Case Reports in Surgery The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Malrotated Subhepatic Caecum with Subhepatic Appendicitis: Diagnosis and Management Thu, 25 Aug 2016 13:31:45 +0000 Subhepatically located caecum and appendix is a very rare entity. It occurs due to the anomaly in fetal gut rotation that results in an incomplete rotation and fixation of the intestine. Appendicitis, which is a common surgical emergency, in combination with the abnormal subhepatic location, presents a great challenge in its diagnosis and management. Here, we describe a 42-year-old male with chronic dyspepsia who presented with sepsis and severe pain at his right hypochondriac and epigastric region. The final diagnosis was acute appendicitis of the subhepatic appendix. Our discussion focuses on the diagnostic approach and clinical and surgical management. We hope that our report will increase the awareness among the clinicians and hasten the management of such rare condition to avoid complications. Hock Chin Chong, Feng Yih Chai, Dhayal Balakrishnan, Siti Mohd Desa Asilah, Irene Nur Ibrahim Adila, and Khuzaimah Zahid Syibrah Copyright © 2016 Hock Chin Chong et al. All rights reserved. Successful Resection of Isolated Para-Aortic Lymph Node Recurrence from Advanced Sigmoid Colon Cancer following 156 Courses of FOLFIRI Regimen Thu, 25 Aug 2016 13:02:57 +0000 Isolated para-aortic lymph node (PLN) recurrence from colorectal cancer (CRC) is rare, with no currently validated treatments. Few reports have described the successful resection of isolated PLN involvement from CRC following chemotherapy. We report the case of a 63-year-old man who underwent sigmoidectomy for sigmoid colon cancer at our hospital. Pathological examination demonstrated advanced sigmoid colon cancer with metastatic involvement in both of the tested PLNs. Palliative chemotherapy was initiated four weeks after surgical resection, with administration of the FOLFIRI regimen. Four years after the operation, computed tomography (CT) revealed an enlarged PLN below the left renal vein. As PLN enlarged to 15 mm in the minor axis on a CT scan in 2014 after receiving a total of 156 courses of the FOLFIRI regimen, we considered the enlarged PLN to represent an isolated metastasis. Accordingly, lymph node resection was performed with microscopically negative margins. The patient maintained a good quality of life without any side effects throughout the whole course of his treatment and remains disease-free at 24 months without chemotherapy after resection of the isolated PLN. Curative resection following chemotherapy may improve survival of carefully selected advanced CRC patients with locoregional recurrence, such as isolated PLN involvement. Kaoru Takeshima, Kazuo Yamafuji, Atsunori Asami, Hideo Baba, Nobuhiko Okamoto, Hidena Takahashi, Chisato Takagi, and Kiyoshi Kubochi Copyright © 2016 Kaoru Takeshima et al. All rights reserved. Laparoscopic Management of a Very Rare Case: Cystic Artery Pseudoaneurysm Secondary to Acute Cholecystitis Mon, 22 Aug 2016 09:13:15 +0000 Pseudoaneurysm of a cystic artery is a rare entity that commonly occurs secondary to biliary procedures. Most of the cases in literature are consisted of ruptured aneurysms and to our knowledge, except our case, there were only 3 cases with unruptured aneurysms, which incidentally were detected by radiological methods. When cystic artery pseudoaneurysm is present with acute cholecystitis, most of the reports in literature suggested open cholecystectomy with the ligation of the cystic artery as a main treatment option. In this paper we present a case of acute cholecystitis with unruptured cystic artery pseudoaneurysm that incidentally was detected by computed tomography (CT). Cystic artery pseudoaneurysm was handled laparoscopically with simultaneous cholecystectomy. Due to high risk of rupture, surgeons have evaded laparoscopic approach to acute cholecystitis, which accompanied cystic artery pseudoaneurysm. However herein, we proved that laparoscopic management of cystic artery pseudoaneurysm with simultaneous cholecystectomy is feasible and reliable method. Deniz Alis, Sina Ferahman, Süleyman Demiryas, Cesur Samanci, and Fethi Emre Ustabasioglu Copyright © 2016 Deniz Alis et al. All