Case Reports in Surgery The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Acute Torsion of Appendicular Mucocele Thu, 27 Apr 2017 06:59:15 +0000 We present the case of an 81-year-old man with a known appendicular mucocele who presented to the emergency department with acute abdominal pain. A CT scan showed a change in orientation of the previously seen ovoid mass with surrounding fat stranding suggesting torsion. An emergency laparotomy with appendicectomy and resection of the caecal pole was performed. We discuss the findings and histopathology. Farshid Ejtehadi, James Brooks, Hebah Hassan Ali, and Vardhini Vijay Copyright © 2017 Farshid Ejtehadi et al. All rights reserved. Difficult Management of a Double-Lumen Endotracheal Tube and Difficult Ventilation during Robotic Thymectomy with Carbon Dioxide Insufflation Wed, 26 Apr 2017 00:00:00 +0000 Robotic surgery with carbon dioxide (CO2) insufflation to the thorax is frequently performed to gain a better operative field of view, although its intraoperative complications have not yet been discussed in detail. We treated two patients with difficult ventilation caused by distal migration of a double-lumen endotracheal tube (DLT) during robotic thymectomy. In the first case, migration of the DLT during one-lung ventilation (OLV) occurred after CO2 insufflation to the bilateral thoraxes was started. Oxygenation rapidly deteriorated because dependent lung expansion was restricted by CO2 insufflation. In the second case, migration of the DLT during OLV occurred while CO2 insufflation to a unilateral thorax and mediastinum was performed. In both cases, once migration of the DLT during OLV occurred with CO2 insufflation, readjusting the DLT became very difficult because our manipulation of bronchofiberscopy was prevented by the robot arms located above the patient’s head and because deformation of the trachea/bronchus induced by CO2 insufflation caused a poor image of the bronchofiberscopic view. Thus, during robotic-assisted thoracoscopic surgery with CO2 insufflation, since there is a potential risk of difficult ventilation with a DLT and since readjustment of the DLT is very difficult, discontinuing CO2 insufflation and switching to double-lung ventilation are needed in such a situation. Yuki Sugiyama, Kunihiro Mitsuzawa, Yuki Yoshiyama, Fumiko Shimizu, Satoshi Fuseya, Takashi Ichino, Hiroyuki Agatsuma, Takayuki Shiina, Ken-ichi Ito, and Mikito Kawamata Copyright © 2017 Yuki Sugiyama et al. All rights reserved. Infrarenal Infected Aortic Aneurysm Caused by Streptococcus pyogenes Wed, 19 Apr 2017 10:09:23 +0000 Infectious aneurysm is a rare entity associated with significant morbidity and mortality. Current knowledge on pathogenesis, outcome, diagnosis, management, and follow-up remains debatable. We report the case of a patient with Streptococcus pyogenes aneurysm who was successfully treated with a homograft implant and discuss microbiological characteristics, diagnostic methods, and treatment options currently available for this serious disease. Floryn Cherbanyk, Markus Menth, Bernhard Egger, and Véronique Erard Copyright © 2017 Floryn Cherbanyk et al. All rights reserved. Acute Pancreatitis with Splenic Infarction as Early Postoperative Complication following Laparoscopic Sleeve Gastrectomy Thu, 13 Apr 2017 07:43:46 +0000 Obesity is becoming a global health burden along with its comorbidities. It imposes tremendous financial burden and health costs worldwide. Surgery has emerged as the definitive treatment option for morbidly obese patients with comorbidities. Laparoscopic sleeve gastrectomy is performed now more than ever making it imperative for physicians and surgeons to recognize both the common and the uncommon risks and complications associated with it. In this report we describe a rare early life-threatening postoperative complication following laparoscopic sleeve gastrectomy. From our extensive review of literature, there is no existing report of acute pancreatitis with splenic infarction postsleeve gastrectomy to this date. Aleksandr Kalabin, Vishnu R. Mani, Ankita Mishra, Hector Depaz, and Leaque Ahmed Copyright © 2017 Aleksandr Kalabin et al. All rights reserved. Synchronous Carotid Bifurcation Endarterectomy and Retrograde Kissing Stenting of the Innominate and Left Common Carotid Artery in a Patient with a Bovine Aortic Arch Tue, 11 Apr 2017 07:22:51 +0000 