Case Reports in Surgery The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Ileocolic Intussusception in a Leukemic Adult Patient: A Case Report and Review of the Literature Thu, 20 Oct 2016 14:16:02 +0000 We present a rare case of intussusception in a 41-year-old man with acute myeloid leukemia without an evidence of leukemic infiltration of the bowel. The patient presented to the emergency room with right lower quadrant pain. Initially he was diagnosed with typhlitis. CT scan was done and showed ileocolic intussusception without a definitive lead point identified. Patient underwent hemicolectomy and histopathological study of the specimen did not show any leukemic infiltrate. High suspicion of intussusception should be kept in mind with leukemic patients presenting with abdominal pain. Ayoub Innabi, Wa’el Tuqan, Alia Alawneh, Alaa Saleh, Kamal Alrabi, and Lina Marei Copyright © 2016 Ayoub Innabi et al. All rights reserved. Duplicate Vas Deferens Encountered during Inguinal Hernia Repair: A Case Report and Literature Review Thu, 20 Oct 2016 09:55:27 +0000 Duplication of the vas deferens is a rare anomaly, defined as the presence of two distinct vasa deferentia within one spermatic cord, with only 28 cases reported worldwide since 1959. We report the case of a 63-year-old man with a duplicate vas deferens, presenting with abdominal pain from bowel obstruction secondary to incarcerated inguinal hernia. Spermatic cord dissection during hernioplasty revealed duplication of the vas deferens within the right spermatic cord. Doppler ultrasonography confirmed absence of waveforms in both vasa deferentia with arterial signal in the accompanying vessel. The hernia was repaired without complication. This report emphasizes recognition of duplicate vas deferens in avoiding iatrogenic injury and optimizing surgical outcome. Maxwell C. Breitinger, Evan H. Roszkowski, Adam J. Bauermeister, and Andrew A. Rosenthal Copyright © 2016 Maxwell C. Breitinger et al. All rights reserved. A Case of Stercoral Perforation Detected on CT Requiring Proctocolectomy in a Heroin-Dependent Patient Tue, 18 Oct 2016 11:40:01 +0000 Stercoral perforation of the colon is rare but carries with it significant morbidity and mortality. Stercoral perforation usually occurs in elderly, immobile patients with chronic constipation. In this manuscript, we report the case of stercoral perforation in a patient due to chronic heroin dependence. We report the case of a 56-year-old male patient with stercoral perforation, diagnosed by computed tomography, secondary to heroin dependence, requiring proctocolectomy and an end ileostomy. There are very few reports in the literature describing cases of stercoral perforation and questions have been asked about the importance of preoperative cross-sectional imaging. In our case, the diagnosis of stercoral perforation was made only on CT. Although this is not the first such case to be reported, it is significant as preoperative CT imaging was influential not only in determining the aetiology of the abdominal distension seen on the plain film, but also in detecting the pneumoperitoneum which was not evident clinically or on plain radiographs. William H. Seligman, Fahreyar Alam, Andy Planner, and Roderick J. Alexander Copyright © 2016 William H. Seligman et al. All rights reserved. Liver Transplantation Utilizing Mixed Biologic and Synthetic Arterial Conduits Wed, 12 Oct 2016 08:15:05 +0000 Arterial conduits are necessary in nearly 5% of all liver transplants and are usually constructed utilizing segments of donor iliac artery. However, available segments of donor iliac artery may not be lengthy enough or may not possess enough quality to enable its inclusion in the conduit. Although there are few reports of arterial conduits constructed solely utilizing prosthetic material, no previous reports of conduits composed of a segment of donor iliac artery and prosthetic material (mixed biologic and synthetic arterial conduits) were found in the medial literature to date. Two cases reporting successful outcomes after creation of mixed biologic and prosthetic arterial conduits are outlined in this report. Reason for creation of conduits was complete intimal dissection of the recipient’s hepatic artery in both cases. In both cases, available segments of donor iliac artery were not lengthy enough to bridge infrarenal aorta to porta hepatis. Both patients have patent conduits and normally