Case Reports in Surgery The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. The First Ever Reported Case of Primary Synovial Sarcoma of Scalp Wed, 29 Jun 2016 10:43:51 +0000 Synovial sarcomas are a rare entity with predilection for extremities and joints. The literature suggests that these tumours are rare in the head and neck region. Very few authors have reported their origin in head. Among the ones occurring in the head region, most of them are found to originate from the parotid area. According to our extensive review of available literature, there has been no reported case of the primary case of synovial sarcoma originating from the scalp convexity. We hereby report one such case in a young female which, by far to the best of our knowledge, is the first ever reported case of a synovial sarcoma occurring on the scalp. The tumour is also the largest ever reported in the literature and posed a great surgical and diagnostic challenge to our team. Through this paper, we recommend that synovial sarcoma should be included as a very rare yet possible differential diagnosis for the scalp tumours. Biplab Mishra, Saurabh Singhal, Deepak Prakash Bhirud, Nitesh Kumar, and Saumyaranjan Mallick Copyright © 2016 Biplab Mishra et al. All rights reserved. A Unique Case of an Aggressive Gangliocytic Paraganglioma of the Filum Terminale Tue, 28 Jun 2016 06:22:20 +0000 Paragangliomas are rare neuroendocrine tumors that are mostly found in the head and neck. Even less common are gangliocytic variant paragangliomas of the spine for which there are only 7 other documented cases in the literature. We report a case of gangliocytic paraganglioma of the sacral spine in a 68-year-old man. The growth pattern is documented over three years, which to our knowledge has not previously been reported in the literature and is different from the natural history. Clinical, radiological, and pathological characteristics of the tumor are discussed in light of available reports of this rare tumor. Omar S. Akbik, Crina Floruta, Muhammad O. Chohan, Karen S. SantaCruz, and Andrew P. Carlson Copyright © 2016 Omar S. Akbik et al. All rights reserved. An Eustachian Tube Neuroendocrine Carcinoma: A Previously Undescribed Entity and Review of the Literature Mon, 27 Jun 2016 15:53:38 +0000 Primary sinonasal and middle ear neuroendocrine carcinomas are rare malignancies of the head and neck. Owing to the rarity of these tumors, the clinical behavior and optimal management of these tumors are not well defined. We present a case of an incidentally discovered sinonasal neuroendocrine carcinoma that was found to originate from the Eustachian tube, which has not previously been described in the literature. This patient was treated with primary surgical resection using a combination of transnasal and transaural approaches and achieved an incomplete resection. Follow-up imaging demonstrated continued tumor growth in the Eustachian tube as well as a new growth in the ipsilateral cerebellopontine angle and findings suspicious of perineural invasion. However, the tumor exhibited a benign growth pattern and despite continued growth the patient did not receive additional treatment and he remains asymptomatic 35 months following his original surgery. Gavin J. le Nobel, Vincent Y. Lin, Vladimir Iakovlev, and John M. Lee Copyright © 2016 Gavin J. le Nobel et al. All rights reserved. Afferent Loop Syndrome after Roux-en-Y Total Gastrectomy Caused by Volvulus of the Roux-Limb Sun, 26 Jun 2016 14:05:15 +0000 Afferent loop syndrome is a rare complication of gastric surgery. An obstruction of the afferent limb can present in various ways. A 73-year-old man presented with one day of persistent abdominal pain, gradually radiating to the back. He had a history of total gastrectomy with a Roux-en-Y reconstruction. Abdominal computed tomography scan revealed dilation of the duodenum and small intestine in the left upper quadrant. Exploratory laparotomy showed volvulus of the biliopancreatic limb that caused afferent loop syndrome. In this patient, the 50 cm long limb was the cause of volvulus. It is important to fashion a Roux-limb of appropriate length to prevent this complication. Hideki Katagiri, Kana Tahara, Kentaro Yoshikawa, Alan Kawarai Lefor, Tadao Kubota, and Ken Mizokami Copyright © 2016 Hideki Katagiri et al. All rights reserved. Pelvic Myxoid Leiomyoma Mass between Vagina and Rectum Sun, 26 Jun 2016 13:27:33 +0000 Leiomyomas are the most common pelvic tumors in women. About 20–30% of women older