http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2013 , Hindawi Publishing Corporation . All rights reserved. Sun, 19 May 2013 09:00:41 +0000 http://www.hindawi.com/crim/surgery/2013/510813/ Perianal Paget’s disease only rarely presents with a synchronous invasive anal or rectal cancer. The purpose of this study is to present a case of an otherwise healthy patient who developed perianal Paget’s disease. He was then found to have an invasive rectal adenocarcinoma, after having undergone an extensive resection and reconstruction with a bilateral V-to-Y reconstruction. This report describes an overview of perianal Paget’s disease, the management of this disease in association with anal or rectal cancer, and our patient’s outcome. Margaret E. Clark, Andrew T. Schlussel, and Ronald A. Gagliano Jr. Copyright © 2013 Margaret E. Clark et al. All rights reserved. Thu, 16 May 2013 12:38:47 +0000 http://www.hindawi.com/crim/surgery/2013/534730/ Background. Visceral metastatic spread of ocular melanoma most commonly occurs via hematogenous route to the liver. Lymphatic spread of ocular melanoma into abdominal lymph nodes has not been reported previously. Case Presentation. A 47-year-old man with a history of ocular melanoma presented with a soft tissue mass on CT scan. The mass encased the portal structures of the hepaticoduodenal ligament. Image-guided biopsy revealed it to be a metastatic melanoma to lymph nodes. The patient underwent surgery with the intent to prolong disease-free survival. On final pathological examination, two lymph nodes were found harboring metastatic melanoma. Conclusion. Extrahepatic lymphatic intra-abdominal spread of ocular melanoma is not impossible. Since this mode of spread is rare, the oncologic significance of surgical resection of isolated intra-abdominal nodal with metastatic ocular melanoma is difficult to determine at the present time. David Aranovich, Karen Meir, Michal M. Lotem, Liat Appelbaum, and Hadar Merhav Copyright © 2013 David Aranovich et al. All rights reserved. Thu, 16 May 2013 11:55:13 +0000 http://www.hindawi.com/crim/surgery/2013/896452/ Iatrogenic diaphragmatic hernias can occur after abdominal or thoracic surgery. Acute presentation of a diaphragmatic hernia varies depending on the extent and nature of the organ which has herniated. The initial diagnosis can be challenging due to the nonspecific nature of the presenting symptoms. Delay in diagnosis poses a significant risk to the patient, and a rapid deterioration can occur in the context of strangulation. We outline two cases of acute gastric herniation through a defect in the diaphragm after an open and a laparoscopic nephrectomy. Both had characteristic findings on imaging, required emergency, surgery and had a successful outcome. Both cases highlight the potential for late presentation with non-specific symptoms and the necessity for urgent surgical management where gastric perfusion is compromised. Conall Fitzgerald, Orla Mc Cormack, Faisal Awan, Jessie Elliott, Narayanasamy Ravi, and John V. Reynolds Copyright © 2013 Conall Fitzgerald et al. All rights reserved. Sun, 12 May 2013 15:17:54 +0000 http://www.hindawi.com/crim/surgery/2013/809479/ To be human is great; to look human is wonderful! It is nature's greatest gift! Mother nature's womb is the safest place on earth for any life, but the calamity strikes and no one knows how Hence, Treasure your exceptions!, since nature seems nowhere accustomed more openly to display, its secret mysteries than in cases where it shows traces of its workings apart from the beaten path. A dismorphological pattern of congenital oro-craniofacial and limb defects which is a rare form of amniotic rupture sequence required persistent coordinated efforts of multiple disciplines and had manifested as bizarre orofacial clefting, cat eye syndrome with an ectopic eye, and aberrant tissue band lesions on limb. The challenge was to meet the child’s clamour for functional demands on premature exposure to open world and was overcome through a phased treatment implementation. Anophthalmos resulting from multiple ophthalmic surgeries for aberrant ectopic left eye and cat eye syndrome of right eye required a staged sequential preemptive