Case Reports in Surgery The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Surgical Management and Reconstruction of Hoffman’s Disease (Dissecting Cellulitis of the Scalp) Sun, 07 Feb 2016 09:03:14 +0000 Dissecting cellulitis of the scalp, or Hoffman’s disease, is a rare dermatologic condition characterized by recurrent pustules and sinus tract formation leading to scarring and alopecia. Medical management includes the use of corticosteroids, antibiotics, isotretinoin, and adalimumab. In cases where the disease is severe, refractory, and intractable, surgery is an option. We report two cases of Hoffman’s disease, where medical management failed to achieve remission. Surgical treatment was undertaken with complete resection of the affected scalp in staged procedures with subsequent split-thickness skin grafting for reconstruction. Surgery achieved both disease remission and excellent aesthetic outcomes in both patients. Justin M. Hintze, Brittany E. Howard, Carrlene B. Donald, and Richard E. Hayden Copyright © 2016 Justin M. Hintze et al. All rights reserved. A Giant Mature Cystic Teratoma Mimicking a Pleural Effusion Thu, 28 Jan 2016 10:54:58 +0000 The vast majority of teratomas originating from more than a single germ layer are benign. Often, such teratomas are initially asymptomatic. Later symptoms are caused by the weight per se of the teratoma and include chest pain, cough, dyspnea, and/or recurrent attacks of pneumonia. A mediastinal teratoma is treated by total surgical resection of the mass. Here, we report a case of giant mature cystic teratoma mimicking a pleural effusion in the thorax at the 7-month-old female patient with a symptom of persistent pulmonary infection and tachypnea. Mustafa Erman Dorterler, Mehmet Emin Boleken, and Sezen Koçarslan Copyright © 2016 Mustafa Erman Dorterler et al. All rights reserved. Simultaneous Extensive Intraductal Papillary Neoplasm of the Bile Duct and Pancreas: A Very Rare Entity Tue, 26 Jan 2016 12:57:42 +0000 Intraductal papillary neoplasm of the bile duct (IPNB) is a specific type of bile duct tumor. It has been proposed that it could be the biliary counterpart of the intraductal papillary neoplasm of the pancreas (IPMN-P). This hypothesis is supported by the presence of simultaneous intraductal tumors of both the bile duct and pancreas. There have been five reports of patients with simultaneous IPNB and IPMN-P. In all of these cases, biliary involvement was limited to the intrahepatic and perihilar bile duct, which had characteristics similar to IPMN-P and usually had slow progression in nature. Herein, we present the first case of extensive intraductal neoplasm involving the extrahepatic bile duct, intrahepatic bile duct, and entire length of the pancreas with a poor outcome, even after being treated aggressively with radical surgery and adjuvant chemotherapy. Additionally, we summarize previous case reports of simultaneous intraductal lesions of the bile duct and pancreas. Vor Luvira, Ake Pugkhem, Theerawee Tipwaratorn, Yaovalux Chamgramol, Chawalit Pairojkul, and Vajarabhongsa Bhudhisawasdi Copyright © 2016 Vor Luvira et al. All rights reserved. Chylous Fistula following Axillary Lymphadenectomy: Benefit of Octreotide Treatment Tue, 26 Jan 2016 08:42:35 +0000 Chyle leak following axillary lymph node clearance is a rare yet important complication. The treatment of postoperative chyle fistula still remains unclear. Conservative management is the first line of treatment. It includes axillary drains on continuous suction, pressure dressings, bed rest, and nutritional modifications. The use of somatostatin analogue is well documented as a treatment for chylous fistulas after neck surgery. We present a case of chylous fistula after axillary surgery resolved with the use of octreotide. Elena González-Sánchez-Migallón, José Aguilar-Jiménez, José Andrés García-Marín, and José Luis Aguayo-Albasini Copyright © 2016 Elena González-Sánchez-Migallón et al. All rights reserved. Pure Laparoscopic Left Hemihepatectomy for Hepatic Peribiliary Cysts with Biliary Intraepithelial Neoplasia Thu, 21 Jan 2016 13:25:35 +0000 Introduction. Hepatic peribiliary cysts (HPCs) usually originate due