Emergent laparoscopic dome resection and omental suturing to the splenic parenchymal edge for a spontaneously ruptured non-parasitic large splenic cyst in a pediatric patient: a case report

Background Spontaneously ruptured large splenic cyst is a rare in children, and traditionally total or partial splenectomy has been performed for treating an emergent case. We herein present a first case with spontaneously ruptured pediatric splenic cyst treated with emergent laparoscopic dome resection with omental suturing to the parenchymal edge of the spleen. Case presentation A 12-year-old girl with a spontaneously ruptured large non-parasitic splenic cyst (SC) was successfully treated by emergent laparoscopic dome resection with omental suturing to the edge of the splenic parenchyma. The patient presented with acute abdominal pain and was diagnosed with a ruptured non-parasitic SC and peritonitis by contrast-enhanced computed tomography (CT). Emergent laparoscopic dome resection of the SC and omental suturing to the splenic parenchymal edge were then performed. The protruding part of the cyst wall was completely resected using an ultrasonically activated device (USAD), and the greater omentum was then sutured to the anterior edge of the splenic parenchyma under a laparoscopic view. No complications were observed during the operation. A histological examination revealed a congenital splenic cyst lined by epithelial cells. The postoperative course was uneventful, and an ultrasound scan showed no evidence of cyst recurrence at 3 years after the operation. Conclusions This minimally invasive laparoscopic procedure was feasible and effective for treating a ruptured large splenic cyst in an emergent pediatric patient.

The Occurrence of Postoperative Complications in Patients Undergoing Surgery due to Complications from Crohn's Disease: A Case Report

Summary Crohn's disease (CD) is a chronic inflammatory condition of the gastrointestinal tract that can give rise to strictures, inflammatory masses, fistulas, abscesses, hemorrhage, and cancer. This disease commonly affects the small bowel, colon, rectum or anus. Less commonly, it affects the stomach, esophagus and mouth. Often, the disease affects multiple areas of the gastrointestinal tract. The cause of CD is not known and there is no curative treatment. The current medical and surgical treatment is effective in controlling the disease, but even with optimal treatment, recurrences and relapses are frequent. Various risk factors specific for the patients with conditions related to the CD can influence the outcome of the surgical treatment in the postoperative period. Those risk factors can be preoperative laboratory inflammatory markers such as WBC and CRP values, phlegmona of the anterior abdominal wall and preoperative interintestinal abscess, positive resection margins. Here we present a case of a patient who was surgically treated as an emergent case because of the complication due to Crohn's disease. At presentation, the patient had leukocytosis, elevated CRP, anemia, low levels of total proteins, and albumin.

Rupture of esophageal varices due to portal hypertension

Variceal bleeding is the most common cause of serious upper gastrointestinal (UGI) bleeding in children. Most variceal bleeding is esophageal.1 Hemorrhages from esophageal varices due to portal hypertension are a major cause of morbidity and mortality. There is a 30% mortality rate following an initial episode of variceal hematemesis. Mortality increases to 70% with recurrent variceal hemorrhage. Moreover, the one year survival rate after variceal hemorrhage is often poor (32 to 80%).2-4 We report a case of esophageal varices rupture caused by portal hypertension, an emergent case in the Pediatric Gastrohepatology division.

Emergent case-based reasoning applications

The basic principle underpinning case-based reasoning (CBR) is that new problems can be solved by reusing solutions to past problems. The generality of this idea means that CBR is finding application in a wide variety of areas. The special advantage of CBR is that a case can be a very convenient means of capturing knowledge, especially in weak theory domains where the relationship between causes and effects may not be well understood. Cases may embody more than problem-solving knowledge; the knowledge in a case may be a creative structure or a complex behavior pattern. The widespread applicability of this idea means that it has been exploited in a diverse range of areas across the arts and sciences. This article provides a brief summary of some of these applications.