planning for a successful outcome. Every phase of fabrication of orbital prosthesis comes with an impending challenge. Thus, a well-defined technique eliminating the common errors and creating a natural looking prosthesis, in the face of limitations, is imperative. Aparna Barabde, Shailesh M. Barabde, Ashish Bhagat, and Amar Thakare Copyright © 2013 Aparna Barabde et al. All rights reserved. Thu, 09 May 2013 14:31:01 +0000 http://www.hindawi.com/crim/surgery/2013/475215/ Cutaneous leiomyomas are benign smooth muscle neoplasms of the skin. They arise from vascular, arrector pili, genital, and areolar smooth muscles. The most common localizations of cutaneous leiomyomas are the extensor surfaces of the extremities and the trunk. To our knowledge, only few cases of one-sided nipple leiomyomas have been reported, but two-sided nipple leiomyomas have not been presented. For the first time, here, we report a bilateral nipple leiomyoma. Ugur Deveci, Mahmut Sertan Kapakli, Fatih Altintoprak, Mine Cayırcı, Manuk Norayk Manukyan, and Abut Kebudi Copyright © 2013 Ugur Deveci et al. All rights reserved. Wed, 08 May 2013 19:29:05 +0000 http://www.hindawi.com/crim/surgery/2013/414260/ Mediastinal neurogenic tumours generally arise as single benign lesions and their typical location is the costovertebral sulcus. In about 10% of cases mediastinal neurogenic tumours may extend to the spinal canal; occasionally they may extend to the cervical region and, more rarely, may be multiple or associated with other synchronous mediastinal lesions. The treatment of choice is surgical resection. This report describes three cases of unusual presentation of mediastinal benign schwannomas successfully treated at our Hospital. In the first case multiple simultaneous paravertebral lesions were resected through a posterior approach. In the second case a tumour of the posterior mediastinum extending to the cervical region was excised through a one-stage combined supraclavicular incision followed by left mini-invasive video-assisted thoracoscopic surgical techniques. The third case describes a patient with a posterior neurogenic mediastinal tumour with a synchronous parathyroid adenoma of the anterior mediastinum, which were both successfully resected by video-assisted thoracoscopic surgery. Giampiero Negri, Alessandro Bandiera, Angelo Carretta, Armando Puglisi, Carlo Mandelli, Paola Ciriaco, and Piero Zannini Copyright © 2013 Giampiero Negri et al. All rights reserved. Tue, 07 May 2013 16:33:16 +0000 http://www.hindawi.com/crim/surgery/2013/604061/ The abdominal cocoon syndrome (or idiopathic encapsulating peritonitis) is a rare cause of intestinal obstruction. It has been reported predominantly in adolescent girls living in tropical/subtropical region in which diagnosis is only made at laparotomy in most cases. The cause and pathogenesis of the condition have not been elucidated. Prolonged administration of practalol, meconium peritonitis, and tuberculous infection of the female genital tract have been incriminated as possible causes. The author reports a case of a female patient with recurrent intestinal obstruction treated for years but failed to settle down on conservative treatment during her last hospital admission and had to undergo surgery. Preoperative diagnosis of this syndrome as the cause of her intestinal obstruction was not made until at laparotomy, when a thick fibrotic peritoneal wrapping of the bowel in a concertina-like fashion with some adhesions was found. Excision of this membrane and adhesiolysis were carried out without any need for bowel resection, and this led to relief of the obstruction and patient’s complete recovery. Awareness of this benign condition in the differential diagnosis of intestinal obstruction will result in early diagnosis and correct management and prevent unnecessary bowel resections and bad outcomes. Julius A. A. Awe Copyright © 2013 Julius A. A. Awe. All rights reserved. Tue, 07 May 2013 11:02:14 +0000 http://www.hindawi.com/crim/surgery/2013/580453/ Sickle-cell trait is a common genetic abnormality in the African American population. A sickle-cell crisis in a patient with sickle-cell trait is uncommon at best. Abdominal painful crises are typical