Case Reports in Surgery The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Limy Bile Syndrome Complicated with Primary Hyperparathyroidism Tue, 03 Mar 2015 15:35:46 +0000 Limy bile is a relatively rare condition, in which a radiopaque material is visible in the gallbladder on plain radiography or computerized tomography. Cases of complicated hyperparathyroidism are extremely rare. We report a patient with right upper quadrant and epigastric pain and extremity weakness in whom abdominal tomography showed limy bile in the gallbladder and laboratory values showed high levels of serum calcium and parathormone. Yavuz Savas Koca, Tugba Koca, and Ibrahim Barut Copyright © 2015 Yavuz Savas Koca et al. All rights reserved. Congenital Agenesis of the Internal Jugular Vein: An Extremely Rare Anomaly Tue, 03 Mar 2015 11:35:11 +0000 Vascular anomalies of major venous vessels are rarely seen. Moreover, congenital absence of internal jugular vein is extremely uncommon. In our case, a female patient presented with primary unknown left cervical mass. Cervical ultrasonography demonstrated absence of right internal jugular vein. In addition, computed tomography and dynamic magnetic resonance imaging scans confirmed this diagnosis. Compensatory left internal jugular vein enlargement mimicked sort of cervical mass. Venous magnetic resonance imaging images revealed the absence of right internal jugular vein with compensatory left internal jugular vein dominance. In the literature, the agenesis of IJV was mentioned in a case with concomitant multiple problems. Here, an asymptomatic case is reported with an incident diagnosis. No interventions were planned upon the patient's request. It should be kept in mind that any kind of anomalies can be seen during venous access and neck surgery. Oguz Kayiran, Caglar Calli, Abdulkadir Emre, and Fatih Kemal Soy Copyright © 2015 Oguz Kayiran et al. All rights reserved. Retroperitoneal Perforation of the Appendix Presenting as a Right Thigh Abscess Sun, 01 Mar 2015 12:21:41 +0000 A rare case of a retroperitoneal rupture of the appendix is being reported here. A 53-year-old male presented to us with a right sided thigh abscess. There were not any abdominal complaints at presentation. There was continuous discharge after incision and drainage from the thigh. Isolation, in culture, of an enteric bacterium from the pus prompted an evaluation of the gastrointestinal tract as a possible source. An MRI scan revealed fluid tracking from the right paracolic gutter over the psoas sheath and paraspinal muscle into the thigh. A CT scan revealed the perforation at the base of the appendix into the retroperitoneum. At laparotomy the above findings were confirmed. A segmental ileocaecal resection was done. The patient made an uneventful recovery. The absence of abdominal symptoms at presentation leads to delay in diagnosis in such cases. Nonresolving thigh and groin abscesses should lead to the evaluation of the gastrointestinal tract as origin. Diagnostic clues may also be provided by culture reports what as happened in this case. Aditya J. Nanavati, Sanjay Nagral, and Nitin Borle Copyright © 2015 Aditya J. Nanavati et al. All rights reserved. A Case of Ruptured Aortic Arch Aneurysm Successfully Treated by Thoracic Endovascular Aneurysm Repair with Chimney Graft Sat, 28 Feb 2015 07:54:48 +0000 We report the case of aortic arch aneurysm rupture treated successfully with thoracic endovascular aneurysm repair (TEVAR) accompanied by aortic arch debranching using the chimney graft technique. A 94-year-old man was transported to the hospital after complaining of chest pain for one day. Contrast-enhanced computed tomographic (CT) images revealed an aortic arch aneurysm rupture. Considering the patient’s age and postoperative activities of daily living, TEVAR was used. In order to place an indwelling stent graft from the ascending aorta to the periphery, the chimney graft technique was used to debranch the brachiocephalic artery. Hemodynamics was stabilized postsurgically. Plain CT performed 20 days postoperatively confirmed