Management of the symptomatic multiple stenosis of supra-aortic vessels (MSSVs) in a “bovine” aortic arch (BAA) configuration is infrequently reported. The optimal treatment choice remains debatable. A successful hybrid treatment for a proximal critical stenosis of the innominate and left common carotid artery was performed in a high-risk patient with a tandem symptomatic lesion in the right carotid bifurcation and a concentric vulnerable plaque in the bovine trunk. This case supports the feasibility, safety, and efficacy of a combined carotid bifurcation endarterectomy and retrograde kissing stenting of common carotid arteries with cerebral protection after evaluation of radiological, anatomical, and clinical parameters. Alessandro Robaldo, Guido Carignano, Alberto Balderi, and Claudio Novali Copyright © 2017 Alessandro Robaldo et al. All rights reserved. Exploring a Third Confirmed Case of Hemoperitoneum following Open Inguinal Hernia Repair Caused by Sampson Artery Hemorrhage Mon, 10 Apr 2017 07:46:03 +0000 Hemoperitoneum is a rare complication of open inguinal hernia repair. This is the third reported case of this complication attributed to the same bleeding source: Sampson’s artery. Sampson’s artery courses along the round ligament of the uterus in the inguinal canal of females, originating from the arcade formed between the uterine and ovarian arteries. Usually obliterated in postembryonic development, this artery can persist in some adult female patients. Disruption of Sampson’s artery can lead to hemoperitoneum following ligation of the uterine round ligament during open inguinal hernia repair in females. This case report describes a third confirmed case of hemoperitoneum complicating an open inguinal hernia repair. We review all three reported cases to date and discuss the recurring signs, symptoms, epidemiologic factors, and diagnostic findings associated. Our review suggests that females of childbearing age, particularly those in the peripartum period, are most at risk of developing this rare complication. Jordan Hebert, Manoj Jagtiani, Alexander Hsu, David Schmelzer, and Fred Wolodiger Copyright © 2017 Jordan Hebert et al. All rights reserved. Squamous Cell Carcinoma Originating from a Crohn’s Enterocutaneous Fistula Sun, 09 Apr 2017 00:00:00 +0000 Purpose. Squamous cell carcinoma (SCC) developing within fistulae and chronic wounds in patients with Crohn’s disease is a rare phenomenon with few reported studies in the literature. Clinical suspicion for SCC in Crohn’s disease patients with chronic painful fistulae is low, leading to delayed diagnosis and treatment. We present a patient with long-standing Crohn’s disease complicated by malignant degeneration of an enterocutaneous fistula tract. Methods. Workup with MRI, CT, and fistulogram revealed a 7 × 3 cm fistulous connection between a loop of small intestine and the patient’s perineum. Biopsies of the fistula tract confirmed the diagnosis of SCC. Results. The patient underwent an abdominoperineal resection with positive margins and is currently awaiting radiation therapy. Conclusions. This is the second case reported within the English literature of SCC arising from an enterocutaneous fistula in the setting of Crohn’s disease. Based on the findings in this case report and others presented in the literature, a high degree of suspicion of malignancy should be present in patients with chronic painful, poor-healing fistulae, especially in the absence of infection. Bogdan Protyniak, Travis Shutt, and Russell Farmer Copyright © 2017 Bogdan Protyniak et al. All rights reserved. Enterocutaneous Fistula Secondary to Stump Appendicitis Mon, 03 Apr 2017 07:46:06 +0000 The management of appendicitis with appendicectomy is very common in surgical practice. A recognised complication of appendicitis and appendicectomy is the formation of an enterocutaneous fistula. We present the case of a seventy-five-year-old woman who presented with an appendicocutaneous fistula on the background of an open appendicectomy performed sixty years prior to presentation. Nelson Agostinho, Harinder K. Bains, and Franko Sardelic Copyright © 2017 Nelson Agostinho et al. All rights reserved. Transmesenteric Internal Herniation Leading to Small Bowel Obstruction Postlaparoscopic Radical Nephrectomy Thu, 30 Mar 2017 12:23:34 +0000 Internal herniation following laparoscopic surgery is rare. We present a