Antonios Vezakis, Dionysios Dellaportas, George Polymeneas, Marios Konstantinos Tasoulis, Constantinos Chondrogiannis, Aikaterini Melemeni, Andreas Polydorou, George Panagiotis Fragulidis[show abstract] [hide abstract]
ABSTRACT: Cystic disease of the spleen is an uncommon entity in general population. Most cases result from parasitic infection by Echinococcus granulosus, a form called splenic hydatid disease (SHD), with a reported frequency of 0.5-6.0% within abdominal hydatidosis. On the contrary, an isolated splenic involvement of hydatid disease is very uncommon even in endemic regions. Two cases of primary SHD managed with open and laparoscopic radical surgery in our department are reported herein. Primary SHD is a rare entity with non-specific symptoms underlying clinical suspicion by the physician for prompt diagnosis. Surgical treatment is the mainstay therapy, while laparoscopic approach when feasible is safe, offering the advantages of laparoscopic surgery.The Korean Journal of Parasitology 06/2012; 50(2):147-50. · 1.04 Impact Factor
Article: Postoperative gastric fistula[show abstract] [hide abstract]
ABSTRACT: Aim-BackgroundThe aim of this study is to highlight the modern diagnostic tools and treatment options for this surgical complication which, if not addressed, could prove life-threatening. Gastrocutaneous fistula (GF) is a rare and serious surgical complication. It usually arises from a traumatized or ischemic stomach wall or gastrojejunal anastomosis following major operations of the upper abdomen or after a leak from a gastroduodenal or gastrojejunal anastomosis. A long standing gastrostomy tube constitutes another common etiologic factor. The increased incidence of GFe in recent years can also be attributed to bariatric surgical procedures. Patients-MethodsWe report three cases of GFe occurring after major operative procedures that were treated either endoscopically or surgically. A short review of the literature related to GFe is also presented. Discussion-ConclusionThe incidence of isolated gastric fistula ranges between 2–20% among different series. The greater curvature of the gastric fundus is the most common site involved. Although the etiology is not well understood, it is postulated that a traumatized, ischemic gastric wall in contact with a foreign body material and surrounded by a significant inflammatory process is a situation conducive to development of a GF. Diagnostic evaluation includes upper GI contrast radiography which is the most accurate technique to demonstrate the tract of the fistula. Treatment of this frustrating complication is initially conservative with the use of supportive measures; surgical intervention should be decided when all other treatment options fail. Endoscopic closure of the leakage defect using metal clips, fibrin glue or other agents provides another current and promising option in the management of GFe. KeywordsGastrocutaneous fistula-Gastrojejunostomy-SpleenectomyHellēnikē cheirourgikē. Acta chirurgica Hellenica 04/2012; 82(3):196-200.
Dionysios Dellaportas, George Polymeneas, Christina Dastamani, Evi Kairi-Vasilatou, Ioannis Papaconstantinou[show abstract] [hide abstract]
ABSTRACT: Introduction. A peritoneal inclusion cyst is a very rare mesenteric cyst of mesothelial origin usually asymptomatic. A rare case of an 82-year-old white Caucasian female with a femoral hernia containing a large peritoneal inclusion cyst, mimicking strangulated hernia, is presented herein. Case Presentation. The patient was admitted to our hospital suffering from a palpable groin mass on the right, which became painful and caused great discomfort for the last hours. Physical examination revealed a tender and tense, irreducible groin mass. An inguinal operative approach was selected and the mass was found protruding through the femoral ring. After careful dissection it turned out to be a large unilocular cyst, containing serous fluid, probably originating from the peritoneum. McVay procedure was used to reapproximate the femoral ring. Histologic examination showed a peritoneal inclusion cyst. Discussion. Peritoneal inclusion cysts are usually asymptomatic but occasionally present with various, nonspecific symptoms according to their size. Our case highlights that high index of clinical suspicion and careful exploration during repair of a hernia is mandatory in order to reach the correct diagnosis about hernia's contents.Case reports in surgery. 01/2012; 2012:528780.
Article: Peritoneal mesotheliomas mimicking adnexal tumors. Clinicopathological characteristics of four cases and a short literature review.D Dellaportas, E Kairi-Vassilatou, P Lykoudis, P Mavrigiannaki, S Mellou, C K Kleanthis, A Kondi-Pafiti[show abstract] [hide abstract]
ABSTRACT: Three cases of peritoneal benign cystic mesotheliomas in women 32-34 years of age and one case of peritoneal malignant mesothelioma in a 47-year-old woman are reported. All cases presented with abdominal discomfort and/or pain and the physical and radiological diagnostic methods showed adnexal tumors. The cystic mesotheliomas developed in the cul-de-sac and the right pelvic sidewall, presented as multiple small cysts or large multilocular cystic mass. The malignant mesothelioma showed extensive infiltration of the omentum the intestinal loops and the surface of the uterus and adnexa, with bilateral hydrosalpinx and ascites. All cases presented histological and immunohistochemical characteristics consistent with tumors of mesothelial origin. No history of asbestos exposure was reported. The correct diagnostic and therapeutic approaches to these neoplasms are discussed.European journal of gynaecological oncology 01/2012; 33(1):101-4. · 0.47 Impact Factor
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ABSTRACT: Ovarian vein thrombosis (OVT) is a rare, but serious condition that affects mostly postpartum women. A high index of suspicion is required in order to diagnose this unusual cause of abdominal pain. A 19-year-old woman at three days postpartum was admitted to our hospital because of severe right lower quandrant abdominal pain and fever 38.5'C. Physical examination revealed an acutely ill patient and right lower quadrant tenderness with positive rebound and Giordano signs. The patient underwent appendectomy which proved to be negative for acute appendicitis. Postoperatively fever and pain persisted and abdominal CT-scan with intravenous contrast agent demonstrated a thrombosed right ovarian vein. The patient was initiated on low-molecular weight heparin (LMWH) and antibiotic treatment and a month later a new abdominal CT-scan showed a patent right ovarian vein. Pathophysiologically, OVT is explained by Virchow's triad, because pregnancy is associated with a hypercoagulable state, venous stasis due to compression of the inferior vena cava by the uterus and endothelial trauma during delivery or from local inflammation. Common symptoms and signs of OVT include lower abdomen or flank pain, fever and leukocytosis usually within the first ten days after delivery. The reported incidence of OVT ranges 0,05-0,18% of pregnancies and in most cases the right ovarian vein is the one affected. Anticoagulation and antibiotics is the mainstay of treatment of OVT. Complications of OVT include sepsis, extension of the thrombus to the inferior vena cava and renal veins, and pulmonary embolism. The incidence of pulmonary embolism is reported to be 13.2% and represents the main source of mortality due to OVT. OVT is a rare condition, usually in the postpartum period. A high index of suspicion is required for the prompt diagnosis and management especially in cases that mimic acute abdomen.World Journal of Emergency Surgery 12/2011; 6(1):45.