COMPLETE THORACIC ESOPHAGUS OBLITERATION: CLINICAL CASE REPORT

Using the example of a clinical case, to present the management features of a patient with complete esophageal obliteration as a chemical burn result, the surgical intervention features in case of a non-standard situation during the operation, and the treatment results analyze. It was described a clinical case of 41-year-old patient with thoracic esophagus obliteration due to extended post-burn cicatricial esophageal stricture, dysphagia of IV degree in very severe general condition. Stamm-Senn-Kader’s gastrostomy was performed as a first step of surgical treatment. Angiography and embolization of the right colic artery and it’s branches was performed in 8 months while preserving the middle colic artery. In 20 days the cologastroanastomosis and feeding colostomy on the right chest wall were performed. In 10 days after the colostomy was disattached from the chest wall, the end-to-side esophagocoloanastomosis was performed intrapleurally. In one month after the third surgery and restoration of the food passage by the natural way, closure of the contact gastrostomy was performed. During the observation over the patient (8 years) the postoperative complications were not observed. The patient survived. The proposed staged surgical treatment tactics of patients with complete esophageal obliteration due to post-burn esophageal stricture, dysphagia of IV degree presents effective treatment results and a significant improvement in the patient’s life quality.

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Surgical treatment of Lhermitte–Duclos disease (dysplastic gangliocytoma of the cerebellum)

Russian journal of neurosurgery ◽

10.17650/1683-3295-2020-22-1-77-82 ◽

2020 ◽

Vol 22 (1) ◽

pp. 77-82

Author(s):

A. A. Bimurzin ◽

A. V. Kalinovsky

Keyword(s):

Surgical Treatment ◽

Clinical Case ◽

Right Hemisphere ◽

Surgical Removal ◽

Study Objective ◽

Dysplastic Gangliocytoma ◽

Satisfactory Condition ◽

Suboccipital Craniotomy ◽

Intact Brain ◽

The Right

The study objective is to describe a clinical case of a rare disorder of the cerebellum, Lhermitte–Duclos disease.Clinical case. The Federal Neurosurgical Center (Novosibirsk) admitted a male patient, 40 years old. Medical history showed that in 2017 he underwent ventriculoperitoneal shunt due to hypertensive hydrocephalus syndrome caused by space-occupying mass of the right hemisphere of the cerebellum. In June of 2017, the patient was consulted by a neurosurgeon. Later, an increase in the mass, partial atrophy of the optic disks were observed. Due to the patient’s complaints of headache, ataxia, vertigo, as well as insufficient effect of the shunt, microsurgical removal of the space-occupying mass in the cerebellum by right paramedian suboccipital craniotomy was performed. Gangliocytoma removal was performed under constant neurophysiological control which allowed to fully resect the gangliocytoma inside intact brain tissue. Histological and immunohistological examinations allowed to diagnose grade I dysplastic gangliocytoma of the cerebellum (Lhermitte–Duclos disease). In the postoperative period, brain symptoms regressed fully, vestibulocerebellar syndrome persisted. The patient was discharged in satisfactory condition. No negative dynamics were observed in 7 months of follow-up.Conclusion. Due to the rareness of Lhermitte–Duclos disease, currently there are no established approaches to treatment, however, in symptomatic course there are indications for surgical removal of the gangliocytoma. Radicality of resection should be correlated with the risk of neurological defects. In our case, surgical treatment allowed to improve the patient’s condition, prevent further progression of the gangliocytoma and obtain an accurate histological diagnosis.

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The right colic artery: An anatomical demonstration and its relevance in the laparoscopic era

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2016.0257 ◽

2016 ◽

Vol 98 (8) ◽

pp. 560-563 ◽

Cited By ~ 5

Author(s):

M Haywood ◽

C Molyneux ◽

V Mahadevan ◽

J Lloyd ◽

N Srinivasaiah

Keyword(s):

