In rare circumstances, a diaphragmatic defect may allow for herniation of intra-abdominal contents into the pericardial space. These occurrences are exceedingly rare and may be due to trauma or congenital defects of the septum transversum or as the result of surgical procedures. We describe a 73-year-old female who presented with cardiac and abdominal symptoms one month after undergoing a subxiphoid pericardioperitoneal window for treatment and evaluation of a symptomatic pericardial effusion.

Jeremy Docekal

Thomas Fabian

Pericardial Window Formation Complicated by Intrapericardial Diaphragmatic Hernia

Intussusception in adult is rare. The etiology is different from that of childhood. The most common cause of intussusception in adult is known as malignancy. When dealing with adult intussusception, surgical resection is usually warranted for correct diagnosis and proper treatment. This is a case report of cecocolic intussusception caused by an acute appendicitis in adult. The causes of cecocolic intussusception were reported as appendiceal adenocarcinoma, appendiceal mucocele, appendiceal adenoma, or idiopathic. Although this patient underwent laparoscopic right hemicolectomy under suspicion of malignancy at cecum base, final pathologic diagnosis revealed only acute appendicitis. Thus, the present case emphasizes the importance of prior thorough examinations including colonoscopy when we encounter this rare kind of intussusception in adult.

Jeonghyun Kang

Kang Young Lee

Seung-Kook Sohn

Cecocolic Intussusception in Adult Caused by Acute Appendicitis

Introduction. Splenic artery Pseudoaneurysm, a complication of chronic pancreatitis, presenting as massive hematemesis is a rare presentation. Case Report. We present a case of 38-year-old male admitted with chief complaints of pain in the upper abdomen and massive hematemesis for the last 15 days. On examination there was severe pallor. On investigating the patient, Hb was 4.0&#x2009;gm/dL, upper GI endoscopy revealed a leiomyoma in fundus of stomach, and EUS Doppler also supported the UGI findings. On further investigation of the patient, CECT of the abdomen revealed a possibility of distal pancreatic carcinoma encasing splenic vessels and infiltrating the adjacent structure. FNA taken at the time of EUS was consistent with inflammatory pathology. Triple phase CT of the abdomen revealed a splenic artery pseudoaneurysm with multiple splenic infarcts. After resuscitation we planned an emergency laparotomy; splenic artery pseudoaneurysm densely adherent to adjacent structures and associated with distal pancreatic necrosis was found. We performed splenectomy with repair of the defect in the stomach wall and necrosectomy. Postoperative course was uneventful and patient was discharged on day 8. Conclusion. Pseudoaneurysm can be at times a very difficult situation to manage; options available are either catheter embolisation if patient is vitally stable, or otherwise, exploration.

Peeyush Varshney

Bhupen Songra

Shivank Mathur

Sudarshan Gothwal

Puneet Malik

Mahnedra Rathi

Rajveer Arya

Splenic Artery Pseudoaneurysm Presenting as Massive Hematemesis: A Diagnostic Dilemma

Introduction. Uterine fibroid tumors (uterine leiomyomas) are the most common benign uterine tumors. The incidence of uterine fibroid tumors increases in older women and may occur in more than 30&#x25; of women aged 40 to 60. Many uterine fibroid tumors are asymptomatic and are diagnosed incidentally. Case Presentation. A 44-year-old woman was admitted to our hospital with general weakness, dyspepsia, abdominal distension, and a palpable abdominal mass. An abdominal computed tomography scan showed a huge tumor mass in the abdomen which was compressing the intestine and urinary bladder. Gastroduodenal endoscopic and biopsy results showed a Borrmann type IV gastric adenocarcinoma. The patient was diagnosed with gastric cancer with disseminated peritoneal carcinomatosis. She underwent a hysterectomy with both salphingo-oophorectomy and bypass gastrojejunostomy. Simultaneous uterine fibroid tumor with other malignancies is generally observed without resection. But in this case, a surgical resection was required to resolve an intestinal obstruction and to exclude the possibility of a metastatic tumor. Conclusion. When a large pelvic or ovarian mass is detected in gastrointestinal malignancy patients, physicians try to exclude the presence of a Krukenberg tumor. If the tumors cause certain symptoms, surgical resection is recommended to resolve symptoms and to exclude a metastatic tumor.

Kwang-Kuk Park

Song-I Yang

A Patient with Advanced Gastric Cancer Presenting with Extremely Large Uterine Fibroid Tumor

Primary hepatic carcinoids are rare tumors that are often diagnosed at a locally advanced stage. Their primary nature can only be ascertained after thorough investigations and long-term follow-up to exclude another primary origin. As with secondary neuroendocrine liver tumors, surgical resection remains the mainstay of therapy. Despite their large size and often central location liver resection is often feasible, offering long-term survival and cure to most patients. In selected patients liver transplantation appears to be a good indication for tumors not amenable to liver resection. An aggressive surgical attitude is therefore warranted. We report a large and unusually fast-growing liver carcinoid that appeared only marginally resectable in a patient who remains free of disease four years after surgery.

