Case Reports in Surgery https://www.hindawi.com The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Open Approach to Primary Lumbar Hernia Repair: A Lucid Option Tue, 17 Oct 2017 00:00:00 +0000 http://www.hindawi.com/journals/cris/2017/5839491/ Background. Lumbar hernia is a rare type of hernia. Awareness of the anatomical basis of this hernia is important for proper diagnosis and treatment. Introduction. Lumbar hernia is a protrusion of either extraperitoneal fat or intraperitoneal contents through either of the lumbar triangles. Primary lumbar hernias are extremely rare thereby rendering such a case reportable, to create an awareness about this condition to upcoming surgeons. Case Report. A case of primary lumbar hernia treated successfully by open mesh repair is presented. Discussion. The anatomical aspects underlying this condition along with diagnostic tests, their pitfalls, and surgical approaches are discussed. Conclusion. Awareness of this condition is essential for arriving at a clinical diagnosis. CT scan provides a road map for deciding the approach. Both the traditional open and the newer laparoscopic approaches are described. However open meshplasty is still a very safe and effective method of treatment. Ketan Vagholkar and Suvarna Vagholkar Copyright © 2017 Ketan Vagholkar and Suvarna Vagholkar. All rights reserved. Symptomatic Bochdalek Hernia in Pregnancy: A Rare Case Report Mon, 16 Oct 2017 00:00:00 +0000 http://www.hindawi.com/journals/cris/2017/2862149/ Introduction. Symptomatic Bochdalek hernia in pregnancy is quite rare. To the best of our knowledge, there are a total of 44 cases reported in the literature between 1959 and 2016 (Hernández-Aragon et al., 2015; Koca et al., 2016). Difficulty and delay in diagnosis may lead to life-threatening complications. Case Report. We report a case of Bochdalek hernia during the 30 gestational weeks’ pregnancy in whom pregnancy continued after surgical repair which resulted in term birth. Discussion. Bochdalek hernia is diagnosed with an incidence of 1 in 2200–12500 live births, while symptomatic diaphragm hernia is much less in adults. The actual incidence of diaphragmatic hernias during pregnancy is still unknown. Symptoms may include abdominal distension, recurrent abdominal pain, nausea, vomiting, inability to defecate, dyspnea, and chest pain. The patient with diaphragmatic hernia may be asymptomatic until the late weeks of gestation, as in our case, or herniation may occur during advanced gestational weeks with increased intraabdominal pressure. Conclusion. In conclusion, diagnosis of the diaphragm hernia during pregnancy is very rare. Diagnosis is rarer in symptomatic patients due to its rarity and the duration of diagnosis may, therefore, be delayed. Diaphragm hernia should be kept in mind in symptomatic patients due to its high maternal and fetal mortality rates. Selçuk Yetkinel, Çağhan Pekşen, and Remzi Kızıltan Copyright © 2017 Selçuk Yetkinel et al. All rights reserved. Mediastinal Tracheostoma for Treatment of Tracheostenosis after Tracheostomy in a Patient with Mucopolysaccharidosis-Induced Tracheomalacia Thu, 12 Oct 2017 00:00:00 +0000 http://www.hindawi.com/journals/cris/2017/2312415/ Background. Treatment of tracheostenosis after tracheostomy in pediatric patients is often difficult. Mucopolysaccharidosis is a lysosomal storage disease that may induce obstruction of the airways. Case Presentation. A 16-year-old male patient underwent long-term follow-up after postnatal diagnosis of type II mucopolysaccharidosis. At 11 years of age, tracheostomy was performed for mucopolysaccharidosis-induced laryngeal stenosis. One week prior to presentation, he was admitted to another hospital on an emergency basis for major dyspnea. He was diagnosed with tracheostenosis caused by granulation. The patient was then referred to our institution. The peripheral view of his airway was difficult because of mucopolysaccharidosis-induced tracheomalacia. For airway management, a mediastinal tracheostoma was created with extracorporeal membrane oxygenation. To maintain the blood flow, the skin incision for the mediastinal tracheal hole was sharply cut without an electrotome. The postoperative course was uneventful, and the patient was weaned from the ventilator on postoperative day 19. He was discharged 1.5 months postoperatively. Although he was referred to another institution because of respiratory failure caused by his primary disease 6 months postoperatively, his airway management remained successful for 1.5 years postoperatively. Conclusion. Mediastinal tracheostomy was useful for treatment of tracheostenosis caused by granulation tissue formation after a tracheostomy. Yasuhiro Chikaishi, Kenichi Kobayashi, Shuichi Shinohara, Akihiro Taira, Yusuke Nabe, Shinji Shinohara, Taiji Kuwata, Masaru Takenaka, Soichi Oka, Ayako Hirai, Kazue Yoneda, Koji Kuroda, Naoko Imanishi, Yoshinobu Ichiki, and Fumihiro Tanaka Copyright © 2017 Yasuhiro Chikaishi et al. All rights reserved. Jejunal Diverticular