Complete Mesocolic Excision ◽

Middle Colic Artery ◽

Colic Artery ◽

Right Colon ◽

Early Evidence ◽

Mesocolic Excision ◽

Tissue Act ◽

Human Tissue Act ◽

The Right ◽

Laparoscopic Techniques

INTRODUCTION Hemicolectomies are not tailored in right-sided colon cancer resections, despite significant variation in the incidence and origin of the right colic artery (RCA). Early evidence suggests that removal of the relevant lymphovascular package and associated cancer as part of complete mesocolic excision (CME), rather than the entire right colon, may produce better outcomes. Advancing laparoscopic techniques are making this possible, and so it is increasingly important to more precisely define the anatomy of the RCA. METHODS To demonstrate the incidence and variation of the RCA, 25 formalin embalmed cadavers were dissected. Consent to dissection and photography was obtained under Human Tissue Act regulations. RESULTS Eleven female and 14 male cadavers (mean age 79.7 years, range 41–95 years) were included. The RCA originated from the right branch of the middle colic artery in nine cadavers (36%), while it arose from the superior mesenteric artery in eight cases (32%) and from the ileocolic or root of the middle colic artery in a smaller number of specimens. The RCA was absent in two individuals. CONCLUSIONS The RCA arises from the right branch of the middle colic artery in a considerable number of cases. The literature to date does not reflect the precision of anatomical understanding required for CME; hence, a new definition for the right colic vessel is proposed.

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Renal Cancer with Tumor Thrombus of the Inferior Vena Cava and the Right Atrium

Vestnik of Experimental and Clinical Surgery ◽

10.18499/2070-478x-2020-13-3-214-226 ◽

2020 ◽

Vol 13 (3) ◽

pp. 214-226

Author(s):

Yulia Aleksandrovna Stepanova ◽

Aleksandr Anatolevich Gritskevch ◽

Amiran Shotaevich Revishvili ◽

Madina Valerevna Kadirova ◽

Egor Sergeyevich Malyshenko ◽

...

Keyword(s):

Surgical Treatment ◽

Inferior Vena Cava ◽

Kidney Cancer ◽

Right Atrium ◽

Tumor Thrombus ◽

Clinical Case ◽

Inferior Vena ◽

Vena Cava ◽

Radical Treatment ◽

The Right

ntroduction. A distinctive feature of kidney cancer is a frequent, compared with other tumors, spread of the tumor through the venous collectors (in the renal and inferior vena cava up to the right atrium), along the path of least resistance to invasive growth.The aim of the study was to present a clinical case of radical treatment of kidney cancer involving extensive IVC thrombosis.Materials and methods. The study describes a clinical case of radical treatment of patient M. with kidney cancer involving extensive IVC thrombosis, extending to the right atrium (written informed consent for patient information and images to be published was obtained prior to the study). During preoperative examination, the patient was diagnosed with renal cell carcinoma with non-occlusive hypervascular tumor thrombus of the renal vein, the inferior vena cava and the right atrium based on the findings of ultrasound examination (transabdominal and transthoracic, and transesophageal), multislice computed tomography (MSCT) and magnetic resonance imaging (MRI).Results and discussion. Surgical treatment remains the main method of treatment of renal cell cancer, moreover, the inferior vena cava thrombosis cannot serve as a cause for refusing surgical treatment. The thrombus spreading along the venous collectors is an important factor in determining the tactics of surgical treatment. The length of the tumor thrombus, as well as the degree of its fixation and ingrowth into the vein wall is of great significance for planning surgical techniques and predicting clinical outcomes. Based on various methods of radiological examination, patient M. was diagnosed with cancer of the right kidney, 3 stage T3cNxM0, IVC tumor thrombus, paraneoplastic syndrome (hyperthermia), right-sided nephrectomy with aortocaval lymphadenectomy, thrombectomy from the IVC, vascular isolation of the liver, resection of the IVC, thrombectomy from the right atrium combined with cardiopulmonary bypass.Conclusion. Despite the technical complexity of nephrectomy with thrombectomy from the IVC, especially in the presence of a massive supradiaphragmatic thrombus, these interventions have no alternatives if a radical treatment is to be achieved. Step-by-step support using radiological methods of investigation is an important aspect of patients preparation; this allowing determining the exact volume of the damage and non-invasively assessing clinical outcomes of surgical treatment.

