An atypical presentation of a multiloculated giant pseudocyst of pancreas

Giant pseudocysts of the pancreas are rare and difficult to manage. Pseudocysts are usually treated by cystogastrostomy but dependent drainage for giant pseudocysts may require alternative methods like cystojejunostomy. We report here a rare case of a multiloculated giant pseudocyst of pancreas which presented atypically with protrusion through the lesser omentum. The pseudocyst protruding through the lesser omentum filled the whole upper abdomen up to umbilical region and displaced the stomach inferiorly. The stomach which is usually displaced anteriorly by pseudocysts was unusually displaced and splayed on the inferior aspect of the pseudocyst. The anterior wall of the fundus and body of the stomach was adherent to the inferior aspect of the pseudocyst. The pseudocyst was managed by draining into the stomach in a different way by performing a cystogastrostomy to the anterior wall of the stomach. Giant pseudocysts are difficult to manage, and good imaging studies are helpful in selecting surgical options for dependent drainage. Cystogastrostomy on the anterior wall of the stomach is a feasible option to drain pseudocysts which are predominantly overlying and adherent to the anterior wall of the stomach.

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A226 INCIDENTAL FINDING OF A LARGE GASTRIC VARIX ASSOCIATED WITH NEONATAL UMBILICAL VEIN CANALIZATION

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwab002.224 ◽

2021 ◽

Vol 4 (Supplement_1) ◽

pp. 261-263

Author(s):

L Tsang ◽

J Abraldes ◽

E Wiebe ◽

G S Sandha ◽

S van Zanten

Keyword(s):

Portal Hypertension ◽

Portal Vein ◽

Portal Vein Thrombosis ◽

Umbilical Vein ◽

Gastroesophageal Junction ◽

Splenic Vein ◽

Gastric Varix ◽

Vein Thrombosis ◽

Inferior Aspect ◽

Upper Abdomen

Abstract Results A 41-year old Asian male, who immigrated to Canada many years ago, and who had previously been successfully treated for Helicobacter pylori infection underwent gastroscopy for investigation of dyspepsia. His gastroscopy was normal except for a large subepithelial abnormality that was noted close to the gastroesophageal junction. Routine gastric biopsies from the antrum and body were normal. Subsequent endoscopic ultrasound revealed flow through the anechoic tortuous lesion and confirmed it was a very large isolated gastric varix type 1. Abdominal CT scan revealed chronic occlusion of the portal vein, splenic vein, and the portal confluence with extensive collateralization in the upper abdomen. There was complete cavernous transformation of the portal vein. Of the numerous varices in the upper abdomen, a very large varix drained into the left renal vein and indented into the posterior wall of the fundus of the stomach which accounted for the endoscopic finding. Multiple mesenteric veins were identified that connected to varices adjacent to the inferior aspect of the pancreas and duodenum. Notably, there was no evidence of cirrhosis or chronic pancreatitis. Liver enzymes, albumin, and INR were normal. Further collateral history revealed that he was hospitalized as a neonate for pneumonia with catheterization of the umbilical vein, which is known to be associated with thrombosis of the portal vein. Conclusions Detection of congenital absence of the portal vein (CAPV) is recognized more often due to advances in diagnostic imaging. Radiologically, the absence of the portal vein in CAPV is distinguished from portal vein thrombosis by the lack of venous collaterals or sequalae of portal hypertension, such as ascites or splenomegaly. A more gradual thrombosis of the portal vein may permit collaterals to develop without acute changes and is not equivalent to portal vein aplasia or agenesis as intrahepatic bile ducts are normal. The gold standard for diagnosis of CAPV is histologic absence of the portal vein in the liver on catheter angiography. CAPV is associated with abnormal embryologic development of the portal vein and frequently presents with complications of portal hypertension or portosystemic encephalopathy or the sequalae of venous shunts, hepatic or cardiac abnormalities found on imaging. Our case is an incidentally discovered absence of the portal venous system due to chronic thrombosis with extensive collateralization and an enlarged gastric varix protruding into the proximal stomach. It is well documented that canalization of the umbilical vein in infancy is associated with portal vein thrombosis, with incidences up to 68%. This case highlights the importance of eliciting a childhood hospitalization history in cases of non-cirrhotic portal hypertension. Funding Agencies None

