The challenging diagnosis and treatment of duodenal diverticulum perforation: a report of two cases

Abstract Background The duodenum is a common site for diverticulum formation. Most of the duodenal diverticula are asymptomatic, incidental findings. Perforation is a rare but potentially lethal complication of duodenal diverticular disease. Surgery remains the mainstay of treatment for perforated duodenal diverticula. In recent years, a few cases were successfully managed either conservatively or with endoscopy. Case presentation We present two cases of female patients treated in our department for duodenal diverticulum perforation. The first case was treated surgically with a diverticulectomy. The second case was managed conservatively with bowel rest and intravenous antibiotics. Both patients had an uncomplicated postoperative course and were discharged home. Conclusions Both surgical and conservative treatments are viable options for a perforated duodenal diverticulum in selected patients. Patients with a contained duodenal diverticular perforation can be managed conservatively at the outset. Possibly, the introduction of a classification system for duodenal diverticulum perforation may help clinicians in making essential therapeutic decisions.

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Q Fever Presented as a Large Retroperitoneal Pseudotumoral Mass

Case Reports in Pathology ◽

10.1155/2017/4076159 ◽

2017 ◽

Vol 2017 ◽

pp. 1-3

Author(s):

Behdokht Nowroozizadeh ◽

Negar Haghighi Mehmandari ◽

Nicolas Gallegos ◽

Mari Perez-Rosendahl ◽

Di Lu

Keyword(s):

Coxiella Burnetii ◽

Bypass Surgery ◽

Q Fever ◽

Acute Infection ◽

Clinical Suspicion ◽

Retroperitoneal Mass ◽

Case Presentation ◽

Postoperative Course ◽

First Case ◽

Histopathologic Findings

Background. Q fever is an infection caused by Coxiella burnetii, an intracellular organism. Acute infection is most often a benign and asymptomatic process; however, some individuals may go on to develop subacute and persistent localized symptomatic Q fever. As such, the clinical and histopathologic findings of Q fever are widely variable and may be missed if clinical suspicion is not high. Case Presentation. Herein we report the first case of C. burnetii infection presenting as an isolated retroperitoneal mass. A 61-year-old male underwent axillary-bifemoral bypass surgery. His postoperative course was complicated by the discovery of a large retroperitoneal mass. Conclusion. Clinical and histopathologic findings of Coxiella burnetii infection are variable and can be deceiving. These are often nonspecific, especially in its persistent localized infectious stages.

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A unique case of a double intra-conal cavernous hemangioma

Egyptian Journal of Neurosurgery ◽

10.1186/s41984-021-00129-7 ◽

2021 ◽

Vol 36 (1) ◽

Author(s):

Simone Ulivieri ◽

Davide Luglietto ◽

Matteo Ulivieri ◽

Antonio Giorgio

Keyword(s):

Vascular Malformations ◽

Adult Population ◽

Lateral Approach ◽

Unique Case ◽

Total Resection ◽

Case Presentation ◽

Postoperative Course ◽

First Case ◽

Cavernous Hemangiomas ◽

Extended Lateral Approach

Abstract Background Cavernous hemangiomas are benign vascular malformations, probably representing the most common intraorbital and intraconal tumors in the adult population. Case presentation We report the case of a 49-year-old female with two intra-conal lesions. We performed a total resection using Ulivieri's extended lateral approach. The postoperative course was uneventful and the patient was discharged three days after surgery. Conclusions To the best of our knowledge, we report here the first case in the literature of a double intra-conal lesion.

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Thoracoscopic Resection of Bilateral Multiple Superior Mediastinal Neurofibromas

10.21203/rs.3.rs-76657/v1 ◽

2020 ◽

Author(s):

Yoko Azuma ◽

Naobumi Tochigi ◽

Atsushi Sano ◽

Takashi Sakai ◽

Satoshi Koezuka ◽

...