functioning liver allografts, respectively, at 4 and 31 months after transplant. Mixed biologic and synthetic arterial conduits constitute a viable technical option and may offer potential advantages over fully prosthetic arterial conduits. Marcio F. Chedid, Tomaz J. M. Grezzana-Filho, Aljamir D. Chedid, Luiz Pedro P. Hendges, Ian Leipnitz, Mario R. Alvares-da-Silva, Ariane N. Backes, Matheus J. Reis, Cleber Dario P. Kruel, and Cleber R. P. Kruel Copyright © 2016 Marcio F. Chedid et al. All rights reserved. Obstructive Uropathy Secondary to Missed Acute Appendicitis Wed, 12 Oct 2016 07:36:34 +0000 Hydronephrosis is a rare complication of acute appendicitis. We present a case of missed appendicitis in a 52-year-old female which presented as a right-sided hydronephrosis. 2 days after admission to the Department of Urology CT revealed acute appendicitis for what open appendectomy was performed. Acute appendicitis can lead to obstructive uropathy by periappendiceal inflammation due to adjacency. Urologists, surgeons, and emergency physicians should be aware of this rare complication of atypical acute appendicitis. Mahir Gachabayov Copyright © 2016 Mahir Gachabayov. All rights reserved. Schwannomatosis of Cervical Vagus Nerve Tue, 11 Oct 2016 10:17:51 +0000 Cervical vagal schwannoma is a rare entity among lesions presenting as a neck mass. They are usually slow-growing benign lesions closely associated with the vagus nerve. They are usually solitary and asymptomatic. Multiple schwannomas occurring in patients without neurofibromatosis (NF) are rare and have recently been referred to as schwannomatosis. Here, we present a case of a neck mass that had imaging features suggestive of vagal schwannoma and was operated upon. Intraoperatively, it was discovered to be a case of multiple vagal cervical schwannoma, all directly related to the right vagus nerve, and could be resected from the nerve in toto preserving the function of the vagus nerve. Final HPR confirmed our pre-op suspicion of vagal schwannomatosis. Faheem Ahmed Abdulla and M. P. Sasi Copyright © 2016 Faheem Ahmed Abdulla and M. P. Sasi. All rights reserved. Giant Mediastinal Germ Cell Tumour: An Enigma of Surgical Consideration Tue, 11 Oct 2016 06:35:21 +0000 We present a case of 16-year-old male, who was referred from private centre for dyspnoea, fatigue, and orthopnea. The chest radiograph revealed complete opacification of left chest which was confirmed by computed tomography as a large left mediastinal mass measuring 14 × 15 × 18 cm. The diagnostic needle core biopsy revealed mixed germ cell tumour with possible combination of embryonal carcinoma, yolk sac, and teratoma. After 4 cycles of neoadjuvant BEP regime, there was initial response of tumour markers but not tumour bulk. Instead of classic median sternotomy or clamshell incision, posterolateral approach with piecemeal manner was chosen. Histology confirmed mixed germ cell tumour with residual teratomatous component without yolk sac or embryonal carcinoma component. Weighing 3.5 kg, it is one of the largest mediastinal germ cell tumours ever reported. We describe this rare and gigantic intrathoracic tumour and discuss the spectrum of surgical approach and treatment of this exceptional tumour. Firdaus Hayati, Nurayub Mohd Ali, Levin Kesu Belani, Nornazirah Azizan, Andee Dzulkarnaen Zakaria, and Mohd Ramzisham Abdul Rahman Copyright © 2016 Firdaus Hayati et al. All rights reserved. Case Report of Ectopic Liver on Gallbladder Serosa with a Brief Review of the Literature Mon, 10 Oct 2016 14:55:08 +0000 This case describes an intraoperative incidental finding and surgical removal of ectopic liver tissue attached to the gallbladder during a standard laparoscopic cholecystectomy for acute cholecystitis. These anomalies are rare, with interesting associations and possible clinically relevant complications. The details of the case, along with a brief literature review of embryology, common ectopic sites, and associations/complications, are presented in this paper. Since laparoscopic cholecystectomy is a very common procedure, it is important to increase vigilance of ectopic liver tissues during surgeries to minimize complications and provide optimal management. Vishnu R. Mani, Mohammad S. Farooq, Utsav Soni, Aleksandr Kalabin, Ajai S. Rajabalan, and Leaque Ahmed Copyright © 2016 Vishnu R. Mani et al. All rights reserved. Primarily Proximal Jejunal Stone Causing