that the intrathoracic hematoma had decreased in size. Although respiratory failure was persistent, there were improvements and the patient was extubated 34 days postoperatively and discharged from the intensive care unit 37 days postoperatively. On postoperative day 75, he was discharged from the hospital to an elder care facility. Few reports have focused on stent grafting for treating aortic arch aneurysm rupture. TEVAR using the chimney graft technique could be an effective treatment option for patients with a decreased ability to tolerate surgery. Yohei Kawatani, Yujiro Hayashi, Yujiro Ito, Hirotsugu Kurobe, Yoshitsugu Nakamura, Yuji Suda, and Takaki Hori Copyright © 2015 Yohei Kawatani et al. All rights reserved. Laparoscopic Excision of Coexisting Left Tubal and Right Pseudotubal Pregnancy after Conservative Management of Previous Ectopic Pregnancy with Methotrexate: An Unusual Clinical Entity Tue, 24 Feb 2015 11:14:21 +0000 Tubal pregnancy concerns 97% of all ectopic pregnancies. Treatment can be either surgical (salpingostomy or salpingectomy) or medical (methotrexate administration). We present a case of a pseudotubal pregnancy after methotrexate treatment of a previous ectopic pregnancy. A37-year-old woman was diagnosed with ectopic pregnancy in the left Fallopian tube. A year ago, she had an ectopic pregnancy in the right tube, which was successfully treated with intramuscular methotrexate. During laparoscopy, two tubal masses were revealed, one in each Fallopian tube, and bilateral salpingectomy was performed. Histological analysis confirmed tubal pregnancy in the left Fallopian tube and presence of endosalpingitis in the right tube with no signs of chorionic villi. The optimal management of such cases has not yet been clarified. However, evaluation of tubal patency after a medically treated ectopic pregnancy would permit proper counsel of the patient on her fertility options, in order to choose the appropriate method of conception to achieve and accomplish a future pregnancy. Panayotis Xiromeritis, Chrysoula Margioula-Siarkou, Dimosthenis Miliaras, and Ioannis Kalogiannidis Copyright © 2015 Panayotis Xiromeritis et al. All rights reserved. A Lethal Complication after Transarterial Chemoembolization with Drug-Eluting Beads for Hepatocellular Carcinoma Mon, 23 Feb 2015 09:21:33 +0000 Background. The current standard of care for patients with large or multinodular noninvasive hepatocellular carcinoma is conventional transarterial chemoembolization (TACE). TACE may also be performed with drug-eluting beads, but serious complications of this procedure have been reported. Methods. Aim of this report is to present a patient affected by multifocal HCC who underwent TACE with drug-eluting bead (DEB-TACE). Results. Following the procedure the patient developed a hepatic abscess and biliobronchial fistula resulting in adult respiratory distress syndrome and death. Conclusion. We speculate that DEB-TACE has a prolonged effect on the tumor and the surrounding liver, resulting in progressive enlargement of the necrotic area. This activity that can extend to the surrounding healthy hepatic tissues may continue indefinitely. Adriana Toro, Gaetano Bertino, Maria Concetta Arcerito, Maurizio Mannnino, Annalisa Ardiri, Domenico Patane’, and Isidoro Di Carlo Copyright © 2015 Adriana Toro et al. All rights reserved. Delayed Total Breast Reconstruction with Brava Sun, 22 Feb 2015 17:01:05 +0000 Several surgical procedures exist in regard to reconstruction of the breast after mastectomy. The use of Brava a vacuum-based external soft-tissue expansion system in combination with fat transplantation is a less documented but viable option in treating patients after mastectomy. We share our experience in treating a 57-year-old patient with mastectomy, describing the complications and pitfalls we experienced when using the Brava system in combination with fat transplantation. Niels Hammer-Hansen, Thomas Bo Jensen, and Tine Engberg Damsgaard Copyright © 2015 Niels Hammer-Hansen et al. All rights reserved. Heterotopic Pancreas within the