Asian Journal of Research in Surgery

Unusual Location of Cystic Lymphangioma of the Pancreas: About a Case and Review of the Literature

Thu, 13 Jun 2024 00:00:00 +0000

Cystic pancreatic lymphangiomas are rare benign lesions that arise from the lymphatic vessels, representing only 1% of abdominal lymphangiomas and less than 0.5% of all cystic pancreatic lesions, generally affecting women.

Its clinical presentation is polymorphic, its positive diagnosis is now possible. However, the definitive diagnosis is histological.

The curative treatment is surgical, complete resection eliminates the risk of recurrence.

In this work, we report the case of a 69-year-old patient who presented to the emergency room with a picture of upper digestive hemorrhage where a fibroscopy, CT scan and abdominal MRI revealed a duodeno-pancreatic cystic mass circumscribing the head and the isthmus of the pancreas. A complete resection was impossible given the risks associated with total duodenopancreatectomy. Pathological examination of the surgical specimen confirmed the lymphangiomatous nature of the tumor.

The objective in this work is to study the diagnostic and therapeutic features of cystic lymphangioma of the pancreas.

Assessment of the Failure Rates of Sustainable Weight Loss after Sleeve Gastrectomy: A Systematic Review

Sat, 22 Jun 2024 00:00:00 +0000

Background: Surgery is the best therapy for extreme obesity. Operating on severely obese individuals (BMI > 60 kg/m²) Patients who are at increased risk with other health issues increases the chances of complications and death after Weight loss surgery. Sleeve gastrectomy is a modern surgical procedureIt has a low risk of postoperative problems and is frequently used as a prelude to gastric bypass or biliopancreatic diversion with duodenal switch. However, part patients may not achieve their projected weight reduction objectives, and many recover part of the lost weight within 2-10 years after surgery.

Objectives: The main objective of this study was to assess the failure rate of sleeve gastrectomy in term of weight loss.

Methodology: A thorough search of PubMed, SCOPUS, Web of Science, and Science Direct was conducted to find relevant literature. Rayyan QRCI was utilized for the entire process.

Results: Several studies investigated the failure rate of sustainable weight loss following sleeve gastrectomy in different countries. In Saudi Arabia, the failure rate was 25% and 23.1% at 5 years follow-up. In the United States, the failure rate was 30% and 15.5% at 5 years post-surgery. In India, the failure rate was reported as 25% and 30% post-surgery. In London, the failure rate was 30%, with 45 out of 150 patients not achieving the desired weight loss. In Egypt, the failure rate was 35%, with only 65% of patients sustaining their goal weight loss throughout a three-year follow-up.

Conclusion: Bariatric surgery, particularly sleeve gastrectomy, has demonstrated tremendous effectiveness in helping obese people lose weight and improve their overall health. While the procedure can lead to substantial Long-term success rates for weight loss and obesity-related comorbidities vary depending on the study and the country. Weight maintenance remains a challenge post-surgery, with gradual weight regain being a common issue. Regular monitoring, follow-up assessments, and multidisciplinary support are crucial to address weight regain and ensure the safety and well-being of patients throughout their the weight reduction journey.

The Safety of Subtotal over Total Cholecystectomy: A Systematic Review

Tue, 25 Jun 2024 00:00:00 +0000

Subtotal cholecystectomy (STC) is a promising alternative to total cholecystectomy (TC) for gallbladder procedures, with research showing a reduced incidence of bile duct damage. However, concerns persist regarding residual gallbladder tissue post-STC, potentially leading to serious postoperative complications like bile leakage. This study aimed to critically assess the safety profile of STC versus TC based on a thorough analysis of the current literature. A systematic review was conducted, involving eight studies from 2012-2024, involving human subjects. The review found that STC demonstrated distinct advantages and disadvantages compared to TC, manifesting differences in complication rates, postoperative outcomes, and healthcare resource utilization. Cumulative evidence suggests that STC may present advantages in select scenarios, such as a reduced risk of common bile duct injury. However, STC is also associated with elevated rates of certain postoperative complications, underscoring the need for careful consideration when opting for this approach. In contrast, TC appears to demonstrate lower rates of specific complications like bile leaks and subhepatic fluid collections. Surgeons should carefully consider the trade-offs between STC and TC based on the complexity of the cholecystectomy case and the associated risks and benefits of each procedure. Further research and ongoing evaluation are necessary to refine the understanding of the safety profile of subtotal cholecystectomy.

Comparison Study between Primary Closure Versus Secondary Closure Surgery for Pilonidal Sinus in Saudi Arabia: 25 Years’ Systematic Review and Meta-analysis

Nuraddin Hussin Alhakami, Wagih Mommtaz Ghannam — Thu, 29 Aug 2024 00:00:00 +0000

Background: Pilonidal sinus disease is a chronic inflammation and infection of the sacrococcygeal region. It is a common disease, affecting roughly 26 per 100 000 populations, usually appears at age between 15&25 years old and predominantly affects young males. It can cause pain, sepsis, and reduced quality of life and has an impact on the individual's ability to attend work or education. Risk factors for the condition include male gender, young age, obesity, hairiness, deep natal cleft, and poor hygiene.