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Surgical tactics in the treatment of gastrointestinal stromal tumors of the duodenum

Grekov s Bulletin of Surgery ◽

10.24884/0042-4625-2019-178-4-65-68 ◽

2019 ◽

Vol 178 (4) ◽

pp. 65-68

Author(s):

A. Yu. Korolkov ◽

T. O. Nikitina ◽

D. N. Popov ◽

A. O. Tantsev

Keyword(s):

Gastrointestinal Stromal Tumor ◽

Tumor Cells ◽

Clinical Examination ◽

Gastrointestinal Stromal Tumors ◽

Clinical Case ◽

Tumor Resection ◽

Anterior Wall ◽

Stromal Tumors ◽

Surgical Tactics ◽

Upper Abdomen

We present the clinical case of the patient with gastrointestinal stromal tumor of the duodenum (dGIST).The 34-year-old women had complaints of intermittent dull pain located in the upper abdomen. Clinical examination of the abdomen revealed a duodenum tumor. Resection of the anterior wall of the descending part of the duodenum with a tumor was performed. Histopathology reported that the removed neoplasm was represented by GIST of the duodenum. Immunohistochemistry reported that the tumor cells had an expression of DOG 1, Vim, CD117, CD 34.

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Diagnosis and management of secondary lymphedema

Journal of Skin and Sexually Transmitted Diseases ◽

10.25259/jsstd_5_2021 ◽

2021 ◽

Vol 3 ◽

pp. 16-25

Author(s):

Puravoor Jayasree

Keyword(s):

Surgical Treatment ◽

Resonance Imaging ◽

Limb Volume ◽

Imaging Studies ◽

Secondary Lymphedema ◽

Rehabilitation Programs ◽

Surgical Options ◽

Combined Decongestive Therapy ◽

Late Stages

Secondary lymphedema, more common than its primary variant is essentially a clinical diagnosis. Evaluation should include measurement of limb circumference and volume and appropriate staging protocols to determine the severity of the condition. Imaging studies such as magnetic resonance imaging and lymphoscintigraphy are invaluable in ruling out other causes of extremity swelling and for planning surgical treatment. Conservative measures such as combined decongestive therapy are of prime importance in reducing the limb volume and should be continued to maintain the results of surgical treatment. Pharmacotherapy does not have much role in lymphedema. Surgical options which were initially restricted to debulking procedures in chronic late stages are now gaining more relevance with the advent of physiological techniques to prevent further progression of the condition. Detailed counseling regarding the chronic nature of the disease and the need for regular follow-up along with rehabilitation programs will further improve the management of lymphedema.

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Unusual cause of gastric perforation

Journal of Clinical Images and Medical Case Reports ◽

10.52768/2766-7820/1203 ◽

2021 ◽

Vol 2 (3) ◽

Author(s):

Jiri Cyrany ◽

◽

Pavel Sieber ◽

Stanislav Rejchrt ◽

◽

...

Keyword(s):

Epigastric Pain ◽

Gastric Wall ◽

Anterior Wall ◽

Proton Pump Inhibitor Therapy ◽

Microcytic Anemia ◽

Esophageal Injury ◽

Reactive Protein ◽

Polypectomy Snare ◽

Surgery Department ◽

Upper Abdomen

39-year-old woman was admitted to surgery department for epigastric pain, upper abdomen was tender on palpation without signs of peritoneal irritation. Abdominal plain X-ray and ultrasound showed no significant pathology, there were mild microcytic anemia and leukocytosis, serum amylase was normal, initial C-reactive protein 6 mg/l rose to 142 mg/l during 2 days. Gastroscopy revealed tiny foreign body stabbed into the anterior wall of gastric antrum with submucosal edema around (Figure 1). Sharp fragment was released from the gastric wall by a polypectomy snare and extracted with a forceps (partially pulled into the working channel to avoid esophageal injury), outside verified as plastic shard (Figure 2). CT scans showed single air bubble in the subhepatic space, thus verifying transmural perforation (Figure 3,4). Nevertheless, subsequent course was uneventful with antibiotic and proton pump inhibitor therapy. Retrospectively, patient admitted intake of beverage with ice prepared by smashing of frozen plastic bottle 2 days before hospital admission.