Perforation Causing Small Bowel Obstruction in a Type 4 Hiatal Hernia: A Rare Case Report of a Nonagenarian Patient and Review of Relevant Literature Tue, 10 Oct 2017 00:00:00 +0000 http://www.hindawi.com/journals/cris/2017/8412927/ Type IV paraesophageal hernia (PEH) is very rare and is characterized by the intrathoracic herniation of the abdominal viscera other than the stomach into the chest. We describe a case of a 90-year-old male patient who presented at our emergency department complaining of epigastric pain that he had experienced over the past few hours and getting progressively worse. On the day after admission, his pain became severe. Chest radiography revealed an intrathoracic intestinal gas bubble; emergency exploratory laparotomy identified a type IV PEH with herniation of only the jejunum with perforated diverticula on mesenteric side through a hiatal defect into mediastinum. There are a few published cases of small bowel herniation into the thoracic cavity in the literature. Our patient represents a rare case of an individual diagnosed with type IV PEH with herniation of jejunum with perforated diverticula. Saptarshi Biswas, Shekhar Gogna, and Prem Patel Copyright © 2017 Saptarshi Biswas et al. All rights reserved. Gossypiboma Resection after Eight Years in a Patient with Rheumatoid Arthritis and Diabetes Tue, 03 Oct 2017 00:00:00 +0000 http://www.hindawi.com/journals/cris/2017/3239093/ Gossypiboma is the term used to refer to a mass formed by surgical material left in the body cavity after surgery. We present the case of a middle-aged woman with a history of rheumatoid arthritis controlled with corticosteroids and biologic therapies, uncontrolled type II diabetes mellitus, and cesarean section with postoperative bleeding eight years earlier, who presents with right lower quadrant abdominal pain and is found to have a gossypiboma from her previous operation. A subsequent operation is undertaken to remove the gossypiboma. After the procedure, our patient’s diabetes and chronic back pain greatly improve, raising the question of gossypiboma’s role in these diseases. A review of our patient’s records found that a correct sponge count was recorded after her cesarean section, raising questions about the operating room policies regarding surgical counts, the presence of falsely correct counts, and the need for postoperative plain films in procedures with an increased risk of a retained object. Our patient’s presentation eight years after the inciting surgery raises questions about the involvement her immunosuppressive therapy may have had in cloaking the gossypiboma. Our case also raises the question of surgical culpability, including the ethical and legal considerations for apology from the culpable surgeon. Kenley Unruh and Hsien Sing Sam Hsieh Copyright © 2017 Kenley Unruh and Hsien Sing Sam Hsieh. All rights reserved. Vaginal Cuff Dehiscence Presenting with Free Air 60 Days after Robotic-Assisted Hysterectomy Mon, 02 Oct 2017 06:36:12 +0000 http://www.hindawi.com/journals/cris/2017/5052634/ Introduction. The vast majority of patients presenting with pneumoperitoneum have visceral organ perforation and require urgent diagnostic laparoscopy. Nonsurgical causes are relatively rare and may be attributed to multiple etiologies. Case Presentation. Here we describe the case of a 38-year-old Caucasian female who presented to the emergency department with three days of cramping, epigastric abdominal pain. Her physical exam was notable for tenderness to palpation in the epigastric area and abdominal and chest X-rays showed free air under the diaphragm. Free air around the porta hepatis was verified on CT scan. Approximately 90% of pneumoperitoneum cases are due to perforation of visceral organs and therefore require operative management. An urgent exploratory laparoscopy revealed no clear source of free air, but postoperatively the patient developed a large volume of watery discharge from her vagina. Subsequent workup revealed a 1 cm vaginal cuff dehiscence which was later repaired with no postoperative complications. Conclusion. Although the majority of patients with pneumoperitoneum require urgent exploratory laparoscopy, a careful diagnostic workup may reveal sources of free air that are not related to hollow viscous perforation. Vaginal cuff dehiscence represents a rare yet nonurgent source of pneumoperitoneum. This differential should be considered in light of the possible intra- and postoperative complications of surgery. D. Munger, M. Iannamorelli, C. Galvez, and C. Service Copyright © 2017 D. Munger et al. All rights reserved. Late Ps. aeruginosa Inguinal Mesh Infection 12 Years after the Initial Operation: Report of the Case and Short Review of the Literature Wed, 27 Sep 2017 06:09:52 +0000 http://www.hindawi.com/journals/cris/2017/4385913/ Inguinal hernia mesh repair is one of the most frequent operations performed worldwide. The Lichtenstein technique and its various modifications are the most popular operations for groin hernia