to the cystic dilatation of the intrahepatic extramural peribiliary glands. We describe our rare experience of pure laparoscopic left hemihepatectomy (PLLH) in a patient with HPCs accompanied by a component of biliary intraepithelial neoplasia (BilIN). Case Presentation. A 65-year-old man was referred for further investigation of mild hepatic dysfunction. Contrast-enhanced computed tomography showed dilatation of the left-sided intrahepatic bile duct, and biliary cytology showed class III cells. The patient was highly suspected of having left side-dominated cholangiocarcinoma and underwent PLLH. Microscopic findings revealed multiple cystic dilatations of the extramural peribiliary glands; hence, this lesion was diagnosed as HPCs. The resected intrahepatic bile duct showed that the normal ductal lumen comprised low columnar epithelia; however, front formation on the BilIN was observed in some parts of the intrahepatic bile duct, indicating that the BilIN coexisted with HPCs. Conclusion. We chose surgical therapy for this patient owing to the presence of some features of biliary malignancy. We employed noble PLLH as a minimally invasive procedure for this patient. Akira Umemura, Takayuki Suto, Akira Sasaki, Hiroyuki Nitta, Seika Nakamura, Fumitaka Endo, Kazuho Harada, and Kazuyuki Ishida Copyright © 2016 Akira Umemura et al. All rights reserved. Management of Urinary Incontinence in Complete Bladder Duplication by Injection of Bulking Agent at Bladder Neck Level into the Proximal Urethra Thu, 21 Jan 2016 09:48:03 +0000 Bladder duplication is a rare entity in children. The term encompasses a wide spectrum of anomalies from isolated bladder duplication in coronal or sagittal planes to duplicated bladder exstrophy and associated musculoskeletal and visceral anomalies. Given this wide variability, the treatment of these patients is not standardized. We hereby present a female patient with chief complaint of long-standing urinary incontinence who had complete bladder and urethral duplication and pubic diastasis. The patient was treated with bulking agent injection at the incompetent bladder neck and proximal urethra with resolution of incontinence, obviating the need for extensive surgeries. Reza Khorramirouz, Seyedeh Sanam Ladi Seyedian, Sorena Keihani, and Abdol-Mohammad Kajbafzadeh Copyright © 2016 Reza Khorramirouz et al. All rights reserved. Retracted: Adrenal Schwannomas: Rare Tumor of the Retroperitoneum Wed, 20 Jan 2016 08:17:39 +0000 Case Reports in Surgery Copyright © 2016 Case Reports in Surgery. All rights reserved. Double Incomplete Internal Biliary Fistula: Coexisting Cholecystogastric and Cholecystoduodenal Fistula Tue, 19 Jan 2016 12:46:24 +0000 Internal biliary fistula is a rare complication of a common surgical disease, cholelithiasis. It is seen in 0.74% of all biliary tract surgeries and is thought to be a result of repeated inflammatory periods of the gallbladder. In this report we present a case of incomplete cholecystogastric and cholecystoduodenal fistulae in a single patient missed by ultrasonography and endoscopic retrograde cholangiopancreatography and diagnosed intraoperatively. In the literature there is only one report of an incomplete cholecystogastric fistula. To our knowledge this is the first case of double incomplete internal biliary fistulae. Kemal Beksac, Arman Erkan, and Volkan Kaynaroglu Copyright © 2016 Kemal Beksac et al. All rights reserved. Iatrogenic Spinal Cord Injury during Removal of the Inferior Articular Process in the Presence of Ossification of the Ligamentum Flavum Mon, 18 Jan 2016 16:31:27 +0000 Ossified ligamentum flavum (OLF) is a condition of heterotopic lamellar bone formation within the yellow ligament. Some patients with OLF can be asymptomatic. However, asymptomatic OLF may not be obvious on preoperative MRI and could increase the risk of iatrogenic injury during treatments for unrelated spinal conditions. This report describes a case of spinal cord injury caused by the indirect transmission of force from an osteotome to an asymptomatic OLF during the resection of a thoracic inferior articular process (IAP). To prevent this outcome, we urge careful review of CT imaging in