Keyword(s):

Thoracoscopic Surgery ◽

Thoracoscopic Resection ◽

Case Presentation ◽

Postoperative Course ◽

Superior Mediastinum ◽

Chest Cavity ◽

Video Assisted ◽

First Case ◽

Video Assisted Thoracoscopic Surgery ◽

Multiple Nodules

Abstract Background: The indications for surgical resection concerning multiple bilateral neurofibromas in the superior mediastinum remain controversial, because vascular injury or development of postoperative Horne syndrome are concerned.Case presentation: A 60-year-old woman presented with multiple nodules in her right neck and bilateral chest cavity tops which indicated neurofibromatosis. The thoracic masses grew slowly over 9 years, and she then underwent a 2-stage resection starting with the left to right side. Bilateral tumors were completely removed via video-assisted thoracic surgery. The patient’s postoperative course was uneventful, without postoperative Horner syndrome. Conclusions: To the best of our knowledge, this is the first case of multiple bilateral superior mediastinal neurofibromas resected from the pulmonary apices via thoracoscopy. We selected a minimally invasive pure video-assisted thoracoscopic surgery approach and enucleated some tumors to avoid nerve injury. This approach may be safe and useful for multiple neurofibromas in patients with neurofibromatosis.

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Endoscopic negative pressure therapy as stand-alone treatment for perforated duodenal diverticulum: presentation of two cases

BMC Gastroenterology ◽

10.1186/s12876-021-02018-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Dörte Wichmann ◽

Kai Tobias Jansen ◽

Flurina Onken ◽

Dietmar Stüker ◽

Emanuel Zerabruck ◽

...

Keyword(s):

Negative Pressure ◽

Treatment Method ◽

Interventional Therapy ◽

Duodenal Diverticulum ◽

Negative Pressure Therapy ◽

Pressure Therapy ◽

Case Presentation ◽

Treatment Start ◽

Duodenal Diverticula ◽

Life Threatening

Abstract Background Endoscopic negative pressure therapy is a novel and successful treatment method for a variety of gastrointestinal leaks. This therapy mode has been frequently described for rectal and esophageal leakages. Duodenal diverticular perforations are rare but life-threatening events. The early diagnosis of duodenal diverticular perforation is often complicated by inconclusive symptoms. This is the first report about endoscopic negative pressure therapy in patients with perforated duodenal diverticula. Case presentation We present two cases of duodenal diverticula perforations treated with endoscopic negative pressure therapy as stand-alone treatment. Start of symptoms varied from one to three days before hospital admission. Early sectional imaging led to the diagnosis of duodenal diverticular perforation. Both patients were treated with endoluminal endoscopic negative pressure therapy with simultaneous feeding option. Three respective changes of the suction device were performed. Both patients were treated with antibiotics and antimycotics during their hospital stay and be discharged from hospital after 20 days. Conclusions This is the first description of successful stand-alone treatment by endoscopic negative pressure therapy in two patients with perforated duodenal diverticulum. We thus strongly recommend to attempt interventional therapy with endoluminal endoscopic negative pressure therapy in patients with duodenal diverticular perforations upfront to surgery.

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Massive Hematochezia from a Large Bleeding Duodenal Diverticulum

Case Reports in Gastrointestinal Medicine ◽

10.1155/2021/5585264 ◽

2021 ◽

Vol 2021 ◽

pp. 1-3

Author(s):

Marcus Juan Esteban ◽

Amit Sureen ◽

Daniel Herlihy ◽

Sherif Elhanafi ◽

Marc J. Zuckerman

Keyword(s):

Duodenal Diverticulum ◽

Common Finding ◽

Upper Endoscopy ◽

Gi Tract ◽

Case Presentation ◽

Epinephrine Injection ◽

Duodenal Diverticula ◽

Life Threatening ◽

Possible Cause ◽

Prompt Diagnosis

Background. Duodenal diverticula are a rare cause of gastrointestinal (GI) bleeding despite being a common finding in the GI tract. We present a case of a patient who had massive hematochezia due to a complex duodenal diverticulum. Case Presentation. A 74-year-old Hispanic female presented initially with generalized weakness. During admission, the patient had an episode of a large amount of hematochezia and had to be transferred to the intensive care unit (ICU). Upper endoscopy was done using a forward-viewing endoscope which revealed a bleeding complex duodenal diverticulum. Successful hemostasis was achieved through epinephrine injection followed by placement of hemostatic clips. Conclusion. Although rare, gastroenterologists need to be aware of duodenal diverticulum as a possible cause of gastrointestinal bleed. It could be life-threatening, and thus, prompt diagnosis and management is necessary.