repair. The rate of surgical site infection (SSI) following inguinal hernia repair ranges between 0 and 14% in various series. Most of these infections developed early postoperatively. The incidence of late mesh infection following open inguinal hernia repair still remains unclear and highly variable. Late deep mesh infections are relatively rare specially after more than 10 years. The most common pathogens reported in the literature are E. coli and St. aureus. The infection is treated by conservative means initially but in case of failure then the mesh should be removed surgically. A unique case of a patient with very late (chronic) mesh infection is presented. The infection was due to Pseudomonas aeruginosa, which occurred 14 years after the initial operation and presented as subcutaneous fistula. Dimitrios Filippou Copyright © 2017 Dimitrios Filippou. All rights reserved. Small Bowel Obstruction Secondary to a Metamucil Bezoar: Case Report and Review of the Literature Wed, 20 Sep 2017 06:44:07 +0000 http://www.hindawi.com/journals/cris/2017/2702896/ Bezoar-induced small bowel obstruction is a rare entity. It should be highly suspected in patients with gastric hypomotility disorders, psychiatric conditions, prior abdominal or bariatric surgery, or improper intake of medication. Their diagnosis is quite challenging and surgical exploration remains the best treatment of choice to ensure the viability of the small bowel tissue and relieve the obstruction. This is a case of a 48-year-old female with no previous abdominal surgery who presented with acute abdominal pain. The patient’s history was remarkable for the daily ingestion of 1.5 teaspoons of Metamucil with minimal amount of water. Computed tomography scan demonstrated dilated small bowel loops and a transition zone at the level of the mid jejunum. On laparoscopy, the patient was found to have a hard mass in the mid jejunum amenable to gentle fragmentation and breakdown. Metamucil bezoars are due to the solidification of psyllium-based substances in the gastrointestinal tract. The usual management of small bowel obstruction induced by a bezoar is exploratory laparotomy with enterotomy and primary anastomosis. Laparoscopic intervention has gained popularity among surgeons with good outcome and lower morbidity. In this unusual case, the small bowel obstruction induced by the Metamucil bezoar was safely treated with laparoscopic fragmentation alone. Sara Abou Azar, Mohammad Rachad Wehbe, Sarah Jamali, and Ali Hallal Copyright © 2017 Sara Abou Azar et al. All rights reserved. A Large Lumbar Adnexal Neoplasm Presenting Characteristics of Eccrine Poroma and Poroid Hidradenoma Tue, 19 Sep 2017 07:10:18 +0000 http://www.hindawi.com/journals/cris/2017/9865672/ Poroma is a rare benign neoplasm that derives from eccrine sweat glands epithelium. Its histological subtypes, with respect to its position within skin layers, are eccrine poroma, hidroacanthoma simplex, poroid hidradenoma, and dermal duct tumor. Poromas commonly exhibit benign clinical behavior as they are usually small and asymptomatic and do not exhibit malignant behavior. Although their histological subtypes share similar histological characteristics, they rarely coexist in the same tumor. In this report we present the case of an unusual poroma in terms of histological and clinical behavior as it was large and presented histological characteristic of both eccrine poroma and poroid hidradenoma. Coexistence of different histologic subtypes in the same tumor indicates simultaneous tumorigenesis, differentiation from one cell type to another, or parallel differentiation from a common progenitor cell. Implications in treatment remain unknown partly due to the rarity of such cases. Adamantios Michalinos, Dimitrios Schizas, Antonios Sarakinos, Georgios Athanasiadis, Eleftherios Spartalis, Dimitrios Vlachodimitropoulos, and Theodore Troupis Copyright © 2017 Adamantios Michalinos et al. All rights reserved. Amyand’s Hernia, State of the Art and New Points of View Sun, 17 Sep 2017 08:56:00 +0000 http://www.hindawi.com/journals/cris/2017/9598478/ Background. Amyand’s hernia (AH) is an inguinal hernia containing the vermiform appendix, with an incidence between 0.4% and 1% of all inguinal hernias. Acute or perforated appendicitis can complicate AH. Case Presentation. A 75-year-old Caucasian man presented with incarceration of vermiform appendix in inguinal hernia sac. Diagnosis was posed preoperatively with computed tomography (CT) scan. Patient underwent urgent surgery and simultaneous appendectomy and hernia repair by Bassini’s technique were performed. Conclusions. Preoperative diagnosis of AH is rare; however it could be useful for surgeon to choose operative approach. Treatment of AH depends on grade of appendix inflammation and/or perforation. The technique utilized to repair hernia depends largely on surgeon’s preferences; the presence of inflamed or perforated appendix is not an absolute contraindication for using a prosthetic mesh. Guido Mantovani, Michela