Management of Sigmoid Volvulus Avoiding Sigmoid Resection

Acute sigmoid volvulus is typically caused by an excessively mobile and redundant segment of colon with a stretched mesenteric pedicle. When this segment twists on its pedicle, the result can be obstruction, ischemia and perforation. A healthy, 18-year-old Caucasian woman presented to the emergency department complaining of cramping abdominal pain, distention, constipation and obstipation for the last 72 h, accompanied by nausea, vomiting and abdominal tenderness. The patient had tympanitic percussion tones and no bowel sounds. She was diagnosed with acute sigmoid volvulus. Although urgent resective surgery seems to be the appropriate treatment for those who present with acute abdominal pain, intestinal perforation or ischemic necrosis of the intestinal mucosa, the first therapeutic choice for clinically stable patients in good general condition is considered, by many institutions, to be endoscopic decompression. Controversy exists on the decision of the time, the type of definitive treatment, the strategy and the most appropriate surgical technique, especially for teenagers for whom sigmoid resection can be avoided

Rectal endometriosis causing colonic obstruction and concurrent endometriosis of the appendix: a case report

Abstract Introduction Endometriosis is a clinical entity which presents with functioning endometrial tissue at sites outside the uterus. Bowel endometriosis is usually asymptomatic, but it may show non-specific symptoms. The presence and/or association of appendiceal endometriosis, concomitant with rectal endometriosis, is possible. Case presentation A 36-year-old Greek woman was admitted to the emergency room of our hospital with signs of acute abdomen. On physical examination, our patient had a painful distended abdomen. Digital examination revealed an empty rectum and bowel obstruction was diagnosed. Our patient underwent exploratory laparotomy and rectum stenosis (almost complete obstruction) was observed. The bowel stenosis was resected, and temporary colostomy and appendectomy were performed. The pathology report showed endometriosis of the colon and the appendix, and our patient received medical treatment for endometriosis. Six months after this operation our patient had another surgery for restoration of large bowel continuity. No endometriosis was found. Our patient was doing well at the one-year follow up. Conclusion Endometriosis of the bowel is a disease that may cause large bowel obstruction. In women of reproductive age, the surgeon should consider endometriosis as a differential diagnosis in case of various gastrointestinal symptoms.</p

Gastrointestinal stromal tumor mesenchymal neoplasms: the offspring that choose the wrong path

Nikolaos Machairiotis,1 Ioanna Kougioumtzi,1 Paul Zarogoulidis,2 Aikaterini Stylianaki,1 Konstantinos Tsimogiannis,3 Nikolaos Katsikogiannis11Surgery Department (National Health System), University General Hospital of Alexandroupolis, Alexandroupolis, 2Pulmonary Department &ndash; Oncology Unit, &ldquo;G Papanikolaou&rdquo; General Hospital, Aristotle University of Thessaloniki, Thessaloniki, 3Department of Surgery, G Hatzikosta General Hospital of Ioannina, Ioannina, GreeceAbstract: Gastrointestinal stromal tumors (GISTs) are relatively rare neoplasms of the gastrointestinal tract originating from the pluripotential mesenchymal stem cells, which differentiate into interstitial Cajal cells. They are usually located in the upper gastrointestinal track. These tumors are typically defined by the expression of c-KIT (CD117) and CD34 proteins in the tumor cells. A small percentage of these tumors is negative for c-KIT. The neoplasms are positive for platelet-derived growth factor &alpha; (PDGF&alpha;) mutations. In addition to PDGFR&alpha; mutations, wild-type c-KIT mutations can also be present. The therapeutic approach to locally developed gastrointestinal stromal tumors is surgical resection, either with open or laparoscopic surgery. In case of systemic disease, molecular pharmacologic agents such as imatinib and sunitinib are used for treatment. These agents block the signaling pathways of neoplastic-cell tyrosine kinases, interfering in their proliferation and causing apoptosis.Keywords: GIST, mesenchymal stem cells, cancer pathways, interstitial cells of Cajal, PDGFR&alpha