Aim of Study: To conduct a systematic review and meta-analysis for studies done in Saudi Arabia comparing lay open versus primary closure for pilonidal sinus done in the past 25 years.

Materials and Methods: We have performed an electronic search for PubMed, Cochrane library and Google Scholar, resulted in 241 studies. Then second filter was done for full text excluding 224 studies were unrelated not met inclusion criteria and 17 studies were obtained. 6 studies compared lay open and primary closure techniques, 5 studies only lay open ,4 studies primary closure. Furthermore two papers were excluded from analysis as one not mentions the surgery type and one paper measure the knowledge of the community about pilonidal disease.

Results: Complication rate (infection mean) was 4.505 in lay open group and 9.447 with primary closure group. Recurrence rate was higher in lay open versus primary closure techniques.

Conclusion: Lay open procedure was associated with shorter operative time and reduced risk of recurrence or complication rate in comparison to primary closure technique, but it takes more time for hospital stay and wound healing.

Tendon Injuries of the Hand: A Study on Pattern/Epidemiology of Cases at a Suburban Tertiary Hospital, Nigeria

Fri, 28 Jun 2024 00:00:00 +0000

Background: Tendon injuries of the hand are one of the commonest presentations of hand injuries which itself bears a social and economic burden to the society as the most commonly affected are the active and working age groups. Most of these injuries will require surgical intervention to restore aesthetics, structure and function.

Objective: This study seeks to assess the pattern of these injuries, etiology and reappraise the preventive modalities with the aim of reducing incidence in our immediate environment.

Methods: A retrospective study of patients who presented and were managed surgically for tendon injuries of the hand with or without injury to other structures of the hand between January 2017 and December 2021. The operation registers as well as case notes of patients were the sources of the information. Information obtained included patients’ biodata, aetiology and pattern of injury, hand involved (whether right or left), collateral injuries as well as surgery offered. The results were analysed using SPSS version 20 and descriptive statistics used to represent frequency distribution.

Results: In the five years under review, a total of 27 patients were managed for hand injuries during the period of study, however, only 21 cases which involved tendon injuries were analyzed making it 77.7% occurrence in hand injuries. There were 17 males [84.2%] and 4 females [15.7%] giving a male to female ratio of 4.25:1. The mean age was 30.3 ± 17.10 years and the highest incidence of tendon injury; 9 (42.8%) occurred within the age range of 21-30 years of age. Industrial accident due to grinding machines, 8(38%) was the commonest cause of tendon associated hand injuries, followed by matchet cut injury to the hand following assault 6(28.6%). The overall most common tendon injury was flexor tendon injury (71.4%) with the right hand being most commonly affected; 16(76.2%). All patients had tendon repair done alongside repair of other associated injuries of the hand.

Conclusion: Our study reveals tendon injuries of the hand as a common occurrence following hand injuries and seen among the economically active groups with crippling implications. In addition to its proper management by a skilled surgeon, preventive measures should be implemented to reduce its occurrence.

A Prospective Study on Non-Operative Management of Solid Organ Injuries in Blunt Abdominal Trauma Patients

Sat, 06 Jul 2024 00:00:00 +0000

Introduction: Following injury to the extremities and head, abdomen is the third most commonly injured part of the body. Blunt abdominal trauma (BAT) is particularly deceptive because of the delay in clinical manifestations for hours or even days, even though the damage to the internal organs might be serious and lethal. The road traffic accident (RTA) is the most common mode of injury to cause blunt abdominal trauma. Diagnostic modalities like FAST and CT scans have caused a significant change in trends regarding management from surgical to a more conservative approach. Our current research aimed at examining the pattern of blunt injury to the abdomen, the mode of injury, and the involvement of various abdominal solid organs, investigating various investigational modalities and their use in the management of blunt abdominal trauma, and examining post-traumatic management with regard to non-operative treatment modality.

Materials and Methods: This prospective study is based on 100 cases of Blunt abdomen trauma who presented in P.D.U. Medical College & Hospital, Rajkot with respect to clinical presentation, investigations, management and outcome. Results and outcomes are depicted in various tables and figures.

Results: In the present study, demographic data like age and sex, the mode of injury, commonly injured solid organs, management done and the associated other treatment parameters was observed and compared. It was found that Blunt abdominal trauma commonly involves young males in the age group of 20 - 30 years. RTA is found to be the most common mode of injury. Liver was the most commonly injured solid organ followed by spleen. Around 27% of total cases have associated other organ system injuries in addition to blunt trauma to abdomen. Non-operative management was successful in 92 out of 100 patients with an average length of the hospital stay around 6 days.