the preoperative setting and advocate the use of a high-speed drill instead of an osteotome during bone removal in the setting of an adjacent area of OLF. Shane M. Burke, Steven W. Hwang, Mina G. Safain, and Ron I. Riesenburger Copyright © 2016 Shane M. Burke et al. All rights reserved. Infected Abdominal Aortic Aneurysm with Helicobacter cinaedi Sun, 17 Jan 2016 16:14:48 +0000 Helicobacter cinaedi is a rare human pathogen which has various clinical manifestations such as cellulitis, bacteremia, arthritis, meningitis, and infectious endocarditis. We report an abdominal aortic aneurysm infected with Helicobacter cinaedi, treated successfully with surgical repair and long-term antimicrobial therapy. Kazuhiro Nishida, Takamasa Iwasawa, Atsushi Tamura, and Alan T. Lefor Copyright © 2016 Kazuhiro Nishida et al. All rights reserved. A Case of a 4-Year-Old Boy with a Mesenteric Chylous Cyst Infected with Histoplasma capsulatum Wed, 06 Jan 2016 12:44:07 +0000 Mesenteric cysts are uncommon entities and chyle- (lymph-) containing cysts are the rarest of this group. This is a case report of a 4-year-old boy with a mesenteric chylous cyst who was later found to have Histoplasma capsulatum infection. Vianney Kweyamba, Mirraim Apiyo, Biratu Olika, and Olivia Kituuka Copyright © 2016 Vianney Kweyamba et al. All rights reserved. Advanced Mesodermal (Müllerian) Adenosarcoma of the Ovary: Metastases to the Lungs, Mouth, and Brain Wed, 30 Dec 2015 09:31:38 +0000 Background. A malignant mixed Müllerian tumor (MMMT) is a malignant neoplasm found in the uterus, the ovaries, the fallopian tubes, and other parts of the body that contains both carcinomatous (epithelial tissue) and sarcomatous (connective tissue) components. Outcome of MMMTs is determined primarily by depth of invasion and stage. The metastatic background of these lesions is controversial and unknown. Case Report. A 75-year-old woman was admitted to the hospital with anorexia, weakness, and persistent coughing. The imaging exams revealed a solid, promiscuous lesion of 16 × 14 cm in dimensions located into the small pelvis, surrounding the uterus and the ovaries. The patient underwent exploratory laparotomy. The mass was removed and the histological examination of the specimen revealed an advanced mesodermal adenocarcinoma of the ovary (MMMT). Nine days after the operation the patient presented with metastatic lesions in the mouth as well as the lungs. Within a month after the discharge from the hospital metastatic lesions of the MMMT were also depicted in the CT brain scan. Conclusion. Despite the fact that sarcomas have a long-term metastatic potential, to our knowledge this is the first case of Müllerian adenosarcoma presenting with such extraperitoneal metastases. A. Daskalaki, S. Xenaki, E. Athanasakis, E. Chrysos, and G. Chalkiadakis Copyright © 2015 A. Daskalaki et al. All rights reserved. Abscess Formation after Septic Arthritis in the Sternoclavicular Joint of Two Healthy Men Wed, 30 Dec 2015 08:11:05 +0000 Abscess formation after septic arthritis in the sternoclavicular joint is a rare phenomenon in healthy people without immune suppression, intravenous drug abuse, or diabetes. Here we report two cases with formation of abscess in two middle-aged men, with no relevant comorbidities and no obvious sites of infection. The abscesses were both treated surgically with debridement followed by negative pressure wound therapy and antibiotics. The cases differ in diagnostic procedures and delay of diagnosis and broach the issues of handling a rare disease. Jeppe Henriksen, Mariann Tang, and Vibeke Hjortdal Copyright © 2015 Jeppe Henriksen et al. All rights reserved. Presentation and Surgical Management of Duodenal Duplication in Adults Wed, 30 Dec 2015 06:47:41 +0000 Duodenal duplications in adults are exceedingly rare and their diagnosis remains difficult as symptoms are largely nonspecific. Clinical presentations include pancreatitis, biliary obstruction, gastrointestinal bleeding from ectopic gastric mucosa, and malignancy. A case of duodenal duplication in a 59-year-old female is presented, and her treatment course is reviewed with description of combined surgical and endoscopic