Be careful of splenic rupture caused by hit by a pitch during a baseball game: a case report

Background To the best of our knowledge, splenic rupture caused by hit by a pitch (HBP) has not been previously reported. We present a patient who underwent emergency laparotomy for splenic rupture after being HBP during a baseball game. Case presentation A 41-year-old male was HBP in the left abdomen during his first at-bat during a baseball game. During the operation, vascular injury of the splenic hilum and a deeply extending parenchymal injury were observed, and splenectomy was performed. Histologic findings were consistent with splenic rupture. Conclusions The patient’s postoperative course was uneventful. Although extremely rare, the possibility of intra-abdominal organ injury should be considered in batters who are hit in the abdomen by a pitched baseball, as illustrated by our patient.

Midgut malrotation: case series

Mal rotation of midgut is associated with other anomalies usually encountered in neonatal period or early childhood. If undetected in childhood it presents in adulthood with small bowel obstruction, repeated appendicitis or chronic abdominal symptoms. CECT abdomen is mandatory for diagnosis though it often presents as surgical surprise on abdominal laparotomy. Hereby, we presented 3 cases where it was undetected till adulthood though CECT was mandatory for definitive diagnosis. Case 1 patient presented with chronic abdominal pain on left abdomen was actually malrotation with appendix lying on left hypochondrium and stenosed fourth part duodenum adding to vomiting off and on. Case 2 patient in adulthood presented with repeated sub-acute intestinal obstruction because of midgut mal-rotation. Relieved after Ladd band was cut and obstructive symptoms relieved. Case 3 patient had inflammed appendix in subhepatic position was cause of chronic pain with para duodenal hernial sac adding to intestinal obstruction with malrotation of midgut.

Modern and promising ways of bowel preparation for instrumental research

A review is presented to summarize data on intestinal preparation approaches and methods for research. The historical background and main stages in the development of the intestinal lavage method are highlighted, and traditional and modern methods of evaluating its effectiveness are characterized. Dietary recommendations and information about the basic drugs used nowadays in preparation of the intestine for instrumental research are adduced. Clinical aspects of different types of osmotic action of drugs are considered. The composition of laxatives for salt and electrolyte components in terms of potential benefit and risk in patients is analyzed. The main positions of the current recommendations of domestic, European and American expert communities concerning the discussed topic are taken into account. Demonstrated “no less efficacy” of sulfate solution compared with macrogol in adult patients. Clinical case is presented: patient A., 22 years old, admitted to the clinic with complaints of recurrent pain in the left abdomen, frequent stools, sometimes with blood, loss of hair, flaky spots on the skin of the upper extremities. The patient was prepared for the examination – colon cleansing with a sulfate drug, endoscopic examination of the colon - colonoscopy was performed. Diagnosis: nonspecific ulcerative colitis. The treatment scheme is presented, clinical remission of the disease is achieved.

Rupture of Adrenal Artery Pseudoaneurysm with Late Manifestation of Hypovolemic Shock

Patient transferred to an intensive care unit idue to sudden low back pain of strong character associated with transient hemodynamic instability and the necessity of volume expansion and blood transfusion. Image exams showed a large retroperitoneal hematoma on the left abdomen and elongated left adrenal artery with 2.3 cm diameter with the presence of active leakage of the inferior adrenal artery. Intervencionist radiology was performed, and two pseudoaneurysms of the joint branch of the left adrenal / lumbar arteries were identified and treated. There are only two reported cases of traumatic adrenal artery pseudoaneurysm in the literature. This is the first report of hemorrhagic shock as a late manifestation of this condition.

Stercoral re-perforation after colostomy takedown: a case report

Background Stercoral perforation (SP) is a rare surgical condition that is associated with high morbidity and mortality. Most of these patients undergo emergent surgery, including colostomy, and some undergo colostomy takedown after recovery. Stercoral re-perforation after colostomy takedown followed by colostomy for SP has not yet been reported. Case presentation A 79-year-old woman presented with abdominal pain for one day. Abdominal-pelvis computed tomography revealed pneumoperitoneum with diffuse mesenteric fat haziness of the left abdomen. During laparoscopic exploration, a 3-cm-sized perforated site was found at the sigmoid-descending colon, with fecal material and reactive fluid outside the colon. Loop colostomy formation was performed, and a takedown was completed after 3 months. Two years 4 months after the initial procedure, the patient was re-admitted to our hospital with abdominal pain. She underwent a second laparoscopic colostomy formation and was discharged, although the postoperative clinical course was poorer than that after the first surgery. Conclusions This case of stercoral re-perforation after colostomy takedown followed by colostomy formation for SP has important clinical implications and can be a reference for physicians. When the first colostomy formation was performed for SP, the decision on performance of a colostomy takedown should be made after carefully considering several factors.