Serge Landen

Maxime Elens

Celine Vrancken

Frederiek Nuytens

Thibault Meert

Veronique Delugeau

Giant Hepatic Carcinoid: A Rare Tumor with  a Favorable Prognosis

Malignant fibrous histiocytoma (MFH) is a common soft tissue sarcoma usually involving limbs and retroperitoneum. MFH of the rectus abdominis muscle is extremely rare. Surgery in similar cases leads to large abdominal wall defects needing reconstruction. Biological and synthetic laminar absorbable prostheses are available for the repair of hernia defects in the abdominal wall. They share the important feature of being gradually degraded in the host, resulting the formation of a neotissue. 
We herein report the case of an 84-year-old man with MFH of the rectus abdominis muscle which was resected and the large abdominal wall defect was successfully repaired with a biological mesh.

Evangelos Falidas

Stavros Gourgiotis

Christina Goudeli

Stavros Mathioulakis

Konstantinos Vlachos

Constantinos Villias

Rectus Abdominis Muscle Malignant Fibrous Histiocytoma Causing a Large Abdominal Wall Defect: Reconstruction with Biological Mesh

Introduction. Blue rubber bleb nevus syndrome is a rare disorder that is characterized by multiple recurrent vascular malformations that involve the skin and the gastrointestinal tract. The disease can present chronic anemia and severe episodes of gastrointestinal bleeding. Case Report. A 41-year-old man was admitted with recurrent episodes of lower gastrointestinal bleeding and anemia that had worsened over the last 3 months. The physical examination showed soft, diffuse, compressible, bluish nodules on all of the skin surfaces of the body. A biopsy from one of these skin lesions allowed a histological diagnosis of cavernous hemangioma. He submitted to a colonoscopy, which showed hemorrhoids and a plane vascular lesion mainly located on the right colon with recent signs of bleeding; this lesion was treated by local excision and sclerosis. The pathological study of the colon specimens also reflected the presence of cavernous hemangioma. The cutaneous hemangiomas and the presence of colonic venous malformations were compatible with blue rubber bleb nevus syndrome. The patient presented a favorable follow-up with clinical control of the anemia and without relapse of the gastrointestinal bleeding two years after the procedure. Conclusion. Although rarely diagnosed, blue rubber bleb nevus syndrome may be responsible for lower digestive bleeding.

Carlos Augusto Real Martinez

Murilo Rocha Rodrigues

Daniela Tiemi Sato

Paulo Pedroso Silveira J&#xfa;nior

Rafael Fernandes Gama

Christian Bornia Mattavelli

Jos&#xe9; Aires Pereira

Blue Rubber Bleb Nevus Syndrome as a Cause of Lower Digestive Bleeding

The exposure of bone, tendons, vessels, and nerves in a digital defect is one of the most frequent and severe problems to solve in hand surgery and current approaches are still disappointing. We show the use of an homodigital adipofascial flap taken from the same finger for covering the pulpar defect in a one-step surgical technique able to preserve the digital artery.

Rosario E. Perrotta

Alessio Stivala

Dario Virz&#xec;

Roberto Grella

Domenico Pagliara

Sergio Brongo

Coverage of the Neurovascular Unit of the Fingertip Using a Reverse Homodigital Dorsal Flap

Choristoma is development of a normal tissue in an aberrant location. This report describes jejunal salivary choristoma (JSC) causing recurring episodes of abdominal discomfort in a 5-year-old girl. Exploratory laporatomy revealed a pale yellow subserosal jejunal lesion. Wedge resection of the lesion and repair of the bowel were performed. The child did well postoperatively and has since that time been free of pain at follow-up. Histopathological examination of the resected lesion revealed salivary gland choriostoma. Literature review (PUBMED search engine) revealed no previous report of this rare clinicopathologic entity. We conclude that choriostoma should be considered a possible differential when evaluating abdominal complaint in children.

T. A. Olajide

S. O. Agodirin

R. W. Ojewola

O. O. Akanbi

T. O. Solaja

Johnson Oluremi Odesanya

O. O. Ariyibi

Jejunal Choristoma: A Very Rare Cause of Abdominal Pain in Children

Necrotising fasciitis is a rare but disastrous complication after elective surgery. We present two patients (both male, 58 and 18 years old) who developed necrotising fasciitis following elective inguinal hernia repair according to Lichtenstein. The importance of both recognition and time interval between symptom occurrence and surgical intervention is illustrated, emphasising the need for immediate action when necrotising fasciitis is suspected. A high index of suspicion of necrotising fasciitis should be maintained when a wound infection is accompanied by disproportional pain, lethargy, or sepsis. Epidermolysis and subcutaneous emphysema are often very late symptoms. Recognition and immediate intervention decrease mortality and morbidity.

T. A. Sigterman

Kim J. Gorissen

Dennis E. J. G. J. Dolmans

Fasciitis Necroticans after Elective Hernia Inguinal Surgery

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Case Reports in Surgery publishes case reports and case series related to all aspects of surgery. Topics include but are not limited to oncology, trauma, gastrointestinal, vascular, and transplantation surgery.

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Case Reports in Surgery - Table of contents 2014

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Case Reports in Surgery publishes case reports and case series related to all aspects of surgery. Topics include but are not limited to oncology, trauma, gastrointestinal, vascular, and transplantation surgery.

Case Reports in Surgery