Proximal Hepatic Duct, Containing Intraductal Papillary Mucinous Neoplasm Sun, 22 Feb 2015 09:48:19 +0000 We report a unique first case of benign heterotopic pancreas arising within the proximal hepatic bile duct, containing a focus of intraductal papillary mucinous neoplasm (IPMN). The condition was diagnosed on pathological explant after left hepatic lobectomy with total extrahepatic bile duct excision. Alistair J. Lawrence, Aducio Thiessen, Amy Morse, and A. M. James Shapiro Copyright © 2015 Alistair J. Lawrence et al. All rights reserved. Hepatocellular Carcinoma with Osteoclast-Like Giant Cells: Report of the Seventh Case in the Literature Sun, 22 Feb 2015 06:09:26 +0000 Hepatocellular carcinoma with osteoclast-like giant cells is extremely rare, and only six cases have been previously reported. Its histogenesis is at the moment controversial. The authors report a case of hepatocellular carcinoma with osteoclast-like giant cells found in a 74-year-old woman. The patient came with a dull pain in the right upper abdominal quadrants due to a liver neoplasm described at CT scan. A wedge resection of the fifth hepatic segment with appendectomy, omentectomy, and debulking of the major peritoneal implants was performed. Histologically, the diagnosis of hepatocellular carcinoma with high grade differentiation associated with giant osteoclast-like cells was done without any evidence of hepatitis or cirrhosis in the surrounding hepatic parenchyma. Immunohistochemistry was positive for CD10 and CD68 and in situ hybridization revealed the expression of receptor activator of nuclear factor-kappa B (RANK) in the giant cells and receptor activator of nuclear factor-kappa B ligand (RANKL) in the tumor cells. Lorenzo Dioscoridi, Damiano Bisogni, and Giancarlo Freschi Copyright © 2015 Lorenzo Dioscoridi et al. All rights reserved. Morel-Lavallée Lesion: Report of a Case of Unknown Mechanism Tue, 17 Feb 2015 11:27:25 +0000 Morel-Lavallée lesions are cystic lesions occurring between the subcutaneous tissue and the underlying layer of a fascia. The most frequent mechanism of occurrence is posttraumatic, usually after degloving injuries. The chain of events leading to the occurrence of this lesion is the formation of a potential space between the subcutaneous tissue and the firmly attached deep fascia, which in turn fills with blood and/or lymph and/or necrotic fat, secondary to disruption of the capillaries. We present a case of a 74-year-old male patient with a cystic lesion of the lateral surface of his left thigh increasing in size over a period of six months. Despite the meticulous history acquisition, we were unable to reveal any alleged mechanism of injury of the area. The patient underwent an MRI which revealed an ovoid cyst. The patient underwent surgical excision of the cyst. The pathology examination revealed a simple cyst, lined by a fibrous capsule and filled with serosanguineous fluid, thus confirming the diagnosis. The patient made a full recovery and since has been asymptomatic. Elissaios Kontis, Antonios Vezakis, Vasiliki Psychogiou, Panagiotis Kalogeropoulos, Andreas Polydorou, and Georgios Fragulidis Copyright © 2015 Elissaios Kontis et al. All rights reserved. Pure Squamous Cell Carcinoma of the Duodenum Mon, 16 Feb 2015 11:24:07 +0000 Primary carcinomas of the small intestine are extremely rare neoplasms. Most of these are adenocarcinomas. Primary squamous cell carcinoma (SCC) of small intestine is exceptionally rare with only occasional case reports in the literature. We report here a surgically treated patient with squamous cell carcinoma arising from duodenal diverticula in the third part of the duodenum. Muharrem Battal, Ozgur Bostancı, Tulay Basak, Kinyas Kartal, and Feza Ekiz Copyright © 2015 Muharrem Battal et al. All rights reserved. Amyand’s Hernia Complicated by Omental Infarct Presenting as Acute Scrotum: Report of a Case and Review of the Literature Mon, 16 Feb 2015 06:40:06 +0000 Inguinal hernia with acute appendicitis known as Amyand’s hernia is uncommon. It may clinically manifest as acute scrotum, inguinal