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A clinical case of surgical treatment of a knife-penetrated wound of the right atrium and the aortic root 2 years after the injury

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2021-2-80-86 ◽

2021 ◽

Vol 25 (2) ◽

pp. 80

Author(s):

K. A. Petlin ◽

E. A. Kosovskikh ◽

B. N. Kozlov ◽

V. A. Tomilin

Keyword(s):

Surgical Treatment ◽

Coronary Sinus ◽

Conflict Of Interest ◽

Right Atrium ◽

Clinical Case ◽

Surgical Care ◽

Right Atrial ◽

Stab Wounds ◽

Pseudo Aneurysm ◽

The Right

Chest injury is an acute, extremely life-threatening condition. Among penetrating heart wounds, approximately 85% are stab wounds. In the case of stab and cut injuries, the lethality, according to various sources, reaches 90% and directly depends on the time of delivery of the victim to the hospital. In the overwhelming majority of cases, emergency operations for stab wounds of the chest are conducted in general surgical hospitals. As a rule, when providing emergency surgical care, only superficial heart wounds are sutured, excluding the correction of damage to the intra-cardiac structures. Aorto-right atrial fistula is a rather rare clinical condition that is formed due to the action of a traumatic factor and is characterised by the formation of a communication between the aorta and the right atrium with the discharge of arterial blood into the venous system. Considering that this pathology is accompanied by an increase in pressure in the right atrium, signs of stagnation are found in the systemic circulation, followed by compensatory dilatation of the right atrium and then dilatation of the right ventricle. The only effective method to treat this problem is surgery. The presented clinical case demonstrates the surgical treatment of chronic post-traumatic aorto-right atrial fistula, pseudo-aneurysm between the non-coronary sinus and the right atrium and pseudo-aneurysm of the left coronary sinus 2 years after the stab wound. Echocardiography performed after surgery indicated a positive trend, i.e., a decrease in the size of the right- and left-sided heart and normalisation of pressure in the pulmonary artery. No inter-chamber shunts were found. This case shows that clinicians must remember that after providing emergency surgical care to patients with penetrating chest wounds, it is necessary to conduct an additional examination of the heart after stabilisation of the condition to detect hidden damage to the intra-cardiac structures.Received 2 February 2021. Revised 2 March 2021. Accepted 3 March 2021.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.

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Surgical treatment of ruptured right middle cerebral artery mycotic aneurysm and central nervous system aspergillosis: Clinical case and literature review

Surgical Neurology International ◽

10.25259/sni_843_2021 ◽

2021 ◽

Vol 12 ◽

pp. 555

Author(s):

Anton Konovalov ◽

Oleg Sharipov ◽

Oleg Shekhtman ◽

Vadim Gadzhiagaev ◽

Pavel Kalinin

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Surgical Treatment ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Immune Suppression ◽

Mycotic Aneurysm ◽

Clinical Case ◽

High Rate ◽

The Right

Background: Central nervous system (CNS) aspergillosis is more often met in patients with expressed immune suppression. Still, in 50% of cases of meningitis caused by Aspergillus spp., it is observed in patients without expressed immune suppression. The prognosis of CNS aspergillosis is unfavorable with the general rate of lethality around 70%. Case Description: Clinical case of a 58-year-old man who developed an Aspergillus abscess in the chiasmosellar region and an associated mycotic aneurysm of the right middle cerebral artery (MCA) and intracerebral hemorrhage. Microsurgical clipping of the fusiform-ectatic aneurysm of the right MCA in the conditions of rupture was performed. An extra-intracranial micro anastomosis was formed on the right. An open biopsy of the neoplasm in the chiasmosellar region was made. The neoplasm was yellow and destroyed the bone plate of the skull base. Biopsy results: Mycotic lesion (aspergillosis). The analysis of surgical treatment for mycotic aneurysms in the acute period of hemorrhage in patients with aspergillosis revealed a high rate of lethality. The issue of the feasibility and effectiveness of complicated revascularization interventions in the patients with hemorrhage and aspergillosis remains unsolved. Conclusion: The lack of generally accepted tactics of the treatment of this pathology requires further studies and systemic analysis. A high risk of the lethal outcome in patients with invasive mycotic infection and rupture of mycotic aneurysm highlight the importance of timely diagnostics and the beginning of antimycotic therapy. WThe issue of the evaluation of the revascularization methods effectiveness in patients after surgical treatment of a mycotic aneurysm associated with cerebral aspergillosis remains poor.