Enterolith Ileus in a Patient without Evidence of Cholecystoenteric Fistula or Jejunal Diverticulosis Mon, 10 Oct 2016 08:51:22 +0000 Stone formation within the intestinal lumen is called enterolith. This stone can encroach into the lumen causing obstruction and surgical emergency. Jejunal obstruction by an enterolith is a very rare entity and often missed preoperatively. To our knowledge, most cases of jejunal obstruction, secondary to stone, were associated with biliary disease (cholecystoenteric fistula), bezoar, jejunal diverticulosis, or foreign body. Hereby we present a rare case report of small bowel obstruction in an elderly man who was diagnosed lately to have primary proximal jejunal obstruction by an enterolith without evidence of a cholecystoenteric fistula or jejunal diverticulosis. This patient underwent laparotomy, enterotomy with stone extraction, and subsequent primary repair of the bowel. Houssam Khodor Abtar, Mostapha Mneimneh, Mazen M. Hammoud, Ahmed Zaaroura, and Yasmina S. Papas Copyright © 2016 Houssam Khodor Abtar et al. All rights reserved. Surgical Approach to the Cavernous Sinus for a Trigeminal Schwannoma Resection: Technical Note and Case Report Mon, 10 Oct 2016 08:44:46 +0000 We report a rare case of schwannoma of the lateral wall of the cavernous sinus, an exceedingly rare lesion affecting this anatomical district, and discuss salient aspects of the surgical approach to the cavernous sinus, which are traditionally considered technically challenging due to the high risk of postoperative morbidity and mortality related to the presence of the cranial nerves and internal carotid artery. Riccardo Caruso, Alessandro Pesce, Venceslao Wierzbicki, Luigi Marrocco, and Emanuele Piccione Copyright © 2016 Riccardo Caruso et al. All rights reserved. Anterior Rectal Resection in a Patient with Aortoiliac Occlusive Disease and Coexisting Collateral Pathways: Management and Pitfalls Sun, 09 Oct 2016 09:47:07 +0000 Chronic aortoiliac occlusive disease most often affects the common iliac arteries and distal aorta but can progress all the way to the renal arteries, occluding the inferior mesenteric artery. A compensatory collateral network typically develops to preserve lower body perfusion. Inadvertent compression or ligation of such collaterals during surgery can have catastrophic consequences. In this article, we present the case of a 63-year-old patient with aortoiliac occlusive disease, requiring surgery for an adenocarcinoma of the rectosigmoid junction. A CT angiography was performed in order to map out the collateral pathways that had developed and Doppler ultrasound was used to mark their positions. The surgical procedure was adapted to his specific anatomy. A successful anterior resection was performed, and the patient made an uneventful recovery. In cases of aortoiliac obliteration, the existence of collaterals must be kept in mind and investigated with a multidisciplinary approach before any surgery is considered. Floryn Cherbanyk, Jean-Loup Gassend, Olivier Martinet, Snezana Andrejevic-Blant, and Henri-Marcel Hoogewoud Copyright © 2016 Floryn Cherbanyk et al. All rights reserved. Variant Superficial Branch of Radial Artery along with Supplementary Tendons on the Dorsum of the Hand and Their Surgical Implications Wed, 05 Oct 2016 11:15:09 +0000 Variations of radial artery, in both its course and branching pattern in the anatomical snuffbox, are clinically significant for the plastic surgeons, cardiologists, and radiologists. Reports on its abnormal high origin and subsequent superficial course have been well documented. Herein, we report an unusual superficial branch of the radial artery given off before its entry into the palm by passing between the two heads of first dorsal interosseous. It eventually divided into princeps pollicis and radialis indicis arteries at the first web space of palm as a unique vascular variation. Apart from this, in the present case, the tendon of extensor digiti minimi and of extensor indicis divided into two parts. The split tendons of extensor digiti minimi were inserted to the dorsal digital expansion of the digitus minimus. However, lateral tendon of split extensor indicis was inserted along with the tendon of extensor digitorum to the index finger and the medial one was inserted along with the tendon of extensor digitorum to the middle finger. Unusual superficial branch of radial artery on the dorsum of the hand