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Thoracoscopic resection of bilateral multiple superior mediastinal neurofibromas

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01690-w ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Yoko Azuma ◽

Naobumi Tochigi ◽

Atsushi Sano ◽

Takashi Sakai ◽

Akira Iyoda

Keyword(s):

Thoracoscopic Surgery ◽

Thoracoscopic Resection ◽

Case Presentation ◽

Postoperative Course ◽

Superior Mediastinum ◽

Chest Cavity ◽

Video Assisted ◽

First Case ◽

Video Assisted Thoracoscopic Surgery ◽

Multiple Nodules

Abstract Background The indications for surgical resection concerning multiple bilateral neurofibromas in the superior mediastinum remain controversial, because vascular injury or development of postoperative Horne syndrome are concerned. Case presentation A 60-year-old woman presented with multiple nodules in her right neck and bilateral chest cavity tops which indicated neurofibromatosis. The thoracic masses grew slowly over 9 years, and she then underwent a 2-stage resection starting with the left to right side. Bilateral tumors were completely removed via video-assisted thoracic surgery. The patient’s postoperative course was uneventful, without postoperative Horner syndrome. Conclusions To the best of our knowledge, this is the first case of multiple bilateral superior mediastinal neurofibromas resected from the pulmonary apices via thoracoscopy. We selected a minimally invasive pure video-assisted thoracoscopic surgery approach and enucleated some tumors to avoid nerve injury. This approach may be safe and useful for multiple neurofibromas in patients with neurofibromatosis.

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Immediate post partum macular subretinal bleeding in a highly myopic patient: a case report

BMC Ophthalmology ◽

10.1186/s12886-021-01814-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Karen Bitton ◽

J.-L. Bacquet ◽

F. Amoroso ◽

S. Mrejen ◽

M. Paques ◽

...

Keyword(s):

Valsalva Maneuver ◽

Post Partum ◽

Pathologic Myopia ◽

Pathological Myopia ◽

Case Presentation ◽

Sudden Loss ◽

Corrected Visual Acuity ◽

First Case ◽

History Of ◽

Macular Hemorrhage

Abstract Background Pathologic myopia is a major cause of visual impairment and blindness. Case presentation We report a case of an immediate post partum macular subretinal bleeding observed in a highly myopic patient. A 30-years-old woman presented two days after childbirth for sudden loss of vision in her right eye. Multimodal imaging showed macular hemorrhage masking a subtle yellowish linear lesion corresponding to lacker crack. Due to the lack of evidence for choroidal neovascularization, a simple clinical and imaging monitoring was recommended. Six weeks later, we noted an improvement in her best-corrected visual acuity and a decreased in size of the macular hemorrhage. Conclusions This is the first case reporting a macular subretinal bleeding on macular lacquer cracks in a highly myopic patient in immediate post partum. Valsalva maneuver associated with vaginal delivery could explain the occurrence of the hemorrhage associated with lacquer crack. However, natural history of pathological myopia could not be excluded.