case of small bowel obstruction secondary to internal herniation in a 76-year-old male patient. Presentation was on postoperative day 28 following transperitoneal laparoscopic radical left nephrectomy for suspected renal carcinoma. The herniation was through a defect in the large bowel mesentery identified at exploratory laparotomy. To date, 10 cases of internal herniation following laparoscopic nephrectomy have been described in the literature. Two cases were managed laparoscopically and the remainder by laparotomy. One case required resection of an ischaemic portion small bowel and the remainder were managed by reduction of the hernia and closure of the defect. Internal herniation is rare but carries significant morbidity. It must be considered in cases presenting with obstructive symptoms after laparoscopic nephrectomy. Early CT scanning and prompt surgical management are hallmarks of best management. G. A. Cuthbert and L. T. Teo Copyright © 2017 G. A. Cuthbert and L. T. Teo. All rights reserved. Emergent Minimally Invasive Esophagogastrectomy Wed, 29 Mar 2017 00:00:00 +0000 Introduction. Esophageal perforation in the setting of a malignancy carries a high morbidity and mortality. We describe our management of such a patient using minimally invasive approach. Methods. An 83-year-old female presented with an iatrogenic esophageal perforation during the workup of dysphagia. She was referred for surgical evaluation immediately after the event which occurred in the endoscopy suite. Minimally invasive esophagectomy was chosen to provide definitive treatment for both her malignancy and esophageal perforation. Results. Following an uncomplicated operative course, she was eventually discharged to extended care for rehabilitation and remains alive four years after her resection. Conclusion. Although traditional open techniques are the accepted gold standard of treatment for esophageal perforation, minimally invasive esophagectomy plays an important role in experienced hands and may be offered to such patients. Thomas Fabian, Dorothy Chiaravalle, and Jeremiah Martin Copyright © 2017 Thomas Fabian et al. All rights reserved. Primary Small Bowel GIST Presenting as a Life-Threatening Emergency: A Report of Two Cases Tue, 28 Mar 2017 00:00:00 +0000 Gastrointestinal stromal tumor (GIST) is a rare stromal neoplasm, which represents the most common mesenchymal tumor of the gastrointestinal tract. It is characterized by indolent clinical symptoms, although it can present as a life-threatening emergency. Herein, we present two cases of primary small bowel GIST treated at our department. A 68-year-old female patient presented to our emergency department with a diffuse abdominal pain of acute onset. Imaging studies revealed a mass at proximal jejunum, with a nearby free air and fluid. At surgery, a mass of 9 cm was found at proximal jejunum, 3 cm distal to the treitz ligament, with perforation on the lateral wall of the mass. En bloc resection was performed. Pathology report was positive for gastrointestinal stromal tumor. A 70-year-old male patient presented to our emergency department with 3 days of dark tarry stool and few hours of hematochezia. Computed tomography angiography revealed a mass at the pelvis, with calcifications, attached to the distal ileum, with intraluminal blush of intravenous iodine. At surgery, a mass of 8 cm at the distal ileum was found. Resection of the mass along with a 20 cm of ileum was completed. Histopathology report was positive for malignant gastrointestinal stromal tumor. Safi Khuri, Hayim Gilshtein, Abd-alkarim Darawshy, Hany Bahouth, and Yoram Kluger Copyright © 2017 Safi Khuri et al. All rights reserved. Intestinal Obstruction in a Patient with Sclerosing Encapsulating Peritonitis Sun, 26 Mar 2017 08:09:04 +0000 Sclerosing encapsulating peritonitis (SEP) is a rare disorder that is characterized by encapsulation of bowel loops by thick fibrinogenous case. Most patients present with vague abdominal symptoms. It is challenging to diagnose the condition preoperatively. Surgical management is preserved for patients with small bowel obstruction with no improvement on conservative measures or for those with signs of bowel ischemia (Li et al., 2014; Habib et al. 2011). Herein, we discuss the clinical signs and symptoms, the radiological features, the surgical management, and outcome of SEP based on a patient who