than 35 are affected. Rare conditions of leiomyomas have extrauterine locations. Myxoid degeneration is a rare type of leiomyoma degeneration. We report a case of solid-cystic myxoid leiomyoma in a 53-year-old woman complained of constipation, urinary hesitation, and malodorous vaginal discharge with palpable  cm mass between vagina and rectum. Regarding the inferior location of the mass, a perineal approach was used to enucleate it. This rare location has not been mentioned before. The woman was finally diagnosed by pathologists which was myxoid leiomyoma. Omar AlShalabi, Fadi Obaied Alahmar, Hazem Aljasem, Bayan Alsaid, and Abdulghani AlShalabi Copyright © 2016 Omar AlShalabi et al. All rights reserved. Atypical Chest Pain: An Unusual Presentation of Spinal Metastasis due to Penile Carcinoma Sun, 26 Jun 2016 12:13:54 +0000 Spinal metastases may present in a myriad of ways, most commonly back pain with or without neurology. We report an unusual presentation of isolated atypical chest pain preceding metastatic cord compression, secondary to penile carcinoma. Spinal metastasis from penile carcinoma is rare with few cases reported. This unusual presentation highlights the need for a heightened level of clinical suspicion for spinal metastases as a possible cause for chest pain in any patients with a history of carcinoma. The case is discussed with reference to the literature. Sarah Pywell, Shumaila Hasan, Mohammad Zain Sohail, Georgios Mamarelis, Cameron Dott, Mohammad Taimur Khan, and Naveethan Sivanadarajah Copyright © 2016 Sarah Pywell et al. All rights reserved. Pectoralis Minor Syndrome: Case Presentation and Review of the Literature Sun, 26 Jun 2016 12:12:30 +0000 We present a case of a healthy young female with axillary vein compression caused by the pectoralis minor muscle. Diagnosis was made by clinical findings and dynamic venography. After pectoralis minor tenotomy, the patient had total resolution of her symptoms. Compression of the axillary vein by the pectoralis minor is a rare entity that needs a careful exam and imaging to reach its diagnosis and establish the appropriate treatment. Mohammed Abdallah, Mohammad Rachad Wehbe, Elias Elias, Muhammad Aghiad Kutoubi, and Roger Sfeir Copyright © 2016 Mohammed Abdallah et al. All rights reserved. Transvaginal Hybrid NOTES Procedure for Treatment of Gallstone Ileus Sun, 26 Jun 2016 10:11:53 +0000 Gallstone ileus is a rare mechanical bowel obstruction, and previously reported cases have been treated laparoscopically with good results. Although transvaginal hybrid NOTES without a minilaparotomy has been reported to decrease the incidence of surgical wound complications, to our knowledge, this procedure has not been used previously to treat gallstone ileus. We present a case of a 63-year-old woman who underwent transvaginal hybrid NOTES procedure for treatment of gallstone ileus. This case was admitted to our hospital following acute-onset abdominal pain and vomiting. We diagnosed gallstone ileus with cholecystoduodenal fistula by computed tomography and performed totally laparoscopic surgery using only three 5 mm abdominal ports with transvaginal specimen extraction and enterectomy. The patient’s postoperative course was uneventful, and laparoscopic cholecystectomy and fistula repair were performed 8 months after the initial surgery. The patient experienced additional pain relief and good cosmetic outcomes. In conclusion, using transvaginal hybrid NOTES may become a future option to minimize the invasiveness of other laparoscopic procedures. Takuya Shiraishi, Naoki Tomizawa, Tatsumasa Andoh, Kazuhisa Arakawa, Yasuaki Enokida, and Naoya Ozawa Copyright © 2016 Takuya Shiraishi et al. All rights reserved. Aplasia Cutis Congenita of the Scalp with a Familial Pattern Sun, 26 Jun 2016 10:11:50 +0000 Aplasia Cutis Congenita (ACC) is a condition characterized by congenital absence of skin, usually on the scalp. ACC can occur as an isolated condition or in the presence of other congenital anomalies. Here we describe a case of a 16-day-old baby girl with an isolated ACC of the scalp. Her elder two siblings have been diagnosed with ACC with concomitant cardiac or limb anomalies. The patient was managed conservatively until the defect has formed scar tissue 6 months later. Waleed AlShehri, Sara AlFadil, Alhanouf AlOthri, Abdulaziz O. Alabdulkarim, Shabeer A. Wani, and Sari M. Rabah Copyright © 2016 Waleed AlShehri et al. All rights reserved. A Case Study of Severe Esophageal Dysmotility following Laparoscopic