of patients with sickle cell anemia. The treatment for an abdominal painful crisis is usually medical and rarely surgical. We present the case of a cocaine-induced sickle-cell crisis in a sickle-cell trait patient that resulted in splenic, intestinal, and cerebral infarctions and multisystem organ failure necessitating a splenectomy, subtotal colectomy, and small bowel resection. This case highlights the diagnostic dilemma that abdominal pain can present in the sickle-cell population and illustrates the importance of recognizing the potential for traditionally medically managed illnesses to become surgical emergencies. Sofya H. Asfaw, Gavin A. Falk, Gareth Morris-Stiff, Ralph J. Tuthill, Matthew L. Moorman, and Michael A. Samotowka Copyright © 2013 Sofya H. Asfaw et al. All rights reserved. Tue, 07 May 2013 10:31:00 +0000 http://www.hindawi.com/crim/surgery/2013/591432/ Introduction. Acrylic cement pulmonary embolism is a potentially serious complication following vertebroplasty. Case Report. A 70-year-old male patient was treated with percutaneous vertebroplasty for osteoporotic nontraumatic vertebral collapse of L5-S1. Asymptomatic pulmonary cement embolism was detected on routine postoperative chest radiogram and the patient was treated with enoxaparin, amoxicillin, and dexamethasone. At the followup CT scan no further migration of any cement material was reported; and the course was uneventful. Discussion. The frequency of local leakage of bone cement is relatively high (about 80–90%), moreover, the rate of cement leakage into the perivertebral veins (seen in up to 24% of vertebral bodies treated) with consequent pulmonary cement embolism varies from 4.6 to 6.8% (up to 26% in radiologic studies); the risk of embolism is increased with the liquid consistency of the cement and with the treatment of some malignant lesions. Patients may remain asymptomatic and develop no known long-term sequelae. Conclusions. Our ancedotal case illustrates the need for close monitoring of patients undergoing percutaneous vertebroplasty and emphasizes the importance of prompt and correct diagnosis and treatment, even if actually there is no agreement regarding the therapeutic strategy. Girolamo Geraci, Giorgio Lo Iacono, Chiara Lo Nigro, Fabio Cannizzaro, Massimo Cajozzo, and Giuseppe Modica Copyright © 2013 Girolamo Geraci et al. All rights reserved. Thu, 02 May 2013 14:33:16 +0000 http://www.hindawi.com/crim/surgery/2013/256062/ Obturator hernia is a rare type of pelvic hernia which generally occurs in elderly patients with accompanying diseases. Because it is difficult to diagnose before surgery, the morbidity and mortality rates for obturator hernia are high. The most common symptom is strangulation combined with mechanical intestinal obstruction. Ibrahim Aydin, Ahmet Fikret Yucel, Ahmet Pergel, and Dursun Ali Sahin Copyright © 2013 Ibrahim Aydin et al. All rights reserved. Thu, 02 May 2013 11:39:41 +0000 http://www.hindawi.com/crim/surgery/2013/763702/ Introduction. Retroperitoneal sarcomas comprise a small proportion of all soft tissue sarcomas, and multiple factors influence their clinical behavior. Histopathological type and grade as well as complete surgical resection especially on the first operative attempt are well recognized as the main prognostic factors. Multifocality is another prognostic factor, which compromises therapy and finally makes prognosis worse due to multiple adverse implications. Case Presentation. A rare case of a 65-year-old male patient suffering from a multifocal retroperitoneal liposarcoma successfully treated in our hospital is presented herein. Discussion. Also, general considerations for these tumors are discussed, and especially multifocality is underlined as an ominous sign of retroperitoneal sarcomas behavior. Despite multifocality, once again complete surgical excision remains the mainstay of treatment of these patients, as long as further systemic and local therapies do not provide durable results. Theodosios Theodosopoulos, Dionysios Dellaportas, Vasiliki Psychogiou, Anneza Yiallourou, George Polymeneas, Georgios Gkiokas, and Dionysios Voros Copyright © 2013 Theodosios Theodosopoulos et al. All rights reserved. Tue, 30 Apr 2013 13:41:28 +0000 http://www.hindawi.com/crim/surgery/2013/906457/ Background. Visceral myopathy is rare pathological condition of gastrointestinal tract with uncertain clinical presentation and unknown etiology. It often presents with symptoms of chronic intestinal pseudoobstruction of colon. We report a case of visceral myopathy which presented to us as acute appendicitis and Ogilvie syndrome, and we managed it surgically. Method and Result. A case report of 20-year female clinically presented as acute appendicitis and we performed laparoscopic exploration which revealed inflamed appendix with grossly dilated ascending colon. We performed laparoscopic appendectomy and postoperatively managed the patients with IV fluids, antibiotics, neostigmine, and extended length rectal tube for enema and decompression. During postoperative period, she developed abdomen distension and peritonitis, and we ordered abdomen CT which revealed colon pseudo- obstruction. We performed right hemicolectomy with permanent ileostomy, and the histopathology reports of resected colon were visceral myopathy. Conclusion. Visceral myopathy is very rare group of disease and poorly understood condition that may present with chronic or acute intestinal pseudo-obstruction and often mimic other more common gastrointestinal disease. VM should be considered as differential diagnosis whenever the patient presents with acute appendicitis, uncharacteristic abdominal symptoms, recurrent attacks of abdominal distention, and pain with no radiological evidence of intestinal obstruction. Punyaram Kharbuja, Raghvendra Thakur, and Jian Suo Copyright © 2013 Punyaram Kharbuja et al. All rights reserved. Tue, 30 Apr 2013 11:18:57 +0000 http://www.hindawi.com/crim/surgery/2013/968394/ Introduction. Gastrointestinal stromal tumors of the esophagus are rare. Case Presentation. This is a case of a 50-year-old male patient who was referred to our department complaining of atypical chest pain. A chest computed tomographic scan and endoscopic ultrasound revealed a submucosal esophageal tumor measuring 5 cm in its largest diameter. Suspecting a leiomyoma, we performed enucleation via right thoracotomy. The pathology report yielded a diagnosis of an esophageal gastrointestinal stromal tumor. The patient has shown no evidence of recurrence one year postoperatively. Conclusions. This report illustrates the complexity and dilemmas inherent in diagnosing and treating esophageal GISTs. Charalampos G. Markakis, Eleftherios D. Spartalis, Emmanouil Liarmakopoulos, Evangelia G. Kavoura, and Periklis Tomos Copyright © 2013 Charalampos G. Markakis et al. All rights reserved. Sun, 28 Apr 2013 17:31:21 +0000 http://www.hindawi.com/crim/surgery/2013/714126/ Malignant transformation of endometriosis is rare and is usually seen in ovarian endometriosis. The colon and rectum are the most common sites for extragonadal endometriosis, and although serosal involvement is commonly seen, mucosal involvement is rare. Malignant transformation of endometriosis is a rare but a well-known complication of endometriosis. We report an unusual presentation of endometrioid adenocarcinoma with lymph node metastasis, arising from endometriosis in the caecal wall and causing ileocaecal intussusception. The patient presented with sudden onset of abdominal pain with features suggestive of acute appendicitis. Diagnostic laparoscopy revealed an ileocaecal intussusception. Conversion to open surgery confirmed a caecal mass causing ileocaecal intussusception, and a radical right hemicolectomy was performed. Histology revealed endometrioid adenocarcinoma arising in a focus of endometriosis in the muscularis propria and involving the mucosa, with one regional metastatic lymph node. Rashmi Verma, Sally Osborn, and Kieran Horgan Copyright © 2013 Rashmi Verma et al. All rights reserved. Sun, 21 Apr 2013 11:14:03 +0000 http://www.hindawi.com/crim/surgery/2013/780862/ Desmoid tumors (also called desmoids fibromatosis) are rare slow growing benign and musculoaponeurotic tumors. Although these tumors have a propensity to invade surrounding tissues, they are not malignant. These tumors are associated with women of fertile age, especially during and after pregnancy. We report a