underwent surgery in our hospital. Oday Obaid, Dawood Alhalabi, and Mohamed Ghonami Copyright © 2017 Oday Obaid et al. All rights reserved. An Appendiceal Carcinoid Tumor within an Amyand’s Hernia Mimicking an Incarcerated Inguinal Hernia Wed, 22 Mar 2017 00:00:00 +0000 Introduction. We report the case of an appendiceal carcinoid tumor within an Amyand’s hernia, presenting as an incarcerated right inguinal hernia. Presentation of Case. A 52-year-old male presented in the emergency department due to a persistent right inguinal pain. Clinical examination revealed a tender right groin mass. Laboratory tests revealed leukocytosis and an increased serum CRP. Under the diagnosis of an incarcerated right inguinal hernia, an emergency operation was taken. Intraoperatively, an inflamed appendix and a part of the cecum were found in the hernia sac. The operation was completed with an appendectomy and a modified Bassini hernia repair. Histological examination revealed a carcinoid tumor, resulting in the performance of a right hemicolectomy. Discussion. Amyand’s hernia is estimated to account for 0.4% to 0.6% of all inguinal hernias. Coexistence of an Amyand’s hernia and a neoplasia is quite rare. Carcinoids are the most frequent tumors found in the appendix, with the size of the primary tumor to be considered the most important prognostic factor and the basis upon which the operative plan is decided. Conclusion. A malignancy of the appendix should always be in the differential diagnosis of a right inguinal mass, in order to provide optimum surgical treatment. Gregorios Christodoulidis, Konstantinos Perivoliotis, Alexandros Diamantis, Dionysios Dimas, Michael Spyridakis, and Konstantinos Tepetes Copyright © 2017 Gregorios Christodoulidis et al. All rights reserved. Laparoscopic Reduction and Closure of an Internal Hernia Secondary to Gynecologic Surgery Sun, 19 Mar 2017 09:17:12 +0000 Internal hernia is a rare cause of bowel obstruction which often requires emergent surgery. In general, the preoperative diagnosis of internal hernia is difficult. The pelvic cavity has various spaces with the potential to result in a hernia, especially in females. In this report, we describe a patient with an internal hernia secondary to previous gynecologic surgery. A 49-year-old woman presented with acute abdominal pain and a history of previous right oophorectomy for a benign ovarian cyst. Computed tomography scan of the abdomen showed obstruction with strangulation and emergent laparoscopic exploration was performed. Intraoperatively, there was an incarcerated internal hernia in the pelvis, located in the vesicouterine pouch, which was reduced. The orifice of the hernia was a 2 cm defect caused by adhesions between the uterus and bladder. The defect was closed with a continuous suture. The herniated bowel was viable, and the operation was completed without intestinal resection. She was discharged four days after surgery without complications. Laparoscopy is useful to diagnose bowel obstruction in selected patients and may also be used for definitive therapy. It is important to understand pelvic anatomy and consider an internal hernia of the pelvic cavity in females, in the differential diagnosis of bowel obstruction, especially those with a history of gynecological surgery. Takashi Sakamoto and Alan Kawarai Lefor Copyright © 2017 Takashi Sakamoto and Alan Kawarai Lefor. All rights reserved. Retracted: A Fatal Case of Wernicke’s Encephalopathy after Sleeve Gastrectomy for Morbid Obesity Wed, 15 Mar 2017 09:52:43 +0000 Case Reports in Surgery Copyright © 2017 Case Reports in Surgery. All rights reserved. An Unusual Case of Resistant Hypokalaemia in a Patient with Large Bowel Obstruction Secondary to Neuroendocrine Carcinoma of the Prostate Mon, 13 Mar 2017 06:16:59 +0000 Neuroendocrine Carcinoma of the Prostate (NECP) is rare and only few cases have been reported, constituting less than 0.5% of prostatic malignancies. We report a rare case of large bowel obstruction from NECP posing a further challenge in management due to resistant hypokalaemia. A 70-year-old man presented with clinical signs of large bowel obstruction who was known to have prostatic carcinoma three years ago, treated initially with hormone therapy then chemoradiation. The blood profile showed a severe hypokalaemia and CT scan revealed liver and lung metastases apart from confirming