Wandering spleen as a cause of sinistral portal hypertension

Wandering spleen (WS) is a rare entity characterized by laxity of peritoneal ligaments that hold the spleen stationary. It is most commonly diagnosed in children and young women. Clinical presentation ranges from asymptomatic to acute abdomen. A 19-yearold woman came to the emergency department with history of progressive abdominal pain. She also had previous episodes of hematemesis. A computed tomography scan showed an ectopic spleen with a “whirlpool sign.” Laparotomy and splenectomy were performed. WS is characterized by a long vascular pedicle and laxity of peritoneal attachments of the spleen. The etiology is usually congenital. Splenopexy is the main treatment; however, splenectomy is indicated when splenic infarction is present. Despite being rare, this condition may be considered in some cases of abdominal pain. An earlier diagnosis would have allowed us to perform a splenopexy, thus reducing morbidity

Management of pneumatosis cystoides intestinalis with pneumoperitoneum: 5-years systematic review.

SummaryBackground: Pneumatosis Cystoides Intestinalis (PCI) is a rare condition, characterized by gas-filled cysts in the intestinal wall. Rarely, it may also involve other places, such as the mesentery. It is classified as primary and secondary and associated with multiple predisposing factors. Its differential diagnosis is mesenteric ischemia.Methods: We conducted a systematic literature review according to PRISMA statement. PubMed and LILACS databases were searched for articles published between January 2015 and December 2020. The subject headings were "Pneumatosis cystoides intestinalis" and "pneumoperitoneum", "pneumatosis intestinalis" and "pneumoperitoneum" or "mesenteric pneumatosis".Results: 51 articles with 58 patients with PCI and pneumoperitoneum were included. Most patients were male and the average age was 64.9 years. The idiopathic etiology was recorded in 29.31% and the most common predisposing factor were immune dysfunction (28.3%). 24.13% were asymptomatic and the most commons symptoms were abdominal pain (43.1%), nausea and vomiting (41.37%) and abdominal distention (37.93%). Diagnostic surgery was performed in 26 patients (44.8%). Just one patient underwent to surgery with treatment intent.Conclusion: PCI is a benign disease that can be confused with a potentially fatal condition, mesenteric ischemia. Treatment is conservative, with periodic clinical evaluations. Surgical procedure is usually not necessary for the diagnosis or management of PCI.

Outcomes of Emergency Groin Hernia Repair in the Elderly: A Systematic Review

Introduction: The number of surgeries for groin hernia (GH) among the elderly follows the increase in life expectancy of the population. The greater number and severity of comorbidities in this group increases the surgical risk, promoting discussion regarding the indication of elective surgery and the benefits of watchful waiting approach (WWA). The aim of the present study was to evaluate the outcomes of emergency hernia surgery among the elderly population.Materials and methods: A systematic review was performed in Pubmed and Scielo databases for the past early 10 years, until July 2022. The subject was groin hernia in the emergency setting focusing the elderly population. The PRISMA statement was followed and the classification of elderly was based on the World Health Organization’s definition.Results: A total of 1,037 results were returned and we ended with nine original articles with emphasis in groin hernia in the emergency among the elderly population. In these subjects, the complications rate ranged between 21.2% and 28.9% and the mortality rate ranged between 1.2% and 6%. Cardiopulmonary disease, high ASA and Charlson’s scales were associated with greater risk of complications and death.Conclusion: Emergency GH surgery in the elderly population carries an increased risk of complications and mortality. GH surgery is safe or, at least, less harmful when done electively. The risk and benefits of WWA and upfront surgery needs to be assessed and exposed to the patients. Our review sugest that elective surgery should be the option over WWA in this patient population

Retroperitoneal fetus in fetu in a 65-year-old man.

