Spontaneous omental infarction in an obese young female patient treated with laparoscopy: a case report.

Partial infarction of the great omentum is a rare cause of abdominal pain and may present as a surgical emergency. Omental infarction might occur due to its torsion, but cases without obvious cause are reported. Risk factors related to this condition are overweight, obesity, abdominal trauma, recent abdominal surgery, hypercoagulability, postprandial vascular congestion and an increase in intra-abdominal pressure. Because of the condition's rarity, most patients are treated with surgery and the diagnosis is established intraoperatively. Preoperative diagnosis allows successful conservative treatment with analgesics and anti-inflammatory drugs. This case reports a young female patient with class III obesity presented with spontaneous partial infarction of the great omentum treated with laparoscopy.

Perianal endometrioma presented as perianal abscess: report of two cases.

Perianal endometriosis is a rare clinical presentation of the extrauterine appearance of endometrium reported in <1% of the cases. The condition is accompanied by perianal cyclic pain and a palpable mass. If diagnosed by physical examination only, the condition may be easily misinterpreted as a perianal abscess and treated improperly with incision, thus resulting in "abscess recurrence." Additional diagnostic imaging such as endoanal ultrasonography and magnetic resonance imaging should be mandatory to provide an accurate diagnosis and proper treatment resulting in low recurrence rates. We present two cases of perianal endometriomas initially diagnosed and treated as perianal abscesses.

Small intestine metastasis from endometrial carcinoma initially presented as enterocutaneous fistula: a case report and literature review.

Although endometrial cancer is the fourth most common malignancy among women, it rarely metastasizes to the small intestine. Cases of endometrial recurrence to the intestine clinically present with secondary anemia, melena, abdominal cramps, and epigastric pain. Only a dozen cases are reported in the literature, but none presented with an enterocutaneous fistula. In this report, we present a case of an 88-year-old female patient previously treated for endometrial adenocarcinoma with surgery and adjuvant radiotherapy. Fourteen months after the surgery, the patient presented with an enterocutaneous fistula on the anterior abdominal wall, which was confirmed to be a metastasis from the primary tumor. To our knowledge, this is the first case of endometrial cancer metastasizing to the small intestine with involvement of the anterior abdominal wall and the occurrence of an enterocutaneous fistula, which was treated with radical surgery.

Unusual initial presentation of prostate adenocarcinoma with inguinal lymph nodes metastases: a case report.

The presence of lymph node metastases in prostate adenocarcinoma is a poor prognostic sign, and mortality rates are often high. Inguinal lymph node metastases are an unusual presentation of advanced disease, and they can be easily misinterpreted with other diseases. We present a case of a 63-year-old patient with no previous symptoms and signs of prostate disorder with a right-sided inguinal lump and abdominal pain. The CT scan showed right inguinal and retroperitoneal lymphadenopathy. Elevated PSA serum levels, digital rectal examination, and skeletal scintigraphy with 99mTc-MDP favored the diagnosis of metastatic prostate adenocarcinoma. Since the patient denied prostate biopsy, a dissection of the right inguinal nodes was performed. Histopathological findings confirmed metastatic prostate adenocarcinoma. The treatment was hormonal and bisphosphonate therapy, with objective posttreatment improvement. Based on this case, it can be concluded that inguinal and generalized lymphadenopathy are potential initial manifestations of metastatic prostate adenocarcinoma in male patients.

Combined approach in the treatment of comminuted lateral Hoffa fracture: a case report.

Coronal-plane intra-articular fractures of the femoral condyle (Hoffa fractures) are rare, and difficult to diagnose and treat. They mostly result as a consequence of high-energy trauma and are combined with concomitant fractures (patellar, tibia shaft) and/or soft-tissue damage. A plain X-ray can miss the diagnosis initially and therefore computerized tomography scan is recommended, which can also help in the preoperative planning. The vast majority of these fractures are unicondylar (mostly lateral condyle fractured). The approach for their treatment can be anterior or posterior. In cases of fracture comminution, much more mutilant approaches with osteotomy have been described. A combined two-stage approach can be used to obtain anatomical reduction and fixation of all the fragments. We present a case of a 46-year-old male patient with comminuted lateral Hoffa fracture treated with a combined approach (extended posterior approach to the proximal tibia and lateral parapatellar) in a time interval of one month.

Pyonephrosis complicated with spontaneous intraperitoneal rupture and diffuse peritonitis: Case report and literature review.

Pyonephrosis is a serious condition that can lead to kidney dysfunction, loss of the organ, and even fatal end due to its complications. The underlying etiologic factors include lithiasis, recurrent urinary infections, ureter stricture, ureteropelvic junction obstruction, malignancy, and retroperitoneal fibrosis. One of the rare possible complications of pyonephrosis is a retroperitoneal rupture with spontaneous communication to the abdomen causing secondary peritonitis. We present such a case which is the first video-documented report of the peritoneal rupture site within the abdominal cavity.