lymphadenitis, or strangulated hernia. The presentation of Amyand’s hernia with acute scrotum has been rarely described. Also, the manifestation of infarcted omentum in the inguinal hernia has been described in one case previously. However, the coexistence of perforated appendix with infarcted omentum in the hernia sac which manifests acute scrotum has not been described previously. Herein, we described a case of a 5-year-old boy, admitted with right tense, painful, and erythematous scrotum in the emergency room. The diagnosis of herniated appendicitis was performed preoperatively by ultrasound. Moreover, the ischemic omentum was confirmed during surgery. Reza Khorramirouz, Amin Bagheri, Alireza Aalam Sahebpour, and Abdol-Mohammad Kajbafzadeh Copyright © 2015 Reza Khorramirouz et al. All rights reserved. Fungal Pulmonary Valve Endocarditis Masquerading as a Pulmonary Embolism Sun, 15 Feb 2015 12:46:01 +0000 Septic pulmonary emboli (SPE) can be a difficult clinical entity to distinguish from thromboembolic pulmonary embolism (TPE) in a patient with history of IV drug abuse (IVDA). We present a case of a patient who presented with failure to thrive and presumed diagnosis of recurrent PE that ultimately was discovered to have fungal pulmonary valve endocarditis resulting in a right ventricular outflow obstruction. This required replacement of the pulmonary valve and repair of the right ventricular outflow tract. This case highlights difficulty in differentiating pulmonary valve endocarditis with septic emboli from chronic PE in a patient with a complex medical history. Kevin B. Ricci, Peter H. U. Lee, Michael Essandoh, and Ahmet Kilic Copyright © 2015 Kevin B. Ricci et al. All rights reserved. Papillary Carcinoma Occurrence in a Thyroglossal Duct Cyst with Synchronous Papillary Thyroid Carcinoma without Cervical Lymph Node Metastasis: Two-Cases Report Sun, 15 Feb 2015 11:43:51 +0000 Background. We present two rare cases of papillary carcinomas which appeared in thyroglossal duct cysts. These cases highlight that thyroglossal duct cyst can serve as malignancy of thyroid gland. Methods. A retrospective case report was carried out on 2 patients at Cipto Mangunkusumo Hospital. Results. A 57-year-old man presented with enlarged right anterior and midline neck mass, which preoperatively were diagnosed as thyroglossal duct cyst (TDC) and nontoxic multinodular goiter. A total thyroidectomy and Sistrunk procedure were performed. In the second case, a 35-year-old woman presented with a lump which occurred at anterior neck region without palpable mass at the thyroid. Preoperatively, it was diagnosed as TDC. Sistrunk procedure was performed, followed by total thyroidectomy a month after the first operation. Histopathology showed papillary thyroid carcinoma in both patients. Conclusion. The occurrence of carcinoma in TDC is very rare but should always be considered as an option in making diagnosis for a neck mass. F. B. Sobri, M. Ramli, U. N. Sari, M. Umar, and D. K. Mudrick Copyright © 2015 F. B. Sobri et al. All rights reserved. Hyperplastic Cardiac Sarcoma Recurrence Sun, 15 Feb 2015 09:15:02 +0000 Primary cardiac sarcomas are rare tumors with a median survival of 6–12 months. Data suggest that an aggressive multidisciplinary approach may improve patient outcome. We present the case of a male who underwent resection of cardiac sarcoma three times from the age of 32 to 34. This report discusses the malignant nature of cardiac sarcoma and the importance of postoperative multidisciplinary care. Masood A. Shariff, Juan A. Abreu, Farida Durrani, Eddie Daniele, Kimberly C. Bowman, Scott Sadel, Kourosh T. Asgarian, Joseph T. McGinn Jr., and John P. Nabagiez Copyright © 2015 Masood A. Shariff et al. All rights reserved. Inflammatory Myofibroblastic Tumor of the Breast Thu, 12 Feb 2015 10:56:19 +0000 Inflammatory myofibroblastic tumors (IMTs) of the breast represent extremely rare lesions. Due to the scarcity of reports, their natural history, recurrence, and metastatic potential remain poorly defined. We report on a case of a primary breast