large bowel obstruction from local invasion of NECP. Severe hypokalaemia was believed to be caused by paraneoplastic syndrome from tumor burden or by recent administration of Etoposide. Intensive potassium correction through a central venous access in maximal doses of 150 mmol/24 hours under cardiac monitoring finally raised serum potassium to 3.8 mmol/L. This safe period allowed us to perform a trephine colostomy at the left iliac fossa. The postoperative period was relatively uneventful. This first case report is presenting a rare cause of large bowel obstruction from a neuroendocrine carcinoma of prostate and highlights the importance of an early, intensive correction of electrolytes in patients with large tumor burden from NECP. Umasankar Mathuram Thiyagarajan, A. Ponnuswamy, A. Bagul, and A. Gupta Copyright © 2017 Umasankar Mathuram Thiyagarajan et al. All rights reserved. Suspected Pulmonary Metastasis of Actinic Cutaneous Squamous Cell Carcinoma Mon, 13 Mar 2017 00:00:00 +0000 Introduction. It is rare for actinic or squamous cell carcinoma (SCC) in situ to metastasize. Case Presentation. A 67-year-old male had a significant medical history including severe psoriatic arthritis treated with UVB, methotrexate, and rapamycin. He had twenty-five different skin excisions of actinic keratosis four of which were invasive SCC. Our patient developed shortness of breath necessitating a visit to the emergency department. A CT scan of his chest revealed a mass in the right lower lung. A subsequent biopsy of the mass revealed well-differentiated SCC. He underwent thoracoscopic surgery with wedge resection of the lung lesion. Discussion. Actinic keratosis (AK) is considered precancerous and associated with UV exposure. It exists as a continuum of progression with low potential for malignancy. The majority of invasive SCCs are associated with malignant progression of AK, but only 5–10% of AKs will progress to malignant potential. Conclusion. In this case, a new finding of lung SCC in the setting of multiple invasive actinic cutaneous SCC associated with a history of extensive UV light exposure and immunosuppression supports a metastatic explanation for lung cancer. Monet E. Meter, David J. Nye, and Christian R. Galvez Copyright © 2017 Monet E. Meter et al. All rights reserved. Three Cases of Pseudo-Meigs’ Syndrome Secondary to Ovarian Metastases from Colorectal Cancer Wed, 08 Mar 2017 00:00:00 +0000 Pseudo-Meigs’ syndrome is used to describe cases of ascites and/or pleural effusion associated with ovarian neoplasms other than benign tumors, which improve after removal of the ovarian lesion. We present three cases of pseudo-Meigs’ syndrome secondary to ovarian metastasis from colorectal cancer. In case 1, the patient has severe dyspnea and hypoxia due to massive right pleural effusion; therefore preoperative thoracic drainage was needed. In case 2, the patient needed paracentesis every two or three days to improve abdominal distension. After two courses of 5-fluorouracil, levofolinate, and oxaliplatin (mFOLFOX6), her ascites could be controlled by diuretics without aspiration and her general condition improved. Then she underwent operation. In case 3, the patient developed a massive pleural effusion and ascites coincident with a rapid enlargement of ovarian tumor after resection and adjuvant chemotherapy for rectal cancer. In all cases, pleural effusions and/or ascites resolved and general conditions and daily activities of the patients improved after oophorectomy. They are all currently in good health without recurrence of pleural effusion or ascites. In patients with suspected pseudo-Meigs’ syndrome secondary to ovarian metastasis of colorectal cancer, operation including oophorectomy may reduce pleural effusions and/or ascites and improve the general condition. Yuta Yamamoto, Yusuke Miyagawa, Takehito Ehara, Makoto Koyama, Satoshi Nakamura, Daisuke Takeuchi, Futoshi Muranaka, Masato Kitazawa, and Shinichi Miyagawa Copyright © 2017 Yuta Yamamoto et al. All rights reserved. First Video Case Report of Chronic Retrograde Jejunojejunal Intussusception after Subtotal Gastrectomy with Braun’s Anastomosis Tue, 07 Mar 2017 00:00:00 +0000 Intussusception, which is seen rarely in adults, is defined as the pulling or invagination of a part of the intestine into another segment of the intestine. In this case report we present chronic retrograde