rights reserved. Management and Reconstruction of a Gastroesophageal Junction Adenocarcinoma Patient Three Years after Pancreaticoduodenectomy: A Surgical Puzzle Thu, 18 Aug 2016 16:03:05 +0000 Introduction. With the improving survival of cancer patients, the development of a secondary primary cancer is an increasingly common phenomenon. Extensive surgery during initial treatment may pose significant challenges to surgeons managing the second primary cancer. Case Presentation. A 69-year-old male, who had a pancreaticoduodenectomy three years ago for pancreatic head adenocarcinoma, underwent an uneventful extended total gastrectomy for gastroesophageal junctional adenocarcinoma. The reconstruction controversies and considerations are highlighted. Discussion. Genetic, environmental, and lifestyle factors are common for several gastrointestinal malignancies. However, the occurrence of a second unfavorable cancer such as gastroesophageal adenocarcinoma after pancreatic head cancer treatment is extremely uncommon. This clinical scenario possesses numerous difficulties for the surgeon, since surgical resection is the mainstay of treatment for both malignancies. Gastrointestinal reconstruction becomes challenging and requires careful planning and meticulous surgical technique along with sound intraoperative judgement. Dionysios Dellaportas, James A. Gossage, and Andrew R. Davies Copyright © 2016 Dionysios Dellaportas et al. All rights reserved. Diagnostic Dilemma in Appendiceal Mucormycosis: A Rare Case Report Thu, 18 Aug 2016 13:02:24 +0000 Appendiceal mucormycosis is a rare life-threatening infection seen in immunocompromised patients. It is usually seen in chemotherapy induced neutropenia in patients with hematological malignancies. Clinically, the symptoms and signs may be masked due to ongoing corticosteroids. The condition may mimic bacterial appendicitis and the less serious condition, typhlitis. The disease demands prompt surgical debulking and aggressive antifungal treatment. However, surgery is delayed due to the poor performance status and severe neutropenia. This may lead to perforative peritonitis and further dissemination. The survival rates of such disease are dismal. Unfortunately, the diagnosis may be confirmed only on histological examination of the surgically excised tissue. Very few cases have been reported so far. We present here once such a fatal case of appendiceal mucormycosis in a 14-year-old boy who was immunosuppressed due to intensive induction therapy for Acute Myeloblastic Leukemia. Sali Priyanka Akhilesh, Yadav Kamal Sunder, Pande Prasad, George Mary Asha, Agarwal Mohan, and Mehta Hitesh Copyright © 2016 Sali Priyanka Akhilesh et al. All rights reserved. A Rare Case of Mixed Neuroendocrine Tumor and Adenocarcinoma of the Pancreas Wed, 17 Aug 2016 16:45:43 +0000 Introduction. Neuroendocrine carcinoma (NEC) of pancreas is a rare tumor with aggressive progression and poor prognosis. Its coexistence with adenocarcinoma poses significant clinical problems and has not been addressed in the literature. Methods. We describe a case of a 51-year-old male who underwent pancreatoduodenectomy due to pancreatic head tumor  cm. Histological examination of the specimen revealed a mixed neoplasm: (1) a well differentiated adenocarcinoma, neoplastic blasts of which are extended focally to the submucosa without invading the muscular layer, and (2) a low differentiated NEC consisting of solid clusters and pagetoid formations. All 18 lymph nodes of the specimen were free of neoplastic disease and the surgical margins of the specimen were tumor-free. No adjuvant treatment was administered and two months after the operation the patient developed liver metastasis. FNA cytology of the hepatic lesions revealed low grade carcinoma with neuroendocrine characteristics. Five lines of chemotherapy were administered: VP + CDDP, paclitaxel + ifosfamide + Mesna + CDDP, Folfox + Avastin, Folfiri + Avastin, and CAV. During his treatment he revealed PD and succumbed to his disease 13 months after the operation. Conclusion. Coexistence of NEC with adenocarcinoma of the pancreas is a very rare entity presenting significant challenges regarding its adjuvant treatment and the treatment of distant relapse. Sofia