Sleeve Gastrectomy Sun, 19 Jun 2016 08:52:52 +0000 Following bariatric surgery, a proportion of patients have been observed to experience reflux, dysphagia, and/or odynophagia. The etiology of this constellation of symptoms has not been systematically studied to date. This case describes a 36-year-old female with severe esophageal dysmotility following LSG. Many treatments had been used over a course of 3 years, and while calcium channel blockers reversed the esophageal dysmotility seen on manometry, significant symptoms of dysphagia persisted. Subsequently, the patient underwent a gastric bypass, which seemed to partially relieve her symptoms. Her dysphagia was no longer considered to be associated with a structural cause but attributed to a “sleeve dysmotility syndrome.” Considering the difficulties with managing sleeve dysmotility syndrome, it is reasonable to consider the need for preoperative testing. The question is whether motility studies should be required for all patients planning to undergo a LSG to rule out preexisting esophageal dysmotility and whether conversion to gastric bypass is the preferred method for managing esophageal dysmotility after LSG. Caroline E. Sheppard, Daniel C. Sadowski, Richdeep Gill, and Daniel W. Birch Copyright © 2016 Caroline E. Sheppard et al. All rights reserved. A Novel Technique for Managing Pancreaticojejunal Anastomotic Leak after Pancreaticoduodenectomy Tue, 14 Jun 2016 11:28:58 +0000 Pancreaticoduodenectomy (Whipple’s procedure) remains the only definitive treatment option for tumors of the periampullary region. The most common and life-threatening complications following the procedure are pancreatic anastomotic leakage and subsequent fistula formation. When these complications occur, treatment strategy depends on the severity of anastomotic leakage, with patients with severe leakages requiring reoperation. The optimal surgical method used for reoperation is selected from among different options such as wide drainage, definitive demolition of the pancreaticojejunal anastomosis and performing a new one, or completion pancreatectomy. Here we present a novel, simple technique to manage severe pancreatic leakage via ligamentum teres hepatis patch. Tufan Egeli, Tarkan Unek, Mucahit Ozbilgin, Mustafa Goztok, and Ibrahim Astarcıoglu Copyright © 2016 Tufan Egeli et al. All rights reserved. Multiple Gastric Gastrointestinal Stromal Tumors in a Patient with Neurofibromatosis Type 1 Tue, 07 Jun 2016 06:23:30 +0000 Gastrointestinal stromal tumors (GISTs) are relatively common in neurofibromatosis type 1 (NF 1) patients. Approximately 90% of GISTs associated with NF 1 are located in the small intestine, while sporadic GISTs are most commonly located in the stomach. Here we report an extremely rare case of an NF 1 patient with multiple gastric GITs (90 or more) but without multiple small intestinal tumors. A 63-year-old female patient who had a history of NF 1 underwent surgery for a gastric neuroendocrine tumor and gastric submucosal tumor (SMT). During the operation, multiple small nodules were identified on the serosal surface of the upper stomach. SMT and multiple nodules on the serosal surface were diagnosed as GISTs consisting of spindle cells positive for KIT, CD34, and DOG-1. Both GIST and the normal gastric mucosa showed no mutations not only in the c-kit gene (exons 8, 9, 11, 13, and 17) but also in the PDGFRA gene (exons 12, 14, and 18). This patient is being followed up without the administration of a tyrosine kinase inhibitor. Makoto Tomatsu, Jun Isogaki, Takahiro Watanabe, Kiyoshige Yajima, Takuya Okumura, Kimihiro Yamashita, Kenji Suzuki, Akihiro Kawabe, Akira Komiyama, and Seiichi Hirota Copyright © 2016 Makoto Tomatsu et al. All rights reserved. Abdominal Wall Endometrioma after Laparoscopic Operation of Uterine Endometriosis Tue, 31 May 2016 11:59:54 +0000 Endometriosis is presence of functional endometrium outside of uterine cavum. As a pluripotent tissue, endometrium has the possibility of implanting itself almost everywhere; even implantation in abdominal wall was described, but it is not common site. This case report presents implantation of functional endometrium in abdominal wall, inside scar tissue, and after insertion of a laparoscopic trocar port. Final diagnosis was confirmed by pathohistological examination. Tihomir Vukšić, Pejana Rastović, and Vedran Dragišić Copyright © 2016 Tihomir Vukšić et al. All rights reserved. Colonic Angiodysplasia with a Huge Submucosal Hematoma in the