is vulnerable for an iatrogenic injury during surgical approaches in the region. Supplementary extensor tendons on the hand are one of the potential causes for the tenosynovitis. Satheesha B. Nayak, Naveen Kumar, Ashwini Aithal Padur, and Surekha D. Shetty Copyright © 2016 Satheesha B. Nayak et al. All rights reserved. Chronic Intussusception Associated with Malrotation in a Child: A Variation of Waugh’s Syndrome? Thu, 29 Sep 2016 13:30:54 +0000 Chronic intussusception is a relatively uncommon disease most commonly observed in older children. Waugh’s syndrome represents a rare entity characterized by intestinal malrotation and acute intussusception. We report a very unusual case of intestinal malrotation associated with chronic intussusception. Clinical presentation, radiological findings, and managing of this association are discussed in the light of the available literature. Nick Zavras, Konstantinos Tsilikas, and George Vaos Copyright © 2016 Nick Zavras et al. All rights reserved. One-Step Posterior and Anterior Combined Approach for L5 Retroperitoneal Schwannoma Eroding a Lumbar Vertebra Tue, 27 Sep 2016 10:00:23 +0000 We report the case of a large lumbar schwannoma eroding the vertebra and originating from spinal canal with invasion of the retroperitoneal space. We also review all the cases in literature reporting lumbar schwannomas eroding the vertebral bodies and invading the retroperitoneal space focusing on the surgical strategies to manage them. Spinal CT-scan revealed a inhomogeneous soft-tissue mass arising from the right L5-S1 neural foramen and its most anterior portion had a clear colliquative aspect. Magnetic resonance image showed a neoplastic lesion with homogeneous low signal in T1WI, heterogeneous signal in T2WI, and strong enhancement in postgadolinium examination. It developed as well in the retroperitoneal space, posteriorly to the iliac vein, up to the psoas muscle with wide erosion of the omolateral conjugate foramen. We performed a one-step combined approach together with the vascular surgeon because the lesion was too huge to allow a complete resection via a posterior approach and furthermore its tight relationship with the psoas muscle and the iliac vessels in the retroperitoneal space should be more safely managed via a retroperitoneal approach. We strongly suggest a 1-step surgery first approaching the dumbbell and the intraspinal schwannomas posteriorly achieving the decompression of the spinal canal and the cleavage of the tumor cutting the root of origin and the vascular supply and valuating the stability of the spine for potential artrodesis procedure. The patient must be then operated on via a retroperitoneal approach achieving the complete en bloc resection of the tumor. Giancarlo D’Andrea, Giovanni Sessa, Veronica Picotti, and Antonino Raco Copyright © 2016 Giancarlo D’Andrea et al. All rights reserved. Stent Graft-in-Stent Graft as a Rescue Technique for Endovascular Treatment of Giant Extracranial Internal Carotid Aneurysm Sun, 25 Sep 2016 09:34:45 +0000 Endovascular treatment of a giant extracranial internal carotid aneurysm by a stent graft implantation was unsuccessful due to a high flow leak directly through the stent graft’s coating. The problem was solved deploying a second stent graft inside the previously implanted one resulting in complete exclusion of the aneurysmal sac and patent carotid lumen preservation. The review of the literature did not provide a case using this endovascular strategy. Follow-up for more than 12 months, using CT angiography, showed confirmed aneurysmal exclusion and carotid patency and no clinical complications have been detected. Adenauer Marinho de Oliveira Góes Junior and Salim Abdon Haber Jeha Copyright © 2016 Adenauer Marinho de Oliveira Góes Junior and Salim Abdon Haber Jeha. All rights reserved. Tracheal Lobular Capillary Haemangioma: A Rare Benign Cause of Recurrent Haemoptysis Sun, 25 Sep 2016 06:48:21 +0000 Lobular capillary haemangioma (LCH), previously known as pyogenic granuloma, is a benign vascular lesion commonly found within the oral and nasal cavity. However, it is rarely encountered within the trachea, where presenting features include recurrent haemoptysis, cough, and wheeze. We here describe a case of a 7 mm tracheal LCH in a 56-year-old woman, which was successfully resected at interventional bronchoscopy using biopsy forceps. Clinicians should be aware of tracheal LCH in the