Laparoscopic fenestration surgery of a large primary splenic cyst

Splenomegaly is a major and perhaps the only concern pertaining to spleen for surgeons. Splenic cysts are rare presentations as splenomegaly, with about 800 cases reported so far. Presenting a case report of a 19 years old boy presented with a mass in the abdomen below the rib cage on the left side since 1 year. No other associated complaints. On clinical evaluation a soft cystic mass of size 10×10 cm approximately, was felt extending upto and just above the umbilicus, occupying the left hypochondrium, epigastrium, left lumbar and part of umbilical region. On contrast enhanced computed tomography (CECT) abdomen and pelvis, a well-defined, rounded cystic swelling arising from the spleen and abutting the surrounding structures was noted. Clinically diagnosing it as a primary splenic cyst and after thorough preoperative evaluation the patient was planned for laparoscopic fenestration surgery of the cyst. Surgery involved aspirating, deroofing of the cyst with omental packing of the cyst cavity. This surgery is a novel minimally invasive spleen preserving approach to such types of splenic cysts. This approach carries the least morbidity and recurrence rate among its other options.

A case report of microvascular decompression for cervical myelopathy and radiculopathy caused by tortuous and abnormal bilateral vertebral artery

Background: Tortuous/abnormal vertebral arteries (VAs) sometimes cause neurovascular compression syndromes (NVCs), such as trigeminal neuralgia, hemifacial spasm, and, rarely, myelopathy/radiculopathy. Abnormalities/tortuosity of the VA at the level of the atlas and axis are of particular note; these may be characterized by a persistent first intersegmental artery (PFIA) and C2 segmental type of VA. Herein, we report a 72-year-old male who presented with cervical myelopathy/radiculopathy due to bilateral tortuosity of the PFIA resulting in spinal cord compression at the craniocervical junction. Case Description: A 72-year-old male presented with cervical pain when turning his neck and progressive gait disturbance. The neurological examination demonstrated a moderate myeloradicular syndrome (Nurick Grade III). The magnetic resonance revealed compression of the medulla and spinal cord due to tortuosity of both dorsal VA at the C1 vertebral level. The three-dimensional computed tomography angiogram confirmed bilateral PFIA running medially. In addition, the left side of VA forms fenestration. Surgery through a C1 laminectomy and midline small suboccipital craniectomy, both VAs were transposed and tethered to the ipsilateral dura utilizing Aron Alpha and vinyl prostheses. In addition, a large vinyl prosthesis was inserted between both VAs to protect them from contacting the spinal cord. Following this decompressive procedure, the patient’s symptoms fully resolved, and he remains asymptomatic 10 years later exhibiting no recurrent vascular pathology. Conclusion: Microvascular decompression of anomalous VAs contributing to cord compression at the C1 level was safe and effective in a 72-year-old male.

Polycystic liver disease: a rare case study

Polycystic liver disease is a rare inherited disorder which affects 1 in 1,00,000 population. There are two forms of polycystic liver disease (PLD) i.e. isolated PLD and autosomal dominant PLD which is associated with renal cysts. PLD is usually asymptomatic and incidentally detected. Some may present with complaints of abdominal distension, bloating, early satiety, weight loss. Computed tomography (CT) or magnetic resonance imaging is the investigation of choice to diagnose polycystic liver disease. Below we report you a case of 55-year-old female who came with the complaints of pain abdomen since 8 days and was diagnosed as polycystic liver disease on CT, who received treatment by laparoscopic fenestration surgery of cysts and showed symptomatic improvement.

Massive Ascites in a Renal Transplant Patient after Laparoscopic Fenestration of a Lymphocele

Retroperitoneal lymphocele is a common complication of renal transplantation. Here, we report the case of a 67-year-old woman with massive ascites after fenestration surgery for a lymphocele that developed following renal transplantation. She had been on continuous ambulatory peritoneal dialysis for 9 years. Living donor renal transplantation was performed and an intrapelvic lymphocele subsequently developed. The lymphocele did not resolve after aspiration therapy; therefore, laparoscopic fenestration was performed. Although the lymphocele disappeared, massive ascites appeared in its stead. Half a year later, the ascites was surgically punctured, which then gradually resolved and disappeared 6 weeks later. Aspiration therapy should be considered in patients on long-term peritoneal dialysis, although laparoscopic fenestration is safe and effective.