Case Reports in Surgery https://www.hindawi.com The latest articles from Hindawi © 2017 , Hindawi Limited . 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 http://www.hindawi.com/journals/cris/2017/5932657/ 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 http://www.hindawi.com/journals/cris/2017/5948962/ 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 http://www.hindawi.com/journals/cris/2017/6764073/ 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 http://www.hindawi.com/journals/cris/2017/2394365/ 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 http://www.hindawi.com/journals/cris/2017/4176071/ 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 http://www.hindawi.com/journals/cris/2017/5235368/ 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 http://www.hindawi.com/journals/cris/2017/6945017/ 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 http://www.hindawi.com/journals/cris/2017/1693912/ 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 http://www.hindawi.com/journals/cris/2017/7416092/ 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 http://www.hindawi.com/journals/cris/2017/2084695/ 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 http://www.hindawi.com/journals/cris/2017/4086056/ 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 http://www.hindawi.com/journals/cris/2017/6149838/ 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 http://www.hindawi.com/journals/cris/2017/6940649/ 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 http://www.hindawi.com/journals/cris/2017/5862871/ 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 http://www.hindawi.com/journals/cris/2017/9135657/ 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 http://www.hindawi.com/journals/cris/2017/1565973/ 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 http://www.hindawi.com/journals/cris/2017/4056459/ 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 http://www.hindawi.com/journals/cris/2017/6256102/ 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. Juvenile Breast Hypertrophy: A Successful Breast Reduction of 14.9% Body Weight without Recurrence in a 5-Year Follow-Up Tue, 31 Jan 2017 10:05:15 +0000 http://www.hindawi.com/journals/cris/2017/3491012/ Juvenile hypertrophy of the breast (JHB) is a rare and relentless disease affecting women in the peripubertal period. We present a 13-year-old girl with massive bilateral JHB, successfully treated with a breast reduction and free nipple graft technique. A total of 7300 grams of breast tissue had been removed, accounting for 14.9% of the patient’s total body weight. Prophylactic hormonal therapy was not commenced. During the 5-year follow-up period, there was no recurrence and the patient remains satisfied with the aesthetic outcome. A recent meta-analysis study indicates that subcutaneous mastectomy is associated with reduced risk of recurrence, but it is more deforming and the aesthetic result is inferior to a reduction mammaplasty. In patients treated with the latter technique, some evidence exists suggesting that the use of a free nipple graft is associated with a less frequent risk of recurrence than a pedicle technique. This present case is unique as it demonstrates the clinical course of this patient at a considerably longer follow-up period than most reported studies. We adhered to the limited available evidence and highlight the long-term reliability of breast reduction with free nipple grafting as the first line surgical option in JHB, eliminating the need for repeated surgeries. Akmal Hisham, Marzida Abd Latib, and Normala Basiron Copyright © 2017 Akmal Hisham et al. All rights reserved. Treatment of Complete Anal Stricture after Diverting Colostomy for Fournier’s Gangrene Tue, 31 Jan 2017 00:00:00 +0000 http://www.hindawi.com/journals/cris/2017/2062157/ Background. Anal stenosis is a rare but serious complication of anorectal surgery. Severe anal stenosis is a challenging condition. Case Presentation. A 70-year-old Japanese man presented with a ten-hour history of continuous anal pain due to incarcerated hemorrhoids. He had a history of reducible internal hemorrhoids and was followed for 10 years. He had a fever and nonreducible internal hemorrhoids surrounding necrotic soft tissues. He was diagnosed as Fournier’s gangrene and treated with debridement and diverting colostomy. He needed temporary continuous renal replacement therapy and was discharged on postoperative day 39. After four months, severe anal stenosis was found on physical examination, and total colonoscopy showed a complete anal stricture. The patient was brought to the operating room and underwent colostomy closure and anoplasty. He recovered without any complications. Conclusion. We present a first patient with a complete anal stricture after diverting colostomy treated with anoplasty and stoma closure. This case reminds us of the assessment of distal bowel conduit and might suggest that anoplasty might be considered in the success of the colostomy closure. Kenji Okumura, Tadao Kubota, Kazuhiro Nishida, Alan Kawarai Lefor, and Ken Mizokami Copyright © 2017 Kenji Okumura et al. All rights reserved. Primary Pure Squamous Cell Carcinoma of the Gallbladder Locally Invading the Liver, Duodenum, and Stomach: A Case Report and Literature Review Sun, 29 Jan 2017 00:00:00 +0000 http://www.hindawi.com/journals/cris/2017/2534029/ Primary pure squamous cell carcinoma (SCC) of the gallbladder is an exceptionally rare type of tumor that comprises only 1% of all gallbladder cancer. SCC of the gallbladder portends a worse prognosis than the more common adenocarcinoma variant because of its aggressive invasion to local structures and because it is often diagnosed at an advanced stage. Owing to its rarity, diagnosis and management can be challenging. Herein, we present the case of a 75-year-old female complaining of abdominal pain, nausea, and vomiting. Computed tomography and ultrasonography results of the abdomen were consistent with acute cholecystitis and cholelithiasis. Histologic evaluation of the resected mass revealed a malignant tumor with prominent keratinization, confirming the diagnosis of an invasive primary pure SCC of the gallbladder. Microscopic examination showed direct infiltration to the liver, duodenum, and stomach. This case report describes the hospital course of a patient with SCC of the gallbladder and suggests that gallbladder cancer should be considered as part of the differential diagnosis in elderly patients presenting with acute cholecystitis. In addition, this article will review existing literature to examine the utility of different diagnostic techniques and treatment modalities available in the management of gallbladder cancer. Aldrin C. Alpuerto, Maximo E. Mora, R. Jonathan Robitsek, and Sebastian D. Schubl Copyright © 2017 Aldrin C. Alpuerto et al. All rights reserved. Acute Thrombotic Occlusion of the Popliteal Artery following Knee Dislocation: A Case Report of Management, Local Unit Practice, and a Review of the Literature Thu, 26 Jan 2017 09:26:34 +0000 http://www.hindawi.com/journals/cris/2017/5346457/ Arterial complications following traumatic knee injury are relatively rare but mandate timely recognition and treatment to avoid significant comorbidity and medicolegal ramifications. In this report we describe a case of acute thrombotic occlusion of the popliteal artery occurring after knee dislocation, successfully repaired by intimal fixation and a limited venous patch reconstruction. We present a review of local practice in screening vascular injuries following knee dislocation, aligned with a review of the literature and considerations for practice. Anthony Dean Godfrey, Fadi Hindi, Callum Ettles, Mark Pemberton, and Perbinder Grewal Copyright © 2017 Anthony Dean Godfrey et al. All rights reserved. Unusual Complication following a Myomectomy: Colic Migration of a Forgotten Abdominal Swab Thu, 26 Jan 2017 00:00:00 +0000 http://www.hindawi.com/journals/cris/2017/3962506/ Surgical sponges are the most common retained foreign bodies following surgery. The morbidity of this condition is illustrated herein with the case of a 36-year-old female patient with a history of myomectomy 5 months before her admission into our unit for enterocutaneous fistula. Although imaging and etiological investigations were made, diagnosis was carried out only by laparotomy. The foreign body found was an abdominal swab that migrated from abdominal cavity to the colon causing several intestinal injuries. The lack of specific clinical signs and the death of the patient raise the necessity of preventing these complications that involve the surgeon liability. Boyodi Tchangai, Fousseni Alassani, and Mazamesso Tchaou Copyright © 2017 Boyodi Tchangai et al. All rights reserved. Unexpected Radiation-Induced Aortic Wall Thickening Requiring Composite Graft Technique during Off-Pump Coronary Artery Bypass Grafting Thu, 19 Jan 2017 11:40:00 +0000 http://www.hindawi.com/journals/cris/2017/3831749/ Mediastinal radiation is commonly used to treat Hodgkin’s and non-Hodgkin’s lymphoma, lung and breast cancer. Cardiac complications after radiation therapy are well described, although rare. A large spectrum of injuries can occur, causing long term morbidity among survivors. We describe a case of post-actinic ascending aortic wall thickening that prevented saphenous vein proximal anastomosis and was successfully managed with aortic no-touch off-pump coronary artery bypass grafting (OPCAB), 25 years after radiation therapy for Hodgkin’s lymphoma. Paola Redaelli, Amando Gamba, Antonello Stefano Martino, and Michele Triggiani Copyright © 2017 Paola Redaelli et al. All rights reserved. A Case of Crossed Left Renal Ectopia Identified during Colostomy Reversal Wed, 18 Jan 2017 13:50:14 +0000 http://www.hindawi.com/journals/cris/2017/3674603/ Unilateral crossed renal ectopia without fusion is an uncommon anatomic anomaly, which often goes undiagnosed. We report a case of this renal variant discovered incidentally during colostomy reversal after Hartmann’s procedure for diverticular stricture. Rachel NeMoyer, Sumana Narayanan, and Nell Maloney-Patel Copyright © 2017 Rachel NeMoyer et al. All rights reserved. Acute “Pseudoischemic” ECG Abnormalities after Right Pneumonectomy Wed, 18 Jan 2017 08:09:35 +0000 http://www.hindawi.com/journals/cris/2017/7872535/ New onset of electrocardiographic (ECG) abnormalities can occur after lung surgery due to the changes in the position of structures and organs in the chest cavity. The most common heart rhythm disorder is atrial fibrillation. So-called “pseudoischemic” ECG changes that mimic classic ECG signs of acute myocardial ischemia are also often noticed. We report the case of a 68-year-old male, with no prior