IMT in a postmenopausal female patient treated successfully with breast conserving surgery and review the literature pertaining to this rare entity. Christos Markopoulos, Petros Charalampoudis, Evangelia Karagiannis, Zoh Antonopoulou, and Dimitrios Mantas Copyright © 2015 Christos Markopoulos et al. All rights reserved. Omental Infarction Mimicking Cholecystitis Mon, 09 Feb 2015 14:15:30 +0000 Omental infarction can be difficult to diagnose preoperatively as imaging may be inconclusive and patients often present in a way that suggests a more common surgical pathology such as appendicitis. Here, a 40-year-old Caucasian man presented to casualty with shortness of breath and progressive right upper abdominal pain, accompanied with right shoulder and neck pain. Exploratory laparoscopy was eventually utilised to diagnose an atypical form of omental infarction that mimics cholecystitis. The vascular supply along the long axis of the segment was occluded initiating necrosis. In this case, the necrotic segment was adherent with the abdominal wall, a pathology not commonly reported in cases of omental infarction. David Smolilo, Benjamin C. Lewis, Marina Yeow, and David I. Watson Copyright © 2015 David Smolilo et al. All rights reserved. Embryonal Rhabdomyosarcoma of the Adult Urinary Bladder: A Rare Case Report of Misclassification as Inflammatory Myofibroblastic Tumor Mon, 09 Feb 2015 12:54:18 +0000 Embryonal rhabdomyosarcoma (ERMS) of the adult urinary bladder is a rare malignant tumour. Inflammatory myofibroblastic tumour (IMT) of the bladder is a benign genitourinary tumour that may appear variable histologically but usually lacks unequivocal malignant traits. Techniques like flow cytometry and immunohistochemistry may be used to differentiate these two tumours. Our patient, a 46-year-old male, had rapidly recurring lower urinary tract symptoms after two transurethral resections of the prostate. He subsequently underwent a transvesical prostatectomy which showed IMT on histology. However, his symptoms did not resolve and an open resection done at our institution revealed a 6 cm tumour arising from the right bladder neck. This time, histology was ERMS with diffuse anaplasia of the bladder. Rapid recurrence of urinary symptoms with prostate regrowth after surgery is unusual. Differential diagnoses of uncommon bladder malignancies should be considered if there is an inconsistent clinical course as treatment approaches are different. Kelven Weijing Chen, Fiona Mei Wen Wu, Victor Kwan Min Lee, and Kesavan Esuvaranathan Copyright © 2015 Kelven Weijing Chen et al. All rights reserved. Is an Incidental Meckel’s Diverticulum Truly Benign? Mon, 09 Feb 2015 10:24:47 +0000 Meckel’s diverticulum is the most common congenital abnormality of the gastrointestinal tract and it is found to affect nearly 2 percent of the population. Interestingly, the surgical management of an asymptomatic Meckel’s diverticulum remains widely controversial in the adult population. Review of the literature finds the overall risk of Meckel’s diverticulum becoming symptomatic to be low; however, the risk accompanying its resection also proves to be minimal thus perpetuating the question of its proper management. We report our experience with an elderly patient who required an emergent operative intervention and was incidentally found to have Meckel’s diverticulum. Review of final pathology found Meckel’s diverticulum to contain a carcinoid tumor. In our review, the presence of a carcinoid tumor within Meckel’s diverticulum is a rare finding, but its incidence may further support the resection of incidentally found asymptomatic Meckel’s diverticulum in patients of all ages. Caroline C. Jadlowiec, Jennifer Bayron, and William T. Marshall III Copyright © 2015 Caroline C. Jadlowiec et al. All rights reserved. Perforated Closed-Loop Obstruction Secondary to Gallstone Ileus of the Transverse Colon: A Rare Entity Thu, 05 Feb 2015 09:56:40 +0000 Introduction. Gallstone ileus (GSI) of the colon is an extremely rare entity with potentially serious complications including