[Show abstract][Hide abstract] ABSTRACT: IntroductionIleosigmoid and ileoileal knotting are two rare entities. They usually present as acute abdomen and the diagnosis is established intraoperatively. The treatment is surgical and should be performed as soon as possible to decrease the incidence of perioperative mortality and morbidity.Case presentationWe report an unusual case of a 26-year-old Argentine man with ischemic necrosis in parts of his small and large intestine due to combined ileosigmoid and ileoileal knotting. He had an ileal loop of ileum concurrently wrapped around the neck of a sigmoid volvulus and other loops of ileum strangulating them, forming two different tangles of tying. This very rare and unusual entity was diagnosed and managed intraoperatively during a diagnostic laparotomy performed on an emergency basis. Both the gangrenous small bowel loops and the affected sigmoid colon area were resected. The continuation of the intestinal tract was restored by primary end-to-end anastomoses. The present case is unusual and to the best of our knowledge no similar cases of simultaneous ileosigmoid and ileoileal knotting have been described in the literature. The postoperative course of our patient was uneventful and he was discharged from the hospital on the 15th postoperative day. One year later he still remains without symptoms from his intestinal tract.ConclusionSimultaneous ileosigmoid and ileoileal knotting is a very rare entity that should be diagnosed and treated surgically on an emergency basis to minimize the high postoperative morbidity and mortality.
Journal of Medical Case Reports 06/2014; 8(1):200. DOI:10.1186/1752-1947-8-200
[Show abstract][Hide abstract] ABSTRACT: Anorectal incontinence is a symptom of a complex multifactorial disorder involving the pelvic floor and anorectum, which is a severe disability and a major social problem. Various causes may affect the anatomical and functional integrity of the pelvic floor and anorectum, leading to the anorectal continence disorder and incontinence. The most common cause of anorectal incontinence is injury of the sphincter muscles following delivery or anorectal surgeries. Although the exact incidence of anorectal incontinence is unknown, various studies suggest that it affects ∼2.2-8.3% of adults, with a significant prevalence in the elderly (>50%). The successful treatment of anorectal incontinence depends on the accurate diagnosis of its cause. This can be achieved by a thorough assessment of patients. The management of incontinent patients involves conservative therapeutic procedures, surgical techniques, and minimally invasive approaches.
European journal of gastroenterology & hepatology 05/2013; 25(11). DOI:10.1097/MEG.0b013e328361dcfd · 2.15 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Primary duodenal adenocarcinoma is a rare entity with an uncertain biologic behaviour whose diagnosis is usually achieved by endoscopy and biopsy. However, it lacks specific symptoms and its diagnosis may be delayed with poor prognosis. Villous adenomas are considered as premalignant lesions with high risk malignant transformation. METHODS: We report a rare case of a patient with two synchronous adenocarcinomas, one of the first portion of the duodenum as a villous tumor and the other in cecum colon. The patient submitted successfully to pacreatoduodenectomy and right hemicolectomy, while postoperatively received also adjuvant chemotherapy. RESULTS: Seventeen months after the operations the patient is alive with no evidence of recurrent or metastatic disease. CONCLUSIONS: The radical resection of primary duodenal adenocarcinoma is considered the treatment of choice, which should be accompanied by adjuvant chemotherapy preventing a recurrence at distant sites.
European Surgery 06/2012; 44(3). DOI:10.1007/s10353-012-0079-6 · 0.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Gastroparesis is defined as an inhibition of the gastric motility associated with delayed gastric emptying, which is mainly presented with acute dyspepsia. Gastroptosis is the downward displacement of the stomach.
We report a rare case of secondary gastroparesis due to gastroptosis in an 11-year-old female child. The patient complained for bulking mass in the left lower quadrate presented a week ago, which was mimicking a large abdominal hernia. The laboratory and radiological exams revealed an excessive gastroptosis associated with gastroparesis. We searched the literature but we failed to find other cases with idiopathic gastroptosis in a child. The patient was treated conservatively and six months after the initial diagnosis and treatment the patient does not complains for dyspepsia.
Gastroparesis associated with gastroptosis is a rare entity that can be treated conservatively with acceptable results.
