Unusual Post-Traumatic Under-Serosa Rupture of the Gallbladder

Gallbladder lesions due to blunt abdominal injury are rare, being found in only about 2% of patients who undergo laparotomy for abdominal trauma. It is commonly associated with other concomitant visceral injuries. It is challenging to make an early diagnosis. We report the case of a 35-year-old woman victim of a public road accident who underwent laparotomic cholecystectomy. Acute post traumatic cholecystitis was suspected based on clinical and radiologic data. Perioperative findings showed no ascites, but a distended gallbladder. Its serosa was intact. After its removal, we opened the gallbladder, we discovered a rupture of the mucosa and bile trapped between the mucosa and the serosa of the gallbladder. The postoperative course was simple.

Treatment of Complex Whole Liver Intrahepatic Ductal Stones Using a Patented Stone-Clearance Sheath Combined with Nephroscopic Holmium Laser Lithotripsy

Purpose: To investigate the clinical efficacy of nephroscopic laser lithotripsy with the aid of a patented suctioning sheath in treating complicated whole-liver dispersed intrahepatic ductal stones. Methods: From September 2013 to September 2017, 150 patients who were diagnosed with whole-liver dispersed intrahepatic ductal stones were included in this study and were divided into two groups randomly. The control group consists of 75 patients who were treated by traditional surgery combined with choledochoscopic laser lithotripsy. The observation group consists of the other 75 patients who were treated by traditional surgery combined with nephroscopic laser lithotripsy with the aid of the patented sheath. Related treatment outcome parameters were compared. Results: There were no significant differences in first surgery operative time, first surgery bleeding amount, complication and stone clearance rates (P>0.05). However, the second surgery operative time was (63.58±9.84) min while the complication rate was 7.5% in the observation group, significantly less than that of control group (P<0.05). There were significantly higher first-stage and second stage sinus ductal stone clearance rates and final stone clearance rate in the observation group compared to that of control group (P<0.05), while operative times, hospitalization duration and cost, and one year stone recurrent rate were significantly lower (P<0.05). Conclusion: The efficacy of using the patented stone-clearance sheath combined with nephroscopic holmium laser lithotripsy was significant, warrants more extensive clinical adoption.

Salvage Lymphadenectomy as a Treatment of Prostate Cancer Recurrence

Biochemical recurrence (BCR) occurs up to 40% of men who had radical prostatectomy for localized prostate cancer. Regional nodes are usually involved in these cases. Salvage lymphadenectomy (sLND) has been advocated in patients with 'node-only' metastasis with biochemical recurrence, following a definitive treatment of primary prostate cancer. In general, limited case number was reported for each previous study. Four relatively larger reports so far with the highest case number of 189. One randomized controlled study has been completed so far at Phase II level. Salvage LND seems to be safe with relatively low incidence of complications without perioperative mortality. It may postpone adjuvant therapy in selected cases, avoiding systemic side effects and possibly reducing the cost. However, long-term outcome is not very encouraging.

Current Status of Single Port Laparoscopic/Robotic Surgeries for Urogenital Cancers

Single port laparoscopic or robotic surgery is emerging and progressing but is still very challenging for many surgeons due to less degree of motion and limited space leading to instrument crash. With the aid of new technology and instrumentation, limitations are constantly broken in robot-assisted laparoscopic surgery. A lot of initiations have been done over the past a few years. A wide range of single port laparoscopic or robot-assisted laparoscopic pelvic and retroperitoneal urological procedures can be done with different approaches for treating urogenital cancers. Randomized trials with larger sample size and longer postoperative follow up are suggested for further evaluation of the outcomes and added value.

Co-Occurrence of Multiple Sclerosis & Ovarian Cancer: A Case Report and Literature Review

Background: The possibility of an association between Multiple Sclerosis (MS) and cancer has not been thoroughly investigated. Case Presentation: We present a case of ovarian cancer in 58-year-old woman with MS. Radical hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and pelvic and para-aortic lymph node dissection was performed. Pathohistological analysis and immunohistochemistry confirmed the diagnosis of a clear cell carcinoma of the left ovary, grade Ⅲ, FIGO2014 stage IA. Adjuvant chemotherapy of paclitaxel-carboplatin regimen (paclitaxel 175mg/m2, carboplatin AUC 6, at intervals of 3 weeks) was implemented for 4 courses. Conclusion: The occurrence of ovarian cancer in MS patients may be coincidental. Nevertheless, the longterm use of immunosuppressive and/or immunomodulatory drugs in MS and the incidence of cancer may be associated.