perforation. Case Presentation. An 88-year-old man presented to the emergency department with abdominal pain and distension. Clinical exam revealed signs of peritonism. Computed tomography (CT) revealed GSI of the transverse colon with a closed-loop large bowel obstruction (LBO) and caecal perforation. The patient underwent emergency laparotomy. A right hemicolectomy was performed, the gallstone was removed, and a primary bowel anastomosis was undertaken. A Foley catheter was sutured into the residual gallbladder bed to create a controlled biliary fistula. The patient recovered well postoperatively with no complications. He was discharged home with the Foley catheter in situ. Discussion. Gallstone ileus is a difficult diagnosis both clinically and radiologically with only 50% of cases being diagnosed preoperatively. Most commonly it is associated with impaction at the ileocaecal valve and small bowel obstruction. Gallstone ileus should also be considered as a rare but potential cause of LBO. This is the first reported case of caecal perforation secondary to gallstone ileus of the transverse colon. Successful operative management consisted of a one-stage procedure with right hemicolectomy and formation of a controlled biliary fistula. S. P. Carr, F. T. MacNamara, K. M. Muhammed, E. Boyle, S. M. McHugh, P. Naughton, and A. Leahy Copyright © 2015 S. P. Carr et al. All rights reserved. Desmoid Tumor of the Popliteal Fossa during Pregnancy Thu, 05 Feb 2015 09:52:58 +0000 Desmoid tumors are fibroblastic neoplasms that have an intermediate behavior with a highly aggressive infiltrative growth arising from deep muscle or aponeurosis. We present the case of a 34-year-old woman that developed a painless mass in the right popliteal fossa during pregnancy after intracytoplasmic sperm injection and hormonal therapy. The MRI scan showed a hyperintense mass of 6,7 cm × 4,7 cm × 3,8 cm surrounding the lateral head of the gastrocnemius muscle. The open biopsy was done one week after delivery, and the histology showed a desmoid tumor. We performed the resection one week later and found the common peroneal nerve completely surrounded by the tumor. The close resection due to the neurolysis was the reason why an adjuvant radiation with 56 Gy was done. The last clinical examination, 18 month later, did not show any signs of recurrence and an excellent functional outcome. This case demonstrates the possible influences of pregnancy and hormonal therapy on the evolution of desmoid tumors. Wolfram Weschenfelder, Robert Lindner, Christian Spiegel, Gunther Olaf Hofmann, and Matthias Vogt Copyright © 2015 Wolfram Weschenfelder et al. All rights reserved. Carcinosarcoma of the Thyroid Gland Tue, 03 Feb 2015 14:08:27 +0000 Introduction. Surgeon has significant role in the management of such rare and controversial clinical entities related to thyroid gland. In this case report we have presented an elderly patient with rapid enlargement in thyroid that was related to carcinosarcoma. Case Presentation. A 60-year-old lady was presented with rapid enlargement of the thyroid gland. A fine needle aspiration of the nodule in right lobe was performed several weeks before presentation to our clinic. End diagnosis was a papillary carcinoma of the thyroid with spindle cell component. Thus the nodule was recognized to be a carcinosarcoma. Conclusion. Thyroid surgery merits a multidisciplinary approach. Indeed the surgeon should make a conclusive decision in some controversial and rare clinical entities such as carcinosarcoma. Mehmet Fatih Ekici, Cengiz Kocak, Zülfü Bayhan, Sezgin Zeren, Faik Yaylak, Mehmet Hüseyin Metineren, and Fatma Emel Kocak Copyright © 2015 Mehmet Fatih Ekici et al. All rights reserved. Complex Liver Resections for Colorectal Metastases: Are They Safe in the Low-Volume, Resource-Poor Caribbean Setting? Mon, 02 Feb 2015 13:42:03 +0000 Introduction. Although many authorities suggest that major liver resections should only be carried out in high-volume specialized centres, many patients in the Caribbean do not have access to these health care