Abdominal wall endometrioma mimicking an incarcerated hernia: a case report

Christos Simoglou,1 Paul Zarogoulidis,2 Nikolaos Machairiotis,3 Konstantinos Porpodis,2 Lambros Simoglou,4 Alexandros Mitrakas,5 Agisilaos Esebidis,5 Eirini Sarika,6 George Kouklakis,7 Alkis Iordanidis,8 Nikolaos Katsikogiannis31Cardiothoracic Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece; 2Pulmonary Department, &amp;quot;G Papanikolaou&amp;quot; General Hospital, Aristotle University of Thessaloniki, Greece; 3Surgery Department (NHS), University General Hospital of Alexandroupolis, Greece; 4Surgical Clinic (NHS), Komotini General Hospital, Thrace, Greece; 51st University Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece; 6Biopathology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece; 7Gastrointestinal Endoscopy Unit, University General Hospital of Alexandroupolis, Democritus University of Thrace, 8Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, GreeceAbstract: The case of a tender, isolated abdominal wall tumor within a Pfannenstiel incision due to a seeding deposit of endometrial tissue secondary to a previous obstetric operation (caesarean section) in a 39-year-old female without previously reported pelvic endometriosis is presented. The lesion clinically mimicked the appearance of an incarcerated incisional hernia at the outer corner of the healed Pfannenstiel incision. The preoperative differential diagnosis also included that of a locally forming post-operative tender granuloma and the remote possibility of an incisional endometrioma (although no link to menstruation could be made). Local malignancy was not taken as a serious possibility. Definitive diagnosis of the excised lesion was made at histology. The pre-operative diagnostic dilemma is presented, along with a short review of the literature.Keywords: endometrioma, seeding endometriosis, abdominal wall tumo

Pelvic schwannoma in the right parametrium

Nikolaos Machairiotis,4 Paul Zarogoulidis,3 Aikaterini Stylianaki,1 Eleni Karatrasoglou,4 Georgia Sotiropoulou,4 Alvin Floreskou,4 Eleana Chatzi,4 Athanasia Karamani,4 Georgia Liapi,5 Eleni Papakonstantinou,5 Nikolaos Katsikogiannis,1 Nikolaos Courcoutsakis,2 Christodoulos Machairiotis4 1Surgery Department, 2Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece; 3Pulmonary Department, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; 4Obstetric Gynecology Department, 5Pathology Department, Thriasio General Hospital, Athens, Greece Abstract: Neurilemomas are benign usually encapsulated nerve sheath tumors derived from the Schwann cells. These tumors commonly arise from the cranial nerves as acoustic neurinomas but they are extremely rare in the pelvis and the retroperitoneal area (less than 0.5% of reported cases), unless they are combined with von Recklinghausen disease (type 1 neurofibromatosis). We report the case of a 58-year-old female with pelvic schwannoma, 6.5 &amp;times; 5.5 cm in size, in the right parametrium. This is the first case reported in the literature. Based on the rarity of this tumor and in order to ensure optimum treatment and survival for our patient, we performed laparotomy with total abdominal hysterectomy and en-block tumor excision. A frozen section was taken during the surgery before complete resection of the mass, which was ambiguous. Because of the possibility of malignancy, complete excision of the mass was performed, with pelvic blunt dissection. Histological examination showed a benign neoplasm, originating from the cells of peripheral nerve sheaths; diagnosis was a schwannoma. There were degenerative areas, including cystic degeneration, hemorrhagic infiltrations, ischemic foci with pycnotic cells, and collagen replacement. Pelvic schwannomas are rare neoplasms that can be misdiagnosed. Laparoscopy is a safe and efficient option for approaching benign pelvic tumors and might offer the advantage of better visualization of structures due to the magnification in laparoscopic view, especially in narrow anatomic spaces. Keywords: pelvis, schwannoma, laparoscopy, neoplas

A case of typical pulmonary carcinoid tumor treated with bronchoscopic therapy followed by lobectomy

Konstantinos Porpodis1, Michael Karanikas2, Paul Zarogoulidis1, Theodoros Kontakiotis1, Alexandros Mitrakas2, Agisilaos Esebidis2, Maria Konoglou3, Kalliopi Domvri1, Alkis Iordanidis4, Nikolaos Katsikogiannis5, Nikolaos Courcoutsakis4, Konstantinos Zarogoulidis11Pulmonary Department, &amp;quot;G Papanikolaou&amp;quot; General Hospital, Aristotle University of Thessaloniki, Greece; 21st University Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece; 31st Pulmonary Department, &amp;quot;G Papanikolaou&amp;quot; General Hospital, Thessaloniki, Greece; 4Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece; 5Surgery Department (NHS), University General Hospital of Alexandroupolis, GreeceAbstract: Carcinoid bronchopulmonary tumors represent approximately 25% of all carcinoid tumors and 1%&amp;ndash;2% of all lung neoplasms. The most common symptoms are: persistent cough, asthma-like wheezing, chest pain, dyspnea, hemoptysis and obstructive pneumonitis. We present a case of a young adult diagnosed with a typical carcinoid tumor. The diagnosis was established on the basis of imaging examination and bronchoscopic biopsy. The patient was treated with bronchoscopic electrocautery therapy to relieve the obstructed airway, followed by surgical lobectomy in order to entirely remove the exophytic damage. This approach was not only a palliative management to bronchial obstruction but also avoided pneumonectomy. Recent studies support the use of such interventional resection methods, as they may result in a more conservative surgical resection.Keywords: carcinoid tumor, typical lung carcinoid, therapeutic bronchoscopy, surgical resectio