Xenaki, Konstantinos Lasithiotakis, Alexandros Andreou, Sofia Aggelaki, Maria Tzardi, Anna Daskalaki, George Chalkiadakis, and Emmanuel Chrysos Copyright © 2016 Sofia Xenaki et al. All rights reserved. Squamous Cell Cancer Arising in an African American Male Cheek from Discoid Lupus: A Rare Case and Review of the Literature Wed, 17 Aug 2016 13:52:51 +0000 A 50-year-old African American male with Discoid Lupus Erythematosus (DLE) presented to the dermatology clinic for a rapidly enlarging left cheek mass. The mass failed to resolve with conservative measures. A biopsy revealed poorly differentiated Squamous Cell Carcinoma (SCC). He was referred to Head and Neck Surgery and successfully underwent a resection with free flap reconstruction. Postoperatively he did well. Squamous cell skin carcinomas arising from lesions of Discoid Lupus are rare and aggressive tumors with greater likelihood of metastases. Cases have been reported among patients with different clinical characteristics; we present a rare case arising in an African American male on the face and involving the ear. Emanuel A. Shapera and Paul D. Kim Copyright © 2016 Emanuel A. Shapera and Paul D. Kim. All rights reserved. Left Upper Lobectomy for Congenital Lobar Emphysema in a Low Weight Infant Mon, 15 Aug 2016 11:19:42 +0000 Congenital lobar emphysema (CLE) is a rare lung congenital malformation. Differential diagnosis of the disease remains challenging in an infant with acute respiratory distress. We report a case of a 3-week-old female infant with a weight of 2.1 kg who presented respiratory distress related to CLE. Left upper lobectomy was performed and she had an uneventful recovery. Meletios Kanakis, Konstantinos Petsios, Dimitrios Bobos, Kosmas Sarafidis, Stefanos Nikopoulos, Konstantinos Kyriakoulis, Achilleas Lioulias, and Nicholas Giannopoulos Copyright © 2016 Meletios Kanakis et al. All rights reserved. Adenocarcinoma of the Right Colon in a Patient with Bloom Syndrome Mon, 15 Aug 2016 06:24:51 +0000 Introduction. Bloom syndrome (BS) is an inherited disorder due to mutation in BLM gene. The diagnosis of BS should be considered in patients with growth retardation of prenatal onset, a photosensitive rash in a butterfly distribution over the cheeks, and an increased risk of cancer at an early age. Clinical manifestations also include short stature, dolichocephaly, prominent ears, micrognathia, malar hypoplasia and a high-pitched voice, immunodeficiency, type II diabetes, and hypogonadism associated with male infertility and female subfertility. The aim of this report is to describe case of patient with BS who developed adenocarcinoma of the cecum, successfully treated by right colectomy. Case Report. A 40-year-old man underwent colonoscopy to investigate the cause of his diarrhea, weight loss, and anemia. The patient knew that he was a carrier of BS diagnosed at young age. The colonoscopy showed an expansive and vegetating mass with 5.5 cm in diameter, located within the ascending colon. Histopathological analysis of tissue fragments collected during colonoscopy confirmed the presence of tubular adenocarcinoma, and he was referred for an oncological right colectomy. The procedure was performed without complications, and the patient was discharged on the fifth postoperative day. Histopathological examination of the surgical specimen confirmed the presence of a grade II tubular adenocarcinoma (stage IIA). The patient is currently well five years after surgery, without clinical or endoscopic signs of relapse in a multidisciplinary approach for the monitoring of comorbidities related to BS. Conclusion. Despite the development of colorectal cancer to be, a possibility rarely described the present case shows the need for early screening for colorectal cancer in all patients affected by BS. Carlos Augusto Real Martinez, Lilian Vital Pinheiro, Debora Helena Rossi, Michel Gardere Camargo, Maria de Lourdes Setsuko Ayrizono, Raquel Franco Leal, and Cláudio Saddy Rodrigues Coy Copyright © 2016 Carlos Augusto Real Martinez et al. All rights reserved. Use of Left Gastric Vein as an Alternative for Portal Flow Reconstruction in Liver Transplantation Tue, 09 Aug 2016 12:54:21 +0000 Portal vein thrombosis is observed in up to 10% of liver transplant