differential diagnosis for recurrent haemoptysis. Metesh Nalin Acharya, Konstantinos Kotidis, and Mahmoud Loubani Copyright © 2016 Metesh Nalin Acharya et al. All rights reserved. A Content Incontinent: Report of Liposomal Bupivacaine Induced Fecal Incontinence Thu, 22 Sep 2016 14:17:23 +0000 Proper surgical management of anal fistula demands sound clinical judgment and extraordinary care to prevent incontinence and adequate postoperative pain control and provide satisfactory resolution to optimize quality of life. Fecal incontinence can be a devastating complication of procedures performed for fistula in ano. We report a unique case in which temporary incontinence (for less than 4 days) followed injection of liposomal bupivacaine for postoperative pain control after draining seton placement for fistula in ano. Patients and physicians should be aware as it may be mistaken for a more serious anatomical and permanent cause of fecal incontinence. Emanuel A. Shapera and Vinay K. Rai Copyright © 2016 Emanuel A. Shapera and Vinay K. Rai. All rights reserved. Gallbladder Volvulus in a Patient with Type I Choledochal Cyst: A Case Report and Review of the Literature Thu, 22 Sep 2016 13:54:29 +0000 Introduction. Gallbladder volvulus is a rare, potentially fatal condition unless diagnosed and treated early. Choledochal cysts are rare congenital malformations of the biliary tree predisposing to different pathologies and posing the risk of degradation into cholangiocarcinoma and gallbladder cancer. Dealing with both diseases at once has not been published yet in the literature. Presentation of Case. We report a case of gallbladder volvulus in an elderly female who happened to have a concomitant type I choledochal cyst. Treatment was achieved with a cholecystectomy and observation and follow-up of the choledochal cyst. Discussion. Prompt diagnosis and surgical management of gallbladder volvulus is important to avoid the morbidity and mortality of gangrenous cholecystitis and biliary peritonitis in a frail old population of patients. Precise clinical diagnosis, supplemented with specific imaging clues, helps in the diagnosis. Management of choledochal cysts is also surgical; however the timing of surgery is still a matter of debate. Conclusion. We describe in this report the first case of gallbladder volvulus in a patient with a choledochal cyst and propose a management algorithm of a very rare biliary tree pathology combination. George Younan, Max Schumm, Fadwa Ali, and Kathleen K. Christians Copyright © 2016 George Younan et al. All rights reserved. Pancreaticopleural Fistula Causing Massive Right Hydrothorax and Respiratory Failure Thu, 22 Sep 2016 12:48:09 +0000 Hydrothorax secondary to a pancreaticopleural fistula (PPF) is a rare complication of acute pancreatitis. In patients with a history of pancreatitis, diagnosis is made by detection of amylase in the pleural exudate. Imaging, particularly magnetic resonance cholangiopancreatography, aids in the detection of pancreatic ductal disruption. Management includes thoracocentesis and pancreatic duct drainage or pancreatic resection procedures. We present a case of massive right hydrothorax secondary to a PPF due to recurrent acute pancreatitis. Due to respiratory failure, urgent thoracocentesis was done. Distal pancreatectomy with splenectomy and cholecystectomy was performed. The patient remains well at one-year follow-up. Esther Ern-Hwei Chan and Vishalkumar Girishchandra Shelat Copyright © 2016 Esther Ern-Hwei Chan and Vishalkumar Girishchandra Shelat. All rights reserved. Massive Preperitoneal Hematoma after a Subcutaneous Injection Wed, 21 Sep 2016 10:39:38 +0000 Preperitoneal hematomas are rare and can develop after surgery or trauma. A 74-year-old woman, receiving systemic anticoagulation, developed a massive preperitoneal hematoma after a subcutaneous injection of teriparatide using a 32-gauge, 4 mm needle. In this patient, there were two factors, the subcutaneous injection of teriparatide and systemic anticoagulation, associated with development of the hematoma. These two factors are especially significant, because they are widely used clinically. Although extremely rare, physicians must consider this potentially life-threatening complication after subcutaneous injections, especially in patients receiving anticoagulation. Hideki Katagiri, Kentaro Yoshikawa, Alan Kawarai Lefor, Tadao Kubota, and Ken Mizokami Copyright © 