jejunojejunal intussusception following gastric surgery with Braun’s anastomosis in adult with video presentation. A 66-year-old woman, who had undergone gastric surgery 39 years ago and cholecystectomy 20 years ago, was admitted to our clinic with the complaints about weight loss, abdominal pain, nausea, and vomiting. Upper gastrointestinal endoscopy (UGISE) was applied, and patient was treated with surgery. This case report indicates that intussusception should be considered in the presence of clinical complaints following gastric surgery, as well as importance of endoscopy in diagnosis. Savaş Bayrak, Hasan Bektaş, Necdet Derici, Ekrem Çakar, and Şükrü Çolak Copyright © 2017 Savaş Bayrak et al. All rights reserved. Thoracoscopic Resection of a Rare Case of Hemangioma of the Azygos Venous Arch Tue, 07 Mar 2017 00:00:00 +0000 Hemangioma of the azygos venous arch is an exceedingly rare incident. This is a case of a thoracoscopic complete resection of a hemangioma of the azygos venous arch in a 37-year-old woman. Ma Husai, Cai Yixin, Zhang Ni, Wang Wenxin, and Fu Xiangning Copyright © 2017 Ma Husai et al. All rights reserved. A Case of Spontaneous Transdiaphragmatic Intercostal Hernia with Contralateral Injury, and Review of the Literature Thu, 23 Feb 2017 06:58:04 +0000 This case report discusses the diagnosis and management of a 67-year-old male presenting with a spontaneous transdiaphragmatic intercostal hernia with contralateral intercostal hernia. The patient had a history of chronic obstructive pulmonary disease (COPD) exacerbations requiring multiple prolonged courses of steroids. The patient was ultimately diagnosed with computed tomography (CT) and underwent surgical repair via thoracotomy with primary repair of the diaphragmatic defect. The patient’s postoperative course was uncomplicated. A review of the literature since the first similar case in 1977 recognizes the propensity of this injury to be found in patients with COPD and chronic steroid usage, as well as its diagnosis and management. The case reviewed is the second documented case of a concurrent abdominal wall herniation and the first one with a contralateral injury. It is important for clinicians to be aware of this pathology when evaluating patients with COPD and chronic steroid usage. Alexander A. Chapman and Steven B. Duff Copyright © 2017 Alexander A. Chapman and Steven B. Duff. All rights reserved. Island Posterior Thigh Flap Revisited in Covering Extensive Sacral Wounds: Our Experience with Two Patients Wed, 22 Feb 2017 06:54:11 +0000 Deep sacral wounds are best covered by flaps. Posterior thigh flaps have routinely been used to cover such wounds. The flap can however be modified as an island flap. Two patients with extensive sacral wounds were managed with island posterior thigh flaps. Both patients were admitted secondary to road traffic accident with subsequent soft tissue loss of the sacral area. The sacral defects in both patients were approximately 17 cm by 23 cm in dimensions. Unilateral island posterior thigh flap was raised and used to cover the wounds. Postoperatively both patients did well; the donor site and recipient sites healed without any complications. Island posterior thigh flap is thus an option in covering extensive defects of the sacral area. The flap is reliable and easy to raise and has minimal donor site morbidity. By raising it as an island flap the dog ear defect is avoided and the flap is able to be tunneled under the gluteal muscle. This maneuver enables the flap to be advanced further allowing it to cover more distal and extensive defects. F. Nangole Wanjala and Ajujo Martin Copyright © 2017 F. Nangole Wanjala and Ajujo Martin. All rights reserved. Spontaneous Intramural Oesophageal Haematoma in a Patient with Uncontrolled Hypertension: An Unusual Chest Pain Aetiology Mon, 20 Feb 2017 10:08:42 +0000 Introduction. Spontaneous intramural oesophageal haematoma is a rare condition that usually occurs secondary to an acute or chronic coagulation disorder. The presenting complaint is often with retrosternal chest pain and most patients are initially investigated to exclude more common causes in the differential diagnosis, such as acute coronary syndromes. Severe life-threatening bleeding or perforation seldom, if ever, arises. Case Presentation. We present a case of spontaneous oesophageal haematoma which appears to have developed