candidates, hindering execution of the procedure. A dilated gastric vein is an alternative to portal vein reconstruction and decompression of splanchnic bed. We present two cases of patients with portal cavernoma and dilated left gastric vein draining splanchnic bed who underwent liver transplantation. The vein was dissected and sectioned near the cardia; the proximal segment was ligated with suture and the distal segment was anastomosed to the donor portal vein. Gastroportal anastomosis is an excellent option for portal reconstruction in the presence of thrombosis or hypoplasia. It allows an adequate splanchnic drainage and direction of hepatotrophic factors to the graft. Uirá Fernandes Teixeira, Mayara Christ Machry, Marcos Bertozzi Goldoni, Cristine Kruse, João Alfredo Diedrich, Pablo Duarte Rodrigues, Caroline Becker Giacomazzi, Estéfano Aurélio Negri, Matheus Koop, Carlos Gustavo Spode Gomes, José Artur Sampaio, Paulo Roberto Ott Fontes, and Fábio Luiz Waechter Copyright © 2016 Uirá Fernandes Teixeira et al. All rights reserved. Simultaneous Renal Cell Carcinoma and Giant Retroperitoneal Liposarcoma Involving Small Intestine Tue, 09 Aug 2016 07:33:55 +0000 Background. The concomitant occurrence of a renal cell carcinoma and retroperitoneal sarcoma is extremely rare with only few cases being reported. Methods. We present a case of simultaneous renal cell carcinoma and exceptionally large size retroperitoneal sarcoma involving small intestine. Surgical resection of retroperitoneal sarcoma and simultaneous right nephrectomy were performed. Results. Patient developed recurrent and metastatic disease and underwent debulking surgery following by chemotherapy. Despite aggressive behavior of the retroperitoneal sarcomas, patient is currently (7 years after simultaneous resection and nephrectomy) recurrence-free. Conclusions. Complete surgical resection is the mainstay of therapy for both renal cell carcinoma and retroperitoneal sarcoma. We present a case of simultaneous renal cell carcinoma and exceptionally large size retroperitoneal sarcoma. Debulking surgery and chemotherapy were helpful in our case. Aleksandr A. Reznichenko Copyright © 2016 Aleksandr A. Reznichenko. All rights reserved. Pantaloon Hernia: Obstructed Indirect Component and Direct Component with Cryptorchidism Thu, 04 Aug 2016 14:34:22 +0000 Cryptorchidism is a condition in which one or both testes have not passed down into the scrotal sac. It is categorized as true undescended testis in which testes are present in the normal path of descent, and as ectopic testis, in which testes are present at abnormal site. Common complications of cryptorchidism are testicular torsion, subfertility, inguinal hernia, and testicular cancer. Here we present a rare case of pantaloon hernia of obstructed indirect component and direct component with cryptorchidism. Mohan Kumar Kariappa, Vivek Harihar, Ashwini Rajareddy Kothudum, and Vivekanand Kedarlingayya Hiremath Copyright © 2016 Mohan Kumar Kariappa et al. All rights reserved. Undifferentiated Pleomorphic Sarcoma Presenting as Abdominal Pain with a Pulsatile Mass Wed, 03 Aug 2016 12:05:39 +0000 Malignant fibrous histiocytoma (MFH) is a rare tumor that mostly involves adults aged 50 to 70. The most common anatomic location is the lower extremities. MFH of the retroperitoneum usually manifests late in its course and may be initially mistaken with other more common diagnosis. Here, the authors describe a 60-year-old man that was brought to the emergency department with a chief complaint of periumbilical abdominal pain. Our patient presented with symptoms consistent with a symptomatic aortic aneurysm, but a mass was encountered during surgery. In such circumstances the diagnosis of malignant sarcoma must be kept in mind and attempts at full resection with tumor-free margins are necessary. Arash Moradi, Abolfazl Afsharfard, and Khashayar Atqiaee Copyright © 2016 Arash Moradi et al. All rights reserved. Laparoscopic Bullet Removal in a Penetrating Abdominal Gunshot Mon, 25 Jul 2016 09:58:54 +0000 Penetrating abdominal trauma has been traditionally treated by exploratory laparotomy. Nowadays laparoscopy has become an accepted practice in hemodynamically stable patient without signs of peritonitis. We