2016 Hideki Katagiri et al. All rights reserved. Colocutaneous Fistula after Open Inguinal Hernia Repair Wed, 21 Sep 2016 09:25:17 +0000 The plug-and-patch technique is frequently used for the open repair of inguinal hernias; however, serious complications may arise on rare occasions. We present the case of a 69-year-old patient who presented with a colocutaneous fistula with the sigmoid colon 9 years after the repair of a left sliding inguinal hernia with the plug-and-patch technique. The patient underwent sigmoidectomy and excision of the fistulous track. He was discharged on postoperative day 5 and had an uneventful recovery. Although such complications are reported rarely, the surgeon must be aware of them when deciding upon the method of hernia repair. Maria Isaia, Demetris Christou, Panayiotis Kallis, Nikolaos Koronakis, and Panayiotis Hadjicostas Copyright © 2016 Maria Isaia et al. All rights reserved. Neglected Fournier’s Gangrene Caused by Acinetobacter baumannii: A Rare Case Report Tue, 20 Sep 2016 17:19:17 +0000 Fournier’s gangrene, rare but life threatening disease, is characterized by an acute necrotic infection of the scrotum, penis, or perineum. Fournier’s gangrene is a mixed infection caused by both aerobic and anaerobic bacteria. Fournier’s gangrene caused by multidrug resistant Acinetobacter baumannii have been reported rarely. The mainstay of treatment is prompt recognition and a combination of antibiotics with radical debridement. We describe a case of a 56-year-old male patient presenting with neglected Fournier’s gangrene caused by Acinetobacter baumannii. Many treatment modalities including broad-spectrum antibiotics, aggressive debridement, negative pressure wound therapy, diversion colostomy, and partial-thickness skin grafts were applied to save the patient’s life. Arif Emre, Mehmet Sertkaya, Sami Akbulut, Yakup Duman, and Ilhami Taner Kale Copyright © 2016 Arif Emre et al. All rights reserved. Endovascular Aneurysm Repair in HIV Patients with Ruptured Abdominal Aneurysm and Low CD4 Thu, 15 Sep 2016 08:43:05 +0000 We report two HIV infected patients with ruptured abdominal aneurysm by using endovascular aneurysm repair (EVAR) technique. A 59-year-old Thai man had a ruptured abdominal aortic aneurysm and a 57-year-old man had a ruptured iliac artery aneurysm. Both patients had a CD4 level below 200 μ/L indicating a low immune status at admission. They were treated by EVAR. Neither patient had any complications in 3 months postoperatively. EVAR may have a role in HIV patients with ruptured abdominal aneurysm together with very low immunity. Saranat Orrapin, Saritphat Orrapin, Supapong Arworn, Termpong Reanpang, and Kittipan Rerkasem Copyright © 2016 Saranat Orrapin et al. All rights reserved. Intraluminal Bowel Erosion: A Rare Complication of Retained Gallstones after Cholecystectomy Wed, 14 Sep 2016 14:13:53 +0000 Laparoscopic cholecystectomy for acute cholecystitis and cholelithiasis is one of the most common operations performed in the United States. Inadvertent perforation and spillage of gallbladder contents are not uncommon. The potential impact of subsequent retained gallstones is understated. We present the case of an intraperitoneal gallstone retained from a previous cholecystectomy eroding into the bowel and leading to intraluminal mechanical bowel obstruction requiring operative intervention. This case illustrates the potential risks of retained gallstones and reinforces the need to diligently collect any dropped stones at the time of initial operation. Alex B. Blair and Nathaniel McQuay Jr. Copyright © 2016 Alex B. Blair and Nathaniel McQuay Jr. All rights reserved. Spontaneous Septic Arthritis of Pubic Symphysis in an Elite Athlete Wed, 14 Sep 2016 14:02:44 +0000 Septic arthritis of the pubic symphysis is a potentially severe disease. Athletes are at risk of this form of spontaneous arthritis, as inflammation of the pubic bone due to muscular stress is relatively common. Oedema due to inflammation might predispose to infection through bacteraemia or local bacterial translocation. Suspicion should be raised when an athlete complains of groin pain and has signs of infection (i.e., fever, elevated white blood cell count, and elevated C-reactive protein). Diagnosis is made by imaging showing signs of inflammation combined with positive (blood) cultures. Broad spectrum antibiotics should be started upon suspicion and adjusted according