gradually in a 69-year-old female with uncontrolled hypertension and antiplatelet medication use. The diagnosis was made on computed tomography imaging and was further evaluated with upper gastrointestinal endoscopy. Management was conservative and a follow-up endoscopy two weeks later showed almost complete resolution of the lesion. Discussion. Spontaneous oesophageal haematomas are very rare and usually result in the separation of the mucosal layer from the underlying muscle, presenting with chest pain, haematemesis, and dysphagia. Usually the diagnosis is one of exclusion, based on computed tomography imaging and endoscopy. Conservative management is almost always successful. Samantha Cooray, Dionysios Dellaportas, Clifford Caruana, and Andrew R. Davies Copyright © 2017 Samantha Cooray et al. All rights reserved. Surgical Management of Unusual Biangular Mandibular Fractures Sun, 19 Feb 2017 08:57:36 +0000 Bilateral mandibular angle fractures, while representing a rarity among mandibular fractures, are a huge challenge of complex management for the maxillofacial surgeon. There are still many open questions regarding the ideal management of such fractures, including the following: the removal of the third molar in the fracture line, the best surgical approach, and the fixation methods. In this report the authors present the case of 40-year-old man presenting with a bilateral mandibular angle fracture referred to the Maxillofacial Surgery Department of Turin. Open reduction and internal fixation has been made for both sides. The left side third molar was removed and the internal fixation was achieved through internal fixation with one miniplate according to Champy’s technique and transbuccal access for a 4-hole miniplate at the inferior border of the mandible. Right side third molar was not removed and fixation was achieved through intraoral access and positioning of a 4-hole miniplate along the external ridge according to Champy. An optimal reduction was achieved and a correct occlusion has been restored. Stefan Cocis, Umberto Autorino, Fabio Roccia, and Chiara Corio Copyright © 2017 Stefan Cocis et al. All rights reserved. A Giant Brunneroma Causing Gastrointestinal Bleeding and Severe Anemia Requiring Transfusion and Surgery Sun, 19 Feb 2017 00:00:00 +0000 Brunner’s gland hamartoma, also called hyperplasia, adenoma, and Brunneroma, is an extremely rare benign proliferative lesion of Brunner’s glands in the duodenum. While being mostly small and asymptomatic, they can result in gastrointestinal bleeding and obstruction. We report the case of a 54-year-old man presenting with melena and severe anemia requiring blood transfusion. CT scans showed a large mass of 8 cm in diameter, presumably arising in the duodenum. Endoscopic biopsies were not conclusive. As we were unable to determine the nature of the mass preoperatively and due to the severe symptoms, its size, and the uncertain malignant potential, a classic Whipple procedure was performed. The resected specimen showed extensive proliferation of Brunner’s glands without signs of malignancy. Nicola C. Frenkel, Miangela M. Laclé, Inne H. M. Borel Rinkes, Izaak Q. Molenaar, and Jeroen Hagendoorn Copyright © 2017 Nicola C. Frenkel et al. All rights reserved. Resection of the Gastric Tube Reconstructed through the Retrosternal Route without Sternotomy Sun, 19 Feb 2017 00:00:00 +0000 With advances of combined modality therapy, prognoses in esophageal cancer have been improving. After resection of esophageal cancer, the development of gastric tube cancer is a risk. While such cancer in an early stage can be cured endoscopically, total gastric tube resection is indicated in advanced stages. A 68-year-old man underwent subtotal esophagectomy reconstructed with a gastric tube through the retrosternal route. Gastric cancer was found one and a half years postoperatively. The gastric tube was resected without sternotomy. This is the first report of a patient undergoing resection of the gastric tube reconstructed through the retrosternal route without sternotomy. Masahiro Kimura, Yasuyuki Shibata, Kotaro Mizuno, Hironori Tanaka, Motoki Hato, Satoshi Taniwaki, Yoichiro Mori, Nobuo Ochi, Takaya Nagasaki, Shuhei Ueno, and Yuki Eguchi Copyright © 2017 Masahiro Kimura et al. All rights reserved. Reconstruction of Chest Wall by Cryopreserved Sternal Allograft after Resection of Aneurysmal