Simultaneous Bilateral Rupture of the Quadriceps Tendon after Minor Trauma in a Patient Receiving Hemodialysis: A Rare Variant to an Uncommon Injury

A spontaneous and simultaneous complete bilateral ruptures of the knee extensor system is a rare entity, and only few cases have been reported in literature. It is a rare occurrence After minor trauma. Therefore, an investigation should be focused on identifying certain medical predisposing conditions including chronic diseases and long-term use of certain drugs. Surgical repair is a treatment of choice. This article describes the case of a 36-year-old patient with renal failure requiring hemodialysis for the past 7 years, who sustained spontaneous bilateral rupture of quadricepital tendon diagnosed by bilateral ultrasound scan of the thighs and successfully managed by surgical repair using sutures passed through drilled holes in the patella. Postoperatively, the patient was immobilized with splints for 6 weeks before starting physiotherapy.

Portal Vein Thrombosis as a Complication of Laparoscopic Sleeve Gastrectomy: A Case Report

Portal vein thrombosis (PVT) is an uncommon and potentially life-threatening complication of bariatric surgery. Three cases of PVT were diagnosed at our regional center. All cases were post-laparoscopic sleeve gastrectomy without any intraoperative complications. All patients presented with vomiting and CT scans confirming PVT. No patients required operative management of venous mesenteric ischaemia and all were managed with anticoagulation. Two out of the three cases were found to have risk factors for venous thromboembolism. Surgeons should be aware of the vague symptomology of this rare entity and have a higher degree of suspicion in patients with risk factors of venous thrombosis.

Adult Intussusception Secondary to Colorectal Cancer in a Young Woman: A Case Report

Adult intussusception (AI) is uncommon condition that represents 1-5 % of intestinal obstruction and is frequently caused by an underlying disease with 70-90% of cases having a demonstrable cause based on imaging findings and surgical results. The most common causes of colonic AI are neoplasm. We report a case of right colo-colic intussusception sustained by a malignant tumor.

Mucinous Adenocarcinoma Associated with Fistula in an 87-Year-Old Managed with Neoadjuvant Chemoradiation and ELAPE at Tata Memorial Hospital, in Mumbai

Colorectal cancer is the third most diagnosed cancer and the fourth leading cancer-related death worldwide. Mucinous adenocarcinoma associated with anal fistula is a rare variant of adenocarcinoma, presents with delayed diagnosis, locally advanced, low nodal, and no distant metastasis. Adenocarcinoma associated with fistula (ACAF) is rare, has delayed diagnosis and poor prognosis but can be managed with neoadjuvant chemoradiation (NACRT) and complete curative resections with reconstruction by V-Y advancement cutaneous flap.

A Unique Case of Anal Atresia with Vestibular Anus, Colorectal Cancer and Renal Cancer in Horseshoe Kidney in Adult Woman: A Case Report and Literature Review

Introduction: Colorectal cancer is a very common malignancy, however the association with kidney cancer is very unusual, even more so if kidney cancer occurs on a horseshoe kidney. Horseshoe kidney is a congenital malformation in which the kidneys appear fused. It is often accompanied by abnormalities of the ureteropelvic and vascular systems, so patients in need of surgery should be carefully evaluated. Materials and Methods: A 64-year-old woman came to our observation with abnormalities of the perineum such as the "vestibular anus", horseshoe kidney, kidney cancer and colorectal cancer. She underwent left open hemicolectomy and right polar resection of the horseshoe kidney. Results: The patient was discharged on the sixth operating day without complications. At the follow-up 54 months after surgery, she was negative for distant metastasis and local disease recovery. Conclusion: From a literature review this is the first case report in a patient with these four associated comorbidities. Preoperative evaluation in these patients by CT is important to evaluate the relation between the nervous, vascular and urinary structures to avoid iatrogenic injury.