Conclusion: Peak incidence of Blunt trauma abdomen is in young males and productive age population. All abdominal solid organ injuries can be given a trail of non-operative management whenever the patient is stable. Liver and spleen have favorable outcome when managed conservatively. Non-operative management is widely accepted in hemodynamically stable blunt abdominal trauma patients. The basic principle of non-operative management is close clinical follow-up of the patient. The non-operative treatment efficacy in well in this study regardless of the type of injury. Early diagnosis, aggressive resuscitation and timely surgical intervention may improve the outcomes for trauma patients.

Predictive Factors for a Prolonged Stay in the Surgical Intensive Care Unit

S. Nadif, W. Machrouh, A. Mounir, C. EL Kettani, L. Barrou — Thu, 11 Jul 2024 00:00:00 +0000

The intensive care unit (ICU) is a place of acute care, where patients' vital prognosis, substitution techniques, and family anxiety are intertwined. A prolonged ICU stay often has a negative connotation, raising numerous questions about patient management, functional prognosis, and the appropriateness of continuing intensive care. This study aims to better understand the characteristics and outcomes of patients with prolonged ICU stays and to identify specific management needs.

A retrospective analytical study was conducted in the anesthesia and surgical intensive care department of the Ibn Rochd University Hospital in Casablanca from January 2015 to December 2017. The study included 184 patients aged ≥18 years with ICU stays ≥10 days. Data were collected from admission registers and medical records and analyzed using statistical tests to assess factors influencing prolonged ICU stay.

From January 2015 to December 2017, 2291 patients were admitted to the ICU at CHU Ibn Rochd. Of these, 184 (8.03%) had extended stays, with an average age of 49.2 years and a predominance of males (55%). The main comorbidities were diabetes (30%) and hypertension (26%). Most patients were admitted via the emergency department (27%) for scheduled (48%) and emergency (19%) surgical conditions. On admission, 40% had a Glasgow score of 13-15, 89% were afebrile, 83% had a normal respiratory rate, and 91% had oxygen saturation >95%.

Mechanical ventilation was required for 80% of patients. The main reasons for admission were neurological distress (35%) and post-operative management (29%). During their stay, 109 patients died, primarily due to infectious complications (58%) and hemorrhage (17%). The mean APACHE II score was 20.79. The average length of stay was 20.59 days, ranging from 10 to 119 days. Factors associated with prolonged stay included age, chronic renal failure, and neurosurgical conditions.

Prolonged ICU stays have significant economic and physical repercussions, with high rates of nosocomial infections and other complications. The length of stay is closely associated with increased morbidity and mortality, necessitating optimal patient care to minimize duration. Neurosurgical pathologies were a major cause of prolonged stays, with demographic factors like age and sex also playing a role.

The study highlights that neurosurgical and traumatic reasons for admission, along with high APACHE II scores, significantly influence prolonged ICU stays. Efforts to reduce stay duration should include setting up weaning or post-intensive care units, especially for neurosurgical patients, to maintain specific care in a safe environment and reduce the economic impact of prolonged stays.

Ten-year Retrospective Study of Breast Cancer Presentation: Insights from a Nigerian Tertiary Palliative Care Center

Abiodun Adegbesan, Adetayo Adebayo, Adewunmi Akingbola, Olajide Ojo — Fri, 26 Jul 2024 00:00:00 +0000

Introduction: Breast cancer is the most frequently diagnosed cancer among women globally and a leading cause of cancer-related death. In Nigeria, late-stage presentation of breast cancer is common due to poor health-seeking behavior and limited access to treatment. This retrospective study aims to assess the patterns of breast cancer presentation over a ten-year period at the Hospice and Palliative Care Department, University College Hospital, Ibadan, Nigeria.

Methodology: This retrospective analysis included 316 breast cancer patients who presented at the department between January 2012 and January 2021. Data were retrieved from hospital records and included patient demographics, tumor localization, metastatic sites, presenting symptoms, and outcomes. Descriptive statistics were used to summarize the data, and findings were analyzed using SPSS.

Results: Of the 1,494 cancer patients seen during the study period, 316 (21%) had breast cancer. The peak incidence occurred in 2016 (28.2%) and 2020 (26.6%), with the lowest in 2017 (16.8%). The average age of diagnosis was 49 years. Tumor localization was evenly distributed between the right (43%) and left (43%) breasts, with 13% presenting with bilateral involvement. Metastatic spread was most common to the lungs/pleura (40%), liver (19%), and brain/CNS (13%). Common presenting symptoms included fatigue, weight loss, breathlessness, pain, and anorexia. Regarding parity, 43.7% of patients had more than four pregnancies, indicating a significant correlation between higher parity and breast cancer incidence in the study population.

Conclusion: The persistent trend of late-stage breast cancer diagnosis in Nigeria necessitates urgent action to enhance early detection and comprehensive palliative care. Community-based education, improved healthcare access, and targeted research are essential to address the challenges and improve outcomes for breast cancer patients in Nigeria. The study provides valuable insights for clinicians and policymakers to develop effective interventions and health policies.

