Laparoscopic Treatment of Gastric Duplication in a Child

Introduction: Gastric duplication is a rare congenital anomaly with an incidence of 4-8% of all gastrointestinal duplications; enteric duplications are ectopic cystic or tubular structures with a mucous and muscular tunics and they can be in contiguity/continuity with the intestinal lumen.1 Gastric duplication is often an occasional finding, associated to aspecific sintomatology for which pre-operative diagnosis is not univoque; differential diagnosis with other retroperitoneal diseases or mesenteric cysts can be difficult.1 (Run time 8min). Material and Methods: We present a case of a one-year-old child with a pre-natal ultrasound (US) finding of endo-abdominal cystic lesion. After birth, US scans showed an anechogenic-cyst of 33x28mm in the left upper quadrant, between stomach, spleen and kidney. The magnetic resonance confirmed the presence of the lesion (40x34mm), imprinting the posterior gastric wall, the spleen and the anterior side of left kidney. An esophagous-stomach-duodenum contrast study was also performed, showing the imprinting cyst on the great curvature close to the gastric fundus without communication with gastric lumen. On follow-up, the child underwent to periodic US scans and no growth or ultrasonographic changes were described. At 13-months, the diagnosis was still unclear and the patient underwent explorative laparoscopy with esophagous-gastric-duodenoscopy (EGDS). The preliminary EGDS showed a 35mm convexity on the posterior wall of gastric fundus with no evidence of orifice. A 5mm trans-umbilical trocar was placed and 5mm trocar in the epigastric region and 10-12mm trocar in the left side were positioned. At the abdominal exploration the cyst resulted to be in continuity with the posterior gastric wall on the superior third of the great curvature. The lesion was isolated from other tissues, but the postero-medial wall of neoformation appeared to be not dissociable and in continuity with the stomach; a complete resection of the cyst, using 45mm linear stapler, was performed including a small portion of the great gastric curvature. At the following intra-operative endoscopic control no more evidence of irregularity of the gastric wall was seen and the suture was assured. Results: The operative time was 140-minutes. No complications occurred and the blood loss was minimal. The patient started oral intake on 5’ post-operative-day and was discharged on 6’ post-operative-day. The histological examination confirmed the gastric nature of cyst. At 1-year of follow-up no recurrences were diagnosed and the child presents in good health with a regular growth. Conclusion: We can assume that laparoscopic surgery is the correct procedure for gastric duplication cysts, to get both definitive diagnosis and treatment, and the radical surgical excision represents the treatment of choice in order to avoid neoplastic degeneration of internal lining mucosa.2 Furthermore surgical laparoscopy appears to be a feasible and safe technique

FIRST CASE OF LAPAROSCOPIC PARTIAL SPLENECTOMY IN A CHILD WITH HAMARTOMA: CASE REPORT AND REVIEW OF THE LITERATURE

INTRODUCTION To date, laparoscopic surgery has played a key role in the treatment of not only splenic hematologic pathologies but also solid ones. Hamartoma is a rare disease; only twenty percent of them are of pediatric relevance; it is a benign tumor, but radiological features never allow proper differentiation from malignant neoplasms. In children, hamartoma may be associated with other morbid conditions, such as sickle cell disease or other hematological alterations. PRESENTATION OF THE CASE We report a case of hamartoma in a 7-year-old child treated with partial laparoscopic splenectomy After a multidisciplinary evaluation, the indication of laparoscopic splenectomy was decided; upon evaluating the age of the patient and the affected spleen portion, a partial splenectomy was proposed. The histological examination during surgery was performed to exclude any form of malignancy. The intraoperative frozen section of the specimen was negative for malignancies, and a partial splenectomy was performed. DISCUSSION Surgery remains the first choice in the definitive treatment of solid lesions of the spleen; minimally invasive technique, namely, laparoscopy, has set itself as the technique of choice for surgical treatment. In this case, the possibility of obtaining an intraoperative pathological diagnosis by frozen section of the specimen, confirming the benign nature of the lesion, allowed the surgeon to decide in favor of a laparoscopic partial splenectomy. CONCLUSION Partial laparoscopic splenectomy can be considered a safe, effective and reproducible alternative in patients suffering from benign solid diseases, safeguarding the hematological functions of the organ itself in pediatric age

CASE report: Acute hepatic failure secondary to metastatic LIVER\u2019S infiltration by upper tract urothelial carcinoma