young female patient with a giant desmoid tumor of the anterior abdominal wall who underwent primary resection. The patient had no history of an earlier abdominal surgery. Preoperative evaluation included abdominal ultrasound, computed tomography, and magnetic resonance imaging. The histology revealed a desmoid tumor. Primary surgical resection with immediate reconstruction of abdominal defect is the best management of this rarity. To the best of our knowledge and PubMed search, this is the first case ever reported in the medical literature of such a giant desmoid tumor arising from anterior abdominal wall weighing 6.5 kg treated surgically with successful outcome. Mahim Koshariya, Samir Shukla, Zuber Khan, Vaibhav Vikas, Avinash Pratap Singh, Puspendra Baghel, Varun Pendro, Vishal Kirti Jain, Shrikant Jagdish Jai, Sanjeev Kumar, and M. C. Songra Copyright © 2013 Mahim Koshariya et al. All rights reserved. Wed, 17 Apr 2013 18:15:24 +0000 http://www.hindawi.com/crim/surgery/2013/754354/ Cholecystocolonic fistulas (CCF) are rare complications of gallstones with a variable clinical presentation. Despite modern diagnostic tools, cholecystocolonic fistulas are often asymptomatic and it is difficult to diagnose them preoperatively. Biliary-enteric fistulae have been found in 0.9% of patients undergoing biliary tract surgery. The most common site of communication of the fistula is the cholecystoduodenal (70%), followed by the cholecystocolic (10–20%), and the least common is the cholecystogastric fistula. Herein, we report a case of female patient with multiple episodes of acute recurrent cholangitis due to common bile duct and gallbladder stones in which preoperative imaging studies were negative for cholecystocolonic fistula that was incidentally discovered and treated during surgery and was appropriately treated. A review of the literature is reported too. Nicola Antonacci, Giovanni Taffurelli, Riccardo Casadei, Claudio Ricci, Francesco Monari, and Francesco Minni Copyright © 2013 Nicola Antonacci et al. All rights reserved. Thu, 11 Apr 2013 10:26:13 +0000 http://www.hindawi.com/crim/surgery/2013/319026/ Congenital or true colonic diverticulosis is a rare condition typified by the preservation of the colonic wall architecture within the diverticular outpouching. Cases of multiple jejunal diverticula have been reported as well as cases of solitary giant diverticula of the colon. There have been no reports in the literature of pancolonic congenital diverticulosis. A. Patel, H. M. N. Joshi, C. Kaur, and J. M. Wilson Copyright © 2013 A. Patel et al. All rights reserved. Wed, 10 Apr 2013 15:35:58 +0000 http://www.hindawi.com/crim/surgery/2013/567186/ We report an unusual case of idiopathic unilateral adrenal haemorrhage (AH) in a 55-year-old patient. This rare case had two characteristics that made it worth of report. First, idiopathic adrenal haemorrhage is very uncommon, and second it was presented as a huge, 23 cm diameter and 2,123 gr weight, “silent” adrenal mass. It is important to distinguish a benign lesion like this from a neoplasm, although we were not able to identify it preoperatively and the diagnosis was only made after the excised specimen was examined by a group of experienced histopathologists. Only a few similar published cases, to our knowledge, are described in the worldwide literature and even fewer of this size. Christos Christoforides, Athanasios Petrou, and Marios Loizou Copyright © 2013 Christos Christoforides et al. All rights reserved. Wed, 10 Apr 2013 10:54:38 +0000 http://www.hindawi.com/crim/surgery/2013/619282/ A 59-year-old male patient with Marfan's syndrome was referred to our clinic due to acute chest pain. His medical history contains complex surgery for type A aortic dissection 19 years ago including composite root replacement using a mechanical aortic valve. Immediate computed tomography indicated perforation at the distal ascending aortic anastomosis plus complete avulsion of both coronary ostia. The patient underwent successful rescue surgery with ascending aortic and arch replacement using a modified Cabrol technique. Konstantin von Aspern, Joerg Seeburger, Christian D. Etz, Matthias Sauer, Lukas Lehmkuhl, Martin Misfeld, and