systems. Presentation of a Case. A 50-year-old woman with a solitary colorectal metastasis invading the inferior vena cava underwent an extended left hepatectomy with caval resection and reconstruction. Several technical maneuvers were utilized that were suited to the resource-poor environment. Conclusion. We suggest that good outcomes can still be attained in the resource-poor, low-volume centres once dedicated and appropriately trained teams are available. Shamir O. Cawich, Dexter A. W. Thomas, Chunilal Ramjit, Roderick Bhagan, and Vijay Naraynsingh Copyright © 2015 Shamir O. Cawich et al. All rights reserved. Photodocumentation of the Development of Type I Posterior Glottic Stenosis after Intubation Injury Sun, 01 Feb 2015 09:41:13 +0000 Bilateral vocal fold immobility may result from bilateral recurrent laryngeal nerve paralysis or physiologic insults to the airway such as glottic scars. The progression of mucosal injury to granulation tissue, and then posterior glottis stenosis, is an accepted theory but has not been photodocumented. This paper presents serial images from common postintubation injury to less common posterior glottic stenosis with interarytenoid synechia. Nelson Scott Howard, Travis L. Shiba, Julianna E. Pesce, and Dinesh K. Chhetri Copyright © 2015 Nelson Scott Howard et al. All rights reserved. Pneumatosis Cystoides Intestinalis after Cetuximab Chemotherapy for Squamous Cell Carcinoma of Parotid Gland Sat, 31 Jan 2015 12:01:44 +0000 Pneumatosis intestinalis, defined as gas in the bowel wall, is often first identified on abdominal radiographs or computed tomography (CT) scans. It is a radiographic finding and not a diagnosis, as the etiology varies from benign conditions to fulminant gastrointestinal disease. We report here a case of pneumatosis intestinalis associated with cetuximab therapy for squamous cell carcinoma of head and neck. The patient underwent laparotomy based on the CT scan and the result was pneumatosis intestinalis without any signs of necrotizing enterocolitis. Christos Petrides, Neofytou Kyriakos, Ioannou Andreas, Parpounas Konstantinos, Georgiou Chrysanthos, Petrou Athanasios, and Emmanouil Pikoulis Copyright © 2015 Christos Petrides et al. All rights reserved. Motor Vehicle Collision Patient with Simultaneous Duodenal Transection and Thoracic Aorta Injury: A Case Report and Review of the Literature Mon, 26 Jan 2015 08:17:17 +0000 Blunt polytrauma can present complex management decisions. Here we report the case of a 31-year-old male involved in a high speed motor vehicle collision resulting in both duodenal and thoracic aorta injury that was managed collaboratively between the trauma, vascular, and cardiothoracic surgical teams. The patient went on to a full recovery. We also review the management of such injuries which has evolved over the past two decades resulting in less morbidity and mortality. Charlie Chen, Kevin Schuster, and Bishwajit Bhattacharya Copyright © 2015 Charlie Chen et al. All rights reserved. Voluminous Omental Inflammatory Myofibroblastic Tumor in an Elderly Man: A Case Report and Literature Review Thu, 22 Jan 2015 09:06:20 +0000 Inflammatory myofibroblastic tumor (IMT) is a rare neoplasm of intermediate biologic potential, with uncertain etiology. This tumor occurs primarily in the lung, but the tumor may affect any organ system. A 75-year-old male was evaluated for voluminous palpable high abdominal mass with continuous and moderately abdominal pain, associated with abdominal distension for the last two months. Abdominal computed tomography showed a large ( cm) heterogeneously enhanced mass with well-defined margins. At surgery, the mass originated from the greater omentum was completely excised. Histologically the tumor was a mesenchymal neoplasm in smooth muscle differentiation and was characterized by spindle-cell proliferation with lymphocytes, plasma cells, and rare eosinophils. Immunohistochemically, the tumor cells were positive for vimentin and smooth muscle actin and negative for anaplastic lymphoma kinase. Complete surgical resection of IMTs remains the