INTRODUCTION: Acute liver failure (ALF) secondary to malignant infiltration of the liver from urothelial carcinoma is a very rare clinical condition and is often diagnosed only after death. Upper tract urothelial carcinoma (UTUC) is a rare, from 5% to 10% of all urothelial tumours, but possible cause of ALF when there is extensive liver metastatic involvement. We report the case of a patient who died in the intensive care unit (ICU) of our hospital from multiple organ failure (MOF) secondary to ALF, as a result of infiltration of the liver from UTUC diagnosed after surgery. PRESENTATION OF THE CASE: A 69-year-old Caucasian man was referred to our hospital for hematuria, melena, right upper quadrant (RUQ) pain and jaundice developed over the previous two weeks. After multidisciplinary discussion, he underwent emergency exploratory laparotomy to perform cholecystectomy because of suspected acute cholecystitis considered as a septic focus within the left kidney. He developed MOF and died on the 6thpostoperative day. DISCUSSION: From the diagnosis of the renal mass and the death of the patient, a few days have passed, and the diagnosis of UTUC has been put only at histological examination.The most common sites of metastases from UTUC are lymph nodes, lungs, liver, bones and peritoneum. Moreover, liver metastases have been identified to have an independent negative impact on overall survival in a patient affected by UTUC. CONCLUSION: The authors suggest that this condition should be taken into account when dealing with patients with evidence of a renal mass and simultaneous ALF. KEYWORDS: Acute liver failure, Upper tract urothelial carcinoma (UTUC), emergency surger

a rare case of diaphragmatic hernia after cytoreductive surgery and hypertermic intraperitoneal chemotherapy

Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is an effective therapeutic approach for selected patients with gastrointestinal and gynecological malignancies with peritoneal spread. The most frequent postoperative surgical complications are anastomotic leakage, digestive perforations, fistulas, intestinal obstruction, abscess and peripancreatitis. This report presents case of a patient with late postoperative diaphragmatic hernia after CRS and HIPEC. A 50- year-old woman previously treated with CRS and HIPEC for a pseudomyxoma peritonei was admitted to our unit with diagnosis of intestinal obstruction. At the CT scan a left diaphragmatic hernia involving the splenocolic flexure was found. Both stripping of the diaphragmatic peritoneum during CRS, sometimes combined with diaphragmatic resection and the heat of HIPEC might be responsible for such complication. The diaphragmatic hernia is rarely diagnosed after CRS and HIPEC. Surgical techniques for repair can be the direct suture of the defect or closure with synthetic or biological tissue, both are possible surgical techniques for repair with a good long term results

A rare case of acute abdomen in the adult: The intestinal duplication cyst. case report and review of the literature

Introduction: Duplications of the gastrointestinal tract are rare congenital anomalies that can occur anywhere throughout the gastrointestinal tract. The reported incidence is 1/4500, and more than 80% occurs before the age of two as an acute abdomen or bowel obstruction. The most common site is Ileum (60%), while the colonic localisation is reported between 4 and 18%. Presentation of the case: Herein we report the case of a 35-year-old man, presented at the Emergency Department with fever and localised abdominal pain in the right iliac fossa. Preoperative abdominal ultrasound and CT scan showed a cystic mass of 44 × 43 × 70 mm adjoining the posterior wall of the right colon. He underwent explorative laparoscopy, laparotomy conversion, right hemicolectomy with an intra-operative diagnosis of colonic duplication cyst, confirmed by histology. Discussion: The review of the literature showed as the intestinal duplication cysts are rare congenital anomalies. The clinical presentation is variable and depends on the site and the related complications. A surgical approach based on the resection of the involved bowel tract is the treatment associated with the best long-term outcomes. Conclusion: It is important to include intestinal duplication in the differential diagnosis of acute abdomen, to ensure the best therapeutic strategy

CYTOREDUCTIVE SURGERY AND HIPEC IN A 14 YEARS OLD PATIENT WITH PERITONEAL RECURRENCE OF ADENOCARCINOMA OF THE RIGHT COLON

Introduction Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is nowadays a feasible and effective treatment for peritoneal metastasis. We present a case of a 14 years old child with peritoneal metastasis from recurrent colorectal cancer. Presentation of case Colonoscopy and CT-scan were performed leading to the diagnosis of a stenosing adenocarcinoma of the right colon in 2015. Two pelvic lesions were found at the total body PET scan, suspected for peritoneal metastasis. Neoadjuvant chemotherapy was administered, and restaging CT-scan and magnetic resonance (MRI) highlighted a partial response. The patient underwent right laparoscopic hemicolectomy. The postoperative staging was T4 N1 G3. Seven months after the last cycle of adjuvant chemotherapy, CT-scan revealed two huge abdominal masses. The patient underwent explorative laparotomy and bilateral oophorectomy, positive for metastasis from colorectal cancer and peritoneal washing cytology was positive for neoplastic cells. A CT-scan was performed on December 2017 showed a suspect lesion below the anterior abdominal wall. The case was discussed at the tumour board and the indication for CRS and HIPEC was given. In January 2018 the child underwent complete CRS and HIPEC with no complications. No adjuvant chemotherapy was administered. After 11 months the follow up is negative for the recurrent disease. Discussion and Conclusion Cytoreduction and HIPEC can be performed even in children as a feasible and safe treatment with successful outcomes. As for adults, an appropriate multidisciplinary pre-operative work up and a correct cases selection is needed to have the best results even regarding the quality of life

Use of strictureplasty technique for surgical treatment of ileal endometriosis: a case series