Friedrich W. Mohr Copyright © 2013 Konstantin von Aspern et al. All rights reserved. Mon, 08 Apr 2013 09:01:43 +0000 http://www.hindawi.com/crim/surgery/2013/265073/ Total avulsion and transection of the esophagus at the esophagogastric junction are very rare after blunt trauma, and their management is challenging. Here, we present the case of a boy with this injury. To date, only two cases have been reported in children. One was treated successfully and the other died. The initial emergency operation should aim to save the life and native esophagus. Therefore, a primary or early thoracal end esophagostomy with gastrostomy should be performed, while primary repair should not be. Ibrahim Uygun, Selcuk Otcu, Bahattin Aydogdu, Mehmet Hanifi Okur, and Mehmet Serif Arslan Copyright © 2013 Ibrahim Uygun et al. All rights reserved. Thu, 04 Apr 2013 13:23:05 +0000 http://www.hindawi.com/crim/surgery/2013/125095/ An Amyand’s hernia refers to the presence of an appendix within an inguinal hernia sac. This uncommon finding occurs in less than 1% of all right side inguinal hernias; to date, this finding has been reported in only 14 patients with left side inguinal hernias. The preoperative diagnosis of this condition is uncommon. We report the 15th case of a left side Amyand’s hernia that was diagnosed preoperatively on a contrast enema study as well as the relatively more common right-sided Amyand’s hernia diagnosed serendipitously at surgery. S. Mewa Kinoo, M. R. Aboobakar, and B. Singh Copyright © 2013 S. Mewa Kinoo et al. All rights reserved. Thu, 04 Apr 2013 11:25:22 +0000 http://www.hindawi.com/crim/surgery/2013/972596/ Appendicectomy for appendicitis is one of the commonest surgical procedures performed worldwide. The residual appendiceal stump left after an initial appendectomy risks the development of stump appendicitis. Stump appendicitis is a real recognized entity but not often considered when evaluating patients with right lower quadrant abdominal pain, especially those with past history of appendectomy. It remains a clinical challenge with the result that its diagnosis and effective treatment are often delayed with possible attendant morbidity or mortality. Stump appendicitis results from obstruction of the lumen of the remaining appendix stump, usually by a faecolith. This increases intraluminal pressure, impairing venous drainage and allowing subsequent bacterial infection. We present the case of a twenty-five (25)-year-old female who underwent laparoscopic appendicectomy and presented four and half (4(1/2)) months later with fever, right lower quadrant abdominal pain, and tenderness associated with repeated vomiting. Exploratory laparotomy was carried out after clinical and imaging studies which revealed big inflammatory mass with abscess at the right iliac fossa and recurrent appendicitis of the appendiceal stump. Surgical treatment is easy but recognition of this important entity but potentially dangerous condition should always be borne in mind in order to avoid delay in its diagnosis and treatment. J. A. A. Awe, A. M. Soliman, and R. W. Gourdie Copyright © 2013 J. A. A. Awe et al. All rights reserved. Thu, 04 Apr 2013 09:06:38 +0000 http://www.hindawi.com/crim/surgery/2013/206768/ A 79-year-old man, with history of recent laparoscopic cholecystectomy, came to our attention for persistent hiccup, dysphonia, and dysphagia. Noninvasive imaging studies showed a nodular lesion in the right hepatic lobe with transdiaphragmatic infiltration and increased tracer uptake on positron emission tomography. Suspecting a malignant lesion and given the difficulty of performing a percutaneous transthoracic biopsy, the patient underwent surgery. Histological analysis of surgical specimen showed biliary gallstones surrounded by exudative inflammation, resulting from gallbladder rupture and gallstones spillage as a complication of the previous surgical intervention. This case highlights the importance of considering such rare complication after laparoscopic cholecystectomy. Elisa Grifoni, Costanza Marchiani, Alessia Fabbri, Gabriele Ciuti, Andrea Pavellini, Francesco Mancuso, Riccardo Viligiardi, and Alberto Moggi Pignone Copyright © 2013 Elisa Grifoni et al. All rights