A Retrospective Study of Cryptorchidectomy in Horses: Diagnosis, Treatment, Outcome and Complications in 70 Cases

The aim of the study was to investigate the breed predisposition and the diagnostic and surgical management of horses referred for cryptorchidism. The breed, localization of retained testis, diagnosis, type of surgical treatment and complications were analyzed. Seventy horses were included in the study; the Western Riding horse breeds were the most affected (Quarter Horse 34/70, 48.5%; Appaloosa 9/70, 12.8%). In unilateral cryptorchids (65/70, 92.8%) the most common location for a retained testis was the left abdomen (28/65, 43%), while in bilateral cryptorchids (5/70, 7.1%), bilateral abdominal retention was the most frequent (3/5, 6%). Information about testis localization was achieved through transabdominal ultrasound (30/49 cases, 61.2%), through per rectum palpation (21/49 cases, 42.9%) and through inguinal palpation (14/49 cases, 28.9%). Cryptorchidectomy was achieved with standing laparoscopy (44/70 cases, 62.8%), or with open inguinal orchiectomy in general anesthesia (26/70 cases, 37.2%). Complications during laparoscopy were spleen puncture (1/44, 2.2%), a self-limiting bleeding from the spermatic cord (10/44 cases, 22.7%), hyperthermia (3/44 cases, 6.8%), and emphysema (15/44, 34%). During inguinal open cryptorchidectomy difficulties with identifying the inguinal testis during surgery (8/26 cases, 30.8%) and a moderate and self-limiting swelling of the inguinal region after surgery (17/26, 65.4%) were observed. For orchiectomy, a standing laparoscopy was confirmed as the preferred procedure for an abdominally retained testis with almost no complications.

Colonic Duplication Cyst in an Adult Woman: A Case Report

Intestinal duplications are rare congenital anomaly found in pediatric age group. Although, ileum is the most common site, there are cases of colonic duplications even in the adult. We report a case of 43 years woman presented with chronic constipation, intermittent colicky abdomen pain and a cystic lump in left abdomen diagnosed as tubular duplication cyst of descending colon. Colonoscopy is a good investigation tool for diagnosis of colonic duplications; however, it may not be true in all cases. She was managed with left hemicolectomy and excision of cyst with uneventful post-operative days. This case has been reported because of rarity of this condition.

Solitary fibrous tumor of the mesentery: a case report and review of the literature

Solitary fibrous tumors are rare mesenchymal tumors that typically arise from the pleura and rarely originate from the mesentery. We herein report a case involving a 66-year-old patient who presented with a mass on the left abdomen. This mass had been incidentally noticed 10 years earlier. The patient sometimes experienced abdominal pain. Physical examination revealed an irregular mass, which was resected. A biopsy of the mass revealed that it was a solitary fibrous tumor originating from the mesentery of the small intestine. The patient was discharged 1 week after surgery and had an uneventful clinical course throughout the 4-month postoperative follow-up.

Benign mesenteric lipomatous tumor in a child: a case report and literature review

Background Lipomatous tumors are the most common type of soft-tissue tumors. Benign lipomatous tumors are lipomas and lipoblastoma. We herein report a case of benign mesenteric lipomatous tumor and the largest collection of known benign mesenteric lipomatous tumors in children in the literature. Case presentation A 3-year-old girl presented with repeated dull abdominal pain and left abdominal mass swelling. On a physical examination, the child had a soft, moderately distended left abdomen that was not tender when palpated. Computed tomography and magnetic resonance imaging demonstrated a large fatty mass within the mesentery, measuring approximately 8 × 6 cm. The mass extended from the right upper quadrant to the lower pole of the kidneys. Laparotomy with resection of the mesenteric tumor was performed under general anesthesia. A well-capsuled tumor was a soft, yellow mass and found loosely attached to the mesenterium of the ileum. A histopathological examination demonstrated the lobular proliferation of mature adipocytes. Atypical lipoblasts were not seen. These features are compatible with benign lipomatous tumor, such as lipoma or lipoblastoma with maturation. Conclusion In conclusion, benign mesenteric lipomatous tumors tend to be large in size over 10 cm in longitudinal length. However, resection is well tolerated in the vast majority of cases with benign post-operative courses.

Case Series : Operative vs Non-Operative Management in Grade III Pancreatic Injury

<p><strong>Introduction</strong><strong>:</strong> Pancreatic injury is a rare case, caused by blunt or sharp trauma. Difficulty in making diagnose on pancreatic trauma cases are associated with high mortality, and the treatment can be either operative or conservatively. However, It is still unclear which treatment is more favorable.</p><p><strong>Case:</strong> We present 2 cases of Grade III pancreatic injury with stable hemodynamic who suffered bicycle accident. First case, 12-year-old boy complaining severe pain on the upper left abdomen (VAS 9-10) and get worsening by time, with vomiting. The patient underwent distal Pancreatectomy-Splenectomy. Second case, 8-year-old boy complaining of pain on the upper left abdomen (VAS 6-7) without extension on whole abdominal region with vomiting and fever. The patient was treated conservatively. In both cases, patient was discharged with improvement. However, about 3 months later patients who were treated conservatively developed into a pseudocyst.</p><p><strong>Conclusion:</strong> The selection of management in grade III pancreatic injury can be operative or conservative depending on clinical findings such as hemodynamic condition and the quality of abdominal pain. But the occurrence of pseudocysts pancreas is another surgical challenge.</p>