[Show abstract][Hide abstract] ABSTRACT: Acute appendicitis is the most common cause of the right lower quadrant acute abdominal pain in children. Some other conditions including cecal epiploica appendix torsion, can simulate acute abdomen. Epiploica appendix torsion usually occurs in the sigmoid colon and rarely in the cecum of adult males. In children, this entity is extremely rare and may represent a diagnostic and therapeutic dilemma. We report a case of an 8-year-old Greek girl, presented with signs and symptoms mimicking acute abdomen. Our patient is the younger one among the other four with cecal epiploica appendix torsion that had been reported in the literature.
[Show abstract][Hide abstract] ABSTRACT: Lower Spigelian hernia is a very rare entity. The clinical findings are similar to those of inguinal hernias and in many cases may be misdiagnosed. In the literature, only a few references to this entity have been reported in children. To the best of our knowledge, this is the first case report of a lower Spigelian hernia in a child who presented with an acute painful scrotum.
We discuss the case of a 6-year-old Greek boy who presented to our emergency department complaining of severe pain in the left inguinal area and scrotum. The acute painful swelling started suddenly, without any obvious cause. The initial diagnosis was incarcerated inguinal hernia which was reduced with difficulty. Five days later, the patient still experienced mild pain during palpation and he was operated on. During the operation, a large lower Spigelian hernia was revealed and reconstructed.
Although Spigelian hernias are rare in children and difficult to diagnose, physicians should be aware of them and include them in the differential diagnosis.
Journal of Medical Case Reports 02/2009; 3:34. DOI:10.1186/1752-1947-3-34
[Show abstract][Hide abstract] ABSTRACT: A case is reported of a young man, who was presented with abdominal pain and an inflammatory abdominal mass resulting from intestinal perforation by a wooden spike. Thorough surgical exploration of the abdominal cavity didn't reveal the perforation site. An inflammatory mass in small bowel mesentery was excised and the cavity drained. The patient had an uneventful recovery. In cases of intestinal perforation by wooden spikes the site of perforation may not be identified. Healing of the opening after the passage of the spike is the possible mechanism. The outcome of these patients even without finding the opening is favorable.
Annali italiani di chirurgia 01/2009; 80(1):61-4. · 0.68 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Carcinoids are the most common tumours of the appendix. These tumours show prevalence in white children. The clinical presentation of the appendiceal carcinoids is similar to that of acute appendicitis, although in many cases the tumour is diagnosed incidentally during an operation. The diagnosis should be confirmed histologically. The prognosis in patients with local disease is excellent. In small lesions isolated appendicectomy is considered as the most appropriate treatment, while in larger lesions right colectomy should be performed. We report a case of a carcinoid tumour in the tip of the appendix of a thirteen year old girl which was diagnosed intraoperatively. The patient received isolated appendicectomy due to the small size of the lesion. Ten years after the operation there is no evidence of recurrence or metastases, and the patient is considered free of disease.
[Show abstract][Hide abstract] ABSTRACT: We report an unusual case of an 11-year-old Greek girl with complicated acute appendicitis. The pelvic plastron that had been formatted secondary to appendix perforation was mimicking appendiceal intussusception in the preoperative ultrasound and computed tomography images. Although acute complicated appendicitis and appendiceal intussusception may represent possible causes of acute abdomen no similar cases have reported in the literature.
[Show abstract][Hide abstract] ABSTRACT: Crohn's disease (CD) can affect any part of the alimentary tract from the mouth to the anus, with most common site being the terminal ileum.
A child suffering from undiagnosed Crohn disease (CD), presented with an acute abdominal obstruction due to a large pseudopolyp in the jejunoileal area. At laparotomy, a jejunoileal segment of 45 cm, containing multiple areas of damage to the small intestine, was excised and a primary end - to - end anastomosis was performed.
The coexistence of an intestinal pseudopolyp with undiagnosed Crohn's disease may be the cause of acute abdominal obstruction in children.
Journal of Medical Case Reports 02/2008; 2:54. DOI:10.1186/1752-1947-2-54
[Show abstract][Hide abstract] ABSTRACT: We report the case of a 3-yr-old boy who presented an acute right hydrocele. A rapid scrotal swelling under tension developed the first hours and the child complained for discomfort especially during palpation of the scrotum. Three days later, surgical exploration revealed an incomplete torsion of a communicated and pedunculated peritoneal sac arising from the tunica vaginalis testis.
The present case report represents the eleventh report of torsion of processus vaginalis saccular protrusion in the literature, being unique due to painless hematocele.