mainstay of treatment associated with a low rate of recurrence. Final diagnosis should be based on histopathological and immunohistochemical findings. Appropriate awareness should be exercised by surgeons to abdominal IMTs in combination with constitutional symptoms, abnormal hematologic findings, and radiological definition, to avoid misdiagnosed. Pasquale Cianci, Antonio Ambrosi, Alberto Fersini, Nicola Tartaglia, Vincenzo Lizzi, Francesca Sanguedolce, Antonina Parafioriti, and Vincenzo Neri Copyright © 2015 Pasquale Cianci et al. All rights reserved. Aneurysmal Rupture of a Mesodiverticular Band to a Meckel’s Diverticulum Wed, 21 Jan 2015 07:37:10 +0000 Aneurysmal rupture of a mesodiverticular band has not previously been reported in the clinical literature. We are reporting a case of hemoperitoneum in a 51-year-old male after an aneurysmal rupture of a mesodiverticular band. This case demonstrates that in rare instances, a rupture of the mesodiverticular band leading to Meckel’s diverticulum can lead to significant hemoperitoneum. This is usually caused by a traumatic injury but in our case was apparently caused by an aneurysm of the mesodiverticular artery. Patients with known Meckel’s diverticula should be aware of the possibility of rupture, as should clinicians treating those with a history of this usually benign congenital abnormality. Rapid surgical intervention is necessary to repair the source of bleeding, as massive blood loss was encountered in this case. Christian Sommerhalder, Kenneth R. Fretwell, Gregory G. Salzler, John M. Creasy, R. Jonathan Robitsek, and Sebastian D. Schubl Copyright © 2015 Christian Sommerhalder et al. All rights reserved. Endometriosis of the Vermiform Appendix within a Hernia Sac Infiltrating the Pubic Bone Mon, 19 Jan 2015 09:47:58 +0000 Purpose. Appendicular endometriosis mimicking appendicitis is a rare finding. Inguinal tumor in the course of appendicular endometriosis located within an inguinal hernia sac and infiltrating the periosteum of the pubic bone has not yet been described. Case Report. This paper describes a case of a rapidly enlarging, solid, unmovable, very painful upon palpation inguinal tumor, in a 36-year-old nulliparous woman. During surgery, a hard (approximately 4 cm in diameter) tumor infiltrating the periosteum of the right pubic bone and continuous with the inguinal hernia sac was dissected. The distal segment of the vermiform appendix was an element of the dissected tumor. Histological examination revealed endometriosis of the distal vermiform appendix. After 6 months of hormone treatment, she was referred for reoperation due to tumor recurrence. Once again histological examination of the resected tissue revealed endometriosis. There was no further recurrence of the disease with goserelin therapy. In addition to the case report, we present a review of the literature about endometriosis involving the vermiform appendix and the inguinal canal (Amyand’s hernia). Conclusion. This case expands the list of differential diagnoses of nodules found in the inguinal region of women. Damian Ziaja, Tomasz Bolkowski, Krzysztof Januszewski, Wioletta Skrzypulec-Plinta, Jerzy Chudek, and Krzysztof Ziaja Copyright © 2015 Damian Ziaja et al. All rights reserved. Primary Adrenal Leiomyosarcoma in an Arab Male: A Rare Case Report with Immunohistochemistry Study Mon, 19 Jan 2015 08:20:02 +0000 Primary adrenal leiomyosarcoma is a rare form of adrenal mesenchymal tumors. Immunohistochemistry (IHC) together with histology takes a major role in determining the tumor type and predicting their biological behavior and differentiating them from adrenal cortical carcinoma. Appropriate radiological investigation is necessary to rule out metastatic disease from primary tumors elsewhere in the body. In this case, we report a primary leiomyosarcoma of the adrenal gland in a 61-year-old Bahraini male clinically presumed to be a renal neoplasm. Veena Nagaraj, Mohammed Mustafa, Essa Amin, Waleed Ali, Shamil Naji Sarsam, and Abdulla Darwish Copyright © 2015 Veena Nagaraj et al. All rights reserved.