Case Reports in Surgery The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Parenchymal Guidewire Perforation during ERCP: An Unappreciated Injury Thu, 26 Nov 2015 14:18:30 +0000 ERCP is attended with certain complications, the majority of which are well known to the medical community. Other less-known complications also exist. Guidewire injury to the hepatic or pancreatic parenchyma represents one of the much less appreciated, albeit preventable, complications. In this report, we present the clinical course of three patients who sustained guidewire perforation of the pancreatic or hepatic parenchyma. In one patient, the clinical deterioration was confidently attributed to guidewire perforation of the pancreatic parenchyma. Conservative treatment was successful and unnecessary emergency surgery was thus avoided. In the other two, in whom the cause of the clinical deterioration was unclear, an emergency surgery was performed. Guidewire injury to the hepatic parenchyma was then confirmed which needed only intraperitoneal drainage, with successful outcome. M. Ezzedien Rabie, Saad Al Faris, Ali Nasser, Abdul Aziz Shahir, Yasser Al Mahdi, and Mansour Youssef Al Asmari Copyright © 2015 M. Ezzedien Rabie et al. All rights reserved. Total Reconstruction of the Upper Lip Using Bilateral Nasolabial Flaps, Submental Flap, and Mucosa Graft following Complete Resection for Squamous Cell Carcinoma Thu, 26 Nov 2015 13:27:58 +0000 Lip reconstruction following resection for tumour or following extensive trauma may pose a challenge. This is more so when the resection is total and a complete lip has to be constructed. We present a case of lip reconstruction following a total resection of the upper lip. The procedure used in this case was a combination of bilateral nasolabial flaps with a submental flap and buccal mucosal graft lining. We believe that this provides an alternative method of total upper lip reconstruction with minimal disruption of the facial aesthesis. O. G. Oseni, A. E. Fadare, M. O. Majaro, and P. B. Olaitan Copyright © 2015 O. G. Oseni et al. All rights reserved. Multivisceral Resection with Performing a Double Roux-en-Y Reconstruction for Advanced Gastric Cancer Tue, 24 Nov 2015 13:12:55 +0000 Background. The role of multivisceral resection, in the setting of locally advanced gastric cancer, is still debated. Previous studies have reported a higher risk for perioperative morbidity and mortality, with limited objective benefit in terms of survival. Patient. A male patient, 55 years old, was admitted to the clinic of surgery for surgical treatment of bleeding gastric ulceration. Preoperative diagnostic evaluation was performed, and patient had undergone a surgical treatment which revealed a large mass in head of the pancreas, infiltrating the hepatoduodenal ligament and transverse mesocolon. Total gastrectomy, duodenopancreatectomy, and right hemicolectomy were performed. The digestive tube continuity was reestablished by deriving the double Roux limbs. Conclusion. The aim of this case presentation is to demonstrate a method of digestive tube reconstruction by performing the double Roux-en-Y reconstruction in advanced gastric cancer when the multivisceral resection is performed. Zijah Rifatbegovic, Zlatan Mehmedovic, Majda Mehmedovic, Jasmin Hasanovic, and Amra Mestric Copyright © 2015 Zijah Rifatbegovic et al. All rights reserved. Seromuscular Colonic Flap for Intrapelvic Soft-Tissue Coverage: A Reconstructive Option for Plastic Surgeons When Traditionally Used Flaps Are Not Available Tue, 24 Nov 2015 08:59:37 +0000 Background. Reconstruction of intrapelvic defects can be a challenging problem in patients with limited regional muscle flap options and previously resected omentum. In such situations, alternative methods of mobilizing vascularized tissue may be required. Methods. A case of a patient that underwent pelvic extirpation for recurrent rectal cancer who had limited donor sites for flap reconstruction is presented. The mucosa was removed from a blind loop of colon, and a pedicled seromuscular flap based on the colonic mesentery was placed into the pelvis for vascularized soft-tissue coverage and elimination of dead space. Results. The postoperative course was only complicated by a small subcutaneous fluid collection beneath the sacrectomy skin incision, which was drained with radiological assistance. The patient recovered without any major postoperative complications. Conclusion. Seromuscular colonic flap is a useful option for soft-tissue coverage