P034 STRANGULATED DIAPHRAGMATIC HERNIA: TEN CASES REPORTS

Aim A diaphragmatic hernia (DH) is a protrusion of abdominal contents into the thoracic cavity as a result of a defect within diaphragm. It is most common as a congenital phenomenon; however, there have also been cases where it can be acquired. DH can be life-threatening, resulting in incarceration and strangulation. Material and Methods From June 2009 to April 2021, ten cases of strangulated diaphragmatic hernia were admitted to our Emergency Surgery Department of General Surgery with respiratory and abdominal symptoms. Patients' characteristics, operation details, and postoperative complications were retrospectively analyzed. Results There were 5 (50%) men and 5 (50%) women with a mean age of 66 years (range, 20–85 years). . Emergency surgery was performed by laparoscopic in 4(40%) patients and open in 6(60%) patients. Two patients had a history of penetrating trauma to the left thoracoabdominal region. Segmental bowel resection was performed in 3 patients and total gastrectomy in 1 patient. Reconstruction was not performed in the patient who underwent total gastrectomy due to ischemia and perforation. In the postoperative period, wound infection was observed in 2 patients. Anastomotic leakage was observed in 1 patient and treated with end enterostomy. Empyema was observed in one patient after discharge, the empyema was evacuated and thoracoscopic decortication was performed .The patient who underwent total gastrectomy died due to septic shock and comorbid diseases. Conclusions Strangulated diaphragmatic hernia is a life-threatening condition and requires emergency surgery. Laparoscopic techniques can also be used in treatment.

Succinate dehydrogenase deficient gastrointestinal stromal tumor in a three month old boy with a fatal clinical course: a case report and review of literature

Background Succinate dehydrogenase deficient gastrointestinal stromal tumors (SDH-deficient GISTs), which lack KIT or PDGFRA mutations demonstrate unique clinical and pathological features, and they respond poorly to standard targeted therapy. We herein present a novel case of SDH-deficient GIST in a three-month-old infant’s colon mesentery, and he is the youngest patientto date. Case presentation The infantpresented with complaints of blood in the stool. CT showed a 6.3 × 4.6 cm mass in the left lower retroperitoneal. Complete resection of tumor and segmental bowel resection was performed without regional lymphadenectomy. Histologically, tumor cells were distinctive in their multinodular colon wall involvement with interspersed tracts of colon wall smooth muscle. The tumor was composed mainly of epithelioid cells. Immunohistochemically, the tumor cells were positive for Vim, CD117, PDGFR, while negative for SDHB. Mutational analysis showed a synonymous mutation for SDHB and wild-type for KIT and PDGFRA. Two months after surgery, metastases were found and Imatinib was administered. Unfortunately, the disease continued to progress, and the infant died 5 months after surgery. Conclusions SDH-deficient GISTs comprise a subgroup of a relatively rare tumor type and show a number of clinically and biologically unique features, especially for infants. It is of great importance to developing new therapeutic targets and novel specific drugs.

Rates of anastomotic leak and fistula following surgical management of bowel endometriosis: a comparison of shaving, discoid excision, and segmental resection

Endometriosis is a complex chronic inflammatory condition that can create a multitude of bothersome painful symptoms for women. Bowel endometriosis is often misdiagnosed or overlooked leading to years of suffering for many women. The surgical management of bowel endometriosis varies based on extent of disease as well as surgeon experience. Surgical treatment for bowel endometriosis is complex and a variety of intraoperative and postoperative complications must be considered. Two significant postoperative complications for bowel endometriosis include anastomotic leak and fistula formation. There is continued debate regarding the appropriate surgical treatment for bowel endometriosis. Aggressive surgery with segmental bowel resection is being utilized more cautiously, with an increase in less aggressive shaving or disc excision techniques. Historic beliefs regarding the limitations of shaving and disc excision are being challenged, and with a reduction in morbidity these less aggressive techniques are winning favor among gynecologic surgeons. Shaving, discoid excision, and segmental bowel resection are all feasible surgical management options for bowel endometriosis. Segmental resection is associated with the highest rates of both anastomotic leak and fistula formation, while shaving is associated with the lowest.