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An Endonasal Incision Adds a Second Vector of Manipulation During Percutaneous Reduction of Fractures Involving the Frontonasal Region

Craniomaxillofacial Trauma & Reconstruction ◽

10.1177/1943387520952689 ◽

2020 ◽

pp. 194338752095268

Author(s):

Akshay Govind ◽

Jonathan Jelmini

Keyword(s):

Case Report ◽

Surgical Technique ◽

Frontal Sinus ◽

Relevant Literature ◽

Anterior Wall ◽

Frontal Bone ◽

Percutaneous Reduction ◽

Inferior Aspect ◽

Stab Incision

Study Design: A case report. Objective: To describe a modification of percutaneous reduction of frontal sinus and/or naso-orbito-ethmoid (NOE) fractures, adding an endonasal intercartilaginous incision to provide a second vector of manipulation. Methods: Case report with particular attention paid to surgical technique, followed by a brief review of relevant literature. Results: Technique: A Carroll-Girard screw is used to engage the thickest part of the anterior wall of the frontal bone through a stab incision just superior to the frontonasal junction. An endonasal intercartilaginous incision is then made and a Cottle elevator is introduced to manipulate the fracture from the inferior aspect of the frontonasal junction. The percutaneous screw and the endonasal elevator provide perpendicular vectors for manipulation, thereby improving ability to reduce fractures when percutaneous traction alone is not successful. The technique is described here in a patient with anterior table frontal sinus fractures combined with posteriorly displaced Markowitz type 1 NOE fractures. Conclusion: While percutaneous reduction of frontal sinus fractures has been previously described, this report adds a subtle but important modification both in indication and technique for optimizing reduction while maintaining surgical simplicity and minimizing morbidity.

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Angiographic computed tomography with selective microcatheterization in delineating surgical anatomy in the case of a dural arteriovenous fistula

Journal of Neurosurgery ◽

10.3171/2008.11.jns08982 ◽

2009 ◽

Vol 111 (5) ◽

pp. 916-918 ◽

Cited By ~ 6

Author(s):

Muneer Eesa ◽

Pranshu Sharma ◽

Alim Pyarali Mitha ◽

Garnette Roy Sutherland ◽

Mayank Goyal

Keyword(s):

Cerebrovascular Diseases ◽

Surgical Anatomy ◽

Cone Beam ◽

Imaging Studies ◽

Arteriovenous Fistulas ◽

Inferior Aspect ◽

Angiography Suite ◽

Dural Arteriovenous Fistulas ◽

Temporal Bone Imaging ◽

Petrous Temporal Bone

Intracranial dural arteriovenous fistulas (dAVFs) are commonly encountered in centers specializing in cerebrovascular diseases. Knowing the precise site of fistulous communication with the venous structures is essential in targeting the appropriate surgical or endovascular therapy once a decision to treat has been made. Such sites can usually be located with digital subtraction angiography alone. The authors describe a case in which localization was best performed using cone-beam volume CT in the angiography suite after selective microcatheterization of the feeding vessel and injection of a contrast agent in a dAVF related to the petrous temporal bone. Imaging studies showed the lesion was related to the inferior aspect of the tentorium, warranting a suboccipital surgical approach to treat the fistula.

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Pituitary Abscess: Two Case Reports and Review of the Literature

Surgical Case Reports ◽

10.31487/j.scr.2021.02.03 ◽

2021 ◽

pp. 1-7

Author(s):

Yanire Sánchez Medina ◽

J. Domínguez ◽

J. Artazkoz ◽

M. Boronat

Keyword(s):

Transsphenoidal Surgery ◽

Case Reports ◽

Clinical Manifestations ◽

Mass Effect ◽

Review Of The Literature ◽

Imaging Studies ◽

Pituitary Abscess ◽

Sellar Lesions ◽

Therapeutic Decisions ◽

Surgical Options

Pituitary abscesses are infrequent entities, often forgotten and hence rarely included in the differential diagnosis of sellar lesions. However, given that they share the clinical manifestations of other more common pathologies in this region, the treatment of pituitary abscesses is usually performed correctly without demonstrating a relevant delay in therapeutic decisions when surgical options are considered as the alternative of choice. Two patients with intrasellar expansive processes and endocrinological alterations who were diagnosed intraoperatively as having pituitary abscesses are presented. In both cases, transsphenoidal surgery was performed; adjuvant antibiotic treatment was established for just one of them. Both patients are currently without symptoms due to mass-effect; one of the patients continues exhibiting residual endocrinological alteration and no signs of relapse in imaging studies.