Evaluation of Honey and Povidone Iodine Dressings on Healing of Wagner 2 Diabetic Foot Ulcers: A Randomized Controlled Trial

Charles I. Iwunze, Phillip D. Eyimina — Sat, 27 Jul 2024 00:00:00 +0000

Diabetic foot ulcers (DFU) are challenging complications which result from pathophysiologic tissue changes in diabetes mellitus. These ulcers require appropriate dressings to boost their healing. Reports on the therapeutic efficacy of honey and povidone iodine stimulated the quest to enhance knowledge on effective and available dressing materials for DFU treatment.

Aim: To compare the efficacy of honey and povidone iodine dressings on the healing of Wagner Grade 2 DFU.

Study design: This was a randomized controlled trial comparing the rate of Wagner grade 2 DFU healing following of honey and povidone iodine dressings at the University of Port Harcourt Teaching Hospital, Port Harcourt over a year duration.

Methodology: Thirty subjects with Wagner grade 2 DFU were recruited (17 males; aged 47-65 years). Data on socio-demographics, HbA1c, ulcer contraction, exudate characteristics and oedema resolution were obtained and analysed using Statistical Package for the Social Sciences (SPSS) 20.0. A p-value <0.05 was considered significant.

Results: The mean change in ulcer diameter was 0.69±0.17mm and 0.61±0.11 mm for the honey and povidone iodine groups respectively (p-value=0.062) in the first week, and 1.17±0.19mm and 1.08±0.16mm for the honey and povidone iodine groups respectively (p-value=0.124) in week 4. By week 5, all ulcers in the honey group were healed, while one ulcer lasted beyond week 6 in the povidone group. The mean change in mid-foot circumference (MFC) was 0.62±0.52cm and 0.29±0.35cm for the honey and povidone iodine groups respectively (p-value 0.051), in week 2.

Conclusion: Honey and povidone iodine dressings have comparable healing effects in the treatment of Wagner 2 DFU, with the honey dressings being marginally more efficacious.

Determine the Incidence of Subclinical Lymph Node Metastases in Laryngeal Cancer

Mon, 29 Jul 2024 00:00:00 +0000

Objective: Lymph node metastases in laryngeal cancer are an important prognostic factor. The aim of our work is to determine the incidence of subclinical lymph node metastases in laryngeal cancer, their therapeutic and prognostic impact, the lymph node territories involved and the usefulness of retrospinal curage in laryngeal cancer.

Materials and Methods: A retrospective study that took place over a 9-month period between January and September 2022 included 40 cases of glotto-sus-glottic cancer initially classified as N0 and presenting with lymph node invasion.

Results: Occult metastases were found in 15 patients, with 28.54% of cases cN0 converted to pN2b in over 50% of cases in ipsilateral territory III.

Conclusion: High rate of occult lymph node metastases in glotto-sus-glottic cancers, involvement of sectors IIa and IV in laryngeal cancers is infrequent and often associated with other sectors, hyper-selective cervical curage (IIa and III) seems justified for glottic and/or supra-glottic tumors classified as T1N0 or T2N0. In the case of advanced tumours (T3 or T4), involvement of the HTE lodge or cartilage infiltration, occult lymph node invasion is more frequent, necessitating functional curage.

Patterns and Factors Associated with Hearing Loss among Adult Patients with Type 2 Diabetes Mellitus

Ali Khalif Gure, Doreen Nakku, Amina Seguya, Jamal Abade Mohamed — Tue, 06 Aug 2024 00:00:00 +0000

Aims: To establish the patterns of hl and associated factors among type 2 DM (T2DM) patients so that intervention is affected

Study Design: A cross-sectional study.

Place and duration of study: Mbarara regional referral hospital’s diabetic and ENT clinic from august 2021 to April 2022.

Methodology: using consecutive sampling, we undertook a cross-sectional study at Mbarara regional referral hospital among 260 adult patients with type 2 diabetic mellitus (T2DM). A semi-structured questionnaire was utilized to gather data on demographics and medical factors. Otoscopy and pure tone audiometry were subsequently done. Data were analyzed using stata v15.0 and results were reported using frequencies and means for continuous data and regression analysis for categorical data. Hearing loss was reported as per who recommendation.

Results: The majority of the participants were female (69.6%) with a mean age of 54.7 years (sd: 12.5). 53.1% of participants had T2DM <5 years, 55.8% had concurrent hypertension and 74% were in poor glycemic control at study time. Almost all had normal otoscopic findings. The overall proportion of hearing loss (HL) was 29.2% (76 of 260). Bilateral SNHL was the most common type of HL at 86.1% (31 of 76) with a combined mild to moderate degree of loss in more than 87% of the cases.

Conclusion: The overall proportion of HL among T2DM patients at MRRH is low and majorly are of mild to moderate SNHL type.