approach to repair, along with a review of historic and current recommendations for management. Traditionally, gastrointestinal duplications have been treated with surgical resection; however, for duodenal duplications, the anatomic proximity to the biliopancreatic ampulla makes surgical management challenging. Recently, advances in endoscopy have improved the clinical success of cystic intraluminal duodenal duplications. Despite these advances, surgical resection is still recommended for extraluminal tubular duplications although combined techniques may be necessary for long tubular duplications. For duodenal duplications, a combined approach of partial excision combined with mucosal stripping may offer advantage. Caroline C. Jadlowiec, Beata E. Lobel, Namita Akolkar, Michael D. Bourque, Thomas J. Devers, and David W. McFadden Copyright © 2015 Caroline C. Jadlowiec et al. All rights reserved. Enucleation of a Giant Hemangioma of Liver: Old School Revisited Wed, 30 Dec 2015 06:46:53 +0000 Hemangiomas are the most frequent benign hepatic tumours and are usually found in patients aged between 40 and 60 years, more frequently in women. In 30–35% of patients, the lesions are multiple. If the lesions are larger than 4–10 cm, they are coined as “giant” hemangioma. Here, we present a case of giant hemangioma treated with enucleation of the lesion and the advantages of the procedure. Karpagavel ChandraBose, A. Ramanujam, and Yega Muthu Copyright © 2015 Karpagavel ChandraBose et al. All rights reserved. Intradural Intramedullary Mixed Type Hemangioma: Optimizing the Surgical Management through Intraoperative Neurophysiological Monitoring Tue, 29 Dec 2015 09:14:06 +0000 Intradural intramedullary mixed type hemangioma is a rare histotype of primary spinal cord tumors, though it can carry a severe clinical burden leading to limb dysfunction or motor and sensory disturbances. Timely intervention with radical resection is the hallmark of treatment but achieving it is not an easy task even for experienced neurosurgeons. We herein present an exemplificative case presenting with sudden paraplegia in which total resection was achieved under intraoperative neurophysiology monitoring. A thorough discussion on the operative technique and the role of neuromonitoring in allowing a safe surgical management of primary spinal cord tumors is presented. Ahmad Jabir Rahyussalim, Adrian Situmeang, Ahmad Yanuar Safri, and Zulfa Indah K. Fadhly Copyright © 2015 Ahmad Jabir Rahyussalim et al. All rights reserved. Hemorrhagic Pseudocyst of Pancreas Treated with Coil Embolization of Gastroduodenal Artery: A Case Report and Review of Literature Sun, 27 Dec 2015 08:58:16 +0000 Hemorrhage into pseudocyst of pancreas can rarely present as life threatening massive UGI bleeding. We present a case of 21-year-old male, admitted to our department, who was a known case of posttraumatic acute pancreatitis and who developed massive upper GI bleeding. CT angiography of abdomen showed aneurysm of gastroduodenal artery. Patient was successfully treated with coil embolization of gastroduodenal artery. Sudhir Kumar Jain, Vishnuraja Rajendran, Maneesh K. Jain, and Ronal Kori Copyright © 2015 Sudhir Kumar Jain et al. All rights reserved. Laparoscopic Cholecystectomy for Acute Calcular Cholecystitis in a Patient with Ventriculoperitoneal Shunt: A Case Report and Literature Review Tue, 22 Dec 2015 07:11:48 +0000 Management of patients who have ventriculoperitoneal shunt presenting with acute calcular cholecystitis has remained a clinical challenge. In this paper, the hospital course and the follow-up of a patient presenting with acute calcular cholecystitis and ventriculoperitoneal shunt managed with laparoscopic cholecystectomy are presented followed by literature review on the management of acute calcular cholecystitis in patients who have ventriculoperitoneal shunts. Abdullah A. Albarrak, Sami Khairy, and Alzahrani Mohammed Ahmed Copyright © 2015 Abdullah A. Albarrak et al. All rights reserved. Successful Treatment of Persistent Postcholecystectomy Bile Leak Using Percutaneous Cystic Duct Coiling Mon, 21 Dec 2015 14:16:56 +0000 Laparoscopic cholecystectomy is one of the most