Gastrointestinal stromal tumour of the duodenum in childhood: a rare case report

<p>Abstract</p> <p>Background</p> <p>Gastrointestinal stromal tumours (GISTs) are uncommon primary mesenchymal tumours of the gastrointestinal tract mostly observed in the adults. Duodenal GISTs are relatively rare in adults and it should be regarded as exceptional in childhood. In young patients duodenal GISTs may be a source of potentially lethal haemorrhage and this adds diagnostic and therapeutic dilemmas to the concern about the long-term outcome.</p> <p>Case presentation</p> <p>A 14-year-old boy was referred to our hospital with severe anaemia due to recurrent episodes of upper gastrointestinal haemorrhage. Endoscopy, small bowel series, scintigraphy and video capsule endoscopy previously done elsewhere were negative. Shortly after the admission, the patient underwent emergency surgery for severe recurrence of the bleeding. At surgery, a 4 cm solid mass arising from the wall of the fourth portion of the duodenum was identified. The invasion and the erosion of the duodenal mucosa was confirmed by intra-operative pushed duodenoscopy. The mass was resected by a full-thickness duodenal wall excision with adequate grossly free margins. Immunohistochemical analysis of the specimen revealed to be positive for CD117 (c-KIT protein) consistent with a diagnosis of GIST. The number of mitoses was < 5/50 HPF. Mutational analysis for c-KIT/PDGFRA tyrosine kinase receptor genes resulted in a wildtype pattern. The patient had an uneventful course and he has remained disease-free during two years of follow-up.</p> <p>Conclusion</p> <p>Duodenal GISTs in children are very rare and may present with massive bleeding. Cure can be achieved by complete surgical resection, but even in the low-aggressive tumours the long-term outcome may be unpredictable.</p

LAPAROSCOPIC MANAGEMENT OF VENTRAL HERNIA IN ACUTE PRESENTATION

Although laparoscopic repair of incisional hernia is a well established practice, little is known about the role of laparoscopy when incisional hernia is complicated by acute bowel obstruction. Based on literature, no evidence for this topic can be drawn. However data from a few case series suggest that this approach does not seem to be associated with increased complication and recurrence rates compared to the same procedure performed electively. Facing emergency hernia repair, the use of minimally invasive surgery is strongly influenced by surgeon’s laparoscopic skill to carefully perform adhesiolysis, to safety reduce the herniated bowel into the peritoneal cavity, and to repair the wall defect in the presence of distended bowel loops. Main critical factors in decision-making process for a laparoscopic approach are: degree of bowel obstruction, intestinal viability, size and location of hernia defect and defect/hernia sac ratio. Keeping an uncontaminated abdomen is the key for a laparoscopic mesh repair and a successful outcome. Herein we present our experience about the laparoscopic management of incarcerated ventral hernia by highlighting tips and tricks to safety and effectively perform this top-challenging approach

Laparoscopic resection of multiple aneurysms of the gastroepiploic arterial arcade

Gastroepiploic arterial aneurysms (GEAA) represent a very rare disorder [1, 2]. The risk of GEAA rupture is high, and it is associated with a high mortality rate [3]. GEAAs are usually identified following rupture or are incidentally diagnosed. In emergency, an open surgical approach to treat GEAAs has been most frequently reported [4]. Alternatively, if the patient is hemodynamically stable, an angiography and embolization can be attempted. Herein we report the case of a patient presenting with two fissurated GEAAs that were successfully excised laparoscopically after failure of the endovascular approach

Acute appendicitis complicating De Garengeot's hernia treated with combined laparoscopic-open technique: a case series and literature review

An acute appendicitis in the context of a De Garengeot's hernia is a very rare event and represents a hard challenge for surgeons. As only few cases have been reported in literature, there is no consensus about its optimal surgical strategy of treatment. Here we present two consecutive cases of female patients presenting an uncommon acute appendicitis in a femoral hernia treated with a combined laparoscopic/open technique

Acute abdomen caused by greater omentum torsion: A case report and review of the literature. Omentum majus torsiyonunun neden olduğu akut batın: Olgu raporu ve literatürün gözden geçirilmesi

Torsion of the greater omentum is a rare cause of acute abdomen. Based on etiopathogenesis, it can be classified as primary or secondary. However, regardless of the cause, segmentary or diffuse omental necrosis will follow. Preoperative diagnosis is not easy, though abdominal ultrasound and computed tomography (CT) scans may show peculiar features suggestive of omental torsion. Laparoscopic resection of the affected omentum is the treatment of choice. Presently reported was a case of primary omental torsion, in addition to a comprehensive literature review

Leiomyosarcoma of the right ovarian vein

The case of a 70-year-old patient with a leiomyosarcoma of the right ovarian vein is presented. For this rare entity, complete surgical excision is believed to offer the best chance of cur

A case of severe blunt traumatic injury of the pancreas

abstract not availabl

An unusual case of repeated splenectomy: traumatic rupture of an accessory spleen in a previously splenectomized patient

The traumatic rupture of an accessory spleen is a very rare condition and only few cases have been reported in the literature. We describe the case of a 51-year-old man undergone splenectomy for trauma several years before, who developed hemoperitoneum due to a laceration of a voluminous accessory spleen, following an accidental two-meter fall. As a conservative management of the injury was not possible, an accessory splenectomy was then required. Thus, a briefly review of the literature about this uncommon topic was perfomed