after pelvic extirpation and should be considered by plastic surgeons when other reconstruction options are not available. Johnathon Aho, Sebastian Winocour, Ziyad S. Hammoudeh, Heidi Nelson, Peter Rose, and Nho V. Tran Copyright © 2015 Johnathon Aho et al. All rights reserved. Two Patients with Fulminant Clostridium difficile Enteritis Who Had Not Undergone Total Colectomy: A Case Series and Review of the Literature Sun, 22 Nov 2015 11:50:15 +0000 Introduction. Clostridium difficile is the most common cause of healthcare associated infectious diarrhea, and its most common clinical manifestation is pseudomembranous colitis. Small bowel enteritis is reported infrequently in the literature and typically occurs only in patients who have undergone ileal pouch anastomosis due to inflammatory bowel disease or total abdominal colectomy for other reasons. Presentation of Cases. We report here two cases in which patients developed small bowel C. difficile enteritis in the absence of these underlying conditions. Discussion. Neither patient had underlying inflammatory bowel disease and both had a significant amount of colon remaining. Conclusion. These two cases demonstrate that small bowel C. difficile enteritis should be included in the differential diagnosis of patients on antibiotic therapy who demonstrate signs and symptoms of worsening abdominal disease during their postoperative course, even if they lack the major predisposing factors of inflammatory bowel disease or history of total colectomy. Eliza W. Beal, Rosara Bass, and Alan E. Harzman Copyright © 2015 Eliza W. Beal et al. All rights reserved. Retroperitoneal Cyst: An Uncommon Presentation of Filariasis Thu, 19 Nov 2015 16:29:13 +0000 Primary retroperitoneal parasitic cysts are rare. Here we report about a middle aged male patient from rural north India with a recent onset of central abdominal retroperitoneal lump, pain, and fever. After surgical resection due to diagnostic uncertainty, at histopathology, it turned out be a filarial cyst. After receiving a course of diethylcarbamazine, the patient is asymptomatic at 4 months’ follow-up. Senthil Ganesan, Saurabh Galodha, and Rajan Saxena Copyright © 2015 Senthil Ganesan et al. All rights reserved. An Asymptomatic Foreign Body in the Nose in an Eighteen-Year-Old Patient: Button Battery Thu, 19 Nov 2015 12:46:27 +0000 Foreign bodies lodged in the upper airway are a common occurrence in children. Many unusual foreign bodies in the nose have been reported as foreign bodies like nuts, plastic toy parts, beads, and so forth. Most of these produce minimal morbidity but button batteries due to their early chemical disintegration require early surgical intervention. Here, we report a case of button battery lodged in the nose for several years with a symptom of nasal obstruction and chronic sinusitis. Merih Onal, Gultekin Ovet, and Necat Alatas Copyright © 2015 Merih Onal et al. All rights reserved. Herpes Zoster-Induced Ogilvie’s Syndrome Thu, 19 Nov 2015 12:39:36 +0000 Ogilvie’s syndrome due to herpes zoster infection is a rare manifestation of VZV reactivation. The onset of rash of herpes zoster and the symptoms of intestinal obstruction can occur at different time intervals posing a significant diagnostic challenge resulting in avoidable surgical interventions. Herein, we describe a case of 35-year-old male who presented with 6-day history of constipation and colicky abdominal pain along with an exquisitely tender and vesicular skin eruption involving the T8–T11 dermatome. Abdominal X-ray and ultrasound revealed generalized gaseous distention of the large intestine with air up to the rectum consistent with paralytic ileus. Colonoscopy did not show any obstructing lesion. A diagnosis of Ogilvie’s syndrome associated with herpes zoster was made. He was conservatively managed with nasogastric decompression, IV fluids, and acyclovir. The patient had an uneventful recovery and was later discharged. Irfan Masood, Zain Majid, Waqas Rind, Aisha Zia, Haris Riaz, and Sajjad Raza Copyright © 2015 Irfan Masood et al. All rights reserved. Carcinosarcoma of the Rectum: Report of a Rare Colorectal Malignancy and Review of the Literature Tue, 17 Nov 2015 12:53:26 +0000 Carcinosarcoma (CS) is a rare mixed mesodermal malignancy most commonly affecting the female reproductive organs, respiratory tract, head, and neck. Though infrequent, it may affect the gastrointestinal tract, most often the oesophagus and only very rarely the rectum. Histologically, it is composed of two