Large bowel perforation secondary to endometriosis.

Endometriosis is described as the implantation of ectopic, viable endometrium. Among the complications associated with this phenomenon, ectopic foci that localizes to the bowel can result in many presentations. An uncommon presentation of such an occurrence is a mass effect on the colon causing an obstruction. This case report describes the progression of endometriosiscausing mass effect in the colon and resulting in perforated hollow viscous. Hence, this demonstrates the importance of maintaining endometriosis as a differential diagnosis in women of childbearing age presenting with bowel obstruction. Although the presence of endometriosis as a cause of bowel obstruction has been reported in the literature, the presentation of large bowel perforation is rare. In this case, an extremely rare presentation of sigmoid obstruction with transverse colonic perforation is observed.

Littre's hernia-a reason for resection.

Littre's hernias are exceedingly rare, with an estimated incidence of 0.09% in strangulated or incarcerated hernias. It may present as a complication of Meckel's diverticulum in less than 1%. In the adult population, it presents as an inguinal (50%), femoral (20%) and umbilical (20%) hernias. Management of Meckel's diverticulum when encountered during a routine repair of hernia in literature is generally resection. We present a case of a healthy 68-year-old gentleman who was found to have a Meckel's diverticulum in the indirect hernia sac during routine elective open right inguinal hernia repair.

Routine Intraoperative Use of Esophageal Bougie in Minimally Invasive Hiatal Hernia Repair is Not Necessary.

Background: Laparoscopic hiatal hernia repair can be performed with an antireflux procedure. Routine use of an esophageal bougie has been advocated to avoid an excessively tight fundoplication. The use of an esophageal bougie carries a risk of iatrogenic complications, such as perforation or laceration of the viscera. However, there is equivocal evidence for the routine use in the surgical literature. Methods: We present a retrospective analysis of patients with Types 3 and 4 paraesophageal hiatal hernias who underwent laparoscopic hiatal hernia repair with fundoplication without the use of an esophageal bougie, between December 1, 2010 and February 28, 2020, by a single surgeon at a community-based, academic hospital. Patients with a diagnosis of achalasia and gastroesophageal dysmotility were excluded. Perioperative outcome measures included: recurrence; prolonged postoperative proton pump inhibitor use; dysphagia; re-operation, and mortality. Results: A total of 174 patients (34 males, 140 females) underwent laparoscopic hiatal hernia repair with fundoplication. The average age was 63-years old. Four patients (2.3%) developed dysphagia with narrowing of the gastroesophageal junction, with one patient (0.6%) requiring postoperative esophageal dilation with bougie and eventual re-operation. Postoperative proton pump inhibitor use was 31.0% after 1 month. Overall hernia recurrence rate was 14.9% and the rate of re-operation was 6.3%. Overall mortality was 0.6%. Conclusion: We conclude that laparoscopic hiatal hernia repair with fundoplication without an esophageal bougie is safe, effective, and efficient. Furthermore, bougie related risks are obviated with a comparable reported incidence of postoperative dysphagia and hiatal hernia recurrence.

Three-Port Laparoscopic Spleen-Preserving Distal Pancreatectomy with Splenic Vessel Preservation.

Laparoscopic distal pancreatectomy is now accepted treatment for benign and certain malignant pancreatic body and/or tail processes and is generally performed using four to six ports. Splenic preservation avoids inherent risks associated with the post-splenectomy state, but adds surgical complexity. In this case series, we describe our single surgeon's experience with a novel technique for safe, successful three-port laparoscopic spleen-preserving distal pancreatectomy with splenic vessel preservation. Our series supports success with our technique for a variety of benign and low-grade pancreatic neoplasms. Our results demonstrate this approach is a technically feasible and safe approach. As previously discussed by our group, this approach is also applicable to other procedures in the left upper quadrant.

Rare case of an adenomatoid tumor cyst of liver.

Adenomatoid tumors are incidentally found, rare tumors that are usually benign. They usually originate from mesothelial cells and have been reported to occur in the genital tract, though occasionally occur in extra-genital locations. A 33-year-old African-American female was found to have a large multiloculated cystic lesion in segments IV and V of the liver. The patient underwent a laparoscopic central hepatectomy and the tumor was resected en bloc. On pathologic analysis, the specimen showed multiple cysts of variable sizes lined by a single layer of low cuboidal cells. Immunohistochemistry revealed cells staining positive for WT-1 and calretinin, indicative of a tumor of mesothelial origin. Adenomatoid tumors are rarely, if ever found to occur in the liver. Their malignant potential and biology in the liver is unknown, however given their benign behavior in other organs, resection was considered curative.