Giant Hydatid Cyst with Diaphragmatic, Pericardial, and Hepatic Involvement: Use of Extracorporeal Circulation for Major Liver Resection: A Case Report and Literature Review.

BACKGROUND Echinococcosis is a zoonosis caused by the echinococcus microorganism, a parasite with 6 described species in the literature, the main one in humans being Echinococcus granulosus. Transmission is via the fecal-oral route, with main hepatopulmonary involvement but with high risk of dissemination. Diagnosis is often incidental and patients present a wide range of non-specific symptoms, closely related to localization, size, and quantity of cysts. The latent risk of the infection is septic shock secondary to intraperitoneal rupture, which increases the risk of mortality. The criterion standard of management involves anthelmintic therapy and radical surgical management. CASE REPORT We present the case of a man in the third decade of life from a rural area of Colombia, presenting abdominal pain and febrile peaks for 2 months. Imaging studies showed a cystic lesion with thoracic and hepatic involvement. He was treated in 2 surgical stages, the first achieving partial resection of the cyst involving lung, diaphragm, and rib cage, and the second with extracorporeal circulation assistance due to infiltration of the retrohepatic vena cava, achieving radical resection of the disease. CONCLUSIONS Echinococcosis is a condition endemic to rural areas, with wide geographical distribution. Given the slow growth, it is mostly asymptomatic, which causes diagnostic and therapeutic challenges involving high rates of complications and mortality. An individualized surgical and medical approach is recommended. Extracorporeal circulation assistance helps achieve hemodynamic stability in patients with cardiac or great vessel involvement. To the best of our knowledge, this is the first report of extracorporeal circulation assistance for large hepatic-diaphragmatic and pericardial cyst resection.

Variations in clinical course and surgical outcomes of acute appendicitis during COVID-19 Pandemic: a multicenter cohort study.

BACKGROUND: COVID-19 pandemic has led to changes in the presentation and treatment of surgical pathologies. Therefore, we aim to describe the influence of the COVID-19 pandemic on the clinical presentation and management of acute appendicitis (AAp) and its surgical outcomes. STUDY DESIGN: A multicenter cohort study with prospectively collected databases. Three high-volume centers were included and all patients over 18 years of age who underwent appendectomy for AAp were included. Multiple logistic regression and multinomial logistic regression were performed, and odds ratio, relative risk, and B-coefficient were reported when appropriate, statistical significance was reached with p-values < 0.05. RESULTS: 1.468 patients were included (709 in the pre-pandemic group and 759 in the COVID-19 group). Female patients constituted 51.84%. Mean age was 38.13 ± 16.96 years. Mean Alvarado's score was 7.01 ± 1.59 points. Open surgical approach was preferred in 90.12%. Conversion rate of 1.29%. Mortality rate was 0.75%. There was an increase of perforated and localized peritonitis (p 0.01) in the COVID-19 group. Presence of any postoperative complication (p 0.00), requirement of right colectomy and ileostomy (p 0.00), and mortality (p 0.04) were higher in the COVID-19 group. Patients in the pre-pandemic group have a lesser risk of mortality (OR 0.14, p 0.02, 95% CI 0.02-0.81) and a lesser relative risk of having complicated appendicitis (RR 0.68, p 0.00, 95% CI 0.54-0.86). CONCLUSION: Complicated appendicitis was an unexpected consequence of the COVID-19 pandemic, due to surgical consultation delay, increased rates of morbidity, associated procedures, and mortality, influencing the clinical course and surgical outcomes of patients with AAp.

Porto-biliary fistula as an uncommon cause of haemobilia: A case report and literature review.

BACKGROUND: Haemobilia is a rare cause of gastrointestinal bleeding. It can be related to iatrogenic injuries, inflammatory diseases, and, more recently, postoperative, or post-procedure complications. Porto-biliary fistula is an uncommon case of haemobilia and has been related to iatrogenic injury or chronic inflammatory processes. To date, less than 30 cases of Porto-biliary fistula have been reported. CASE PRESENTATION: We present a 53 years-old woman with a history of biliary obstruction due to a choledochal cyst that required hepaticojejunostomy with evidence of anastomotic stricture. A percutaneous transhepatic biliary drainage (PTBD) was performed, with 3 failed attempts of percutaneous dilatation. A new hepaticojejunostomy was completed, however, 45 days later the patient presented to the emergency room with haemobilia and secondary hemodynamic instability. An emergency damage control laparotomy was performed, achieving bleeding control. In the second procedure, there is evidence of an ulcerative injury of the biliary tract secondary to a Porto-biliary fistula. CONCLUSION: Porto-biliary fistula is an entity that cannot be ruled out in cases of haemobilia, especially in cases with a history of bile duct surgical or percutaneous procedures. The prognosis is usually good if multidisciplinary management is performed, and the source of the bleeding is identified early.

Cholecystogastric fistula in Bouveret syndrome: Case report and literature review.

INTRODUCTION AND IMPORTANCE: Cholelithiasis is the benign bile pathology with major prevalence. A rare condition has been described, when a stone migrates through the duodenum causing small bowel obstruction (SBO), it's known as Bouveret syndrome, and it's attributed to almost 5% of SBO. Just 2% of the cases present with the migration of the stone through a fistula between gastric chamber and gallbladder, with limited reports in the literature. CLINICAL FINDINGS: We present a case of an 87-year-old male with Bouveret syndrome and a cholecystogastric fistula with a stone in the gastric chamber who underwent laparoscopic gastrotomy to resolve the clinical case. CONCLUSION: Bouveret syndrome remains to be a rare condition in benign bile pathology. Individualized treatment should be performed and multidisciplinary approach leads to improved outcomes for the patient.