distinct elements of epithelial and mesenchymal origin. Clinically, it is a very aggressive tumour with many patients presenting with metastatic lymph nodes or distant metastases at the time of diagnosis. Prognosis is poor despite intervention with the majority of patients dying within six months. Due to the rarity of this condition, there are no specific treatment guidelines presently available. We describe the case of an 80-year-old patient with carcinosarcoma of the rectum with discussion of the immunohistochemistry and review the available literature pertaining to this rare presentation. Alexis Sudlow, Ming Ho Liu, Geoffrey Waters, and Vamsi R. Velchuru Copyright © 2015 Alexis Sudlow et al. All rights reserved. Extensive Subcutaneous Emphysema as a Presentation of Ischemic Colitis Tue, 17 Nov 2015 10:08:41 +0000 Introduction. Subcutaneous emphysema is usually benign and self-limited; however, it may be associated with a life-threating situation. Case Report. An elderly woman with progressive malaise with extensive subcutaneous emphysema (cervical to abdominal wall) was observed at the emergency department. Colonic perforation was diagnosed and the patient underwent surgery. Intraoperatively, necrosis and perforation of the sigmoid colon into the retroperitoneum were found and a Hartmann procedure was performed. Conclusion. Cervical and thoracic subcutaneous emphysema may be the first sign of intra-abdominal lesion. Ana Franky Carvalho, Claudio Branco, Pedro Leão, and Conceição Antunes Copyright © 2015 Ana Franky Carvalho et al. All rights reserved. Primary Left Cardiac Angiosarcoma with Mitral Valve Involvement Accompanying Coronary Artery Disease Mon, 16 Nov 2015 14:07:00 +0000 We report here on a 43-year-old female patient presenting with non-ST elevation myocardial infarction, severe mitral regurgitation, and mild mitral stenosis secondary to encroachment of the related structures by a primary cardiac angiosarcoma. A coronary angiography revealed significant stenosis in the left main and left circumflex arteries and at exploration, the tumour was arising from posterior left atrial free wall, invading the posterior mitral leaflet, and extending into all of the pulmonary veins and pericardium. Therefore, no further intervention was performed, except for left internal mammarian artery to left anterior descending artery anastomosis and biopsy. As far as we know, this case is unique with respect to its presentation. Cagdas Baran, Serkan Durdu, Sadik Eryilmaz, Mustafa Sirlak, and A. Ruchan Akar Copyright © 2015 Cagdas Baran et al. All rights reserved. Intraoperative Conversion to ALPPS in a Case of Intrahepatic Cholangiocarcinoma Mon, 16 Nov 2015 13:47:15 +0000 Background. Surgical resection remains the best treatment option for intrahepatic cholangiocarcinoma (ICC). Two-stage liver resection combining in situ liver transection with portal vein ligation (ALPPS) has been described as a promising method to increase the resectability of liver tumors also in the case of ICC. Presentation of Case. A 46-year-old male patient presented with an ICC-typical lesion in the right liver. The indication for primary liver resection was set and planed as a right hepatectomy. In contrast to the preoperative CT-scan, the known lesion showed further progression in a macroscopically steatotic liver. Therefore, the decision was made to perform an ALPPS-procedure to avoid an insufficient future liver remnant (FLR). The patient showed an uneventful postoperative course after the first and second step of the ALPPS-procedure, with sufficient increase of the FLR. Unfortunately, already 2.5 months after resection the patient had developed new tumor lesions found by the follow-up CT-scan. Discussion. The presented case demonstrates that an intraoperative conversion to an ALPPS-procedure is safely applicable when the FLR surprisingly seems to be insufficient. Conclusion. ALPPS should also be considered a treatment option in well-selected patients with ICC. However, the experience concerning the outcome of ALPPS in case of ICC remains fairly small. F. Oldhafer, K. I. Ringe, K. Timrott, M. Kleine, W. Ramackers, S. Cammann, M. D. Jäger, J. Klempnauer, H. Bektas, and F. W. R. Vondran Copyright © 2015 F. Oldhafer et al. All rights reserved. Duplication Cyst in the Third Part of the Duodenum Presenting with Gastric Outlet Obstruction and Severe Weight Loss Sun, 15 Nov 2015 07:59:30 +0000 Duodenal duplication is a rare developmental abnormality which is usually diagnosed in infancy and