to cultures. An abscess causing clinical deterioration under antibiotic treatment is an indication for invasive intervention (i.e., surgical or image-guided drainage). This is the first case of spontaneous septic arthritis of the pubic symphysis in an athlete requiring surgical and additional image-guided drainage. F. Jasmijn Smits, Herman Frima, Christoph Schaeffeler, and Christoph Sommer Copyright © 2016 F. Jasmijn Smits et al. All rights reserved. Wandering Spleen and Organoaxial Gastric Volvulus after Morgagni Hernia Repair: A Case Report and Review of the Literature Wed, 14 Sep 2016 13:49:58 +0000 Wandering spleen and gastric volvulus are two rare entities that have been described in association with congenital diaphragmatic hernia. The diagnosis is difficult and any delay can result in ischemia and necrosis of both organs. We present a case of a 13-year-old girl, previously operated on for anterior diaphragmatic hernia and intrathoracic gastric volvulus, that presented to our service for a subdiaphragmatic gastric volvulus recurrence associated with a wandering spleen. In this report we reviewed the literature, analyzing the clinical presentation, diagnostic assessment, and treatment options of both conditions, in particular in the case associated with diaphragmatic hernia. Noemi Cantone, Caterina Gulia, Vittorio Miele, Margherita Trinci, and Vito Briganti Copyright © 2016 Noemi Cantone et al. All rights reserved. An Unusual Case of Abdominal Leiomyoma Presenting as a Free Lying Intraperitoneal Mass in an Elderly Gentleman Thu, 08 Sep 2016 17:34:42 +0000 Introduction. Leiomyomas are common benign tumours of female reproductive tract and are rarely seen in extrauterine location. Case Report. We report an interesting case of a free lying abdominal leiomyoma presenting as a painless abdominal lump in an elderly gentleman. Discussion. Primary abdominal leiomyomas are uncommon and require surgical removal if symptomatic. Amrit Nasta, Kunal Nandy, and Yogesh Bansod Copyright © 2016 Amrit Nasta et al. All rights reserved. Organ Preservation in a Case of Retroperitoneal Ganglioneuroma: A Case Report and Review of Literature Wed, 07 Sep 2016 14:04:00 +0000 The retroperitoneum is a closed space harbouring vital organs including the great vessels, kidneys and adrenal glands, ureters, and the ascending and descending colon. Surgical management of retroperitoneal pathologies may need multiorgan resection in order to achieve complete surgical resection while preservation of surrounding organs should be attempted, especially in case of benign tumors. We present a case of 15-year-old girl with an 11 × 6 × 5 cm retroperitoneal ganglioneuroma displacing the right kidney, renal vein, and ureter and abutting the IVC which was excised in toto preserving the right kidney and ureter with careful dissection around the great vessels. We also attempt to review the various surgical options available while dealing with these benign retroperitoneal tumors which are often detected incidentally and usually surround important retroperitoneal organs and vessels. Santosh Kumar, Shivanshu Singh, and Abhishek Chandna Copyright © 2016 Santosh Kumar et al. All rights reserved. Recurrent Midgut Bleeding due to Jejunal Angioleiomyoma Wed, 07 Sep 2016 13:33:34 +0000 Angioleiomyoma being a type of true smooth muscle gastrointestinal tumors can lead to serious life-threatening gastrointestinal bleeding. We report a case of 21-year-old male patient with recurrent midgut bleeding. Contrast-enhanced CT revealed highly vascular small bowel neoplasm. The patient underwent laparotomy with bowel resection and recovered uneventfully. Histopathology revealed jejunal angioleiomyoma. Mahir Gachabayov and Petr Mityushin Copyright © 2016 Mahir Gachabayov and Petr Mityushin. All rights reserved. The Application of Vacuum-Assisted Closure Device in the Management of Empyema Necessitans Wed, 31 Aug 2016 13:40:17 +0000 Vacuum-assisted closure (VAC) is gaining popularity in the management of many types of acute and chronic wounds. The use of VAC devices in thoracic surgery is limited, but it appears to be promising in complex cases of empyema thoraces. We report a case of empyema necessitans, in which VAC was used to achieve complete wound healing after open drainage which was communicating with the pleural space. Yasser Aljehani, Zahra Al-Matar, and Samah Nawar Copyright © 2016 Yasser Aljehani et al. All rights reserved.