report a case of a lower anterior abdominal gunshot patient treated laparoscopically. A 32-year-old male presented to the Emergency Department with complaint of gunshot penetrating injury at left lower anterior abdominal wall. The patient had no symptoms or obvious bleeding and was vitally stable. On examination we identified 1 cm diameter entry wound at the left lower abdominal wall. The imaging studies showed the bullet in the peritoneal cavity but no injured intraperitoneal and retroperitoneal viscera. We decided to remove the bullet laparoscopically. Twenty-four hours after the intervention the patient was discharged. The decision for managing gunshot patients should be based on clinical and diagnostic findings. Anterior abdominal injuries in a stable patient without other health problems can be managed laparoscopically. Christos Stefanou, Nicolaos Zikos, George Pappas-Gogos, Spyridon Koulas, and Ioannis Tsimoyiannis Copyright © 2016 Christos Stefanou et al. All rights reserved. Mixed Adenoneuroendocrine Carcinoma Causing Colonic Intussusception Mon, 25 Jul 2016 08:52:43 +0000 Colonic intussusception is a rare cause of intestinal obstruction in adults and is caused by a malignant lesion in about 70% of cases. Early diagnosis and treatment are essential. We present a 64-year-old male patient with right colonic intussusception caused by a mixed adenoneuroendocrine carcinoma (MANEC), presenting as a giant pedunculated polyp (54 mm of largest diameter). The patient underwent right colectomy with primary anastomosis and adjuvant chemotherapy. The diagnosis of intussusception of the colon in adults is difficult because of its rarity and nonspecific clinical presentation. In this case, the cause was a rare histological type malignant tumor (MANEC). Marina Morais, André Costa Pinho, Ana Marques, Joanne Lopes, Alexandre Duarte, Pedro Correia da Silva, José Manuel Lopes, and J. Costa Maia Copyright © 2016 Marina Morais et al. All rights reserved. Solid Serous Adenoma of the Pancreas: A Case Report and Review of the Literature Mon, 25 Jul 2016 06:56:33 +0000 Herein, we report a case of a solid-type serous cystadenoma of the pancreas which is the 16th case reported worldwide and the first ever reported in Greece. Magnetic resonance imaging showed a hypervascular mass in the tail of the pancreas of a 72-year-old female who presented with mild abdominal pain. Distal pancreatectomy was performed by laparotomy and histological and immunohistochemical examination revealed a solid-type serous cystadenoma of the pancreas. Preoperative diagnosis of a solid-type serous cystadenoma of the pancreas is difficult, and, due to its benign nature, simple excision of the tumor is the recommended treatment. Anastasios Katsourakis, Ioannis Dimitriou, Georgios Noussios, Iosiph Chatzis, and Efthimios Chatzitheoclitos Copyright © 2016 Anastasios Katsourakis et al. All rights reserved. Acute Lower Leg Compartment Syndrome: A Rare Complication following CABG Thu, 21 Jul 2016 08:08:25 +0000 Compartment syndrome of lower legs following coronary artery bypass grafting is a rare complication which results from a combination of local and systemic factors. Early recognition is vital for good outcome. The case discussed describes this rare complication of CABG resulting in long term disability. Muazzam Tahir and Sean Galvin Copyright © 2016 Muazzam Tahir and Sean Galvin. All rights reserved. Appendagitis following Diagnostic Laparoscopy and Laparoscopic Appendicectomy Mon, 04 Jul 2016 08:22:09 +0000 Appendagitis is an uncommon clinical entity, often not recognised, and mistaken for more serious infective conditions. We describe a proven case of appendagitis which occurred after confirmed appendicitis. We postulate that this condition can coexist with appendicitis and indeed may be the result of coinflammation. This has several implications. Firstly, clinicians must retain an index of suspicion for this condition in a patient with localised abdominal pain which occurs after appendicitis. Secondly, it would be reasonable to suggest careful examination of colocated appendages in a patient with an otherwise normal-appearing appendix. Treatment might require laparoscopic resection, as performed in this case. R. Kumar, R. F. Bamford, D. Kumar, and