childhood, but less frequently in adulthood. We report a case of a 16-year-old female with a duplication cyst in the third part of the duodenum. The patient presented with symptoms of gastric outlet obstruction, including severe anorexia and weight loss. The diagnosis was made preoperatively by CT scan and upper endoscopy. The cyst was successfully treated by marsupialization on the duodenum using a GIA stapler. Duodenal duplication presents with a wide variety of symptoms. Although illusive, many cases can be properly diagnosed preoperatively by using the appropriate imaging modalities. Treatment choices are tailored according to the size and location of the cyst, in addition to its relation to adjacent structures. The outcomes are favorable in the majority of patients. Osama Shaheen, Samer Sara, Mhd Firas Safadi, and Bayan Alsaid Copyright © 2015 Osama Shaheen et al. All rights reserved. Open Reduction and Internal Fixation of the Isolated Tibial Lateral Plateau Posterior Fracture Using Direct Posterior Split Gastrocnemius Approach Thu, 12 Nov 2015 06:57:17 +0000 Open reduction and internal fixation of the isolated tibial lateral plateau posterior fractures using direct posterior split gastrocnemius approach is a safe and effective method. Guzelali Ozdemir, Baris Yilmaz, and Ahmet Oztermeli Copyright © 2015 Guzelali Ozdemir et al. All rights reserved. Amyand’s Hernia with Appendicitis: A Case Report and Integrative Review Tue, 10 Nov 2015 13:54:36 +0000 Introduction. Inguinal hernia is a common disorder with an estimated prevalence of 1.2% of the entire population and it is 12 times more common in males. Objective. To describe a case of appendix with signs of inflammation in the hernia sac, condition that is rare and difficult to diagnose, and to perform literature review, describing the most relevant aspects and the main controversies. Method. Report of a case and search in PubMed on June 1, 2015, using the terms “Appendix” [MeSH term] AND “hernia, inguinal” [MeSH term]. Results. The search resulted in 38 articles in total, and after deleting the articles that were not part of the inclusion criteria, there were 26 case reports remaining. Discussion. The search resulted in a total of 38 articles and after deleting the articles that were not part of the inclusion criteria, there were 26 case reports remaining. Conclusion. Amyand’s hernia is a rare and difficult to diagnose condition, being commonly found occasionally in surgical procedures. It should be remembered in the presence of cases of incarcerated hernia, due to its possible complications if not diagnosed. Jéssica Feitosa Cavalcante, Hermes Melo Teixeira Batista, Ivo Cavalcante Pita Neto, Jairo Fernandes Frutuoso, Woneska Rodrigues Pinheiro, Italla Maria Pinheiro Bezerra, Luiz Carlos de Abreu, and Gylmara Bezerra de Menezes Silveira Copyright © 2015 Jéssica Feitosa Cavalcante et al. All rights reserved. Enterohepatic Migration of Fish Bone Resulting in Liver Abscess Sun, 08 Nov 2015 16:10:32 +0000 Liver abscess formation due to enterohepatic migration of a foreign body is extremely rare. Foreign body ingestion is generally an unconscious and painless event, thus complicating preoperative diagnosis in most patients. We report the case of a 61-year-old man who presented with secondary peritonitis from a ruptured hepatic abscess after an ingested fish bone migrated into the liver. Chikwendu Ede, Sanju Sobnach, Delawir Kahn, and Ahmed Bhyat Copyright © 2015 Chikwendu Ede et al. All rights reserved. Massive Hemothorax Caused by a Single Intercostal Artery Bleed Ten Days after Solitary Minimally Displaced Rib Fracture Thu, 05 Nov 2015 14:21:11 +0000 Delayed hemothorax (DHX) following blunt thoracic trauma is a rare occurrence with an extremely variable incidence and time to diagnosis that is generally associated with clinically insignificant blood loss. In this report, we present a case of acute onset DHX ten days after a relatively mild traumatic event that resulted in a single minimally displaced rib fracture. The patient awoke from sleep suddenly with acute onset dyspnea and chest pain and reported to the emergency department (ED). The patient lost over six and a half liters of blood during the first 9 hours of his admission, the largest volume yet reported in the literature for DHX, which was eventually found to be due to a single intercostal artery bleed. Successful management in this case entailed two emergent thoracotomies and placement of multiple thoracostomy tubes to control blood loss. The patient