Awareness, Acceptance, and Barriers of Vasectomy among Male Resident Doctors at Jos University Teaching Hospital

R. E Akpa, A. N Ocheke, A.F Andibanbang — Sat, 10 Aug 2024 00:00:00 +0000

This study will help identify the barriers to vasectomy as a family planning option among male medical resident doctors in Jos University Teaching Hospital. Vasectomy, or male surgical sterilization, involves the division or occlusion of the lumen of the vas deferens leading to disruption of the passage of sperm from the testes. it is one of the few fertility control methods that enable men to take personal responsibility for contraception. Respondents were selected using a stratified proportionate random sampling technique. Of the three tertiary health facilities in Jos North, JUTH was picked by simple random sampling by balloting. A list of all the resident doctors was obtained for each department and the names were sorted by sex and arranged by seniority. This study also showed that the negative attitude towards vasectomy was influenced by the need for more children as most of the participants had concerns about regrets experienced by couples after the procedure. it is recommended that strategies should be developed to tackle major identified barriers, especially to personal use of vasectomy. Training programmes which are focused on evidence-based facts on male sterilisation would help promote proper counselling in birth control consultations.

Cardiovascular Evaluation before and after Splenectomy in Children with β Thalassemia

Tue, 10 Sep 2024 00:00:00 +0000

Background: Cardiac complications represent the leading cause of mortality and morbidity in β thalassemia, with iron overload and high output state being the main precipitating factors. Splenectomy is used in the management of β thalassemia, and its impact on cardiovascular function is an area of controversy with a paucity of data.

Objective of the Study: To evaluate the effect of splenectomy on cardiovascular function in β thalassemia.

Methodology: This proposed longitudinal observational study was carried out in the Department of Paediatric Surgery in MMCH from January 2017 to April 2018. Patients consent and permission were sought from the medical director to carry out the study on 20 β thalassemia patients who were candidates for splenectomy. Pre- and post-operation changes in hematological and echocardiographic characteristics were apparent using SPSS version 20.

Results: The mean age was of the patients at splenectomy was 8.18±2.59 years. Among the 20 cases 12 (60.00%) were male and 8 (40.00%) were female with the ratio 1.5:1, male predominant. All patients were transfusion dependent thalassemia among them maximum 16 (80%) was severe Hb E/β thalassemia and 4 (20%) was β thalassemia major. Major indication of splenectomy 14(70%) was increased requirement of blood transfusion. Mean 6-monthly pretransfusion hemoglobin was significantly increased after splenectomy from 4.19±0.92 to 8.66±0.73 g/dl (p<0.001). Postoperatively, the 6-monthly transfusion requirements were significantly reduced from 14.30±3.18 to 2.15±1.46 units (p<0.001), while blood transfusions were discontinued in 4 patients (20%). The mean serum ferritin was not significantly different after surgery (p>0.05). All 20 patients were in a high output state, with mean cardiac output being 5.85±1.72 L/min in patients versus 3.6±1.03 L/min in controls (p<0.001). Postoperatively, cardiac output was significantly reduced from 5.85±1.72 L/min to 4.99±1.64 L/min (p<0.05). Other parameters were not significantly different after surgery (p>0.05). Before splenectomy 3(15%) patient clinically developed Heart failure and after splenectomy out of 3 heart failure patients 1(5%) have features of restrictive cardiomyopathy in echocardiogram and 2(10%) have normal findings except high cardiac output.

Conclusion: Splenectomy stabilizes the hemoglobin concentration at higher levels and reduces transfusion needs, reduces high cardiac output and prevent high output failure. Though other cardiac parameters remain unchanged within the first 6 months after splenectomy, it can be assumed that removal of the spleen may contribute to the prevention of further cardiac damage.

Indocyanine Green Compared to Technetium-99m in Sentinel Node Detection in Breast Cancer: A Single-center Retrospective Study

A. Akhdamch, M. Anajjar, M. Ben Moussa, Y. Alami, F. Tijami, H. Hachi — Fri, 28 Jun 2024 00:00:00 +0000

Introduction: Sentinel lymph node biopsy (SLNB) is a standard procedure in the surgical management of early-stage breast cancer. While the Tc99m radioisotope technique is the gold standard for SLNB, indocyanine green (ICG) fluorescence imaging has emerged as a potential alternative. Our study aimed to evaluate the concordance between ICG and Tc99m in detecting axillary sentinel lymph nodes (SLNs) in breast cancer patients.

Materials and Methods: We conducted a retrospective single-center study between January 2021 and October 2021. Patients with localized breast cancer and indication for axillary SLNB were included. Preoperative Tc99m lymphoscintigraphy and intraoperative ICG fluorescence imaging were performed. The primary outcome was the concordance rate between the two methods in detecting SLNs.

Results: Eleven patients with a total of 34 SLNs were included. The detection rate was 94.1%, with 32 SLNs detected by ICG and 23 by Tc99m. Concordance between the two methods was 67.6%. All discordant SLNs (26.5%) were ICG positive/Tc99m negative, including one micrometastatic SLN detected only by ICG. No complications related to ICG use were observed.

Conclusion: Our study suggests that ICG could be a promising alternative to Tc99m for SLNB in breast cancer, potentially offering higher sensitivity. However, larger prospective studies are needed to confirm these findings and establish standardized protocols for ICG use.