De Angelis, Francesco Di Lecce, Annalisa Pascariello, Domenico Risio, and Luigi Boccia Copyright © 2017 Guido Mantovani et al. All rights reserved. Hem-o-lok Clips Migration: An Easily Neglected Complication after Laparoscopic Biliary Surgery Thu, 14 Sep 2017 06:26:23 +0000 http://www.hindawi.com/journals/cris/2017/7279129/ Clip migration into the common bile duct (CBD) is a rare but well-established phenomenon of laparoscopic biliary surgery. The mechanism and exact incidence of clip migration are both poorly understood. Clip migration into the common bile duct can cause recurrent cholangitis and serve as a nidus for stone formation. We present a case, a 54-year-old woman, of clip-induced cholangitis resulting from surgical clip migration 12 months after laparoscopic cholecystectomy and laparoscopic common bile duct exploration (LC+LCBDE) with primary closure. Jun-wen Qu, Gui-yang Wang, Zhi-qing Yuan, and Ke-wei Li Copyright © 2017 Jun-wen Qu et al. All rights reserved. Jejunojejunal Intussusception due to Metastatic Melanoma Seven Years after the Primer Tue, 12 Sep 2017 09:20:31 +0000 http://www.hindawi.com/journals/cris/2017/1237510/ Intestinal intussusception in adults is a rare medical condition accounting for less than 5% of all intussusceptions. Herein we present a 45-year-old patient with a history of abdominal pain and loss of weight. CT scan revealed jejunojejunal intussusceptions. The patient was subjected to exploratory operation and small intestine resection due to a mass causing intestinal intussusception. Pathology confirmed suspected diagnosis of metastatic melanoma to small intestine secondary to melanoma, 7 years after the initial manifestation. Postoperative evaluation with 18FDG-PET/CT revealed increased uptake in the thyroid gland. Subsequent total thyroidectomy revealed severe Hashimoto thyroiditis and no signs of metastasis. The patient received adjuvant immunotherapy and is healthy with no signs of recurrence 3 years after the initial diagnosis and treatment. Alexander Giakoustidis, Thomas Goulopoulos, Anastasios Boutis, George Kavvadias, Aristidis Kainantidis, Thomas Zaraboukas, and Dimitrios Giakoustidis Copyright © 2017 Alexander Giakoustidis et al. All rights reserved. Utilization of Liposuction for Delayed Morel-Lavallée Lesion: A Case Report and Review Mon, 11 Sep 2017 08:42:07 +0000 http://www.hindawi.com/journals/cris/2017/8120587/ Morel-Lavallée lesions are irregularly occurring and often overlooked results of traumatic injuries, resulting in potential long-term encapsulation of fluid between soft-tissue layers. The objective in this review was to discuss the delayed presentation of a Morel-Lavallée lesion and operative utility of liposuction in the patient’s treatment and review literature with particular focus on diagnosis and therapeutic interventions. The reviewed case demonstrates the presentation and successful therapy of a young female presenting with a MLL and contour deformity. Preston Gardner, Diana Flis, and Kongkrit Chaiyasate Copyright © 2017 Preston Gardner et al. All rights reserved. Paralytic Ileus Secondary to Methamphetamine Abuse: A Rare Case Thu, 31 Aug 2017 00:00:00 +0000 http://www.hindawi.com/journals/cris/2017/9762803/ Methamphetamine hydrochloride, colloquially referred to as “crystal meth,” is a potent psychoactive amphetamine derivate. Methamphetamine produces stimulant effects in the user including increased energy and alertness as well as inducing intense euphoric symptoms and suppressing appetite through its dopaminergic, serotonergic, and adrenergic actions. Use of methamphetamine can adversely affect cardiovascular, neurological, and gastrointestinal physiology leading to significant morbidity. We present a rare case of paralytic ileus secondary to methamphetamine abuse which has only once before been described in the literature. Mark Aidan McKelvie and Yuksel Gercek Copyright © 2017 Mark Aidan McKelvie and Yuksel Gercek. All rights reserved. Thoracoscopic Surgery in a Patient with Multiple Esophageal Carcinomas after Surgery for Esophageal Achalasia Wed, 30 Aug 2017 00:00:00 +0000 http://www.hindawi.com/journals/cris/2017/3272014/ We present a case in which we used a thoracoscopic approach for resection of multiple esophageal carcinomas diagnosed 33 years after surgery for esophageal achalasia. A 68-year-old Japanese man had been diagnosed with esophageal achalasia and underwent surgical treatment 33 years earlier. He was examined at our hospital for annual routine checkup in which upper gastrointestinal endoscopy showed a “0-IIb+IIa” lesion in the middle esophagus. Iodine staining revealed multiple irregularly shaped iodine-unstained areas, the diagnosis of which was esophageal carcinoma. Thoracoscopic subtotal esophagectomy was performed. Esophageal carcinoma may occur many years after surgery for esophageal achalasia, even if the passage symptoms have improved. So, long-term periodic follow-up is necessary for detection of carcinoma at an earlier stage. Yuki Yamasaki, Tomoya