[Show abstract][Hide abstract] ABSTRACT: Hepatic abscesses have been reported as a rare complication of diverticulitis of the bowel. This complication is recognized more commonly at the time of the diagnosis of diverticulitis, or ruptured diverticula, but also can be diagnosed prior to surgery, or postoperatively.
This report describes a man who developed an hepatic abscess within a simple hepatic cyst, two months after operation for ruptured diverticula of the sigmoid colon. The abscess was drained surgically and the patient made a complete recovery.
The development of an hepatic abscess in a pre-existing hepatic cyst, secondary to diverticulitis, is a rare complication. A high degree of clinical suspicion is required for immediate diagnosis and treatment.
Journal of Medical Case Reports 02/2008; 2:83. DOI:10.1186/1752-1947-2-83
[Show abstract][Hide abstract] ABSTRACT: Nitric oxide (NO) is an important signal molecule in many types of cells and tissues. Efficiently balanced NO production was noted to play an important role in the healing of burns. However, the exact pathophysiological role of NO in burns and its potent relation with clinical and laboratory parameters has not been elucidated.
A cohort of 23 burn patients followed for 5 days were enrolled. NO, antioxidant capacity (AC), NO synthase (NOS) activity and xanthine oxidase (XO) activity were indirectly determined by fluorophotometer. Multiple regression against total burn surface area (TBSA), age, weight, height, proximity of septic episode, hemoglobin, white blood cells, percent of neutrophils, platelets, glucose, urea, potassium, sodium and albumin was performed.
Elevation of NO, XO and AC levels is observed from day 2 (p<0.00001), day 4 (p=0.005) and day 6 (p=0.036), respectively. At the end of follow-up period (day 6), NO production was found to independently correlate with TBSA, glucose levels and percent of neutrophils (p=0.0004), AC with age, hemoglobin and glucose levels (p=0.012), and NOS with proximity of septic episode and glucose levels (p=0.027).
NO production exerts its prophylactic effect from the first 24h after burn, and is independently correlated with severe injury, enhanced neutrophil motivation and augmented glucose levels, thus possibly representing a response to stress. This need might trigger induction of XO and salvage of antioxidants, as suggested by their rise at a later stage. These data underline that an effort to compromise stress and to administer antioxidants could be a priority in the treatment of these patients.
[Show abstract][Hide abstract] ABSTRACT: We present a rare case of a carcinoid tumor of the appendix that was diagnosed during pregnancy in a 24-year-old female. The patient was admitted to our department for acute abdominal pain localized on the right half of the abdomen, mimicking acute appendicitis. Open appendectomy was carried out and at the histological examination carcinoid was found in the surgical specimen. Only few similar cases were found in the literature reporting appendiceal carcinoid tumor during pregnancy.
Journal of B.U.ON.: official journal of the Balkan Union of Oncology 01/2008; 13(2):271-5. · 0.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The mastoid process originates from a recent phylogenetic formation and is currently considered as an evolution of the supper-structures bones. The aim of this study was the detailed description of the anatomic elements of the mastoid and the temporal bone in a large Greek adult corpse material. In total, 298 temporal bones from 149 cadaverous (74 male and 75 female) were examined from 1973 through 1993. Concerning the shape of the mastoid apex 94.0% were normal, while the rest presented several variations No statistically significant difference was revealed between genders. The diameters and axis of the temporal bone presented an independent correlation with gender in a multiple regression model. This prescription may add in easier surgical approach by adding new morphological details directly from the corpse material.
Italian journal of anatomy and embryology = Archivio italiano di anatomia ed embriologia 01/2008; 113(2):117-28.