was discharged home on postoperative day 5. Karleigh R. Curfman, R. Jonathan Robitsek, Gregory G. Salzler, Katherine D. Gray, Charles S. Lapunzina, Ravi K. Kothuru, and Sebastian D. Schubl Copyright © 2015 Karleigh R. Curfman et al. All rights reserved. Repeat Minimally Invasive Mitral Valve Replacement for Recurrent Mitral Stenosis after OMC in Patients Who Decline Blood Product Transfusion for Religious Reasons Thu, 05 Nov 2015 12:37:37 +0000 Cardiac surgery for Jehovah’s Witness (JW) patients is considered to be high risk because of patients’ refusal to receive blood transfusion. We report a successful mitral valve replacement for recurrent mitral stenosis after OMC with minimally invasive right thoracotomy, without any transfusion of allogeneic blood or blood products. This minimally invasive mitral valve replacement through right thoracotomy was an excellent approach for JW patients. Yujiro Ito, Yoshitsugu Nakamura, Osamu Tagusari, and Shigehiko Yoshida Copyright © 2015 Yujiro Ito et al. All rights reserved. Isolated Renal Metastasis from Non-Small-Cell Lung Cancer: Report of 2 Cases Wed, 04 Nov 2015 10:00:43 +0000 Renal metastasis from non-small-cell lung cancer is rather uncommon; isolated metastasis especially is rare. Herein we report 2 cases who developed a solitary renal metastasis after undergoing a curative resection for non-small-cell lung cancer. They received nephrectomy. Masaki Tomita, Takanori Ayabe, Eiichi Chosa, and Kunihide Nakamura Copyright © 2015 Masaki Tomita et al. All rights reserved. Sternalis Muscle: An Unexpected Finding during Mastectomy Mon, 02 Nov 2015 11:06:05 +0000 Sternalis muscle also called rectus sternalis, rectus thoracis, or episternalis is an anomalous muscle of the anterior chest wall with unknown anatomical function. It is regularly observed in lower animal but infrequently in humans. Presence of this muscle can create confusion with tumours of the anterior chest wall during routine mammography. Although less is known about its origin and innervations, knowledge about this muscle can have many clinical implications. A case of unilateral sternalis muscle detected during mastectomy, in a female with carcinoma of the right breast, is being reported with a brief review of the literature and highlighting its clinical significance. Prakash K. Sasmal, Susanta Meher, Tushar S. Mishra, N. Deep, Prabhas R. Tripathy, and Satyajit Rath Copyright © 2015 Prakash K. Sasmal et al. All rights reserved. A Rare Case of Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia Mon, 02 Nov 2015 06:15:07 +0000 Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare clinical condition with only about 100 cases reported in the literature. It is characterized by primary hyperplasia of pulmonary neuroendocrine cells (PNECs) which are specialized epithelial cells located throughout the entire respiratory tract, from the trachea to the terminal airways. DIPNECH appears in various forms that include diffuse proliferation of scattered neuroendocrine cells, small nodules, or a linear proliferation. It is usually seen in middle-aged, nonsmoking women with symptoms of cough, dyspnea, and wheezing. We present a 45-year-old, nonsmoking woman who presented with symptoms of DIPNECH associated with bilateral pulmonary nodules and left hilar adenopathy. Of interest, DIPNECH in our patient was associated with metastatic pulmonary carcinoids, papillary carcinoma of the left breast, oncocytoma and angiomyolipoma of her left kidney, and cortical nodules suggestive of tuberous sclerosis. She had video assisted thoracoscopic surgery (VATS), modified radical mastectomy with reconstruction, and radical nephrectomy. She is currently symptom-free most of the time with over two years of follow-up. Godwin Ofikwu, Vishnu R. Mani, Ajai Rajabalan, Albert Adu, Leaque Ahmed, and Dennis Vega Copyright © 2015 Godwin Ofikwu et al. All rights reserved. Primary Gallbladder Lymphoma in a Male Patient with No Risk Factors Detected Incidentally by CT Colonography Mon, 26 Oct 2015 11:50:10 +0000 Primary gallbladder lymphoma, although rare, usually presents in females with symptoms mimicking cholecystitis. We present a rare case of primary gallbladder in an 81-year-old male with no risk factors whose only symptom was weight loss. Routine blood tests including liver function tests were unremarkable. A CT colonography was carried out to exclude colonic malignancy. Unilateral gallbladder wall thickening and lymphadenopathy were incidentally detected and confirmed by ultrasound and