G. Singh-Ranger Copyright © 2016 R. Kumar et al. All rights reserved. The First Ever Reported Case of Primary Synovial Sarcoma of Scalp Wed, 29 Jun 2016 10:43:51 +0000 Synovial sarcomas are a rare entity with predilection for extremities and joints. The literature suggests that these tumours are rare in the head and neck region. Very few authors have reported their origin in head. Among the ones occurring in the head region, most of them are found to originate from the parotid area. According to our extensive review of available literature, there has been no reported case of the primary case of synovial sarcoma originating from the scalp convexity. We hereby report one such case in a young female which, by far to the best of our knowledge, is the first ever reported case of a synovial sarcoma occurring on the scalp. The tumour is also the largest ever reported in the literature and posed a great surgical and diagnostic challenge to our team. Through this paper, we recommend that synovial sarcoma should be included as a very rare yet possible differential diagnosis for the scalp tumours. Biplab Mishra, Saurabh Singhal, Deepak Prakash Bhirud, Nitesh Kumar, and Saumyaranjan Mallick Copyright © 2016 Biplab Mishra et al. All rights reserved. A Unique Case of an Aggressive Gangliocytic Paraganglioma of the Filum Terminale Tue, 28 Jun 2016 06:22:20 +0000 Paragangliomas are rare neuroendocrine tumors that are mostly found in the head and neck. Even less common are gangliocytic variant paragangliomas of the spine for which there are only 7 other documented cases in the literature. We report a case of gangliocytic paraganglioma of the sacral spine in a 68-year-old man. The growth pattern is documented over three years, which to our knowledge has not previously been reported in the literature and is different from the natural history. Clinical, radiological, and pathological characteristics of the tumor are discussed in light of available reports of this rare tumor. Omar S. Akbik, Crina Floruta, Muhammad O. Chohan, Karen S. SantaCruz, and Andrew P. Carlson Copyright © 2016 Omar S. Akbik et al. All rights reserved. An Eustachian Tube Neuroendocrine Carcinoma: A Previously Undescribed Entity and Review of the Literature Mon, 27 Jun 2016 15:53:38 +0000 Primary sinonasal and middle ear neuroendocrine carcinomas are rare malignancies of the head and neck. Owing to the rarity of these tumors, the clinical behavior and optimal management of these tumors are not well defined. We present a case of an incidentally discovered sinonasal neuroendocrine carcinoma that was found to originate from the Eustachian tube, which has not previously been described in the literature. This patient was treated with primary surgical resection using a combination of transnasal and transaural approaches and achieved an incomplete resection. Follow-up imaging demonstrated continued tumor growth in the Eustachian tube as well as a new growth in the ipsilateral cerebellopontine angle and findings suspicious of perineural invasion. However, the tumor exhibited a benign growth pattern and despite continued growth the patient did not receive additional treatment and he remains asymptomatic 35 months following his original surgery. Gavin J. le Nobel, Vincent Y. Lin, Vladimir Iakovlev, and John M. Lee Copyright © 2016 Gavin J. le Nobel et al. All rights reserved. Afferent Loop Syndrome after Roux-en-Y Total Gastrectomy Caused by Volvulus of the Roux-Limb Sun, 26 Jun 2016 14:05:15 +0000 Afferent loop syndrome is a rare complication of gastric surgery. An obstruction of the afferent limb can present in various ways. A 73-year-old man presented with one day of persistent abdominal pain, gradually radiating to the back. He had a history of total gastrectomy with a Roux-en-Y reconstruction. Abdominal computed tomography scan revealed dilation of the duodenum and small intestine in the left upper quadrant. Exploratory laparotomy showed volvulus of the biliopancreatic limb that caused afferent loop syndrome. In this patient, the 50 cm long limb was the cause of volvulus. It is important to fashion a Roux-limb of appropriate length to prevent this complication. Hideki Katagiri, Kana Tahara, Kentaro Yoshikawa, Alan Kawarai Lefor, Tadao