Metachronous colon cancer metastasis to abdominal wall 7 years after rectosigmoid resection: a case report and literature review.

Distant metastases from colorectal cancer to the abdominal wall are rare presentations of the end-stage of the disease. In this case, we present a female patient treated for Stage I rectosigmoid cancer with the late occurrence of abdominal wall metastasis, 7 years after the primary cancer surgery. The patient was treated with surgical excision and abdominal wall reconstruction with the use of synthetic mesh. Literature research on the abdominal wall recurrence/metastases from colorectal cancer was performed.

Emphysematous Calculous Cholecystitis Diagnosed with Abdominal CT in a Diabetic Female Patient - Case Report.

Emphysematous cholecystitis is reported to have a low incidence of less than 1% in all cases of acute cholecystitis and yet a high mortality rate of up to 15%. It is most commonly seen in male diabetic patients with advanced age. The diagnosis is established with the presence of gas in the gallbladder lumen and/or within its wall which can be seen on plain abdominal radiography, abdominal ultrasound, and abdominal computerized tomography. The clinical presentation refers to one of acute cholecystitis, but the treatment requires prompt cholecystectomy since the patient's condition can deteriorate due to the possibility of gallbladder perforation. We present a case of a 71-year-old female diabetic patient with calculous emphysematous cholecystitis treated with emergency open cholecystectomy.

The Incidence of Lymphovascular and Perineural Invasion and their Impact on Survival in Patients with Rectal Cancer.

Aim: Lymphovascular Invasion (LVI) and Perineural Invasion (PNI) represent undesirable but still realistic pathological features of rectal cancer, associated with poor prognosis and worse survival. The aim of this study is to assess the incidence of LVI and PNI in patients treated for rectal cancer and the impact of LVI and PNI on patient survival. Material and Methods: This retrospective single center observational study, conducted in the period of 2016-2019, includes patients with rectal cancer treated with/without long-course neoadjuvant chemoradiotherapy (nCRT). Data collection encompassed demographics, tumor characteristics, type of surgery (abdominal perineal rectal resection - APR and low anterior rectal resection - LAR), and LVI/PNI presence. Survival during follow-up was estimated and compared for patients with/without LVI and PNI involvement. Results: A total number of 234 patients (77 females and 157 males) with mean age of 61.3 enrolled in the study. Neoadjuvant CRT was conducted in 170 patients. APR procedure was performed in 67 of them and LAR in 167. LVI presence was noted in 55 (24.4%) and PNI in 77 (34.2%) patients. Mean survival during follow-up was 42.07 months. The use of nCRT influenced on survival (p < 0.033). Patients treated with LAR had better survival outcomes (p = 0.001). Presence of LVI and PNI was associated with a worse prognosis (p < 0.001). Conclusion: PNI was more frequent than the LVI in this study. Patients with nCRT conduction had better overall survival. LVI and PNI presence was associated with poor prognosis in terms of overall survival in patients with rectal cancer.

Large biloma as the initial presentation of gallbladder perforation: a case report and literature review.

Biloma is an encapsulated intra or extra-hepatic collection of bile after biliary tree trauma. Post-procedural and traumatic biliary damage are the most common etiologic causes. Gallbladder perforation due to acute cholecystitis rarely presents with biloma occurrence. We present a case of large extrahepatic biloma formation as a consequence of a perforated gallbladder.

Low-grade malignancy glomus tumor of the abdominal wall: a case report and literature review.

Glomus tumors are painful neoplasms arising from the glomus body (responsible for body temperature and blood pressure regulation) in the skin. Although mostly present in the interdigital areas, glomus tumors can arise elsewhere. The vast majority of them are benign. Rarely, malignant variants are reported and are associated with the potential for local infiltration and metastatic dissemination. The abdominal wall location of glomus tumors is extremely rare regardless of whether they present as benign or malignant. We present a case of a 58-year-old female patient with a low-grade malignancy infiltrative glomus tumor of the abdominal wall.

When is surgery indicated in metastatic small intestine neuroendocrine tumor?

Small intestine neuroendocrine tumors are predominantly small but with high potential for distant metastases development. Diagnosis establishment in early-stage is often difficult and challenging. Small intestine neuroendocrine tumors often initially present with liver metastases. According to the Consensus Guidelines of the North American Neuroendocrine Tumor Society, in patients with liver metastases from unknown origin of primary neuroendocrine tumor, surgical exploration should be performed in order to identify the primary location, prevent small intestine obstruction, and treat one if already present. We present a case of a 69-year-old male patient diagnosed with liver and peritoneal metastases due to small bowel neuroendocrine tumor treated with surgery due to the presence of small intestine obstruction.