Bone Cyst of Sternum Sun, 19 Feb 2017 00:00:00 +0000 A 20-year-old female was referred to our hospital due to deformity and bulging in anterior aspect of chest wall in sternal area. Chest X-ray and CT scan confirmed a large mass with destruction of sternum. Pathologic diagnosis after incisional biopsy was compatible with aneurysmal bone cyst. We resected sternum completely and reconstructed large anterior defect by a cryopreserved sternal allograft. In follow-up of patient there was no unstability of chest wall with good cosmetic result. Kambiz Sheikhy, Azizollah Abbasi Dezfouli, and Farahnaz Sadegh Beigee Copyright © 2017 Kambiz Sheikhy et al. All rights reserved. Dental Implant Placement with Simultaneous Anterior Maxillary Reconstruction with Block and Particulate Fresh Frozen Allograft Bone: A Case Report with 24-Month Follow-Up Data Thu, 16 Feb 2017 00:00:00 +0000 Fresh frozen allograft bone is routinely used in orthopedic surgery for the reconstruction of large bone defects, and its use in oral and maxillofacial surgery is increasing. The purpose of this case was to demonstrate the installation of dental implants and the use of fresh frozen bone for reconstruction of anterior maxilla in the same surgery. This case report presents the insertion of dental implants followed immediately by a placement of fresh frozen allograft in block and particle for a reconstruction of atrophic anterior maxillary in the same surgery. Ten months subsequent to this procedure, provisional fixed prosthesis was installed on the implants. Four months later (postoperative month 14), the final fixed prosthesis was installed and the clinical success was observed. The insertion of dental implants followed immediately by a placement of fresh frozen allograft is a safe and efficient process that results in the successful return of dental function and aesthetic rehabilitation for the patient. J. S. Vieira, E. M. Brandão-Filho, F. R. Deliberador, J. C. Zielak, A. F. Giovanini, and T. M. Deliberador Copyright © 2017 J. S. Vieira et al. All rights reserved. Stewart-Treves Syndrome Involving Chronic Lymphedema after Mastectomy of Breast Cancer Thu, 09 Feb 2017 08:10:13 +0000 Steward-Treves syndrome is a cutaneous angiosarcoma that usually appears after long evolution of a lymphoedema after mastectomy for mammary neoplasia associated with an axillary dissection. This is a rare disease develop most of the time in upper arm and often confounded with cutaneous metastasis. Only the biopsy and immunohistochemical study confirm the diagnosis. The treatment is surgical and consists of large cutaneous excision, an amputation of the limb or even its disarticulation and will be followed by chemotherapy. Despite the treatment, the prognosis remains severe with poor survival. We report the case of a patient who had a Steward-Treves syndrome 20 years after lymphoedema following a left mastectomy with axillary dissection. Smain Nabil Mesli, Amin Khayreddine Ghouali, Fouad Benamara, Fouzi Ahmed Taleb, Hicham Tahraoui, and Chakib Abi-Ayad Copyright © 2017 Smain Nabil Mesli et al. All rights reserved. Demanding Diagnosis of Splenic Angiosarcoma as Cause of Delayed Treatment of Spontaneous Splenic Rupture: A Case Report and Literature Review Thu, 02 Feb 2017 00:00:00 +0000 Background. Primary splenic angiosarcoma is a very rare mesenchymal malignant tumor associated with a poor prognosis due to its high metastatic potential. This disease can be easily neglected and spontaneous splenic rupture is a frequent manifestation at the time of diagnosis leading to a poor outcome because of peritoneal dissemination. Case Presentation. We describe the case of a 49-year-old man who presented with asthenia, left upper quadrant abdominal pain, and anemia. Computerized tomography scan showed an enlarged spleen with no nodules and a nontraumatic rupture of the splenic capsule. Splenectomy was performed on account of the severe anemia and histopathology examination showed a primary angiosarcoma. Conclusions. Splenic angiosarcoma should be considered as one of the differential diagnoses in patients with nontraumatic spleen rupture and a specific previous medical history. Regrettably, splenectomy allows for a definitive diagnosis but not a curative treatment. Sara Coppola, Andrea Leva, Fabio Pagni, Simone Famularo, and Luca Gianotti Copyright © 2017 Sara Coppola et al. All rights reserved.