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Emphysematous pyelonephritis with air bubble in the inferior vena cava

African Journal of Urology ◽

10.1186/s12301-020-00081-2 ◽

2020 ◽

Vol 26 (1) ◽

Author(s):

Tiffany A. Perkins ◽

Alberic Rogman ◽

Murali K. Ankem

Keyword(s):

Septic Shock ◽

Inferior Vena Cava ◽

Inferior Vena ◽

Vena Cava ◽

Rare Presentation ◽

Emphysematous Pyelonephritis ◽

Case Presentation ◽

Air Bubble ◽

First Case ◽

The Right

Abstract Background Emphysematous pyelonephritis (EPN) with gas in the inferior vena cava (IVC) is a rare presentation and to our knowledge, this is the first case report in the urologic literature. Case presentation A 35-Year-old obese diabetic Hispanic female presented to the emergency room with a clinical picture of septic shock. Prompt computerized tomography scan revealed EPN with gas throughout the right renal parenchyma and extending to the right renal vein, IVC, and pulmonary artery. She died before surgical intervention Conclusion This case demonstrates that patients presenting with severe EPN have a high mortality risk and providers should acknowledge that septic shock, endogenous air emboli, or a combination of both could result in cardiovascular collapse and sudden death.

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Robotic-assisted proximal gastrectomy using the double-flap technique for early gastric cancer with situs inversus totalis: a case report

Surgical Case Reports ◽

10.1186/s40792-021-01262-z ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Atsushi Takeno ◽

Toru Masuzawa ◽

Shinsuke Katsuyama ◽

Kohei Murakami ◽

Kenji Kawai ◽

...

Keyword(s):

Gastric Cancer ◽

Situs Inversus ◽

Autosomal Recessive ◽

Intraoperative Complications ◽

Proximal Gastrectomy ◽

Situs Inversus Totalis ◽

Upper Body ◽

Robot Assisted ◽

Case Presentation ◽

First Case

Abstract Background The robotic system has been applied in the treatment of gastric cancer (GC), and the procedure has been found to be safe and feasible. Situs inversus totalis (SIT) is a relatively rare autosomal recessive congenital anomaly. We successfully performed robot-assisted proximal gastrectomy (RAPG) and handsewn double-flap esophagogastrostomy for GC in a patient with SIT. Case presentation A 71-year-old woman was referred to us with an asymptomatic ulcerative lesion in the upper body of the stomach. Computed tomography revealed that she had SIT. She was diagnosed with cT1bN0M0, cStageIA gastric cancer. RAPG with lymph node dissection and handsewn double-flap esophagogastrostomy was performed. Robotic surgery enabled the surgeon to perform the surgery without changing his position and experiencing any confusion resulting from the patient’s reversed anatomy. It took 448 min, and no intraoperative complications occurred. Her postoperative course was uneventful; she was discharged on postoperative day 10. The final pathologic report showed pT1b1N0M0, pStage IA. Conclusions This is the first case describing RAPG with handsewn double-flap esophagogastrostomy for a SIT patient with early GC.

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Fetal pulmonary choristoma: report of first case and literature review

Case Reports in Perinatal Medicine ◽

10.1515/crpm-2020-0072 ◽

2020 ◽

Vol 9 (1) ◽

Author(s):

Anupam Nanda ◽

Rajinder Nanda ◽

Seema Thakur ◽

Tej Prakash Gupta ◽

Sudhir Jain ◽

...

Keyword(s):

Literature Review ◽

Exome Sequencing ◽

Posterior Fossa ◽

Spinal Column ◽

Fetal Autopsy ◽

Case Presentation ◽

Antenatal Ultrasound ◽

Clinical Exome Sequencing ◽

First Case ◽

Pathologic Findings

AbstractObjectivesLung tissue choristoma is a very rare disorder where mature lung tissues develop in the site not normal to the lung.Case presentationWe hereby report a first case of fetal pulmonary choristoma in a 23–24 weeks fetus where antenatal ultrasound showed a mass in posterior fossa with severe ventriculomegaly. The mass extended inferiorly in cervical spinal column and thereafter extended in the skin over the back of fetus. Fetal autopsy confirmed these findings. Pathologic findings showed mature lung tissues with bronchi, bronchioles, and alveoli. Clinical exome sequencing showed normal results.ConclusionsWe describe the antenatal ultrasound, fetal autopsy and pathologic findings of an intracranial and cutaneous pulmonary choristoma.

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