Occupational chemical burns: a 2-year experience in the emergency department

Panagiotis Touzopoulos1, Paul Zarogoulidis2, Alexandros Mitrakas1, Michael Karanikas1, Panagiotis Milothridis1, Dimitrios Matthaios1, Ioannis Kouroumichakis3, Stella Proikaki3, Paschalis Pavlioglou3, Nikolaos Katsikogiannis4, Theodoros C Constantinidis511st University Surgical Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, 2Pulmonary Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, 32nd Internal Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, 4Surgical Department (NHS), University General Hospital of Alexandroupolis, 5Medical School, Laboratory of Hygiene and Environmental Protection, Democritus University of Thrace, Regional Laboratory of Public Health (Eastern Macedonia-Thrace), GreeceAbstract: Chemical burn injuries are a result of exposure to acid, alkali, or organic compounds. In this retrospective study, a total of 21 patients suffering occupational chemical burns, came to the emergency room at the University General Hospital of Alexandroupolis, from 2008 to 2010; 76.2% were workers, 19% were farmers, and 4.8% were desk officers. The majority of burns were due to exposure to acid (61.9%). Upper extremities were the most frequently injured area followed by the lower extremities and thorax. None of the patients needed further hospital care, but in the follow-up, four of the patients suffered keloid. Proper surgical treatment at the emergency room decreases the length of hospital stay for patients who suffer chemically induced burns.Keywords: chemical burns, surgical treatment, labor accident

Fat embolism due to bilateral femoral fracture: a case report

Konstantinos Porpodis1, Michael Karanikas2, Paul Zarogoulidis1, Maria Konoglou3, Kalliopi Domvri1, Alexandros Mitrakas2, Panagiotis Boglou4, Stamatia Bakali5, Alkis Iordanidis6, Vasilis Zervas1, Nikolaos Courcoutsakis6, Nikolaos Katsikogiannis7, Konstantinos Zarogoulidis11Pulmonary Department, &amp;ldquo;G Papanikolaou&amp;rdquo; General Hospital, Aristotle University of Thessaloniki, Thessaloniki, 21st Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, 31st Pulmonary Department, &amp;ldquo;G Papanikolaou&amp;rdquo; General Hospital, Thessaloniki, Greece; 4Pulmonary Department, 5Microbiology Department, 6Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece; 7Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, GreeceAbstract: Fat embolism syndrome is usually associated with surgery for large bone fractures. Symptoms usually occur within 36 hours of hospitalization after traumatic injury. We present a case with fat embolism syndrome due to femur fracture. Prompt supportive treatment of the patient&amp;rsquo;s respiratory system and additional pharmaceutical treatment provided the positive clinical outcome. There is no specific therapy for fat embolism syndrome; prevention, early diagnosis, and adequate symptomatic treatment are very important. Most of the studies in the last 20 years have shown that the incidence of fat embolism syndrome is reduced by early stabilization of the fractures and the risk is even further decreased with surgical correction rather than conservative management.Keywords: fat embolism syndrome, trauma, femur fracture, ARD

Williams&amp;ndash;Campbell syndrome: a case report

Maria Konoglou1, Konstantinos Porpodis2, Paul Zarogoulidis2, Nikolaos Loridas1, Nikolaos Katsikogiannis3, Alexandros Mitrakas2, Vasilis Zervas2, Theodoros Kontakiotis2, Despoina Papakosta2, Panagiotis Boglou4, Stamatia Bakali5, Nikolaos Courcoutsakis6, Konstantinos Zarogoulidis21First Pulmonary Clinic, &amp;quot;G. Papanikolaou&amp;quot; General Hospital, Thessaloniki, Greece; 2Pulmonary Department, &amp;quot;G. Papanikolaou&amp;quot; General Hospital, Aristotle University of Thessaloniki, Greece; 3Surgery Department (NHS), University General Hospital of Alexandroupolis, Greece; 4Pulmonary Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece; 5Microbiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece; 6Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, GreeceIntroduction: Williams&amp;ndash;Campbell syndrome, also known as bronchomalacia, is a rare disorder characterized by a deficiency of cartilage in subsegmental bronchi, leading to distal airway collapse and bronchiectasis. There have been few reports about patients affected by saccular bronchiectasis, paracicatricial emphysema, and diminished cartilage. These are all characteristic of Williams&amp;ndash;Campbell syndrome.Case presentation: This report presents a 57-year-old woman with progressive dyspnea, cough, sputum production, and fever. The clinical and laboratory examination revealed that the patient had a respiratory infection due to bronchiectasis caused by Williams&amp;ndash;Campbell syndrome, which was undiagnosed in the patient until then.Conclusion: Although a rare syndrome, when patients&amp;#39; signs and symptoms include recurrent respiratory infections, bronchiectasis, productive cough, and dyspnea, Williams&amp;ndash;Campbell syndrome should be included in the differential diagnosis.Keywords: bronchietasis, Williams&amp;ndash;Campbell syndrome, bronchomalaci