commonly performed operations worldwide. Cystic duct is the most common site of bile leak after cholecystectomy. The treatment of choice is usually conservative. Using sufficient percutaneous drainage of the biloma cavity and endoscopic retrograde cholangiography (ERCP) with sphincterotomy and/or stenting, the cure rate of bile leaks is greater than 90%. In very rare cases, all of these measures remain unsuccessful. We report a technique for the successful treatment of persistent cystic duct leak. After failed ERCP and stenting, bile leak was treated by coiling the cystic duct through a drain tract. This technique is safe and effective and helps avoid the morbidity of reoperation. Vinay Rai, Akin Beckley, Anna Fabre, and Charles F. Bellows Copyright © 2015 Vinay Rai et al. All rights reserved. Corrigendum to “Hiatal Hernia Repair with Gore Bio-A Tissue Reinforcement: Our Experience” Mon, 21 Dec 2015 14:12:15 +0000 Antonino Agrusa, Giorgio Romano, Giuseppe Frazzetta, Daniela Chianetta, Giovanni De Vita, Giuseppe Di Buono, Vincenzo Sorce, Silvia Di Giovanni, and Gaspare Gulotta Copyright © 2015 Antonino Agrusa et al. All rights reserved. Multiple, Pan-Enteric Perforation Secondary to Intestinal Tuberculosis Mon, 21 Dec 2015 06:27:04 +0000 Free perforation is one of the most feared complications of the intestinal tuberculosis. The terminal ileum is the most common site of perforation, while the majority of (90%) perforations are solitary. Herein, we describe a case of a 25-year-old male who presented with generalized peritonitis requiring an emergency exploratory laparotomy, which revealed pan-enteric perforation characterized by multiple perforations of the small bowel extending 10–15 cm from the DJ flexure up to the terminal ileum. The perforations were primarily closed, while 6–8 cm of the diseased terminal ileum was resected and the two ends were brought out as double-barreled ostomy. To the best of our knowledge, such an extensive tuberculous perforation of the small bowel has not been previously reported in the literature before. Irfan Masood, Zain Majid, Ali Rafiq, Waqas Rind, Aisha Zia, and Sajjad Raza Copyright © 2015 Irfan Masood et al. All rights reserved. Embolization of a Jejunal Artery Pseudoaneurysm via Collateral Vessels Sun, 20 Dec 2015 06:53:30 +0000 Visceral artery pseudoaneurysms are rare and only few cases have been reported. They are considered to be life threatening in case of rupture. Rapid treatment is mandatory and endovascular procedure is recommended as the treatment of choice. Occasionally, endovascular approach is difficult to achieve, owing to unusual vascular anatomy. Whenever it is the case, an alternative method has to be considered. We report the case of a jejunal artery pseudoaneurysm that required an access via collateral vessels to accomplish complete occlusion in a 34-year-old woman who presented with a sudden epigastric pain 14 days after a cephalic duodenopancreatectomy. Romain Breguet, Lawrence F. Pupulim, and Sylvain Terraz Copyright © 2015 Romain Breguet et al. All rights reserved. General Anaesthesia and Emergency Surgery in Heart Transplant Recipient Wed, 16 Dec 2015 09:12:11 +0000 The number of patients who undergo heart transplant is increasing. Due to surgical emergencies, many of those may require general anesthesia in hospitals where subspecialized anesthetists may not be available. We present a case of a male patient who had heart transplant and required general anesthesia for emergency appendicectomy. Physiology of the heart after transplant, preoperative considerations, and postoperative monitoring has been discussed in our report. Farshid Ejtehadi, Sharon Carter, Lucy Evans, Mubashar Zia, and Howard Bradpiece Copyright © 2015 Farshid Ejtehadi et al. All rights reserved. Pancreatic Pseudocyst with Splenic Artery Erosion, Retroperitoneal and Splenic Hematoma Sun, 13 Dec 2015 07:53:23 +0000 The erosion of the peripancreatic vascular structures is a rare but life-endangering complication of pancreatic diseases. We report a female patient with a multicompartmentalized pancreatic pseudocyst that eroded the splenic artery resulting in a retroperitoneal and splenic hematoma with