Diffuse intra-abdominal low grade fibromyxoid sarcoma with hepatic metastases: Case report and review of the literature.

INTRODUCTION: Low grade fibromyxoid sarcoma (LGFMS)(1) is a rare soft tissue tumor involving deep soft tissues of the extremities and trunk. Abdominal location is extremely uncommon in which the few cases published in the literature are characterized by slow tumoral progression and long recurrence-free intervals. METHODS: We report the first case of an intra-abdominal LGFMS which was discovered incidentally in a 42-year-old woman presenting diffuse peritoneal nodules and hepatic metastasis on CT and MRI scans. RESULTS: The patient was successfully treated through conservative measures and remained asymptomatic at the 48 month follow-up. CONCLUSIONS: This is the first reported case of LGFMS with peritoneal and hepatic metastases. Despite the discovery of an advance disease at exploration, the patient who refused a major surgical operation presents an uneventful follow-up and long term survival.

Rare complication post sleeve gastrectomy: Acute irreducible paraesophageal hernia.

INTRODUCTION: Laparoscopic sleeve gastrectomy has been accepted as a standalone effective bariatric procedure. With the increase in the number of cases done worldwide, we are witnessing the emergence of new unexpected complications. PRESENTATION: A seemingly straight forward sleeve gastrectomy was complicated by acute post-operative vomiting which was diagnosed as an acute intra thoracic migration of part of the new sleeve. Surgical repair was done, with reduction and fixation of the stomach. Patient was subsequently relieved of his symptoms and discharged. DISCUSSION: This is a rare complication of a relatively well studied operation. Faced with severe post operative repeated vomiting, clinical suspicion and correct use of all para-clinical tools should help delineate the cause. CONCLUSION: We report this case hoping to expand the existing literature on the topic and to highlight the potential role of gastrophrenic membrane dissection in the occurrence of such complication.

Surgical strategy in abnormally increased Fluorine-18 fluorodeoxyglucose uptake in an asymptomatic lower esophageal submucosal tumor - Report of a case.

INTRODUCTION: Leiomyoma is the most common benign tumor of the esophagus (67-80%), it represents 0.4-1% of all esophageal tumors. PRESENTATION OF CASE: An incidentally discovered gastro-esophageal submucosal tumor was found to have increased fluorine-18-fluorodeoxyglucose (FDG) uptake on positron emission computed tomography (PET/CT). After laparoscopic surgical exploration and local enucleation the tumor turned out to be a benign esophageal leiomyoma. DISCUSSION: There are few reports of esophageal leiomyomas with a positive uptake on (PET/CT) and even fewer adopting our combination of a minimally invasive approach and frozen section examination as a management plan. Our approach avoided excessive morbid surgical resections and underestimation of a malignant disease. CONCLUSION: We report this case hoping to expand the existing literature on the topic and to highlight the limitations of PET/CT in guiding the diagnosis and subsequently the management of esophageal submucosal tumors.

Preventing staple-line leak in sleeve gastrectomy: reinforcement with bovine pericardium vs. oversewing.

One of the most serious, potentially life-threatening complications of laparoscopic sleeve gastrectomy (LSG) is staple-line leakage. Oversewing the LSG staple line vs buttressing it with bovine pericardial strips (BPS) to reduce perioperative bleeding and postoperative gastric leak was evaluated. From 2006 through 2011, 160 patients underwent LSG with suturing as the only staple-line reinforcement (Group A). From March 2010 through August 2012, 84 LSG patients had BPS incorporated into their last two stapler firings (Group B). Staple lines were evaluated perioperatively for bleeding, and patients were monitored for indications of staple-line leaks (peritonitis, abnormal output from the drain). In preoperative Group A and B, there were 117 (73.1%) vs. 56 (66.7%) females; mean age, 35.2 years (18.0-68.0) vs. 33.8 years (15.0-64.0); mean body mass index (BMI, kilograms per square meter), 42.5 (27.0-76.0) vs. 42.0 (30.0-58.0). Three months after surgery, mean BMI for Group A was 37.3 (-5.9); Group B, 35.2 (-7.3); at 6 months, 32.7 (-10.8) and 31.5 (-11.3; p < 0.001). Although there was no significant difference in perioperative blood loss, oversewn staple lines in Group A often required electrocautery to stanch bleeding; this was not required for Group B. In Group A, 15 patients (9.4%) developed complications; in Group B, five (6.0%; p = 0.46). Gastric fistula, verified by barium swallow, occurred in eight Group A patients (5.0%); in Group B, one (1.2%; p = 0.17). Relative to oversewing, staple-line buttressing with bovine pericardium was readily accomplished, safe, and associated with a lower staple-line leak rate.

Reporting an unusual case of mesenteric desmoid tumor.

A 51-year-old male patient with no history of medical illnesses presented to the emergency department with abdominal pain and a temperature of 39 degrees Celsius. His condition deteriorated rapidly within a few hours. Clear signs of acute abdomen, raised white blood cell count and small gas-fluid levels on abdominal X ray prompted an urgent CT scan of the abdomen. The latter revealed a space occupying lesion arising from the central mesentery containing gas-fluid levels measuring approximately 9 x 9 cm. An urgent exploratory laparotomy was performed. This revealed a mesenteric mass measuring 10 x 10 cm with an abscess. Anatomopathologic investigations showed a mesenteric desmoid tumor. Both colonoscopy and gastroscopy were within normal range ruling out Gardner's syndrome with no polyps or other lesions. The patient made full recovery with radical surgery. This is to our knowledge the fifth case of a desmoid tumor presenting with abdominal abscess not associated with familial adenomatous polyposis. We therefore believe this is an important finding to report.