Incidentally Diagnosed Large Asymptomatic Morgagni Hernia in Adult Male Patient.

Background: Congenital diaphragmatic hernias are rare congenital defects resulting in abdominal organ protrusion into the thoracic cavity; they mainly present with pulmonary or gastrointestinal symptoms. Although congenital and discovered in utero or in early childhood, they can be asymptomatic for a long time and even remain asymptomatic despite the growing hernia sac dimensions and the hernia sac contents. Case description: We present a case of a 58-year-old patient with incidentally diagnosed Morgagni hernia during the COVID-19 pandemic following a computerised tomography (CT) scan of the chest. He presented without any symptoms related to the existence of the hernia. Another CT scan was performed 20 months after the initial diagnosis to evaluate the progression of the hernia. The patient refused the offered surgery due to the absence of symptoms. Discussion: A Morgagni hernia is usually discovered during pregnancy or in early childhood, but sometimes can be asymptomatic for years. Main symptoms originate from the respiratory and gastrointestinal system. Conclusion: Due to the refusal of surgery, we were able to follow the CT scan enlargement progression of patients' hernia over a 20-month period. LEARNING POINTS: Congenital diaphragmatic Morgagni hernias can remain undiscovered for a long period of time.Despite the usual clinical presentation with pulmonary and/or gastrointestinal symptoms, it can be asymptomatic in some patients.Surgery is the recommended treatment for a Morgagni hernia (via the thoracic or abdominal access).

Bleeding metastasis of renal cell cancer to anal canal treated with radiation.

Renal cell cancer (RCC) has the ability to metastasize to various organs, including the anal canal which is reported to be the rarest location. An 88-year-old male patient who had previously been treated for right RCC subsequently developed distant metastases to the prostate, lungs, and small bowel. Four years following nephrectomy, the patient presented with a bleeding anal mass which was excised and has been proven to be an anal canal metastasis of RCC. Eight months post excision, regrowth occurred. The patient underwent stereotactic ablative body radiotherapy resulting in satisfactory regression during the 2-month follow-up period, without episodes of bleeding. The treatment options for metastatic post-nephrectomy disease should be considered with a multidisciplinary approach in order to achieve satisfactory symptom relief.

Enhancing surgical planning of distal splenopancreatectomy through 3D printed models: a case report.

The complex anatomy of the peripancreatic region was a challenge to many surgeons in the past. Up until recently, the only way to prepare and plan a surgery was through the use of traditional 2D images, obtained via computed tomography or magnetic resonance imaging. Recently, the advantages in the field of 3D printing (also called additive manufacturing, or rapid prototyping) allowed the creation of replicas of the patient's anatomy which is to be used for preoperative planning and visual reference. We present the case of a 46-y.o. patient with a distal pancreatic lesion requiring a distal splenopancreatectomy, who benefited from the use of 3D printing technology. No intraoperative or postoperative complications were encountered, while the created model was used to plan and perform the needed resection.

Tumour budding - an additional prognostic factor in colorectal cancer survival.

Tumour budding (TB) in cancer is a phenomenon of tumour cells forming clusters, and it is associated with an epithelial-mesenchymal transition into the extracellular matrix of the tumour. It has been shown that the presence of TB in colorectal cancer (CRC) is associated with worse overall survival, higher possibility for vessel invasion, lymph node involvement, and distant metastases appearance. In this retrospective study TB presence in operated patients for CRC is analysed. In the data from 81 patients, 26 presented with TB. Analysis revealed high statistical significance of the effect of TB presence on the number of metastatic lymph nodes, and the lymphovascular and perineural invasion. A statistically meaningful correlation was found between the presence of TB and CRC survival ( p = 0.016). Patients with right-sided colon cancer presented with worse overall survival ( p = 0.011). The patients who presented lymph node metastases and TB presence had worse overall survival ( p = 0.026 and p = 0.021, respectively). Tumour budding, tumour location, and age over 64 years are found to be the independent prognostic factors in CRC patients. Tumour budding is an important prognostic factor in CRC patients that will contribute to treatment. Pathological examination must consider TB in detail.

Analysis of Survival in Complete Pathological Response after Long-Course Chemoradiotherapy in Patients with Advanced Rectal Cancer.

BACKGROUND: Neoadjuvant chemoradiotherapy prior to surgery is the standard treatment for locally advanced rectal cancer. This consists in the patient's complete pathological response being achieved with no residual tumor presence in the resected specimen, which results in survival improvement. METHODS: This retrospective study aimed to examine the rate of complete pathological response in patients with advanced rectal cancer treated with neoadjuvant long-course chemoradiotherapy and to examine the survival differences between the different tumor regression grade (TRG) scores. RESULTS: A total of 154 patients were operated prior to long-course chemoradiotherapy with a total of 50 Gy plus FOLFOX protocol. Complete pathologic response was achieved in 29 (18.8%) patients. There was no statistical difference for the different pathologic responses according to gender, type of surgery, and number of harvested lymph nodes. Mean survival for all the groups was 37.2 months. Survival within a different TRG score exhibited statistical significance (p = 0.006). Overall, the survival rate during the follow-up period was of 81.8%. CONCLUSIONS: The complete pathological response rate in this study was of 18.8%. High tumor regression grade scores (TRG0 and TRG1) had a survival rate of over 90% during follow-up. Multivariate analysis identified perineural invasion and tumor regression grade as independent factors that affect survival.