Fetus in fetu (FIF) is a rare congenital anomaly in which a malformed fetus grows within the body of its twin. It was first described in the late 18th century and has an incidence of 1:500,000 live births. The diagnosis is established in infancy or young adults in most cases. The oldest patient reported so far was a 47-year-old patient. We described the case of a 65-year-old patient with FIF, the oldest reported in the literature. Our patient meets all criteria for the diagnosis of FIF, with the presence of a limb in advanced formation inside the lesion. The treatment was surgical excision. FIF must be considered in the differential diagnosis of an abdominal mass, typically recognized in infancy. Symptoms arise from the mass effect and treatment is surgical resection due to the potential for malignancy

Severe hepatopulmonary syndrome with hypoxemia refractory to liver transplant : recovery after 67 days of ECMO support

Hepatopulmonary syndrome (HPS) is a complication of end stage liver disease (ESLD) and is manifested by severe hypoxemia, which usually responds to liver transplantation (LT). As compared to patients undergoing LT for other etiologies, patients with HPS present an increased risk of postoperative morbidity and mortality. There is no effective treatment for patients whose hypoxemia does not respond to LT. This subset of patients is at a highly increased risk of death. There are very few reports on the use of extracorporeal membrane oxygenation (ECMO) in this setting with rapid response. However, there is no prior report of ECMO utilization for longer than 4 weeks. We present the case of a 17 year-old male patient who underwent LT for ESLD secondary to chronic portal vein thrombosis and HPS. He received a liver from a deceased donor and presented with severe HPS after LT, requiring ECMO support for 67 days. The patient was discharged home and is breathing in ambient air. He is currently asymptomatic and has a normal liver function

Management of pneumatosis cystoides intestinalis with pneumoperitoneum: 5-years systematic review.

SummaryBackground: Pneumatosis Cystoides Intestinalis (PCI) is a rare condition, characterized by gas-filled cysts in the intestinal wall. Rarely, it may also involve other places, such as the mesentery. It is classified as primary and secondary and associated with multiple predisposing factors. Its differential diagnosis is mesenteric ischemia.Methods: We conducted a systematic literature review according to PRISMA statement. PubMed and LILACS databases were searched for articles published between January 2015 and December 2020. The subject headings were "Pneumatosis cystoides intestinalis" and "pneumoperitoneum", "pneumatosis intestinalis" and "pneumoperitoneum" or "mesenteric pneumatosis".Results: 51 articles with 58 patients with PCI and pneumoperitoneum were included. Most patients were male and the average age was 64.9 years. The idiopathic etiology was recorded in 29.31% and the most common predisposing factor were immune dysfunction (28.3%). 24.13% were asymptomatic and the most commons symptoms were abdominal pain (43.1%), nausea and vomiting (41.37%) and abdominal distention (37.93%). Diagnostic surgery was performed in 26 patients (44.8%). Just one patient underwent to surgery with treatment intent.Conclusion: PCI is a benign disease that can be confused with a potentially fatal condition, mesenteric ischemia. Treatment is conservative, with periodic clinical evaluations. Surgical procedure is usually not necessary for the diagnosis or management of PCI.

Wandering spleen as a cause of sinistral portal hypertension

Wandering spleen (WS) is a rare entity characterized by laxity of peritoneal ligaments that hold the spleen stationary. It is most commonly diagnosed in children and young women. Clinical presentation ranges from asymptomatic to acute abdomen. A 19-yearold woman came to the emergency department with history of progressive abdominal pain. She also had previous episodes of hematemesis. A computed tomography scan showed an ectopic spleen with a “whirlpool sign.” Laparotomy and splenectomy were performed. WS is characterized by a long vascular pedicle and laxity of peritoneal attachments of the spleen. The etiology is usually congenital. Splenopexy is the main treatment; however, splenectomy is indicated when splenic infarction is present. Despite being rare, this condition may be considered in some cases of abdominal pain. An earlier diagnosis would have allowed us to perform a splenopexy, thus reducing morbidity

Severe Cholestatic Syndrome Secondary to Graves’ Disease

This paper reports a case of severe cholestasis as an atypical manifestation of Graves’ disease. It discusses the pathophysiology, the diagnosis and the investigation of this complication of hyperthyroidism as well as the impact of this finding on the therapeutic options for managing the disease.Keywords: Graves’ disease; hyperthyroidism; cholestasi