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Three-Dimensional Vascular Anatomy Relevant to Oncologic Resection of Right Colon Cancer

International Surgery ◽

10.9738/cc20.1 ◽

2011 ◽

Vol 96 (4) ◽

pp. 300-304 ◽

Cited By ~ 16

Author(s):

Yusuke Tajima ◽

Hideyuki Ishida ◽

Tomonori Ohsawa ◽

Kensuke Kumamoto ◽

Keiichiro Ishibashi ◽

...

Keyword(s):

Colon Cancer ◽

Three Dimensional ◽

Vascular Anatomy ◽

Middle Colic Artery ◽

Common Trunk ◽

Colic Artery ◽

Right Colon ◽

Right Colon Cancer ◽

Oncologic Resection ◽

The Right

Abstract We analyzed data on the three-dimensional vascular anatomy of the right colon from the operative documents of 215 patients undergoing oncologic resection for right colon cancer. The right colic artery (RCA) was absent in 146 patients (67.9%), with the ileocolic artery (ICA) crossing the superior mesenteric vein (SMV) ventrally in 78 patients (36.3%). When the RCA was present, both the ICA and the RCA crossed the SMV ventrally in 44 patients (20.5%), dorsally in 10 patients (4.7%), the RCA crossed the SMV ventrally and the ICA dorsally in 10 patients (4.7%), and the RCA crossed the SMV dorsally and the ICA ventrally in 5 patients (2.2%). The arterial branches toward the hepatic flexure crossed the SMV ventrally in 151 eligible cases: the branch originated from the common trunk of the middle colic artery in 97 patients (64.2%) and 1 and 2 arteries directly originated from the SMA in 49 patients (32.5%) and in 5 patients (3.3%), respectively. These data would be useful to safely perform lymph node dissection around the SMV.

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Transcatheter Embolization for Treatment of Acute Lower Gastrointestinal Bleeding

Acta Radiologica ◽

10.1177/028418518702800411 ◽

1987 ◽

Vol 28 (4) ◽

pp. 425-430 ◽

Cited By ~ 16

Author(s):

R. Uflacker

Keyword(s):

Gastrointestinal Bleeding ◽

Transcatheter Embolization ◽

Lower Gastrointestinal Bleeding ◽

Mesenteric Arteries ◽

Middle Colic Artery ◽

Colic Artery ◽

Selective Embolization ◽

Diverticular Hemorrhage ◽

Carcinoma Of The Bladder ◽

The Right

Treatment of lower gastrointestinal bleeding was attempted in 13 patients by selective embolization of branches of the mesenteric arteries with Gelfoam. Bleeding was adequately controlled in 11 patients with active bleeding during the examination. One patient improved after embolization but bleeding recurred within 24 hours and in another patient the catheterization was unsuccessful. Five patients with diverticular hemorrhage were embolized in the right colic artery four times, and once in the middle colic artery. Three patients had embolization of the ileocolic artery because of hemorrhage from cecal angiodysplasia, post appendectomy, and leukemia infiltration. Three patients had the superior hemorrhoidal artery embolized because of bleeding from unspecific proctitis, infiltration of the rectum from a carcinoma of the bladder, and transendoscopic polypectomy. One patient was septic and bled from jejunal ulcers. Ischemic changes with infarction of the large bowel developed in two patients and were treated by partial semi-elective colectomy, three and four days after embolization. Four other patients developed pain and fever after embolization. Transcatheter embolization of branches of mesenteric arteries is an effective way to control acute lower gastrointestinal bleeding, but still has a significant rate of complications that must be seriously weighed against the advantages of operation.