Kubota, and Ken Mizokami Copyright © 2016 Hideki Katagiri et al. All rights reserved. Pelvic Myxoid Leiomyoma Mass between Vagina and Rectum Sun, 26 Jun 2016 13:27:33 +0000 Leiomyomas are the most common pelvic tumors in women. About 20–30% of women older than 35 are affected. Rare conditions of leiomyomas have extrauterine locations. Myxoid degeneration is a rare type of leiomyoma degeneration. We report a case of solid-cystic myxoid leiomyoma in a 53-year-old woman complained of constipation, urinary hesitation, and malodorous vaginal discharge with palpable  cm mass between vagina and rectum. Regarding the inferior location of the mass, a perineal approach was used to enucleate it. This rare location has not been mentioned before. The woman was finally diagnosed by pathologists which was myxoid leiomyoma. Omar AlShalabi, Fadi Obaied Alahmar, Hazem Aljasem, Bayan Alsaid, and Abdulghani AlShalabi Copyright © 2016 Omar AlShalabi et al. All rights reserved. Atypical Chest Pain: An Unusual Presentation of Spinal Metastasis due to Penile Carcinoma Sun, 26 Jun 2016 12:13:54 +0000 Spinal metastases may present in a myriad of ways, most commonly back pain with or without neurology. We report an unusual presentation of isolated atypical chest pain preceding metastatic cord compression, secondary to penile carcinoma. Spinal metastasis from penile carcinoma is rare with few cases reported. This unusual presentation highlights the need for a heightened level of clinical suspicion for spinal metastases as a possible cause for chest pain in any patients with a history of carcinoma. The case is discussed with reference to the literature. Sarah Pywell, Shumaila Hasan, Mohammad Zain Sohail, Georgios Mamarelis, Cameron Dott, Mohammad Taimur Khan, and Naveethan Sivanadarajah Copyright © 2016 Sarah Pywell et al. All rights reserved. Pectoralis Minor Syndrome: Case Presentation and Review of the Literature Sun, 26 Jun 2016 12:12:30 +0000 We present a case of a healthy young female with axillary vein compression caused by the pectoralis minor muscle. Diagnosis was made by clinical findings and dynamic venography. After pectoralis minor tenotomy, the patient had total resolution of her symptoms. Compression of the axillary vein by the pectoralis minor is a rare entity that needs a careful exam and imaging to reach its diagnosis and establish the appropriate treatment. Mohammed Abdallah, Mohammad Rachad Wehbe, Elias Elias, Muhammad Aghiad Kutoubi, and Roger Sfeir Copyright © 2016 Mohammed Abdallah et al. All rights reserved. Transvaginal Hybrid NOTES Procedure for Treatment of Gallstone Ileus Sun, 26 Jun 2016 10:11:53 +0000 Gallstone ileus is a rare mechanical bowel obstruction, and previously reported cases have been treated laparoscopically with good results. Although transvaginal hybrid NOTES without a minilaparotomy has been reported to decrease the incidence of surgical wound complications, to our knowledge, this procedure has not been used previously to treat gallstone ileus. We present a case of a 63-year-old woman who underwent transvaginal hybrid NOTES procedure for treatment of gallstone ileus. This case was admitted to our hospital following acute-onset abdominal pain and vomiting. We diagnosed gallstone ileus with cholecystoduodenal fistula by computed tomography and performed totally laparoscopic surgery using only three 5 mm abdominal ports with transvaginal specimen extraction and enterectomy. The patient’s postoperative course was uneventful, and laparoscopic cholecystectomy and fistula repair were performed 8 months after the initial surgery. The patient experienced additional pain relief and good cosmetic outcomes. In conclusion, using transvaginal hybrid NOTES may become a future option to minimize the invasiveness of other laparoscopic procedures. Takuya Shiraishi, Naoki Tomizawa, Tatsumasa Andoh, Kazuhisa Arakawa, Yasuaki Enokida, and Naoya Ozawa Copyright © 2016 Takuya Shiraishi et al. All rights reserved. Aplasia Cutis Congenita of the Scalp with a Familial Pattern Sun, 26 Jun 2016 10:11:50 +0000 Aplasia Cutis Congenita (ACC) is a condition characterized by congenital absence of skin, usually on the scalp. ACC can occur as an isolated condition or in the presence of other congenital anomalies. Here