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Characterization of Efficacy and Animal Safety across Four Caprine Disbudding Methodologies

Animals ◽

10.3390/ani11020430 ◽

2021 ◽

Vol 11 (2) ◽

pp. 430

Author(s):

Kelly M. Still Brooks ◽

Melissa N. Hempstead ◽

Jessica L. Anderson ◽

Rebecca L. Parsons ◽

Mhairi A. Sutherland ◽

...

Keyword(s):

Alternative Methods ◽

Clove Oil ◽

Tissue Necrosis ◽

Short Term ◽

Skull Defects ◽

Feasible Option ◽

Animal Safety ◽

Oil Injection

There is a strong industry demand for technically simple and highly efficacious alternatives to heat cautery disbudding in goat kids that can be performed as a stand-alone procedure without adjunct anesthesia, and that result in improved overall welfare through reduced acute pain, reduced tissues healing interval, and a consistent safety record. The objective of this study was to consider the net effect of disbudding techniques on goat welfare by examining vocalization frequency, long-term efficacy and animal safety associated with four alternative caprine disbudding methods against sham-disbudded and heat-cautery controls. Sixty-five commercial male dairy kids were disbudded at 3–10 days of age with one of six disbudding treatments (clove oil injection, caustic paste, two cryosurgical methods, heat-cautery, and sham procedure). Heat cautery was 91% effective, caustic paste was 55% effective, and the other treatments were ineffective. Heat cautery and sham procedures resulted in similar vocalization efforts; freezing with a liquid-nitrogen cooled iron resulted in significantly greater vocalization numbers. No unintended paste transfer injuries were observed with short-term application of the caustic paste. Heat cautery resulted in numerous superficial infections but no permanent injury. Clove oil injection was associated with several unexpected and severe complications including unintended tissue necrosis, temporary paresis, skull defects, meningitis, and death. Collectively, we did not find that any of the alternative methods of disbudding provided a feasible option over heat cautery to improve welfare.

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Intraoperative diagnosis of an anterior sacral meningocele mimicking a giant ovarian cyst in an adult

Vojnosanitetski pregled ◽

10.2298/vsp160508364s ◽

2018 ◽

Vol 75 (8) ◽

pp. 832-835

Author(s):

Hakan Simsek

Keyword(s):

Ovarian Cyst ◽

Rare Condition ◽

Knee Extension ◽

Anterior Wall ◽

Screening Tools ◽

Pelvic Cavity ◽

Resonance Imaging ◽

Imaging Studies ◽

Dural Sac ◽

Anterior Sacral Meningocele

Introduction. Anterior sacral meningocele (ASM) is a very rare condition that is the herniation of the meningeal sac into the pelvic cavity through a developmental bone defect of the anterior wall of the sacrum. Most of the ASM are diagnosed in childhood but the reported cases that are diagnosed in adults exhibit a gamut of complications. Case report. We presented a case of ASM excision that was misdiagnosed as a giant ovarian cyst. A 28-year-old woman was admitted to the General Surgery Clinic and than to the Gynecology Department with suspect of ovarian cyst depending on ultrasonography (US) scans solely. Adnexial torsion was suspected and surgery to remove the cyst and adnexial exploration was planned. When the lesion was found out to be ASM, neurosurgery team tied the neck and excised the whole meningocele. Histopathologic evaluations confirmed dural sac. Neurological examinations right after the operation revealed 20% weakness in knee extension. It totally recovered in 6 months time. Her MR imaging studies and computed tomography (CT) scans revealed multiple ASM sacs and defects of the anterior wall of the sacrum. Conclusion. This case emphasizes the importance of utilizing available screening tools including CT andmagnetic resonance imaging (MRI) studies as the gold standard in addition to US scans in the preoperative period in order to accurately evaluate and characterize any pelvic lesion.

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