hemodynamic instability which required emergency laparotomy with splenectomy, partial cystectomy, ligation of the splenic artery at the level of the vascular erosion, cholecystectomy (lithiasis), and multiple drainage. The postoperative course was difficult (elevated level of platelets, pancreatic fistula) but eventually favourable, with no abdominal complaints and no recurrence at 2-year follow-up. The case shows that the pancreatic pseudocysts may present with acute hemorrhagic complications with life-endangering potential and significant postoperative morbidity. Petre V. H. Botianu, Adrian S. Dobre, Ana-Maria V. Botianu, and Danusia Onisor Copyright © 2015 Petre V. H. Botianu et al. All rights reserved. A Urachal Cyst Case with Painful Mass Locates at Ileal Mesentery Sun, 13 Dec 2015 07:36:03 +0000 Urachal cyst is an unusual clinical condition, which is usually asymptomatic. In some adult cases, it may lead to complications. The cyst is between umbilicus and urinary bladder. It is diagnosed via ultrasonography and computed tomography. However, in some cases, the diagnosis is made by means of surgical exploration and histopathological evaluation. In this paper, we report a case of a 17-year-old female presenting with painful abdominal mass. At the first evaluation, the case was diagnosed as a mesenteric cyst because the mass located in the mesentery, and final histopathological report revealed the urachal cyst. Selahattin Koray Okur, Hüseyin Pülat, Oktay Karaköse, Ismail Zihni, Kazım Çağlar Özçelik, and Hasan Erol Eroğlu Copyright © 2015 Selahattin Koray Okur et al. All rights reserved. Mediastinal Teratoma with Neuroendocrine Features in 34-Year-Old Male with Syncope Thu, 10 Dec 2015 14:26:25 +0000 Neuroendocrine tumors that arise in an extragonadal teratoma are extremely rare. Somatic-type malignancy, defined as any sarcoma, carcinoma, leukemia, or lymphoma developing in a germ cell tumor, occurs in approximately 2% of all germ cell tumors. Our case represents a mediastinal mass that was incidentally found in a patient with syncope. Surgical resection confirmed mature teratoma with neuroendocrine features. Peter A. Andrawes, Masood A. Shariff, Qing Chang, Fanyi Kong, and Frank M. Rosell Copyright © 2015 Peter A. Andrawes et al. All rights reserved. A Rare Case of a 15-Year-Old Boy with Two Accessory Nipples: One in the Forearm and One in the Milk Line Thu, 10 Dec 2015 13:01:23 +0000 A 15-year-old male presented for evaluation of a volar forearm mass that he noticed four years before. The mass was not painful and his main concern was cosmesis. The mass was two centimeters in diameter with a pinpoint central sinus and scant drainage. After excision, the pathology report noted pilosebaceous units and smooth muscle bundles, consistent with an accessory nipple. In addition, the patient had another accessory nipple in the “milk line” on his torso. While accessory nipples and breast tissue have been reported in numerous locations throughout the body, this is the first reported case of an accessory nipple on the forearm. Alexander J. Tauchen, Essie Kueberuwa, Kenneth Schiffman, Kumaran M. Mudaliar, and Shelley S. Noland Copyright © 2015 Alexander J. Tauchen et al. All rights reserved. Unusual Presentation of Recurrent Early Stage Endometrial Carcinoma 28 Years after Primary Surgery Wed, 09 Dec 2015 11:08:02 +0000 Endometrial carcinoma is the most common neoplasia of female genital tract. The prognosis of early stage disease (FIGO I and FIGO II) is excellent: recurrence after surgery is less than 15%, most of which are reported within 3 years after primary treatment. Herein we report a case of late rectal recurrence from FIGO Ib endometrial adenocarcinoma. Patient had also familiar and personal history of colonic adenocarcinoma and previous findings of microsatellite instability (MSI); molecular analysis evidenced heterozygotic somatic mutation in MLH1 gene. Twenty-eight years after hysterectomy and bilateral salpingoovariectomy, a rectal wall mass was detected during routine colonoscopy. Patients underwent CT scan, pelvic MRI, and rectal EUS with FNA: histopathological and immunohistochemical analysis revealed differentiated carcinoma