a decision for the patient to undergo laparoscopic cholecystectomy and intraoperative cholangiogram was made. Histology confirmed extranodal marginal zone lymphoma with follow-up staging and biopsy of the bone marrow not demonstrating spread. Cholecystectomy was therefore deemed curative and no adjuvant therapy was necessary. Thickening of the gallbladder wall on any imaging with or without symptoms should not be ignored or assumed to be cholecystitis, even in males with no risk factors. In these patients urgent cholecystectomy with intraoperative cholangiogram is indicated with histology and haematology follow-up. Monil Karia, Grigorios Mitsopoulos, Ketan Patel, Akkib Rafique, and Hemant Sheth Copyright © 2015 Monil Karia et al. All rights reserved. Laparoscopic Distal Pancreatectomy with or without Preservation of the Spleen for Solid Pseudopapillary Neoplasm Mon, 26 Oct 2015 09:38:24 +0000 Solid pseudopapillary neoplasm (SPN) is a rare tumor of the pancreas. Laparoscopic distal pancreatectomy (DP) is a feasible and safe procedure, and successful spleen preservation rates are higher using a laparoscopic approach. We hypothesized that certain patients with SPN would be good candidates for laparoscopic surgery; however, few surgeons have reported laparoscopic DP for SPN. We discuss the preoperative assessment and surgical simulation for two SPN cases. A simulation was designed because we consider that a thorough preoperative understanding of the procedure based on three-dimensional image analysis is important for successful laparoscopic DP. We also discuss the details of the actual laparoscopic DP with or without splenic preservation that we performed for our two SPN cases. It is critical to use appropriate instruments at appropriate points in the procedure; surgical instruments are numerous and varied, and surgeons should maximize the use of each instrument. Finally, we discuss the key techniques and surgical pitfalls in laparoscopic DP with or without splenic preservation. We conclude that experience alone is inadequate for successful laparoscopic surgery. Tomohide Hori, Toshihiko Masui, Toshimi Kaido, Kohei Ogawa, Kentaro Yasuchika, Shintaro Yagi, Satoru Seo, Kyoichi Takaori, Masaki Mizumoto, Taku Iida, Yasuhiro Fujimoto, and Shinji Uemoto Copyright © 2015 Tomohide Hori et al. All rights reserved. 17-Week Delay Surgery after Chemoradiation in Rectal Cancer with Complete Pathological Response Thu, 22 Oct 2015 09:42:33 +0000 Neoadjuvant chemoradiation (CRT) followed by curative surgery still remains the standard of care for locally advanced rectal cancer (LARC). The main purpose of this multimodal treatment is to achieve a complete pathological tumor response (ypCR), with better survival. The surgery delay after CRT completion seems to increase tumor response and ypCR rate. Usually, time intervals range from 8 to 12 weeks, but the maximum tumor regression may not be seen in rectal adenocarcinomas until several months after CRT. About this issue, we report a case of a 52-year-old man with LARC treated with neoadjuvant CRT who developed, one month after RT completion, an acute myocardial infarction. The need to increase the interval between CRT and surgery for 17 weeks allowed a curative surgery without morbidity and an unexpected complete tumor response in the resected specimen (given the parameters presented in pelvic magnetic resonance imaging (MRI) performed 11 weeks after radiotherapy completion). Marisa D. Santos, Manuel T. Gomes, Filipa Moreno, Anabela Rocha, and Carlos Lopes Copyright © 2015 Marisa D. Santos et al. All rights reserved. Small Bowel Obstruction Secondary to Interstitial Hernia: Laparoscopic Approach Wed, 21 Oct 2015 12:54:35 +0000 Interstitial hernias are a rare entity. Most of them are detected incidentally on imaging studies. We present a case of abdominal bowel obstruction secondary to interstitial hernia on the fifth postoperative day of an open incisional hernia repair. Laparoscopy confirmed the diagnosis and led to an accurate treatment avoiding a new laparotomy. In this case, prompt surgical decision based on clinical and CT scan findings allowed a mini-invasive approach with satisfactory outcome. J. M. Alvarez Gallesio, F. Schlottmann, and E. E. Sadava Copyright © 2015 J. M. Alvarez Gallesio et al. All rights reserved. Minimally Invasive Surgical Approach to Complicated Recurrent Pilonidal Sinus Wed, 21 Oct 2015 12:46:42 +0000 Pilonidal sinus is considered as a simple and frequently occurring disease localized at the sacrococcygeal