Sigmoid Colon Tue, 31 May 2016 08:14:06 +0000 Colonic angiodysplasia (AD) with bleeding as a comorbidity in the aging population is being increasingly reported. However, to our knowledge, there is no report on colonic AD accompanied by a huge hematoma. Herein, we report a case of colonic AD with a huge submucosal hematoma. A 75-year-old man with sudden melena was referred to our hospital. Helical computed tomographic angiography (CTA) revealed bleeding from the sigmoid colon. Additionally, colonoscopy showed a huge submucosal hematoma with bleeding in the sigmoid colon. As endoscopic hemostasis was difficult, sigmoidectomy was performed. The pathological diagnosis was colonic AD. The present case indicates that colonic AD should be considered in the differential diagnosis for melena. In addition, the case shows that helical CTA, which is a noninvasive imaging modality, is useful for the diagnosis of colonic AD and is as effective as colonoscopy and angiography for diagnosis. Takayuki Shimizu, Daisuke Koike, Yukihiro Nomura, and Kenji Ooe Copyright © 2016 Takayuki Shimizu et al. All rights reserved. Breast Metastasis in Esophagus Cancer: Literature Review and Report on a Case Tue, 31 May 2016 07:41:40 +0000 Esophagus cancer metastases often involve locoregional lymph nodes, lung, bone, liver, and brain. Metastatic involvement of the breast from esophagus cancer is uncommon, but if it happened, it usually presents as a part of multiple organ distal metastases. Here we report a case of the largest metastatic esophagus cancer of the breast and the chest wall, and we review the similar reported cases. Abdulaziz Ghibour and Osama Shaheen Copyright © 2016 Abdulaziz Ghibour and Osama Shaheen. All rights reserved. Streptococcus milleri and Recurrent Intra-Abdominal Abscesses: A Case Report and Literature Review Mon, 30 May 2016 11:30:00 +0000 We report a case of recurrent intra-abdominal abscesses as a postoperative complication following diverticular perforation in which Streptococcus milleri (SM) was isolated. SM is evaluated here as a potent pyogenic organism commonly associated with intra-abdominal abscess especially in the postoperative setting. With the commonly adopted conservative management, the challenges of recurrence and prolonged hospital stay experienced in the indexed case as well as many other previous reports are highlighted. We also present a recommendation of the need for a more intensive approach of SM-related abscess drainage along with areas that would benefit further research. Tabitha M. Gana, Olugbenga Awolaran, and Sobia Akhtar Copyright © 2016 Tabitha M. Gana et al. All rights reserved. Syncope with Surprise: An Unexpected Finding of Huge Gastric Diverticulum Thu, 26 May 2016 15:12:05 +0000 A gastric diverticulum is a pouch protruding from the gastric wall. The vague long clinical history ranging between dyspepsia, postprandial fullness, and upper gastrointestinal bleeding makes this condition a diagnostic challenge. We present a case of large gastric diverticulum that has been diagnosed during clinical investigations for suspected cardiovascular issues in a patient admitted at the medical ward for syncope. A 51-year-old man presented to the medical department due to a syncopal episode occurring while he was resting on the beach after having his lunch, with concomitant vague epimesogastric gravative pain without any other symptom. A diagnosis of neuromediated syncopal episode was made by the cardiologist. Due to the referred epimesogastric pain, an abdominal ultrasound scan was carried out, showing perisplenic fluid. A CT scan of the abdomen was performed to exclude splenic lesions. The CT scan revealed a large diverticulum protruding from the gastric fundus. The upper gastrointestinal endoscopy visualized a large diverticular neck situated in the posterior wall of the gastric fundus, partially filled by undigested food. The patient underwent surgery, with an uneventful postoperative course. Histologic examination showed a full-thickness stomach specimen, indicative of a congenital diverticulum. At the 2nd month of follow-up, the patient was asymptomatic. Mauro Podda, Jenny Atzeni, Antonio Messina Campanella, Alessandra Saba, and Adolfo Pisanu Copyright © 2016 Mauro Podda et al. All rights reserved. Uncommon Presentation of Isolated Jejunal Lymphoma Masquerading as Crohn’s Disease Mon, 23 May 2016 11:29:42 +0000 Primary gastrointestinal lymphoma is a rare entity, commonly involving stomach, small bowel, and colorectum. The usual