reserved. Wed, 03 Apr 2013 09:35:48 +0000 http://www.hindawi.com/crim/surgery/2013/596362/ Renal cell carcinoma (RCC) is rare but aggressive, with greater than 20% of patients presenting with stage III or IV, disease. Surgical resection of the primary tumor regardless of stage is the treatment of choice, and en bloc resection of involved organs provides the only potential chance for cure. This case report describes a patient with metastatic right-sided RCC with invasion of the inferior vena cava and duodenum managed by en block resection and pancreaticoduodenectomy. This report will review the workup and treatment of locally advanced RCC, as well as the role of cytoreductive nephrectomy in the setting of metastatic disease. Andrew T. Schlussel, Aaron B. Fowler, Herbert K. Chinn, and Linda L. Wong Copyright © 2013 Andrew T. Schlussel et al. All rights reserved. Tue, 02 Apr 2013 18:26:49 +0000 http://www.hindawi.com/crim/surgery/2013/539737/ Intra-abdominal disease can present as an extra-abdominal abscess and can follow several routes, including the greater sciatic foramen, obturator foramen, femoral canal, pelvic outlet, and inguinal canal. Nerves and vessels can also serve as a route out of the abdomen. The psoas muscle extends from the twelfth thoracic and fifth lower lumbar vertebrae to the lesser trochanter of the femur, which means that disease in this muscle group can migrate along the muscle, out of the abdomen, and present as a thigh abscess. We present a case of a primary pelvic staphylococcal infection presenting as a thigh abscess. The patient was a 60-year-old man who presented with left posterior thigh pain and fever. Physical examination revealed a diffusely swollen left thigh with overlying erythematous, shiny, and tense skin. X-rays revealed no significant soft tissue lesions, ultrasound was suggestive of an inflammatory process, and MRI showed inflammatory changes along the left hemipelvis and thigh involving the iliacus muscle group, left gluteal region, and obturator internus muscle. The abscess was drained passively via two incisions in the posterior left thigh, releasing large amounts of purulent discharge. Subsequent bacterial culture revealed profuse growth of Staphylococcus aureus. The patient recovered uneventfully except for a moderate fever on the third postoperative day. T. O. Abbas Copyright © 2013 T. O. Abbas. All rights reserved. Tue, 02 Apr 2013 17:00:31 +0000 http://www.hindawi.com/crim/surgery/2013/150457/ Introduction. Although adrenal cysts are uncommon, the incidence rate is increasing with the advances in radiological technologies. The incidental detection of adrenal cysts nowadays has become more frequent as a result of the increase usage of high quality imaging modalities. Adrenal cysts originate from the adrenal gland and can be classified into either true or pseudocyst. Presentation of Case. In this report, we described an adrenal cyst of endothelial type, in a 30-year-old lady who was mistakenly diagnosed to have a hydatid cyst both clinically and by imaging. Discussion. Although adrenal cysts are uncommon, the incidence rate is increasing with the frequent use of various high quality radiological technologies. Adrenal cyst should be considered in the differential diagnosis when dealing with upper abdominal cysts. The size of the adrenal cyst can vary from a few millimeters up to 50 cm in diameter. Most of the adrenal cysts are unilateral, while 8%–15% of those cysts do present bilaterally. The majority of cases are diagnosed between the 3rd and 5th decades. Conclusion. Although most of the adrenal cysts are benign in nature, surgical excision is advisable especially when the cysts are greater than 5 cm in diameter and in the case of suspecting malignancy. Abdulla Darwish, Veena Nagaraj, Mohmmed B. Mustafa, and Ahmed Al Ansari Copyright © 2013 Abdulla Darwish et al. All rights reserved. Thu, 28 Mar 2013 11:33:47 +0000 http://www.hindawi.com/crim/surgery/2013/389013/ Contralateral axillary lymph node metastases (CAMs) in breast cancer patients are uncommon. CAM can be found at the time of primary breast cancer diagnosis or following prior treatment of breast cancer as a recurrence. This distinction may have important