Succinate dehydrogenase deficient gastrointestinal stromal tumor in a three month old boy with a fatal clinical course: A case report and review of literature

Background: Succinate dehydrogenase deficient gastrointestinal stromal tumors (SDH-deficient GISTs), which lack KIT or PDGFRA mutations demonstrate unique clinical and pathological features, and they respond poorly to standard targeted therapy. We herein present a novel case of SDH-deficient GIST in a three-month-old infant’s colon mesentery, and he is the youngest patient to date .Case presentation: The infant presented with complaints of blood in the stool. CT showed a 6.3×4.6 cm mass in the left lower retroperitoneal. Complete resection of tumor and segmental bowel resection was performed without regional lymphadenectomy. Histologically, tumor cells were distinctive in their multinodular colon wall involvement with interspersed tracts of colon wall smooth muscle. The tumor was composed mainly of epithelioid cells. Immunohistochemically, the tumor cells were positive for Vim, CD117, PDGFR, while negative for SDHB. Mutational analysis showed a synonymous mutation for SDHB and wild-type for KIT and PDGFRA. Two months after surgery, metastases were found and Imatinib was administered. Unfortunately, the disease continued to progress, and the infant died 5 months after surgery.Conclusions: SDH-deficient GISTs comprise a subgroup of a relatively rare tumor type and show a number of clinically and biologically unique features, especially for infants. It is of great importance to developing new therapeutic targets and novel specific drugs.

Hysteroscopic vaginoscopy. An additional diagnostic tool for recto-vaginal deep infiltrating endometriosis

Endometriosis is the presence of endometrial tissue outside the uterine cavity. Rectovaginal infiltration is present in 5% to 25% of the patients diagnosed with endometriosis. Accurate diagnosis is imperative for adequate counseling. Hysteroscopic vaginoscopy allows the inspection of the posterior vaginal fornix, not only providing better visualization of the area due to image magnification, but also allowing to obtain biopsy providing pathologic confirmation. We report the case of a 49-year-old nulliparous patient with long history of severe dysmenorrhea, deep dyspareunia and debilitating chronic pelvic pain not responding to medical treatment. On physical exam, recto-vaginal tender nodularity was palpated. Vaginal ultrasound and magnetic resonance imaging confirmed the presence of the nodular formation extending up to the rectum. In-office vaginoscopy revealed a perforated bulge on the uterine cervix, mimicking a double cervix. A biopsy of the nodule confirmed the presence of endometrial tissue, confirming the diagnosis of endometriosis. Patient underwent total hysterectomy with excision of deep infiltrating endometriosis which required segmental bowel resection with diverting loop colostomy. The final pathology confirmed the diagnosis of deep infiltrating endometriosis.

Succinate Dehydrogenase Deficient Gastrointestinal Stromal Tumor in a Three Month Old Boy With a Fatal Clinical Course: A Case Report and Review of Literature

Background: Succinate dehydrogenase deficient gastrointestinal stromal tumors (SDH-deficient GISTs) which lack KIT or PDGFRA mutations demonstrate unique clinical and pathological features, and respond poorly to standard targeted therapy. We herein present a novel case of SDH-deficient GIST in a three-month-old boy in colon mesentery which is the youngest patient until now. Case presentation: The baby presented with complaints of blood in the stool. CT showed a 6.3×4.6 cm mass in the left lower retroperitoneal. Complete resection of tumor and segmental bowel resection was performed without regional lymphadenectomy. Histologically, tumors are distinctive in their multinodular colon wall involvement with interspersed tracts of colon wall smooth muscle. The tumor was composed mainly of epithelioid cells. Immunohistochemically, the tumor cells were positive for Vim, CD117, PDGFR, while negative for SDHB. Mutational analysis showed a synonymous mutation for SDHB and wild-type for KIT and PDGFRA. Two months after surgery, metastases were found and Imatinib was administered. Unfortunately, the disease continued to progress, the baby died 5 months after surgery. Conclusions: SDH-deficient GISTs comprise a subgroup of a relatively rare tumor type and show a number of clinically and biologically unique features, especially for infants. It is of great importance to developing new therapeutic targets and novel specific drugs.

Clinicodemographic Profile and Outcome of Patients with Symptomatic Meckel's Diverticulum: Preliminary Findings

Background: Meckel's diverticulum is the commonest gastrointestinal congenital anomaly. Though most of the cases do not present clinically, they are challenging to diagnose if become symptomatic. Spectrum of clinical presentation may be different from umbilical fistula, omphalomesenteric cyst to fibrous band from diverticulum to umbilicus. Bleeding, obstruction and infection are the most common complications. Vast majority of them are detected only intra-operatively. Methods: We analyzed our patients who were intra-operatively diagnosed as symptomatic Meckel's Diverticulum. Socio-demographic profile and immediate outcome of operated patients was analyzed from patient's records. Results: Total 9 patients were operated for symptomatic Diverticulitis. All patients were diagnosed intraoperatively. Intestinal obstruction was the commonest presentation. Diverticulectomy was the most common procedure performed followed by wedge resection and segmental bowel resection. Conclusions: Symptomatic Meckel’s Diverticulum is difficult to diagnose pre-operatively. Vast majority of them are found only intra-operatively. Most of the patients do well after resection of Meckel's Diverticulum. Keywords: Meckel’s diverticulum; surgery; symptoms.