area. However, at the intergluteal region, it can often turn into a chronic and complicated disease. In some cases, it can fistulize up to the gluteal region and appear at the secondary orifices. Minimally invasive surgical techniques are becoming widespread in recent years due to the increased experience and development of new instruments. Limited excision of the pilonidal sinus tract can be a better treatment option compared with large excisions in terms of recovery time and patient’s comfort. This case study reports the single-phase surgical treatment of complicated and recurrent pilonidal sinus localized at the gluteal area, with minimal tissue loss and inflammation. Vahit Onur Gul, Sebahattin Destek, Serhat Ozer, Ergin Etkin, Serkan Ahioglu, Mehmet Ince, Vedat Cimin, Deniz Sen, and Yesim Erbil Copyright © 2015 Vahit Onur Gul et al. All rights reserved. Portomesenteric Vein Thrombosis, Bowel Gangrene, and Bilateral Pulmonary Artery Embolism Two Weeks after Laparoscopic Sleeve Gastrectomy Wed, 21 Oct 2015 09:32:29 +0000 Sleeve gastrectomy and gastric bypass surgery are popular and effective options for weight loss surgery. Portomesenteric vein thrombosis (PMVT) is a documented but rare complication of bariatric surgery. Proper surgical technique, careful postoperative prophylaxis, and early mobilization are essential to prevent this event. The diagnosis of PMVT in the postoperative period requires a high index of suspicion and early directed intervention to prevent a possibly fatal outcome. We present a case of PMVT complicated by small bowel ischemia resulting in gangrene that necessitated resection. David G. Darcy, Ali H. Charafeddine, Jenny Choi, and Diego Camacho Copyright © 2015 David G. Darcy et al. All rights reserved. Retracted: Fitz-Hugh-Curtis Syndrome in a Male Patient: A Case Report and Literature Review Wed, 21 Oct 2015 06:24:27 +0000 Case Reports in Surgery Copyright © 2015 Case Reports in Surgery. All rights reserved. Cavernostomy for Pulmonary Aspergillosis Associated with Destroyed Lung after Surgery for Lung Cancer: Report of 3 Cases Tue, 20 Oct 2015 06:04:40 +0000 Slow, progressive, and destructive changes in the residual lung after surgery for lung cancer, known as “destroyed lung,” are delayed nonrecurrent complications. Destroyed lung can be a difficult condition to treat due to repeated infections and is therefore a complication that should not be ignored. We had three cases of intractable pulmonary aspergillosis difficult to treat associated with destroyed lung, after lung cancer surgery. Two of these patients followed a characteristic clinical course, which started with a cystic change just below the pleura and subsequently led to respiratory failure and death due to repeated infections. The third patient followed a similar clinical course and is currently under regular follow-up. Our cases suggest that concomitant occurrence of severe complications following surgery for lung cancer, such as destroyed lung and pulmonary aspergillosis, should be monitored because these complications can lead to respiratory failure and fatal clinical course. Radical surgery is not possible, especially when medical treatment is ineffective in controlling repeated infections and the patient’s general condition is worsened due to prolonged chronic inflammation. Therefore, aggressive surgical intervention should be considered before patients worsen. Ryo Takahashi, Taiki Fujiwara, and Hisami Yamakawa Copyright © 2015 Ryo Takahashi et al. All rights reserved. A Case of Pneumococcal Peritonitis after Caesarean Section in a Healthy Woman Tue, 13 Oct 2015 14:38:37 +0000 Pneumococcal peritonitis is prevalent in children and adults with comorbidities but extremely rare in healthy adults. Here we describe a case of pneumococcal peritonitis in a previously healthy woman with no known risk factors who presented with constipation, abdominal pain, and distention. Her only past medical history was an uncomplicated C-section two months prior to presentation. A laparotomy revealed a pneumococcal peritonitis without visible source of infection. The patient remained hospitalized until completion of antibiotic regimen with Ceftriaxone and resolution of symptoms. This report adds to the small body of evidence showing possible pneumococcal peritonitis in healthy young adults. Georgios Kourounis, Yiannis Panayiotou, Patrick Paul Tabet, Brian David Wensley Richards, Athanasios Petrou, and Marios Loizou Copyright © 2015 Georgios Kourounis et al. All rights reserved.