Diverticular Peritonitis Revealing an Incidental Neuroendocrine Tumor of the Appendix: A Rare Case Report and Review of the Literature

Wed, 12 Jun 2024 00:00:00 +0000

Three main histological types of appendicular tumor have been described: adenoma, carcinoma and endocrine tumor. Endocrine tumors are the most common, accounting for almost two-thirds of appendicular tumors. Adenomas and adenocarcinomas are rare and present two particularities: A predominant and frequent mucinous component, and a privileged peritoneal extension.

We report the case of a 57-year-old patient, a chronic smoker with 30 pack-year. The patient was admitted to our department as an emergency patient with perforated sigmoidal diverticulitis. Clinically, the patient presented a hypogastric pain and generalized abdominal tenderness on examination, the CT scan showed a pneumoperitoneum with multiple sigmoidal diverticula the surgical exploration revealed a perforated sigmoidal diverticulum with an inflamed appendix with a normal base.

In the light of this review of the literature, we would like to emphasize the importance of histological examination in the diagnosis of neuroendocrine tumors of the appendix, and to highlight the importance of intraoperative exploration, whatever the diagnosis.

Unusual Location of Synovial Sarcoma of the Abdominal Wall: About a Case and Review of the Literature

Sat, 15 Jun 2024 00:00:00 +0000

Synovial sarcoma is a primary malignant mesenchymal tumor first described in 1893, which accounts for 2.5 – 10.5% of all primary soft tissue cancers.

Abdominal synovialosarcoma is a rare and aggressive tumor that presents diagnostic and treatment challenges, as well as a difficult to predict prognosis. In this work we present the case of a 38-year-old patient who underwent surgery due to a cystic tumor of the left anterior abdominal wall. Medical imaging, particularly abdominal CT, revealed tissue heterogeneity which leads to compression of the rectus abdominis muscle as well as the left external oblique muscle. A large single-piece surgical resection of the tumor was performed on the patient. A biphasic synovialosarcoma of the abdominal wall was confirmed by pathological examination.

Adjuvant chemotherapy was administered to the patient and after approximately 2 years he developed a recurrence of his disease which required appropriate management. It is important to discuss synovialosarcoma of the abdominal wall because of its rarity and the nonspecificity of its clinical symptoms. Its precise cause remains unknown; However, some studies suggest that particular genetic mutations may contribute to the development of this tumor. Its therapy is mainly based on surgery with adjuvant chemotherapy and/or radiotherapy which can improve the prognosis.

Intracolonic Migration of an Abdominal Drain through an Appendiceal Fistula: A Rare Post-Appendectomy Complication Managed Conservatively

Mon, 17 Jun 2024 00:00:00 +0000

In patients with appendiceal fistula undergoing conservative management, the main complication is inadequate or incomplete drainage of the fistula, which often leads to the consideration of more aggressive measures. We describe an extremely rare complication with an abdominal drain: intracolonic migration through appendiceal fistula. No such cases have been described in the literature. Our aim is to describe our experience and the therapeutic approach adopted to offer a less invasive treatment alternative, avoiding major surgeries, with good results.

Post Traumatic Membranous Cystic Lipodystrophy: A Case Report and Review of Literature

A. Saoudi, R. Laouiti, A. Zehani, MA. Sbai, R. Maala — Wed, 19 Jun 2024 00:00:00 +0000

Membranous Cystic Lipodystrophy (MCL) is a rare form of panniculitis diagnosed histologically by the presence of cystic cavities bordered by eosinophilic crenated hyaline membranes, which stain positively with Periodic Acid-Schiff (PAS).

It was first described as a morphological characteristic of Nasu-Hakola disease (NHD). Subsequently, this panniculitis has been reported in several other clinical circumstances, predominantly associated with vascular disorders.

We present a rare case of post-traumatic membranous cystic lipodystrophy.

Ulnar Tunnel Syndrome Caused by Neurofibroma in the Elbow: A Case Report

Mon, 01 Jul 2024 00:00:00 +0000

Purpose: compression of the ulnar nerve at the elbow is the second nerve entrapment syndrome of the upper limb, often idiopathic, neurofibroma of the ulnar nerve is an exceptional cause of this syndrome.

Case Report: A 55-year-old man presented with progressive numbness and weakness of the right ring finger and the right little finger for one year. A provisional diagnosis of cubital tunnel syndrome was made according to physical examination and electrophysiological studies. The magnetic resonance imaging showed a nodular lesions over ulnar aspect of the right elbow, which was demonstrated to be a neurofibroma by histopathology. The patient had moderate improvement after surgical decompression of the right cubital tunnel.

Conclusion: This case illustrates the heterogeneous group of pathologies causing peripheral neuropathy. The diagnosis of ulnar nerve neurofibroma with ulnar tunnel syndrome was made carefully according to clinical manifestations as well as a series of electrophysiological, imaging, and pathological studies.