implications for disease staging and treatment selection. We report the case of a premenopausal woman with synchronous CAM. Despite extensive multimodality treatment, a recurrence was found 27 months after primary surgery. We reviewed the literature on histopathological tumor characteristics associated with CAM, lymphatic drainage of the breast to other sites than the ipsilateral axilla, and outcome of cases with CAM. This case contradicts current conceptions that CAM only develops from tumors with poor histopathological features. Emerging evidence shows that altered lymphatics play a central role in development of synchronous CAM. It is precisely this etiology that supports the concept that synchronous CAM occurs by lymphatic spread and not by hematogenous spread. Although controversial, treatment of synchronous CAM (without evidence of distant metastases) should therefore be of curative intent. C. Zhou, M. C. Richir, M. W. H. Leenders, B. L. A. M. Langenhorst, H. P. Knol, and W. H. Schreurs Copyright © 2013 C. Zhou et al. All rights reserved. Wed, 27 Mar 2013 17:33:08 +0000 http://www.hindawi.com/crim/surgery/2013/560712/ Invasive micropapillary carcinoma (IMPC) of the breast, urinary bladder, ovary, and colon has been reported. However, few reports have described IMPC of the stomach. In addition, IMPC has been described as a histological indicator for lymphatic invasion and nodal metastasis, resulting in poor prognosis. We report a case of 5-year survival after surgery for IPMC of the stomach. A 69-year-old woman was admitted to our hospital with symptoms of upper abdominal pain. Upper gastrointestinal endoscopy revealed a tumor at the antrum of the stomach. Histological examination of the biopsy specimen indicated poorly differentiated adenocarcinoma. The patient underwent distal gastrectomy with lymph node dissection. Microscopic examination of the specimen revealed that the tumor consisted of an invasive micropapillary component. Carcinoma cell clusters were floating in the clear spaces. The patient recovered uneventfully and remains alive without recurrence 5 years after surgery. Shigeo Ninomiya, Kazuya Sonoda, Hidefumi Shiroshita, Toshio Bandoh, and Tsuyoshi Arita Copyright © 2013 Shigeo Ninomiya et al. All rights reserved. Wed, 27 Mar 2013 17:24:04 +0000 http://www.hindawi.com/crim/surgery/2013/947295/ Introduction. The congenital anomalies of breast, especially the polymastia (supernumerary breast) and polythelia (supernumerary nipple), always do not fail to amuse the clinicians because of their varied presentations, associated renal anomalies, and pathologies arising from them. The axillary polymastia is a variant of ectopic breast tissue (EBT). Ectopic breast tissue can undergo the same physiological and pathological processes as the normally located breast. The incidence of fibroadenoma developing in ectopic breast is reported as a rare entity, the most common being the carcinoma. Case Presentation. A 31-year-old Dravidian female presented with a lump of 4 cm in the right axilla for the past year which gradually increased in size, giving discomfort. Our initial differential diagnosis was fibroadenoma, lipoma, and lymphadenopathy. Further investigation and histopathological report of excision biopsy confirmed it as a fibroadenoma on ectopic breast tissue in the axilla. Patient has no associated urological or cardiac anomaly. Conclusion. This case has been reported for its rarity and to reemphasise the importance of screening of EBT for any pathology during routine screening of breast. Anandhi Amaranathan, Kanchana Balaguruswamy, Ramachandra V. Bhat, and Manash Kumar Bora Copyright © 2013 Anandhi Amaranathan et al. All rights reserved. Wed, 27 Mar 2013 11:23:10 +0000 http://www.hindawi.com/crim/surgery/2013/902943/ Ingestion of a foreign body is a rare cause of small bowel obstruction. Ingested foreign bodies will usually pass without clinical sequelae, however on occasion can contribute to significant morbidity. Here we present an unusual case of small bowel obstruction and perforation as a result of accidental ingestion of a nectarine pit. Mahmoud Al-Najjar and Thomas Arthur Copyright © 2013 Mahmoud Al-Najjar and Thomas Arthur. All rights reserved.