Gallbladder volvulus diagnosed intraoperatively: Case report.

INTRODUCTION: Gallbladder volvulus is a rare disease whose presentation usually overlaps with that of typical calculous cholecystitis. It's diagnosis is critical as it is associated with high morbidity and mortality and therefore should be managed urgently with cholecystectomy. CASE PRESENTATION: 85-year-old female patient presented with right upper quadrant pain of one day duration that is associated with nausea and vomiting, but no fever or jaundice. She was tachycardiac and had severe abdominal right upper quadrant tenderness with positive Murphy's sign. Laboratory results showed only increase in inflammatory markers. Both ultrasound and computed tomography scan of the abdomen were done and acalculous cholecystitis was diagnosed. Open cholecystectomy was planned and performed, but gallbladder volvulus as the cause of cholecystitis was noted intraoperatively. DISCUSSION: There is still no consensus on the exact cause of gallbladder volvulus. Even though it presents mostly in elderly patients, different ages have been already reported. It's diagnosis can be suspected based on the appearance, symptoms, and examination of the patient. Laboratory tests and imaging might provide some clues for it's diagnoses. It's ischemic process prompts urgent surgical intervention and does not improve conservatively. Our patient did not present with all of it's typical symptoms and the diagnosis was made intraoperatively. CONCLUSION: Gallbladder volvulus could have been missed had we not opt for an urgent surgery. More studies should be done to further define its presentation, and accurately know when to consider it up in our differential diagnosis.

The Surgical Treatment of Tuberous Breast Deformity: A Review Article.

ABSTRACT: Tuberous breast is a common congenital deformity that might present as unilateral or bilateral breast base constriction, asymmetry, areolar herniation, hypoplasia, ptosis, and skin deficiency. Patients might present with one or more of the mentioned features, rendering a consensus about the optimal surgical technique to correct this deformity nonexistent. In our review article, we present the most common classifications of a tuberous breast, in addition to several surgical approaches that attempt to treat this deformity.

Rectus Muscle Plication in Mini-abdominoplasty with Umbilicus Preservation.

Diastasis recti is a frequent problem that women, particularly, experience after pregnancy. It is an abdominal wall defect in which there is more than 2 cm separation between the abdominal rectus muscles. Aside from being repaired most commonly with a full abdominoplasty, in some cases, diastasis might present with minimal excessive adipocutaneous tissue, thus requiring a mini-abdominoplasty. Because umbilical transposition is not needed in that latter scenario, diastasis repair is only possible by ligating and cutting the existing umbilical stalk to be able to have a direct clear access to the supraumbilical linea alba. However, detaching the umbilical stalk will most certainly lead to the displacement of the umbilicus inferiorly. To overcome this problem, we performed a modified mini-abdominoplasty technique, which repairs the recti diastasis, keeps the umbilical stalk in place, and leaves behind a mini-abdominoplasty scar, thus providing a more cosmetically appealing result in addition to a radical solution to the defect. Moreover, this technique can be performed by any qualified plastic surgeon under basic operating settings.