Tsukada, Tatsuya Aoki, Yusuke Haba, Katsuhisa Hirano, Toshifumi Watanabe, Masahide Kaji, and Koichi Shimizu Copyright © 2017 Yuki Yamasaki et al. All rights reserved. IgG4-Related Kidney Disease: Report of a Case Presenting as a Renal Mass Tue, 22 Aug 2017 07:29:19 +0000 http://www.hindawi.com/journals/cris/2017/9690218/ IgG4-related disease (IgG4-RD) is a nosological entity defined as a chronic immune-mediated fibro-inflammatory condition characterized by a tendency to form tumefactive, tissue-destructive lesions or by organ failure. Urologic involvement in IgG4-RD has been described in some short series of patients and in isolated case reports, most often involving the kidneys in so-called IgG4-related kidney disease (IgG4-RKD). The disease can occasionally mimic malignancies and is at risk of being misdiagnosed due to its rarity. We report the case of a 56-year-old man presenting with a right renal mass suspected of being malignant. Laboratory tests showed normal creatinine levels, a high erythrocyte sedimentation rate, and high levels of C-reactive protein and microalbuminuria. The patient underwent radical right nephroureterectomy and histopathologic examination revealed features proving IgG4-RKD. He was therefore referred to immunologists. Typical clinical presentation of IgG4-RKD includes altered renal function with inconstant or no radiologic findings. Conversely, in the case we presented, a single nodule was detected upon imaging evaluation, thus mimicking malignancy. This raises the issue of a proper differential diagnosis. A multidisciplinary approach can be useful, although in clinical practice the selection of patients suspected of having IgG4-RKD is critical in the cases presenting with a renal mass that mimics malignancy. Daniele Bianchi, Luca Topazio, Gabriele Gaziev, Valerio Iacovelli, Pierluigi Bove, Alessandro Mauriello, and Enrico Finazzi Agrò Copyright © 2017 Daniele Bianchi et al. All rights reserved. Laparoscopic Repair of Diaphragmatic Rupture: A Case Report with Radiological and Surgical Correlation Sun, 20 Aug 2017 00:00:00 +0000 http://www.hindawi.com/journals/cris/2017/4159108/ The leading cause of diaphragmatic rupture is penetrating abdominal trauma, including gunshot- and stab-related wounds; however, diaphragmatic rupture can also result from blunt trauma to the abdomen. The diagnosis can be difficult to make as the physical examination may be unremarkable, and imaging, that is, a conventional chest X-ray and/or CT imaging, may initially fail to reveal the injury. Failure to recognize diaphragmatic rupture can result in a delayed presentation, sometimes years later, with a potential catastrophic outcome. Therefore, prompt and swift diagnosis is critical to avoid this potential harmful scenario. Traditionally, repair is performed through a laparotomy or a thoracotomy incision. Owing to the many advances made in minimally invasive surgery, not only has laparoscopy become the modality of choice to diagnose diaphragmatic rupture due to its high degree of sensitivity and specificity, but it can provide simultaneous therapeutic intervention as well. We report a case of laparoscopic repair of a diaphragmatic rupture in a 22-year-old female who sustained blunt abdominal trauma during a motor vehicle accident. Patrick Nguyen, Bonnie Davis, and Daniel D. Tran Copyright © 2017 Patrick Nguyen et al. All rights reserved. Percutaneous Emergency Needle Caecostomy for Prevention of Caecal Perforation Tue, 15 Aug 2017 00:00:00 +0000 http://www.hindawi.com/journals/cris/2017/1090769/ Caecal perforation is a life-threatening complication of large bowel obstruction with a reported mortality of 34% to 72%. This case describes the novel use of percutaneous needle caecostomy as a life-saving measure to prevent imminent caecal perforation in a 68-year-old lady with large bowel obstruction secondary to an incarcerated incisional hernia. After careful review of computed tomography images and measurement of distances from the abdominal wall to the caecum, the patient’s caecum was decompressed in the emergency department using a needle under local anaesthetic. The patient subsequently underwent laparoscopic hernia repair and had an uncomplicated recovery. When conducted safely and with precision in an appropriate patient, percutaneous needle caecostomy can provide immediate symptom relief, reduce risk of caecal perforation, and allow a laparoscopic surgical approach. Alexandra M. Limmer and Zackariah Clement Copyright © 2017 Alexandra M. Limmer and Zackariah Clement. All rights reserved. Cutaneous Erythema at Scar Site of Modified Radical Mastectomy: An Unexpected Manifestation of Recurrent Carcinoma Thu, 10 Aug 2017 09:44:41 +0000 http://www.hindawi.com/journals/cris/2017/6879626/ A 44-year-old woman presented with marked erythema over right mastectomy scar, while on Herceptin therapy. She had neoadjuvant chemotherapy, modified radical mastectomy, and radiotherapy less than one year earlier for the treatment of invasive ductal carcinoma. On