Primary Large Exophytic Leiomyosarcoma of the Stomach: A Case Report with Review of Literature

S. N. Jatal, Sudhir Jatal, Ajay Punpale, Sachin Ingle — Thu, 11 Jul 2024 00:00:00 +0000

Gastric leiomyosarcoma accounts for 1% of all gastric tumors. This type of tumor typically arises from the muscularis propria and is most often found in the body, fundus, cardia, and pyloric antrum of the stomach. Gastric leiomyosarcoma commonly presents as a polypoidal mass, exophytic mass, or ulcerative mass. The primary symptoms include bleeding leading to hematemesis, anaemia, abdominal pain, weight loss, and the presence of an abdominal mass.

Effective diagnostic modalities include endoscopic ultrasonography, contrast-enhanced CT scan, and MRI. Immunohistochemically, the tumoral cells in gastric leiomyosarcoma show positive immunoreactivity to smooth muscle actin and desmin while testing negative for CD117 (C-kit) and CD34. The most effective treatment is complete surgical resection with negative margins, typically achieved through either open or laparoscopic partial gastrectomy.

We report the case of a 57-year-old male who presented with a large mass in the epigastric and left hypochondriac region. Diagnosis was confirmed via CT scan of the abdomen, and histopathological examination verified a high-grade gastric leiomyosarcoma.

Fascia-preserving, Less Invasive Surgery for Abdominal Wall Desmoid: A Retrospective Study of 7 Cases

S. N. Jatal, Sudhir Jatal, Ajay Punpale, Sachin Ingle — Mon, 15 Jul 2024 00:00:00 +0000

Desmoid tumors are benign, tumors arising from connective tissue within musculoaponeurotic structures. Classically these tumors do not metastatic but locally invasive and high rate of recurrence. Desmoid tumors, also known as aggressive fibromatosis, deep fibromatosis or musculoaponeurotic fibromatosis are rare tumors. They have an incidence rate of approximately 2-4 cases per million individuals and represents about 0.03% of all neoplasms and 3% of all soft tissue tumors. The highest incidence is between the age of 30 - 40 years with a strong prevalence among fertile aged women and female to male ratio in 2:1. They are uncommon during menopause.

Desmoid tumors could be extra abdominal, intra-abdominal and abdominal wall. The commonest site is the anterior abdominal wall, with an incidence of 50% approximately 5-10% of cases are associated with familial adenomatosis polyposis and gardener syndrome.

In our study, we are reporting three female patients in between the age of 30-50 years. Diagnosis confirmed on CT imaging and wide surgical excision with clear margin was performed.

We performed Fascia-Preserving, less invasive surgery for abdominal wall desmoid.

Hysteroscopic Retrieval of Numerous Retained Fetal Bones Six Years Post Mid Trimester Abortion in a Patient with Secondary Infertility and Severe Dysmenorrhoea: A Case Report

Sat, 03 Aug 2024 00:00:00 +0000

This case report highlights the significance of prolonged retention of multiple fetal bones six years following termination of pregnancy. Prolonged retention of fetal bone or bone fragments is an established cause of secondary infertility from recurrent endometritis and subsequent Asherman’s syndrome or bilateral tubal blockage. It is usually encountered following unsafe abortion in second trimester (mid trimester abortions). Transvaginal sonography is the initial screening imaging modality for evaluating the uterus of women in gynaecological outpatient clinic while a diagnostic or operative hysteroscopy is the gold standard in treating a woman with retained fetal bone.

We present a 33-year-old nullipara with a six-year history of severe dysmenorrhea following termination of pregnancy. On further evaluation she was found to have numerous retained fetal bone particles in her endometrial cavity which were retrieved via the use of hysteroscopy. She did well clinically and currently have painless menstruation.

A Giant Intraabdominal Desmoid Tumour of the Sigmoid Colon Mesentery

S. N. Jatal, Sudhir Jatal, Ajay Punpale, Sachin Ingle — Fri, 09 Aug 2024 00:00:00 +0000

Desmoid tumors of the colon are exceptionally rare and represent an aggressive form of intra-abdominal desmoid tumors. The sigmoid colon mesentery, while generally associated with lower morbidity, can be affected by these tumors. The etiology of mesenteric desmoid tumors includes factors such as trauma, surgery, hormonal influences, and hereditary conditions like familial adenomatous polyposis coli and Gardner’s syndrome. Intra-abdominal desmoid tumors are most commonly located in the mesentery in about 80% of cases.

Solitary desmoid tumors in the sigmoid colon mesentery are typically benign and have a favourable prognosis. These tumors are characterized by mesenteric fibroblastic growth, which can occur spontaneously or as a result of surgical trauma. Mesenteric desmoids most frequently develop in the intestinal mesentery, followed by the omentum and mesocolon.

These tumors more commonly originate from the left side of the colon and the sigmoid colon, accounting for 60-70% of cases. They are usually diagnosed using simple ultrasonography and CT scans of the abdomen and pelvis. Complete surgical excision is the preferred treatment.

