infection or malignancy. The patient recovered without complications and has not had a recurrence so far. Retroperitoneal chyloma is difficult to diagnose preoperatively. A definitive diagnosis is usually made only after surgery and a histopathological examination. The treatment of choice is a complete excision. Other approaches, such as marsupialization or drainage, will likely result in a recurrence. However, surgery in the retroperitoneal space is associated with a risk of injury to major vessels or organs. In conclusion, retroperitoneal chyloma is a rare entity that is best treated by complete excision. For small lesions, a wait-and-watch approach may be advisable.
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INTRODUCTION: Primary neuroendocrine tumors (NETs) of the liver are rare tumors that are challenging to diagnose. PRESENTATION OF CASE: A 41-year old woman presented with a four-month history of moderate abdominal pain in the right upper quadrant. A computed tomography scan of the abdomen revealed a large hypervascular liver lesion measuring 14 × 10 × 15 cm occupying segments IV and VIII and part of segment V of the liver. A liver biopsy revealed findings consistent with a well-differentiated NET. Transarterial chemoembolization was offered to the patient; however, the procedure was unsuccessful. Surgical management was therefore considered and resulted in a favorable outcome. DISCUSSION: Primary hepatic NETs are thought to originate from NET cells that may subsequently propagate to the intrahepatic biliary tree and become cancerous. These tumors are often missed during an initial evaluation due to a low clinical index of suspicion. In some cases, nonspecific symptoms such as abdominal pain and bloating may be an indication of early disease. No guidelines have been developed for the treatment of primary hepatic NETs; nevertheless, surgical resection remains the treatment of choice and plays a potentially curative role. CONCLUSION: Surgical resection may be beneficial in the management of a primary NET of the liver even when the procedure appears to be challenging, such as in the case of a centrally located liver tumor.
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BACKGROUND: Tranexamic acid is a synthetic lysine-analogue antifibrinolytic that competitively inhibits the activation of plasminogen to plasmin, it is a well-documented blood sparing agent. However, its routine use in idiopathic scoliosis surgery is poorly documented. The objective of this meta-analysis was to determine TXA's efficacy in reducing blood loss and blood transfusion in idiopathic scoliosis surgery. METHODS: Five databases (Medline, PubMed, Web of Science, Embase and The Cochrane Central Register of Controlled Trials) were searched to identify the relevant randomized controlled trials (RCTs), prospective cohort control (PCC), and retrospective controlled trails regarding the TXA efficacy in idiopathic scoliosis surgery. Mean differences (MDs) of blood loss and blood transfusions in TXA-treated group compared to control and/or placebo group were extracted and combined using random-effect meta-analysis model. RESULTS: A total of seven studies comprising 426 patients were included in the meta-analysis according to the pre-defined selection criteria. TXA-treated group had an overall significantly (P<0.005) less volume of blood loss [ES (MD) =727.71 mL; CI, 281.86-1,173.56 mL]. Six studies comprising 346 patients TXA-treated group had an overall significantly {P<0.001 less transfusion volume [ES (MD) =268.30 mL; CI, 105.19-431.44 mL]}. CONCLUSIONS: Patients treated with TXA had a significantly lower blood loss and lower rates of allogeneic blood transfusion than the control group. Further investigation is required regarding the safety of TXA before it can be generalized in the use of idiopathic scoliosis surgery.