physical examination, no palpable masses were detected in the erythematous skin. A biopsy revealed permeation of the skin lymphatics by emboli of metastatic ductal carcinoma, similar to what is seen in inflammatory carcinoma. The involved skin was excised, followed by immediate reconstruction with transverse rectus abdominis muscle (TRAM) flap. On follow-up, the wound was healing well, with no signs of inflammation. Awrad Mohammed-Reda Nasralla, Mohammed Abdulirazzaq Al-Duhileb, Ali Jamal-Aldein Arini, and Samir Sami Amr Copyright © 2017 Awrad Mohammed-Reda Nasralla et al. All rights reserved. Malrotation Induced Small Intestine Ischemia in an Adolescent Mon, 31 Jul 2017 00:00:00 +0000 http://www.hindawi.com/journals/cris/2017/4809406/ Intestinal malrotation occurs if midgut does not complete or partially completes its 270° counter-clockwise rotation around the superior mesenteric artery during embryologic life. In general, it frequently manifests with vomiting due to duodenal obstruction and volvulus in the initial months of life, and it is very rare to manifest in the adulthood. A 20-year-old male patient who had severe abdominal pain, nausea, vomiting, and distention for one day was evaluated at the emergency department. On abdominal tomography “swirling appearance of structures around the superior mesenteric artery” was reported. CT appearance was considered compatible with a rotational anomaly. Emergency surgery was planned for the patient. In laparotomy, it was observed that an approximately 100 cm long small intestine segment was rotated around a band (Ladd) and ischemia was developed in this segment due to rotation of its mesentery. The rotation of the small intestinal mesentery was corrected by opening the bands. After the warm application to the intestinal mesenteric ischemia for a while, the color and the peristalsis of the intestines became normal. The patient was discharged on postoperative day 2 with suggestions. Karadeniz Erdem and Atamanalp Selçuk Sabri Copyright © 2017 Karadeniz Erdem and Atamanalp Selçuk Sabri. All rights reserved. The Role of Laparoscopy in the Management of a Diagnostic Dilemma: Jejunal Ectopic Pancreas Developing into Jejunojejunal Intussusception Thu, 27 Jul 2017 08:37:48 +0000 http://www.hindawi.com/journals/cris/2017/8452947/ Ectopic pancreas (EP) is a rare congenital anomaly defined as the presence of pancreatic tissue in topographic anomaly. It is usually silent but it may become clinically evident when complicated by acute conditions. The development of laparoscopic surgery has changed the way to manage such conditions, especially in the setting of emergency surgery, thanks to its diagnostic and therapeutic role with excellent results. We decided to perform an emergency diagnostic exploratory laparoscopy in a 29-year-old man with an acute abdomen and nonspecific radiological images for intestinal occlusion. A jejunojejunal intussusception was found, caused by a mass. We decided to carry out minilaparotomy to perform a resection of the affected jejunum. Histological examination confirmed the presence of a jejunal ectopic pancreas. Adult intussusception caused by EP represents 5% of all cases of intussusception. As CT scan, especially when performed in emergency setting for small bowel obstruction diagnosis, can usually demonstrate nondiagnostic findings suggestive of intussusception of unknown origin, laparoscopic exploration could help surgeons in order to perform a resolute diagnosis and treat the pathology. Alessio Giordano, Giovanni Alemanno, Carlo Bergamini, Paolo Prosperi, Alessandro Bruscino, and Andrea Valeri Copyright © 2017 Alessio Giordano et al. All rights reserved. Prostatic Abscess after Stapled Hemorrhoidopexy Caused by ESBL Extended Spectrum Beta Lactamase Producing Klebsiella pneumoniae: An Additional Challenge to Postoperative Sepsis Mon, 17 Jul 2017 07:21:18 +0000 http://www.hindawi.com/journals/cris/2017/4154016/ Postoperative septic complications of hemorrhoids surgical interventions are rare, but very serious with high mortality rate. Early diagnosis and prompt therapy are essential to save patient’s life. There are a good number of articles and case reports about these septic complications. We are presenting a case report of a prostatic abscess caused by extended spectrum beta lactamase (ESBL) producing Klebsiella pneumoniae after hemorrhoidopexy. Our patient was a healthy middle aged Saudi male who has no significant medical history apart from morbid obesity and recurrent urinary tract infections. ESBL producing K. pneumoniae could be detected only after aspiration of the prostatic abscess, but proper antibiotic was introduced intravenously on admission before culture of aspirate of the abscess was available. Antibiotic was continued for 30 days and abscess resolved completely. In our electronic search, we could not find any case report of prostatic abscess after stapled hemorrhoidopexy caused by ESBL producing organism. This is an additional challenge for treating physicians as