location for small bowel B cell lymphoma is distal ileum due to abundant lymphoid tissue. We are reporting the case of a 53-year-old lady presumptively diagnosed as Crohn’s disease on clinical and radiological grounds but histopathologically proven to be an unusual variant of isolated primary non-Hodgkin’s lymphoma. Swati Sattavan, Lalit Aggarwal, and Priyadarshi Dikshit Copyright © 2016 Swati Sattavan et al. All rights reserved. How to Surgically Remove the Permanent Mesh Ring after the Onstep Procedure for Alleviation of Chronic Pain following Inguinal Hernia Repair Thu, 19 May 2016 12:34:49 +0000 A promising open inguinal hernia operation called Onstep was developed in 2005. The technique is without sutures to the surrounding tissue, causing minimal tension. A specific mesh is used with a memory recoil ring in the border, which may cause pain superficial to the lateral part of the mesh for slender patients. The aim of this study was to illustrate an easy procedure that alleviates/removes the pain. A male patient had persistent pain six months after the Onstep operation and therefore had a ring removal operation. The procedure is presented as a video and a protocol. At the eleven-month follow-up, the patient was free of pain, without a recurrence. It is advised to wait some months after the initial hernia repair before removing the ring, since the mesh needs time to become well integrated into the surrounding tissue. The operation is safe and easy to perform, which is demonstrated in a video. Stina Öberg, Kristoffer Andresen, and Jacob Rosenberg Copyright © 2016 Stina Öberg et al. All rights reserved. Acute Deep Vein Thrombosis in Venous Aneurysm following Closure of the Chronic Traumatic Arteriovenous Fistulae of the Lower Extremities Wed, 18 May 2016 12:30:40 +0000 Chronic traumatic arteriovenous fistula (AVF) commonly results from an unrecognized vascular injury. In this report, there were two cases of chronic traumatic AVF of the legs with a long history of stab (case 1) and shotgun wounds (case 2). Both cases presented with varicose veins together with hyperpigmentation around the ankle of the affected leg. Angiograms showed a single large AVF in case 1, whereas, in case 2, there was a single large AVF together with multiple small AVFs. In both cases large venous aneurysm was found next to a large AVF. An open surgical AVF closure for the large AVF was performed in case 1 successfully, but patient developed acute deep vein thrombosis (DVT) in a large venous aneurysm. In the second case, in order to prevent DVT, only closure of the large AVF was performed, which preserved arterial flow into the venous aneurysm. Case 2 did not have acute DVT. This report raised the concern about acute DVTs in venous aneurysms following the closure of chronic traumatic AVF in terms of prevention. Also chronic traumatic AVF is commonly due to misdiagnosis in the initial treatment, so complete and serial physical examinations in penetrating vascular injury patients are of paramount importance. Saranat Orrapin, Supapong Arworn, and Kittipan Rerkasem Copyright © 2016 Saranat Orrapin et al. All rights reserved. Progressive Dyspnea in a 40-Year-Old Man Caused by Giant Mediastinal Thymolipoma Tue, 17 May 2016 09:11:51 +0000 Thymolipomas are rare tumors of the anterior mediastinum containing both thymic stroma and an abundance of fat. We present a 40-year-old man with no underlying disease who presented with cough and progressive dyspnea. Clinical evaluation revealed a giant mass of lipid density filling almost the entire left hemithorax with mediastinal shift. Total excision of the 40 33 8 cm mass weighing 4 kg was performed via a left thoracotomy and the histopathologic diagnosis of the mass was reported as thymolipoma. The patient remains alive and disease-free, twelve months after the intervention. Mohammad Vaziri and Kamelia Rad Copyright © 2016 Mohammad Vaziri and Kamelia Rad. All rights reserved. Laparoscopic Treatment of Type III Mirizzi Syndrome by T-Tube Drainage Sun, 15 May 2016 06:56:16 +0000 Mirizzi syndrome (MS) is an impacted stone in the cystic duct or Hartmann’s pouch that mechanically obstructs the common bile duct. We would like to report laparoscopic treatment of type III MS. A 75-year-old man was admitted with the complaint of abdominal pain and jaundice. The patient was accepted as MS type III according to radiological imaging and intraoperative view. Laparoscopic subtotal cholecystectomy, extraction of impacted stone by opening anterior surface