cardiovascular disease, who underwent extensive surgical resection for lung cancer. On a second postoperative day, clinical and electrocardiographic signs of acute myocardial ischemia occurred. According to clinical course, diagnostic procedures, and therapeutic response, we excluded acute coronary syndrome. We concluded that physical lesion of the pericardium, caused by extended pneumonectomy with resection of the pericardium, provoked the symptoms and ECG signs that mimic acute coronary syndrome. Our final diagnosis was postpericardiotomy syndrome after extended pneumonectomy and further treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) was recommended. It is necessary to consider possibility that nature of ECG changes after extended pneumonectomy could be “pseudoischemic.” Nada Vasic, Sanja Dimic-Janjic, Ruza Stevic, Branislava Milenkovic, and Verica Djukanovic Copyright © 2017 Nada Vasic et al. All rights reserved. Pedicle Temporalis Fascial Flap with Axial Scalp Flap Obviates Need of Free Flap in Extensive Scalp Wound Tue, 17 Jan 2017 07:22:21 +0000 http://www.hindawi.com/journals/cris/2017/4821329/ Extensive scalp defect with exposed bone is best reconstructed with flaps. Majority of these wounds are now routinely reconstructed with free flaps in many centers. Free flaps however require lengthy operative time and may not be available to all patients, where possible less extensive options should thus be encouraged. A sixty-eight-year-old patient presented to us with a Marjolin’s ulcer on the vertex of the scalp. After wide local excision a defect of about 17 cm and 12 cm was left. The defect was successfully covered with a combination of an ipsilateral pedicle temporalis fascial flap and an axial supraorbital scalp flap with good outcome. In conclusion wide defects of the scalp can be fully covered with a combination of local flaps. The axial scalp flap and the pedicle temporalis fascial flap where applicable provide an easy and less demanding option in covering such wounds. These flaps are reliable with good blood supply and have got less donor side morbidity. F. W. Nangole and S. O. Khainga Copyright © 2017 F. W. Nangole and S. O. Khainga. All rights reserved. Utility of the CT Scan in Diagnosing Midgut Volvulus in Patients with Chronic Abdominal Pain Sun, 15 Jan 2017 00:00:00 +0000 http://www.hindawi.com/journals/cris/2017/1079192/ Symptomatic intestinal malrotation first presenting in the adults is rare. Midgut volvulus is the most common complication of malrotation in the adults. Because of more differential diagnosis, Computed Tomography (CT) scan can play an important role in the evaluation of patients with this abnormality. The whirl pattern around the superior mesenteric artery found on CT scan in patients with midgut volvulus is pathognomonic and diagnostic. We describe a case of intestinal malrotation complicated by midgut volvulus in an adult patient. The preoperative CT findings were pathognomonic. Ehsan Shahverdi, Mehdi Morshedi, Maryam Allahverdi Khani, Mohammad Baradaran Jamili, and Fatemeh Shafizadeh Barmi Copyright © 2017 Ehsan Shahverdi et al. All rights reserved. Anterior-to-Posterior Migration of a Lumbar Disc Sequestration: Surgical Remarks and Technical Notes about a Tailored Microsurgical Discectomy Tue, 10 Jan 2017 09:57:37 +0000 http://www.hindawi.com/journals/cris/2017/1762047/ Extrusion of disc material within the spinal canal complicates up to 28.6% of lumbar disc herniations. Due to the anatomical “corridors” created by the anterior midline septum and lateral membranes, relocation occurs with an anterior and anterolateral axial topography. Posterior migration is an extremely rare condition and anterior-to-posterior circumferential migration is an even rarer condition. Its radiological feature can be enigmatic and since, in more than 50% of cases, clinical onset is a hyperacute cauda equina syndrome, it may imply a difficult surgical decision in emergency settings. Surgery is the gold standard but when dealing with such huge sequestrations, standard microdiscectomy must be properly modified in order to minimize the risk of surgical trauma or traction on the nerve roots. Alessandro Frati, Alessandro Pesce, Mauro Palmieri, Tommaso Vangelista, Riccardo Caruso, Maurizio Salvati, and Antonino Raco Copyright © 2017 Alessandro Frati et al. All rights reserved. Thoracoscopic Surgery for Glomus Tumor: An Uncommon Mediastinal Neoplasm and Iatrogenic Tracheal Rupture Wed, 04 Jan 2017 10:06:33 +0000 http://www.hindawi.com/journals/cris/2017/3621839/ Mediastinal glomus tumors are rarely recognized, and only seven cases have been reported in the literature. Here, we describe a rare mediastinal glomus tumor and review the characteristics of this rare clinical case. The patient was a 50-year-old female who presented with coughing for 3 months. Her chest computed tomography scan demonstrated a localized tumor in the posterior superior mediastinum. Intraoperatively, we found a longitudinal rupture of the membranous trachea above the carina. We completely resected the tumor and repaired the tracheal rupture under a thoracoscopy using a pedicled muscle flap. The tissue was diagnosed as a mediastinal glomus tumor according to its histological and immunophenotypic characteristics. Zhongjie Fang, Dehua Ma, Baofu Chen, and Huarong Luo Copyright © 2017 Zhongjie Fang et al. All rights reserved.