Intestinal deep infiltrating endometriosis is the most frequent extragenital localisation and its traditional surgical treatment is segmental resection of the affected tract. The need for implementing alternative techniques in the treatment of intestinal endometriosis arises from those cases of multiple ileal and recto-sigmoidal localisations, in which removing excessive lengths of intestine could lead to a higher rate of adverse events. Ileal endometriosis represents 4.7% of all intestinal localisations, often associated with multiple lesions and yet, to the best of our knowledge, there are no data on techniques other than intestinal resection for its treatment. Since its capacity to solve fibrostenotic lesions without removing centimeters of intestine, strictureplasty is widely implemented in the management of Crohn's disease. We propose the use of strictureplasty for the treatment of ileal endometriosis. We performed surgical treatment for symptomatic deep infiltrating endometriosis in two patients with either ileal and sigmoidal localisations. We approached ileal nodules with strictureplasty technique, while sigmoidal nodules were removed by traditional segmental resection. No complications occurred and both patients are now asymptomatic after a 12 months-follow up. Therefore, strictureplasty could provide a tool to eliminate small bowel endometriosis maintaining a regular caliber of the ileal tract without modifying its length

Incidental thyroid carcinoma (ITC): a retrospective study in a series of 737 patients treated for benign disease

Aim: aim of the study is to evaluate correlations between incidental thyroid carcinoma (ITC) and benign thyroid pathologies (BTP), to determine the most represented histotype and to point out the total thyroidectomy’s possible advantages in terms of radicality, follow-up management and incidence of complications.Materials and Methods: during 10 years, 739 patients underwent thyroid surgery for BTP. Fine needle biopsy (FNAB) was negative in all cases; 503 total thyroidectomies(TT), 5 subtotal thyroidectomies(ST) and 231 emithyroidectomies(ET) were performed.Results: the specimens pathological examination revealed the presence of a ITC in 82 patients (11,1%); the prevalent histotype was the papillary one with a less than 1cm diameter in almost the totality of cases but with nodes metastasis in the 3,6% of cases. Complications were detected in 117 patients with a morbidity rate of 15,8%. Discussion: in our study the ITC prevalence was of 11,1% similar to literature with a higher incidence in patients affected by multinodular than uninodular goiter. No statistical significant differences were found between euthyroid and toxic pathologies. In our series hyperthyroidism doesn’t seem to hold a protective role towards the ITC onset. Conclusions: The ITC incidence is relevant; the prevalent histotype is papillary and nodes metastasis are present even if in a low percentage of cases. Besides, the complications of TT are similar to conservative procedures. The recurrence of goiter and ITC require a second surgical procedure, with a higher risk of complications. So we can claim that the standard surgical treatment of bilateral PBT would be represented by TT

Surgical treatment of splenic hydatidosis: Report of a case

Hydatid disease is a zoonitic infection caused by Echinococcus granulosus and rarely by multilocularis, that affects predominantly liver, to a lesser extent lung and occasionally other organs. This paper discusses a case study conducted at our Institute to evaluate the surgical management of splenic hydatidosis, and to illustrate the utility of a range of new techniques. Splenic involvement alone is a rare event, even in endemic countries; many patients have no symptoms and its diagnosis can be either made fortuitously during diagnostic procedures such as chest or abdomen X-ray, or based on the appearance of those local symptoms caused by the pressure of growing cyst. The treatment of hydatidosis traditionally consists of surgery, either conservative or radical, along with a perioperative course of antielmintic medications. A number of therapeutic options for splenic localization exist, including conservative treatments such as Percutaneous Aspiration, Injection and Reaspiration (PAIR), cyst enucleation and partial splenectomy; and radical interventions such as total splenectomy. The splenectomy remains today, as it was in the past, the treatment of choice for the radical treatment of the disease under consideration because of its associated rates of low mortality, low relapse and low hemorrhagic complications. The laparoscopic approach has to be reserved for well-selected cases: small cysts without adhesion to others organs

Fibroadenoma of the perianal region: A case report and review of the literature

Ectopic breast tissue (EBT) is defined as glands located outside of the breast. EBT has been thought to arise from a remnant of the embryonic mammary ridge along the milk line from the axilla to the groin, including the anal region. Fibroadenomas of the perianal region are very uncommon, in literature has not been reported a complete review yet. We report a case of a 36-year-old woman presented to the surgical outpatient department with complaints of swelling and growing mass in the anal region. The lesion was completely excised as a day surgery case. histological examination showed a rare case of fibroadenoma. Additionally, a comprehensive review of the literature of the last 39 years was performed, collecting 12 cases of fibroadenomas of the perianal region. The population affected was young, the mean age at presentation was 39 years and no male was reported, 6 patients reported a tender painful mass and after a completely excision no recurrence was reported despite 10 of the 12 publications analyzed did not mentioned the follow-up. in conclusion, if a lesion is discovered along the milk line, the possibility of pathological ectopic breast tissue should always be considered, and excision should be the treatment of choice