We report a case of a giant desmoid tumor of the sigmoid colon mesentery in a 37-year-old male patient, diagnosed via CT scans of the abdomen and pelvis. The patient presented with a painless large mass in the pelvis, arising from the mesentery of the sigmoid colon, and was planned for open surgery.

Low-grade Appendiceal Mucinous Neoplasm Causing Pseudomyxoma Peritonei and Review

S. N. Jatal, Sudhir Jatal, Atul Deshmukh, Rupesh Gundawar — Fri, 16 Aug 2024 00:00:00 +0000

Mucocele of the appendix is an obstructive dilatation of the appendix caused by the accumulation of mucinous material within the lumen. This rare condition occurs in 0.2-0.7% of all appendectomy specimens and is most commonly seen in individuals aged 50-60 years. Surgical intervention is always required and depends on the integrity and size of the appendix, base as well as the histological type of the original lesion. The prognosis is favourable if the appendix remains intact. However, perforation and subsequent leakage of its contents into the abdominal cavity can lead to pseudomyxoma peritonei, a condition with a very poor prognosis if not properly treated.

Low-grade appendiceal mucinous neoplasm (LAMN) is a rare condition, affecting approximately 1% of patients undergoing appendectomy. While LAMN is often asymptomatic, it can rupture and release mucin and neoplastic epithelial cells into the peritoneum, leading to pseudomyxoma peritonei. This condition produces abundant mucin or gelatinous ascites, commonly referred to as “Jelly-belly” syndrome.

Patients with LAMN without perforation have a better prognosis. However, those with perforation may experience symptoms similar to appendicitis, including pain in the right iliac fossa, fever, nausea, and vomiting. Increased mucin within the appendix lumen may present as a palpable mass or be diagnosed incidentally during an appendectomy.

For early-stage, non-perforated LAMN, a simple appendectomy is often adequate. In advanced stages, treatment may include appendectomy, right hemicolectomy, peritonectomy, and additional hypothermic intraperitoneal chemotherapy (HIPEC).

We report a rare case of low-grade appendiceal mucinous neoplasm leading to pseudomyxoma peritonei in a 56-year-old male patient. The diagnosis was made via ultrasonography and CT abdomen, identifying a perforated mucocele of the appendix.

A Case Report on Giant Lipoma of Hand

R. Laouiti, A. Saoudi, MA. Sbai, R. Maala — Fri, 30 Aug 2024 00:00:00 +0000

Lipomas are very common benign tumors which are preferentially located in the neck and trunk, however other locations which are rare but can exist such as the hand and its commissures.

We report one case of a massif lipoma of the first commissural that progressed for 10 years of a 61year-old woman.

In spite of the size of the tumor and its extensions to others interosseous spaces no nerve compression sign was reported by the patient.

We signal the interest of MRI that allow us to define limits of the mass and to ease the surgical treatment.

The mass was resected in a bloc without any lesions of vessels, nerves or tendons.

Post operative period was uneventful. And the patient had excellent hand and fingers function after a few days of gentle mobilization exercises.

A Giant Intra-abdominal Small Intestinal Desmoid Tumor – A Rare Case Report

S. N. Jatal, Sudhir Jatal, Ajay Punpale, Sachin Ingle — Thu, 12 Sep 2024 00:00:00 +0000

Desmoid tumors, also known as aggressive fibromatosis, are benign neoplasms originating from mesenchymal cells or fibroblasts. Despite their benign nature, these tumors are locally aggressive and do not metastasize distantly. They account for less than 3% of all soft tissue tumors and have an incidence of approximately 0.03% among all neoplasms.

Primary desmoid tumors of the small intestinal wall are particularly rare, with the most common site of origin being the mesentery, retroperitoneum, or small bowel wall. While extra-abdominal desmoid tumors occur in about 60% of cases, with 25% arising from the anterior abdominal wall and 15% being intra-abdominal, those originating from the small bowel are exceedingly uncommon. Such tumors often present as an abdominal mass.

For preoperative diagnosis and surgical planning, abdominal CT and MRI are the preferred imaging modalities. Surgical resection with negative margins remains the cornerstone of effective treatment.

In this report, we present a rare case of a giant intra-abdominal desmoid tumor arising from the small intestine in a 45-year-old female. The diagnosis was confirmed via CT, and the patient is scheduled for open surgical resection.

Anatomical Snuffbox Lipomas - Diagnosis, Particularities and Surgical Management: A Case Report

A. Saoudi, R. Laouiti, MA. Sbai, R. Maala — Tue, 17 Sep 2024 00:00:00 +0000

Lipomas are among the most common benign soft tissue tumors of the body. They are commonly encountered in neck, trunk and upper extremity. Hand localization remains rare and only represents 1% to 3.8% of cases [1]. Anatomical Snuffbox (Radial Fossa) lipoma are exceptional. Management of anatomical snuffbox lipomas may be challenging due to its particular anatomy.

In this article we will discuss the surgical approach to anatomical snuffbox lipomas through two cases.