cells of endometrial origin. No neoadjuvant treatment was planned and low rectal anterior resection with protective colostomy was performed; histology confirmed rectal lesion as metastasis from endometrial carcinoma. Recurrence of early stage endometrial carcinoma after a long period from primary surgery is possible. It is important to keep in mind this possibility in order to set a correct diagnostic and therapeutic algorithm, including preoperative immunohistochemical staining, and to plan a prolonged follow-up program. Alessandro Franchello, Gianruggero Fronda, Giacomo Deiro, Alessia Fiore, Davide Cassine, Luca Molinaro, Luigi Chiusa, Sara Galati, Andrea Resegotti, and Stefano Silvestri Copyright © 2015 Alessandro Franchello et al. All rights reserved. Management of Septic Open Abdomen in a Morbid Obese Patient with Enteroatmospheric Fistula by Using Standard Abdominal Negative Pressure Therapy in Conjunction with Intrarectal One Tue, 08 Dec 2015 07:06:29 +0000 Introduction. Management of open abdomen (OA) with enteroatmospheric fistula (EAF) in morbid obese patient with comorbid disease is challenging. We would like to report the management of septic OA in morbid obese patient with EAF which developed after strangulated recurrent giant incisional hernia repair. We would also like to emphasize, in this case, the conversion of EAF to ileostomy by the help of second Negative Pressure Therapy (NPT) on ostomy side, and the chance of new EAF occurrence was reduced with intrarectal NPT. Case Presentation. 62-year-old morbid obese woman became an OA patient with EAF after strangulated recurrent giant hernia. EAF was converted to ostomy with pezzer drain by the help of second NPT on ostomy. Colonic distention was reduced with the third NPT application via rectum. Abdominal reapproximation anchor (ABRA) system was used for delayed abdominal closure. Conclusions. Using the 2nd NPT on ostomy side may help in the maturation of the ostomy created in a difficult condition in an open abdomen. Using the 3rd NPT through rectum may decrease the chance of EAF formation by reducing the pressure difference between intraluminal pressure and extraluminal pressure in hollow viscera. Fahri Yetisir, A. Ebru Salman, Hasan Zafer Acar, Mehmet Özer, Muhittin Aygar, and Gokhan Osmanoglu Copyright © 2015 Fahri Yetisir et al. All rights reserved. A Case Report on the Successful Treatment of Streptococcus pneumoniae-Induced Infectious Abdominal Aortic Aneurysm Initially Presenting with Meningitis Tue, 08 Dec 2015 06:46:48 +0000 Infectious abdominal aortic aneurysms often present with abdominal and lower back pain, but prolonged fever may be the only symptom. Infectious abdominal aortic aneurysms initially presenting with meningitis are extremely rare; there are no reports of their successful treatment. Cases with Streptococcus pneumoniae as the causative bacteria are even rarer with a higher mortality rate than those caused by other bacteria. We present the case of a 65-year-old man with lower limb weakness and back pain. Examination revealed fever and neck stiffness. Cerebrospinal fluid showed leukocytosis and low glucose levels. The patient was diagnosed with meningitis and bacteremia caused by Streptococcus pneumoniae and treated with antibiotics. Fever, inflammatory response, and neurologic findings showed improvement. However, abdominal computed tomography revealed an aneurysm not present on admission. Antibiotics were continued, and a rifampicin soaked artificial vascular graft was implanted. Tissue cultures showed no bacteria, and histological findings indicated inflammation with high leukocyte levels. There were no postoperative complications or neurologic abnormalities. Physical examination, blood tests, and computed tomography confirmed there was no relapse over the following 13 months. This is the first reported case of survival of a patient with an infectious abdominal aortic aneurysm initially presenting with meningitis caused by Streptococcus pneumoniae. Yohei Kawatani, Yoshitsugu Nakamura, Yujiro Hayashi, Tetsuyoshi Taneichi, Yujiro Ito, Hirotsugu Kurobe, Yuji Suda, and Takaki Hori Copyright © 2015 Yohei Kawatani et al. All rights reserved.