[Show abstract][Hide abstract] ABSTRACT: tract and on their immunophenotype as specific c-kit expressing and kit signaling driven mesenchymal tumours, most of which have kit-activating mutations 2,3 . We describe herein an unusual case of GIST, due to the combination of morphological and pathological features. Case report A 76 year old woman was initially admitted to our hos-pital for investigation of anemia and of an intra-abdom-inal tumor, which had been identified on physical exam-ination. On admission the patient was well nourished. The pre-senting symptoms were weakness and constipation for Gastrointestinal stromal tumor of the gastric serosa protruding to the greater omentum. Report of a giant tumor with a rare histological pattern. We report an unusual case of a 76 year old woman admitted to our hospital for investigation of anemia and palpable epigastric mass. Intraoperatively a huge (19 cm), well defined tumor was found adhering to the stomach wall, protrud-ing into the greater omentum and compressing the transverse colon. A tumorectomy was performed and the greater omen-tum was removed due to its close relation. Pathology revealed a high risk Gastrointestinal Stromal tumor of the gastric serosa. Histologically the tumor was of mixed type (spindle and epitheliod cells) with hemangiopericytomatoid pattern peripherically, variably myxoid stroma, central necrosis and cytologic pleomorphism. On immunohistochemical examina-tion there was a consistent positivity for c-kit (CD-117) and CD-34, but without myogenic or neural differentiation. We consider this case unusual because of its huge size, its gastric serosal location and its extremely rare histological pat-tern.
[Show abstract][Hide abstract] ABSTRACT: The mastoid apophysis originates from a recent phylogenetic formation, associated with the standing attitude and it is currently considered as an evolution of the bone super-structures. The aim of the present study was to measure the diameters of the mastoid and the temporal bone in the Greek adult population. A total of 298 temporal bones from 149 cadavers (74 male, 75 female) were examined. The distances between six landmarks were measured by means of a pachymeter on both vertical and transverse axes of the mastoids and the temporal bone. The estimated mean values for each dimension were as follows: vertical diameter, 2.37 +/- 0.42 cm; transverse diameter, 2.33 +/- 0.51 cm; anterior margin, 2.12 +/- 0.67 cm; posterior margin, 1.96 +/- 0.55 cm; oblong diameter, 10.30 +/- 0.60 cm; while the mean distance between the mastoid apex and mandibular fossa calva was 3.67 +/- 0.35 cm. Gender differences were detected for the vertical (P < 0.001), the transverse diameter of the mastoid (P < 0.001), the anterior (P < 0.001) and the posterior margin of the mastoid (P < 0.001). In both genders, the vertical diameter of the mastoid was positively correlated with the transverse diameter, as well as with its anterior and posterior margins. In the present study, direct measurements of the mastoid and temporal bone in a Mediterranean population are reported. This description may facilitate a more accurate surgical approach to the temporal bone structures.
Anatomical Science International 09/2007; 82(3):139-46. DOI:10.1111/j.1447-073X.2007.00175.x · 0.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: As part of the multifactorial role of liver in protein synthesis, many coagulation factors, natural anticoagulants, and compounds of the fibrinolytic system are produced in the liver. A prolonged liver disease, either biliary obstruction or parenchymal liver disease, is consecutively accompanied by abnormal clotting. In the present paper we review the haemostasis impairment in obstructive jaundice with special reference to the hepatic cirrhosis and failure, to systemic inflammation and sepsis that develops in cholestatic diseases, and finally in some other benign or malignant diseases including pancreatic adenocarcinoma, acute pancreatitis, cholangiocarcinoma, and hepatocellular carcinoma. Finally, a special reference to the possible therapeutic interventions has been made. The aim of the present review is to collect the current concepts concerning the haemostasis impairment in obstructive jaundice and provide practical guidelines for the diagnostic and therapeutic strategies. Understanding the pathophysiology of haemostatic changes in patients with cholestasis, and, more generally, liver disease, is the hallmark of accurate diagnosis and treatment.
Journal of gastrointestinal and liver diseases: JGLD 07/2007; 16(2):177-86. · 1.85 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Echinococcosis or hydatid cyst disease is a zoonosis caused by the larval cestode Echinococcus granulosus. It consists of a parasitic tapeworm disease affecting mainly liver. Nevertheless, the disease might well spread to more unusual sites such as lungs and brain. The definitive diagnosis of liver echinococcosis requires a combination of imaging, serologic, and immunologic studies. Despite the fact that a number of scolecoidal agents have been developed against liver hydatid disease, the cornerstone of the definitive treatment remains surgery. Both the classic surgical techniques and the recently developed minimally invasive and laparoscopic methods target the eradication of the disease by simultaneously avoiding perioperative spillage and dissemination or recurrence of echinococcosis. The present article constitutes a review of the biology of the parasite as well as the epidemiology, diagnosis, and therapeutic options of the liver hydatid disease.
Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 03/2007; 5(2):152-9. DOI:10.1016/j.cgh.2006.08.017 · 6.53 Impact Factor