these organisms are sensitive only to one group of antibiotics (carbapenem group). Asem Saleh, Abdelnasir Kibeida, Elsaid Amin, Abdalla Khalil, Rafat Abu Shakra, and Mohamed Elwakil Copyright © 2017 Asem Saleh et al. All rights reserved. Rare Reported Left Hepatic Subcapsular Biloma and Management Mon, 17 Jul 2017 00:00:00 +0000 http://www.hindawi.com/journals/cris/2017/8609185/ Subcapsular bilomas are a rare complication of laparoscopic cholecystectomy and an even more rare occurrence to occur spontaneously. We present a case of left sided subcapsular biloma following a laparoscopic cholecystectomy. The location of the biloma was unrelated to our area of dissection. The operation was without difficult dissection or pressurization of the biliary tree. In addition, we present percutaneous drainage alone, without ERCP as adequate management in subcapsular bilomas. Sarah Brown, Pablo Giuseppucci, and Christopher Esper Copyright © 2017 Sarah Brown et al. All rights reserved. Laparoscopic Common Bile Duct Exploration for Retrieval of Impacted Dormia Basket following Endoscopic Retrograde Cholangiopancreatography with Mechanical Failure: Case Report with Literature Review Thu, 13 Jul 2017 09:33:33 +0000 http://www.hindawi.com/journals/cris/2017/5878614/ Dormia baskets are commonly used during endoscopic retrograde cholangiopancreatography (ERCP). One complication is basket retention, through impaction with a gallstone or wire fracture. We describe a case where the external handle of the basket snapped causing retained basket plus large gallstone impacted in the common bile duct (CBD). Following laparoscopic cholecystectomy, laparoscopic CBD exploration allowed direct stone fragmentation under vision with the choledochoscope. Fragments were removed using a choledochoscopic basket and Fogarty catheter, and the basket was withdrawn. Literature search identified 114 cases of retained baskets with management including shockwave lithotripsy (27%), papillary balloon dilatation (22%), open CBD exploration (11%), and one laparoscopic case. J. W. O’Brien, R. Tyler, S. Shaukat, and A. M. Harris Copyright © 2017 J. W. O’Brien et al. All rights reserved. Spontaneous Diaphragmatic Rupture in Hypermobile Type Ehlers-Danlos Syndrome Thu, 13 Jul 2017 06:13:48 +0000 http://www.hindawi.com/journals/cris/2017/2081725/ Ehlers-Danlos Syndrome refers to a spectrum of connective tissue disorders that have a variety of clinical manifestations. In this case, we present a spontaneous diaphragmatic rupture in a patient with type III Ehlers-Danlos Syndrome. The patient presented with worsening shortness of breath after failure of medical therapy for a presumed pneumonia. A CT scan was obtained which showed diaphragmatic rupture with splenic herniation which was repaired in the operating room via thoracotomy. It is important to include diaphragmatic rupture in the differential diagnosis for patients with connective tissue disease and acute onset tachypnea and pain, as this complication has the potential for significant morbidity without prompt surgical intervention. Ruchi Amin and Brett H. Waibel Copyright © 2017 Ruchi Amin and Brett H. Waibel. All rights reserved. Laparoscopic Repair of a Large Paraesophageal Hernia with Migration of the Stomach into the Mediastinum Creating an Upside-Down Stomach Mon, 10 Jul 2017 08:55:52 +0000 http://www.hindawi.com/journals/cris/2017/7428195/ Upside-down stomach is a relatively rare type of a large paraesophageal hernia characterized by the migration of the stomach into the posterior mediastinum. Upside-down stomach is prone to severe complications and therefore surgery is recommended even in asymptomatic patients. A 62-year-old male presented with frequent abdominal pain with nausea and vomiting that persisted for one year. The patient was obese with fatty liver and was treated medically for gastroesophageal reflux disease (GERD) for 4 years. On upper gastrointestinal CT study a level-IV paraesophageal hernia was detected with upside-down stomach, and he was referred for elective surgery. Laparoscopic surgery included reduction of the stomach into the abdominal cavity followed by dissection of the paraesophageal membrane and hernia sac. The hiatal defect was closed using a wound closure device and nonabsorbable sutures. The defect closure was reinforced using Physiomesh tucked anteriorly and sutured posteriorly to the diaphragm. Follow-up was uneventful and the patient is free of complaints. The results of this surgical intervention support previous reports that laparoscopic repair with the use of biological mesh in the setting of large paraesophageal hernia should be favorably considered. Nasser Sakran, Hadar Nevo, Ron Dar, Asnat Raziel, and Dan Hershko Copyright © 2017 Nasser Sakran et al. All rights reserved. Small Bowel Obstruction Caused by Internal Hernia through a Peritoneal Defect of the Pouch of Douglas: Report of a Case and Review of the Literature Wed, 05 Jul 2017 09:48:23 +0000 http://www.hindawi.com/journals/cris/2017/9819270/ Herniation of small bowel through the peritoneal defect of the Pouch of Douglas is extremely rare type of internal hernia, and this type of internal hernia has been described as an entity of perineal hernia. Here, we describe a case of a 26-year-old female without history of abdominal surgery presenting with incarcerated small bowel hernia through a peritoneal defect of the Pouch of Douglas. She visited an emergency department presenting with abdominal pain and distension. Without improvement symptom by conservative management, an operation was performed. During the operation, the distal ileum had been herniated through a peritoneal defect of the Pouch of Douglas, and there were no specific findings on gynecological examination. Reduction of the herniated bowel and primary repair of the peritoneal defect were performed. The case represents a very rare type of internal hernia and provides published cases of hernia through a peritoneal defect of the Pouch of Douglas. Pyong Wha Choi Copyright © 2017 Pyong Wha Choi. All rights reserved. An Unusual Cause of Intestinal Obstruction in a Young Adult Patient: Inflammatory Fibroid Polyp Wed, 05 Jul 2017 00:00:00 +0000 http://www.hindawi.com/journals/cris/2017/3675848/ Inflammatory fibroid polyps are uncommon benign lesions that originate in the submucosa of the gastrointestinal tract. The stomach and the ileum are the most commonly affected sites. Although inflammatory fibroid polyp is one of the rare conditions leading to intestinal obstruction in adults, it should be considered as a possible diagnosis in obstructive tumors of the small bowel causing intussusceptions. We present one case of inflammatory fibroid polyp as a rare cause of intussusception in a young adult patient. Meryem Rais, Hafsa Chahdi, Mohammed Elfahssi, Abderrahmane Albouzidi, and Mohamed Oukabli Copyright © 2017 Meryem Rais et al. All rights reserved. Posttraumatic Progressive Vertebral Hemangioma Induced by a Fracture Tue, 20 Jun 2017 09:11:26 +0000 http://www.hindawi.com/journals/cris/2017/8280678/ The authors present an extremely rare case of an aggressive and progressive vertebral capillary hemangioma of the lumbar spine secondary to a trauma. A 40-year-old man who complained of back and leg pain due to a hemangioma of L1 that had begun a year after the fracture of the same vertebra was subsequently operated on. Due to the profuse bleeding, only a subtotal removal was possible. Histopathological diagnosis of the lesion revealed a capillary hemangioma. Postoperative control MRI taken at eight months showed that the lesion and destruction of the L1 vertebra were progressive. A second embolization procedure was performed and this time the hemangioma was totally removed via an anterior approach and corpectomy. Fusion was achieved by Th12-L2 graft and plaque. In the fourteenth year of follow-up, he was symptom-free and radiologically clear of this lesion. We propose that progressive hemangioma is extremely rare and that its cure is possible by total surgical removal of the lesion. This case is the second extradural capillary hemangioma secondary to spinal trauma ever to have been documented in English literature. The emergence of a hemangioma in a fractured vertebra suggests that its pathogenesis can be related to the deviation of the angiogenetic pathways from the normal healing process. Kaya Kilic, Emre Unal, Zafer Orkun Toktas, Fugen Vardar Aker, Akın Akakın, and Türker Kilic Copyright © 2017 Kaya Kilic et al. All rights reserved. Adrenal Rest Tumor of the Liver Preoperatively Diagnosed as Hepatocellular Carcinoma Mon, 19 Jun 2017 08:21:30 +0000 http://www.hindawi.com/journals/cris/2017/8231943/ Background. Hepatic adrenal rest tumors are rare and show similar findings to hepatocellular carcinoma (HCC). It is difficult to distinguish an adrenal rest tumor from HCC due to radiological similarity. We report a case of an adrenal rest tumor in the liver that mimicked HCC radiologically. Case Presentation. A 67-year-old female was referred to our hospital due to the finding of a hepatic mass. Enhanced computed tomography revealed a 17 mm well-defined tumor that was enhanced in the arterial phase and washed out in the portal and delayed phase in the posterosuperior subsegment of the right hepatic lobe, and HCC was suspected. We performed a subsegmental resection of the liver. Microscopic findings showed that the tumor was composed of pale cells, and tumor cells were aligned in alveolar or fascicular arrangements in a similar manner to features of adrenocortical tissue. Immunohistochemically, the tumor expressed synaptophysin and CD56. The final histopathologic diagnosis in this case was an adrenal rest tumor of the liver. Conclusions. An adrenal rest tumor is similar to HCC in radiological findings. This hepatic tumor should be added to the list of radiological differential diagnoses of hypervascular hepatic tumors. Megumu Enjoji, Katsuya Sanada, Ryota Seki, Takashi Ito, and Masato Maeda Copyright © 2017 Megumu Enjoji et al. All rights reserved.