Extralevator Abdominoperineal Excision (ELAPE) is Not Superior to Abdominoperineal Excision (APE) in the Era of Neoadjuvant Treatment in Rectal Cancer.

Aim: To evaluate the effect of extralevator abdominoperineal excision of the rectum (ELAPE) on the circumferential resection margin (CRM) and overall survival in comparison to standard abdominoperineal excision of the rectum (APE) in patients with advanced rectal cancer. Material and Methods: This retrospective study encompasses patients with advanced rectal cancer operated on with two different methods: prone Jack-Knife position ELAPE and APE. In part of them, neoadjuvant chemoradiation was conducted. Postoperative patient, tumor, and outcome data were analyzed in terms of differences in CRM positivity and overall survival. Results: Of 67 patients treated with either APE (52) or ELAPE (15), 43 were male and 24 were female. Neoadjuvant treatment was conducted on 49 of the total patients. Complete pathological response (T0) was achieved in 3 patients. Positive CRM was reported in 7 patients (11.5 %), 3 in ELAPE and 4 in APE group (p = 0.348). The overall postoperative complication rate was 56.7%. Mean survival period was 42.2 months. Overall survival rate for both groups was 67.2 %. No statistical differences were seen between the ELAPE and APE procedure in terms of overall survival (p = 0.483). Conclusions: Differences between the use of ELAPE and APE in terms of CRM positivity and overall survival were not statistically significant. Therefore, we conclude that ELAPE is not superior to standard APE in the treatment of advanced rectal cancer.

Uncommon causes of acute appendicitis: Retrospective analysis of 6785 histopathological findings in a tertiary center.

BACKGROUND: This study aims to determine the uncommon causes of acute appendicitis in analyzed post appendectomy specimens. METHODS: Histopathology reports of 6785 removed appendices were analyzed retrospectively in order to confirm the uncommon cause of acute appendicitis in single tertiary institution. RESULTS: Unusual cause of acute appendicitis was found in 98 (1.44%) samples (40 female and rest 58 male patients). Neuroen-docrine tumor of the appendix was the most common pathology, followed by serrated adenoma, low-grade appendicular mucinous neoplasm, hyperplastic polyp, and intestinal parasite. In four patients (0.05%), appendicular adenocarcinoma was confirmed with an overall mortality of 75%. Age was significantly higher in uncommon acute appendectomies than in ordinary appendectomies. Survival analysis of unusual appendectomies showed that advanced age is of prognostic importance (Kaplan Meier p<0.0001). There was also a difference in survival between different disease groups in unusual appendectomies, but Cox multifactorial analysis showed that these two factors were not statistically significant. CONCLUSION: Although rare, unusual causes are the etiological factor responsible for acute appendicitis. These reasons should be kept in mind in the older age group and the diagnosis of appendicitis should be made carefully.

Factors affecting the success of crystallized phenol treatment in sacrococcygeal pilonidal sinus disease.

There are 2 mainstays of sacrococcygeal pilonidal disease (SPD) treatment: non-operative and surgical. None of them was superior, and it was associated with some degree of recurrence. Crystallized phenol treatment is a non-operative procedure performed in outpatient settings. This retrospective study aimed to asses crystallized phenol treatment in patients with primary and recurrent SPD and the factors that influence disease recurrence. A total of 92 patients were included and followed up. Crystallized phenol was administered in an outpatient setting under local anesthesia. All demographic, patient, sinus features, procedure and outcome data were recorded and analyzed for treatment success and factors for recurrence were identified. Between January 2019 and December 2021, 92 patients (77 male and 15 female) with a mean age of 28.4 were treated with 1, 2, or 3 doses of crystallized phenol. Recurrence rate after the procedure was 20.7%. Univariate regression analysis showed that the grade of hirsutism, initial presence of abscess, pit number and number of showers per week had statistically significant effect on recurrence. Multivariate logistic regression analysis pointed on the hirsutism grade (P = .008) and the number of pit openings (P = .003) as a statistically significant factors for recurrence. Crystallized phenol application for primary and recurrent SPD is safe, inexpensive and efficient non-operative method with few minor complications, even when is repeated. Factors responsible for the recurrence of the procedure are grade of hirsutism and sinus pit number.