of dilated cystic duct and choledochus, and repair of this opening by using the remaining part of gallbladder over the T-tube drainage were performed in a patient with type III MS. Application of reinforcement suture over stump was done in light of the checking with oliclinomel N4 injection trough the T-tube. At the 18-month follow-up, he was symptom-free with normal liver function tests. Fahri Yetışır, Akgün Ebru Şarer, H. Zafer Acar, Yılmaz Polat, Gokhan Osmanoglu, Muhittin Aygar, A. Erdinc Ciftciler, and Omer Parlak Copyright © 2016 Fahri Yetışır et al. All rights reserved. A Low-Grade Fibromyxoid Sarcoma of the Internal Abdominal Oblique Muscle Tue, 10 May 2016 13:16:11 +0000 A low-grade fibromyxoid sarcoma (LGFMS) is a rare tumor, with a benign histologic appearance but malignant behavior. This report describes a 74-year-old man with an internal abdominal oblique muscle mass. The tumor appeared as a well-defined ovoid mass on computed tomography, with mild uptake on fluorine-18-fluorodeoxyglucose positron-emission tomography images. Radical resection with wide safe margins was performed. Histologically, the tumor was composed of spindle-shaped cells in a whorled growth pattern, with alternating fibrous and myxoid stroma. MUC4 expression, a highly sensitive and specific immunohistochemical marker for LGFMS, was detected. Therefore, we diagnosed the tumor as LGFMS. At the 3-month follow-up, there was no sign of recurrence or metastasis. We report the first case of LGFMS arising from the internal abdominal oblique muscle. Masakazu Hashimoto, Kei Koide, Michinori Arita, Koji Kawaguchi, Yoshihiro Mikuriya, Jun Iwata, and Toshiyuki Iwamoto Copyright © 2016 Masakazu Hashimoto et al. All rights reserved. Sampson’s Artery Hemorrhage after Inguinal Hernia Repair: Second Case Reported Tue, 10 May 2016 10:45:22 +0000 Sampson artery is normally obliterated in postembryonic development. In rare cases it can remain patent and complicate a routine outpatient herniorrhaphy when severed. This is the second reported case in the available English literature of hemoperitoneum due to bleeding from a patent Sampson’s artery following an open inguinal hernia repair. Joseph Adjei Boachie and Eduardo Smith-Singares Copyright © 2016 Joseph Adjei Boachie and Eduardo Smith-Singares. All rights reserved. Resection and Abdominal Wall Reconstruction of a Desmoid Tumor with Endometrioma Features Tue, 10 May 2016 07:21:00 +0000 Desmoid tumors are rare, musculoaponeurotic mesenchymal origin tumors arising from the proliferation of well-differentiated fibroblasts. Desmoid tumors may arise from any location with the abdominal cavity, abdominal wall and extremity locations being most frequent. We present the case of a 35-year-old female with a history of endometriosis who presented palpable abdominal mass and cyclic abdominal pain. Resection was performed for a presumed desmoid soft tissue tumor. Final pathology demonstrated desmoid histology admixed with abdominal wall endometriosis (endometrioma). This unique pathologic finding has only been rarely reported and is discussed with a brief review of the literature. Jaqueline Majors, Nathaniel F. Stoikes, Reza Nejati, and Jeremiah L. Deneve Copyright © 2016 Jaqueline Majors et al. All rights reserved. A Giant Aggressive Angiomyxoma of the Pelvis Misdiagnosed as Incarcerated Femoral Hernia: A Case Report and Review of the Literature Thu, 05 May 2016 08:09:19 +0000 Aggressive angiomyxoma (AA) is an uncommon mesenchymal tumor that is mostly derived from the female pelvic and perineal regions. AA is a locally infiltrative slow growing tumor with a marked tendency to local recurrence. Painless swelling located around the genitofemoral region is the common symptom; thus, it is often misdiagnosed as a gynecological malignancy or a groin hernia. A 35-year-old female patient who previously underwent surgery for left femoral hernia operation resulting in surgical failure was reoperated for a giant AA located in the pelvis. The tumor was completely excised with free margins. Histopathologic examination revealed an AA. The tumor size was measured as 24 × 12 × 6 cm with a weight of 4.2 kg. Immunohistochemically, the cells show positive staining with vimentin, desmin, estrogen, and progesterone receptor. S100, MUC4, CD34, and SMA were negative in the tumor cells. AA should be considered in the differential diagnosis of any painless swelling located in the genitofemoral region, particularly in women of reproductive age. The principle treatment