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Clinical case of congenital abnormality of the iris floccula eye vasculature

Modern technologies in ophtalmology ◽

10.25276/2312-4911-2021-2-177-179 ◽

2021 ◽

pp. 177-179

Author(s):

L.A. Kantyukova ◽

◽

G.R. Altynbaeva ◽

Keyword(s):

Visual Acuity ◽

Surgical Treatment ◽

Congenital Abnormality ◽

Clinical Case ◽

Vision Loss ◽

Risk Area ◽

High Risk Area ◽

Vascular Abnormalities ◽

Optical Zone ◽

The Right

Purpose. Description of a clinical case of an iris floccule in a girl of 17 years old. Material and methods. 17-year-old patient who complained about a decrease in vision of the right eye and a change in the shape of the pupil. she was examined by visimetry, biomicroscopy, tonometry, ophthalmoscopy. 3 years ago she was consulted at the ophthalmology center, where there was revealed lysoriness and changes in the eyes. No surgical or laser treatment has been proposed. Changes in the area of pupil's parents noticed in early childhood, in the last 3 years the changes increased. Result. The patient was assigned midriatics, to open the optical zone and improve visual acuity, recommended consultation to resolve the issue of surgical or laser removal of brush-shaped floccules to eliminate obscuration and prevent amblyopia. Conclusion. Clinical case indicates that timely surgical treatment is necessary to achieve results. Treatment should be carried out as soon as possible, since vision loss is a high-risk area for the development of obscurative amblyopia. Key words: iris flocculi, vascular abnormalities.

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Carotid chemodectoma in the otorhinolaryngological practice: a clinical case

Kuban Scientific Medical Bulletin ◽

10.25207/1608-6228-2020-27-2-135-143 ◽

2020 ◽

Vol 27 (2) ◽

pp. 135-143

Author(s):

A. N. Vachev ◽

O. V. Dmitriev ◽

O. V. Zeleva ◽

P. M. Zelter

Keyword(s):

Computed Tomography ◽

Surgical Treatment ◽

Carotid Artery ◽

Blood Loss ◽

Clinical Case ◽

Interdisciplinary Approach ◽

Complete Recovery ◽

Peritonsillar Abscess ◽

Surgical Removal ◽

The Right

Aim. To describe a clinical case of carotid chemodectoma in a patient seeking treatment from an otorhinolaryngologist.Results. A 79-year-old woman complained of sore throat and difficulty swallowing. Mesopharyngoscopy revealed a significant asymmetry of the pharynx on the right with a sagging soft palate. Computed tomography revealed the asymmetry of the pharynx on the right due to compression from outside. An irregularly shaped formation intensely accumulating contrast medium was detected in the periopharyngeal space on the right, near the bifurcation of the carotid artery. Carotid chemodectoma was suspected. The patient underwent surgical removal of the chemodectoma followed by the autoarterial reconstruction of the carotid artery on the right. The postoperative period was uneventful.Conclusion. The management of patients with carotid chemodectoma requires an interdisciplinary approach with participation of vascular surgeons, otorhinolaryngologists and radiologists. This approach ensures timely surgical treatment leading to complete recovery without neurological consequences and profuse blood loss. The disease can be mistaken for a peritonsillar abscess with the possibility of serious complications during surgical treatment.

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Surgical Treatment of Severe Forefoot Deformity

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17816/vto201522384-85 ◽

2015 ◽

Vol 22 (3) ◽

pp. 84-85

Author(s):

I. V Usol’tsev ◽

S. N Leonova ◽

M. A Kosareva

Keyword(s):

Surgical Treatment ◽

Weight Bearing ◽

Metatarsophalangeal Joint ◽

Pain Syndrome ◽

Lateral Release ◽

Treatment Results ◽

Forefoot Deformity ◽

Scarf Osteotomy ◽

Akin Osteotomy ◽

The Right

Treatment results of 61 years old patient with severe forefoot deformity - right-side transverse-longitudinal stage II platypodia: right-side II-III degree deforming arthrosis of 1st metatarsophalangeal joint, hallus valgus with subluxation, combined 1st metatarsophalangeal joint contracture, pain syndrome, are presented. Surgical treatment included operation by Schede, lateral release of 1stmetatarsophalangeal joint, SCARF osteotomy of 1st metatarsal bone, Akin osteotomy of proximal hallux phalanx and tenoplasty of dorsal hallux flexor. As a result correction of right forefoot deformity was achieved, pain syndrome was arrested and weight bearing ability of the right foot was restored.

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