Experience in managing splenic hilar vascular injury during laparoscopic total gastrectomy.

Splenic hilar vascular injury may occur during laparoscopic radical total gastrectomy for splenic hilar lymph node dissection and often causes massive hemorrhage, requiring conversion to laparotomy and splenectomy. Surgeons treating splenic hilar vascular injuries need a way to stop bleeding promptly and accurately. Herein, we report a case of splenic hilar vascular injury during laparoscopic total gastrectomy in which we successfully managed to stop the bleeding and preserve the spleen.

Peritoneal carcinomatosis secondary to metastatic lung cancer complicated with acute suppurative appendicitis: A case report and literature review.

RATIONALE: Lung cancer (LC) is a malignant tumor with the highest morbidity and mortality in the world. The most common metastatic sites of LC are the brain (47%), bone (36%), liver (22%), adrenal glands (15%), thoracic cavity (11%) and distant lymph nodes (10%). Peritoneal carcinomatosis (PC) is a rare clinical event in LC patients. Considering the rarity and nonspecific clinical symptoms of peritoneal metastasis among LC patients, a case of peritoneal metastasis secondary to LC incidentally observed by laparoscopic appendectomy is unusual. PATIENT CONCERNS: Here, we present a 53-year-old never-smoker woman who presented to the emergency department with a 2-day history of pain in the right abdominal quadrant. Later, laparoscopy revealed acute suppurative appendicitis accompanied by a peritoneal metastatic mass. DIAGNOSIS: The patient was diagnosed with PC secondary to metastatic LC complicated with acute suppurative appendicitis by immunohistochemistry. Positron emission tomography computed tomography (PET CT) findings further strengthen the evidence of PC from LC. OUTCOMES: Based on the results of genomic analysis, the patient received targeted therapy with osimertinib 80 mg/d. LESSONS: Due to the discovery of new targets, the use of molecular therapies improved progression-free survival (PFS) and overall survival (OS), which increases the chance of identifying peritoneal metastasis of LC. For LC patients with abdominal symptoms, clinicians should be aware of the possibility of peritoneal metastasis from LC, especially for patients diagnosed with lung adenocarcinoma or with pleural effusion.

Widespread Metastasis to the Stomach 10 Years After Primary Breast Cancer: A case report and review of the literature.

RATIONALE: Breast cancer is a common malignant tumor. The most common metastatic sites of breast cancer are the bone, brain, liver and lung, and gastrointestinal metastases are rare. Considering that the median time interval from the initial breast cancer diagnosis to stomach metastasis is 77.5 months, gastrointestinal metastases are rarely observed 10 years after primary breast cancer. PATIENT CONCERNS: Here, we present a 63-year-old female with unusual endoscopy results that revealed scattered polyps and mucosal infiltration throughout the stomach, which were later confirmed to be metastatic lobular carcinoma of the breast that had been surgically removed 10 years earlier. DIAGNOSIS: The patient was diagnosed with gastric metastases of breast cancer by immunohistochemistry. INTERVENTIONS: The patient underwent endocrine therapy with palbociclib and tamoxifen. OUTCOMES: After 1 year of endocrine therapy, the symptoms of upper abdominal discomfort and fatigue were relieved and a new gastroscopy revealed there had been no significant progression of the gastric metastasis. According to the Response Evaluation Criteria in Solid Tumors (RECIST), the patient reached a state of stable disease. LESSONS: Gastric metastases of breast cancer are rare in the clinical setting. However, considering the possibility of gastric metastases from breast cancer and performing an upper endoscopy are crucial for patients who present with any subtle gastric symptoms and have a past medical history of breast cancer, even if the breast cancer occurred more than 10 years ago.

Small bowel racemose hemangioma complicated with obstruction and chronic anemia: A case report and review of literature.

BACKGROUND: Gastrointestinal hemangiomas are rare benign tumors. According to the size of the affected vessels, hemangiomas are histologically classified into cavernous, capillary, or mixed-type tumors, with the cavernous type being the most common and racemose hemangiomas being very rare in the clinic. Melena of uncertain origin and anemia are the main clinical manifestations, and other presentations are rare. Due to the rarity of gastrointestinal hemangiomas and lack of specific manifestations and diagnostic methods, preoperative diagnoses are often delayed or incorrect. CASE SUMMARY: We report a 5-year-old girl who presented with abdominal pain, nausea, and vomiting for a duration of 10 h. The laboratory studies showed prominent anemia. Computed tomography and contrast-enhanced computed tomography of the abdomen revealed a small bowel obstruction caused by a giant abdominal mass. Segmental resection of the ileal lesions was performed through surgery, and the final pathology results revealed a diagnosis of racemose hemangioma complicated by a small bowel obstruction and simultaneous chronic anemia. CONCLUSION: The current report will increase the understanding of the diagnosis and treatment of gastrointestinal hemangiomas and provide a review of the related literature.