should be complete surgical excision with tumor-free margins. Long-term follow-up and careful monitoring are essential due to its high tendency of local recurrence in spite of wide excision of the tumor. Adjuvant antihormonal therapy yields promising results for preventing recurrence. Alper Sozutek, Oktay Irkorucu, Enver Reyhan, Kemal Yener, Ali Ayberk Besen, Kivilcim Eren Erdogan, Gulfiliz Gonlusen, and Figen Doran Copyright © 2016 Alper Sozutek et al. All rights reserved. Extraction of a Large Central Airway Foreign Body Using Flexible Bronchoscopy Combined with an Endobronchial Blocker Wed, 04 May 2016 07:42:21 +0000 Adult foreign body (FB) aspiration is an uncommon but potentially fatal event. Options for extraction include flexible bronchoscopy (FLXB), rigid bronchoscopy (RB), and surgical extraction. We report the case of a large, smooth aspirated rock causing airway obstruction in an elderly male. RB is generally the preferred approach for extraction of a large complex FB; however, due to its size, the FB had to be removed using FLXB combined with an endobronchial blocker. In this report, we describe the anesthetic and surgical considerations and the novel technique used to extract the FB. Tyler Paradis, Michael Wollenberg, and Brandon Tieu Copyright © 2016 Tyler Paradis et al. All rights reserved. Vascular Anomalies in Pancreaticoduodenectomy: A Lesson Learned Thu, 21 Apr 2016 13:39:15 +0000 It is essential to identify any variant anatomy prior to surgery as this could have a drastic effect on surgical planning. We describe a case in which two vascular irregularities, an Arc of Buhler and celiac stenosis, were identified on angiogram after completion of a pancreaticoduodenectomy. While there could have been catastrophic results from his surgery in the setting of celiac stenosis, the presence of the aberrant Arc of Buhler allowed this patient to emerge without any permanent morbidity. Joana E. Ochoa, David T. Pointer Jr., and John B. Hamner Copyright © 2016 Joana E. Ochoa et al. All rights reserved. Concurrent Occurrence of Tumor in Colon and Small Bowel following Intestinal Obstruction: A Case Report and Review of the Literature Wed, 20 Apr 2016 09:25:09 +0000 An intestinal obstruction occurs when either the small or large intestine is partly or completely blocked so it prevents passing the food or fluid through the small/large bowel. This blockage is due to the existence of a mechanical obstruction such as foreign material, mass, hernia, or volvulus. Common symptoms include cramping pain, nausea and vomiting, changes in bowel habits, inability to pass stool, and lack of gas. We present a case of an 83-year-old man who had been referred to Taleghani Hospital with symptoms of bowel obstruction. He underwent the surgery. The findings of exploration of the entire abdomen showed two types of mass separately in two different organs. In postoperative workup, pathology reported two types of tumors (adenocarcinoma and neuroendocrine tumors). Seyed Mohammad Reza Nejatollahi and Omid Etemad Copyright © 2016 Seyed Mohammad Reza Nejatollahi and Omid Etemad. All rights reserved. Robotic Compartment-Based Radical Surgery in Early-Stage Cervical Cancer Mon, 18 Apr 2016 07:39:46 +0000 A radical hysterectomy with pelvic lymphadenectomy is the recommended treatment option in patients with early-stage cervical cancer. Although various classifications were developed in order to define the resection margins of this operation, no clear standardization could be achieved both in the nomenclature and in the extent of the surgery. Total mesometrial resection (TMMR) is a novel procedure which aims to remove all components of the compartment formed by Müllerian duct in which female reproductive organs develop. TMMR differs from the conventional radical hysterectomy techniques in that its surgical philosophy, terminology, and partly resection borders are different. In this paper, a TMMR with therapeutic pelvic lymphadenectomy operation that we performed for the first time with robot-assisted laparoscopic (robotic) approach in an early-stage cervical cancer patient was presented. This procedure has already been described in open surgery by Michael Höckel and translated to the robotic surgery by Rainer Kimmig. Our report is the second paper, to our knowledge, to present the initial experience regarding robotic TMMR in the English literature. Tayfun Toptas, Aysel Uysal, Isin Ureyen, Onur Erol, and Tayup Simsek Copyright © 2016 Tayfun Toptas et al. All rights reserved.