we describe a case of a 16-day-old baby girl with an isolated ACC of the scalp. Her elder two siblings have been diagnosed with ACC with concomitant cardiac or limb anomalies. The patient was managed conservatively until the defect has formed scar tissue 6 months later. Waleed AlShehri, Sara AlFadil, Alhanouf AlOthri, Abdulaziz O. Alabdulkarim, Shabeer A. Wani, and Sari M. Rabah Copyright © 2016 Waleed AlShehri et al. All rights reserved. A Case Study of Severe Esophageal Dysmotility following Laparoscopic Sleeve Gastrectomy Sun, 19 Jun 2016 08:52:52 +0000 Following bariatric surgery, a proportion of patients have been observed to experience reflux, dysphagia, and/or odynophagia. The etiology of this constellation of symptoms has not been systematically studied to date. This case describes a 36-year-old female with severe esophageal dysmotility following LSG. Many treatments had been used over a course of 3 years, and while calcium channel blockers reversed the esophageal dysmotility seen on manometry, significant symptoms of dysphagia persisted. Subsequently, the patient underwent a gastric bypass, which seemed to partially relieve her symptoms. Her dysphagia was no longer considered to be associated with a structural cause but attributed to a “sleeve dysmotility syndrome.” Considering the difficulties with managing sleeve dysmotility syndrome, it is reasonable to consider the need for preoperative testing. The question is whether motility studies should be required for all patients planning to undergo a LSG to rule out preexisting esophageal dysmotility and whether conversion to gastric bypass is the preferred method for managing esophageal dysmotility after LSG. Caroline E. Sheppard, Daniel C. Sadowski, Richdeep Gill, and Daniel W. Birch Copyright © 2016 Caroline E. Sheppard et al. All rights reserved. A Novel Technique for Managing Pancreaticojejunal Anastomotic Leak after Pancreaticoduodenectomy Tue, 14 Jun 2016 11:28:58 +0000 Pancreaticoduodenectomy (Whipple’s procedure) remains the only definitive treatment option for tumors of the periampullary region. The most common and life-threatening complications following the procedure are pancreatic anastomotic leakage and subsequent fistula formation. When these complications occur, treatment strategy depends on the severity of anastomotic leakage, with patients with severe leakages requiring reoperation. The optimal surgical method used for reoperation is selected from among different options such as wide drainage, definitive demolition of the pancreaticojejunal anastomosis and performing a new one, or completion pancreatectomy. Here we present a novel, simple technique to manage severe pancreatic leakage via ligamentum teres hepatis patch. Tufan Egeli, Tarkan Unek, Mucahit Ozbilgin, Mustafa Goztok, and Ibrahim Astarcıoglu Copyright © 2016 Tufan Egeli et al. All rights reserved. Multiple Gastric Gastrointestinal Stromal Tumors in a Patient with Neurofibromatosis Type 1 Tue, 07 Jun 2016 06:23:30 +0000 Gastrointestinal stromal tumors (GISTs) are relatively common in neurofibromatosis type 1 (NF 1) patients. Approximately 90% of GISTs associated with NF 1 are located in the small intestine, while sporadic GISTs are most commonly located in the stomach. Here we report an extremely rare case of an NF 1 patient with multiple gastric GITs (90 or more) but without multiple small intestinal tumors. A 63-year-old female patient who had a history of NF 1 underwent surgery for a gastric neuroendocrine tumor and gastric submucosal tumor (SMT). During the operation, multiple small nodules were identified on the serosal surface of the upper stomach. SMT and multiple nodules on the serosal surface were diagnosed as GISTs consisting of spindle cells positive for KIT, CD34, and DOG-1. Both GIST and the normal gastric mucosa showed no mutations not only in the c-kit gene (exons 8, 9, 11, 13, and 17) but also in the PDGFRA gene (exons 12, 14, and 18). This patient is being followed up without the administration of a tyrosine kinase inhibitor. Makoto Tomatsu, Jun Isogaki, Takahiro Watanabe, Kiyoshige Yajima, Takuya Okumura, Kimihiro Yamashita, Kenji Suzuki, Akihiro Kawabe, Akira Komiyama, and Seiichi Hirota Copyright © 2016 Makoto Tomatsu et al. All rights reserved.