7 research outputs found
Begleitappendektomie: ja oder nein?
No full textZusammenfassung
Hintergrund Die Appendizitis stellt mit über 50% die häufigste operationsbedürftige akute intraabdominelle Erkrankung dar. Häufig wird aber auch im Rahmen anderer Operationen eine simultane bzw. prophylaktische Appendektomie, auch als Begleitappendektomie (BA) bezeichnet, durchgeführt.
Ziel der Arbeit Inwieweit eine BA im Rahmen anderer Haupteingriffe gerechtfertigt erscheint, wurde in dieser Studie überprüft.
Patienten und Methode In dieser prospektiven Studie wurden alle Patienten (n = 173) erfasst, die im Katharinen-Hospital Unna im Zeitraum vom 1.1.2010 bis 30.10.2013 simultan konventionell appendektomiert wurden. Folgende Variablen wurden untersucht: Alter, Geschlecht, Art der Primäroperation, Notfall- oder Elektivoperation, Komplikationen, Letalität, intraoperative und histopathologische Beurteilung der Appendix. Zusätzlich erfolgte eine postoperative Kontaktaufnahme in Form eines Fragebogens.
Ergebnisse Intra- wie postoperativ zeigten sich keine BA-spezifischen Komplikationen. 117 Patienten (68%) nahmen an der postoperativen Befragung mittels Fragebogen teil. Ein Anteil von 15% der Patienten hatte in der Vergangenheit eine Symptomatik geboten, die auf eine Appendixreizung zurückzuführen sein könnte. Insgesamt zeigten bis auf einen einzigen unauffälligen Befund alle BA-Präparate pathologische Befunde in der histologischen Untersuchung. Insbesondere erfolgte durch die BA die frühzeitige Diagnosestellung von 4 Adenomen, einem neuroendokrinen Tumor und 6 Metastasen bzw. Peritonealkarzinoseherden.
Diskussion In Anbetracht der fehlenden Komplikationen und der Verhinderung einer Reoperation im Falle einer späteren Appendizitis sowie der Früherkennung maligner Befunde sehen wir die BA als präventiv ethisch vertretbar an.</jats:p
A Rare Case of Primary Cutaneous Adenoid Cystic Carcinoma
No full textPrimary cutaneous adenoid cystic carcinoma (PCACC) isa rare skin malignancy first reported in the 1970s with limited number of cases found in the literature. These neoplasms are typically identified in middle-to-older-age individuals and are mostly located in the scalp and neck region but can identified throughout the body. We describe the case of a 67-year-old male patient that presented to our department with a slow-growing nodule in the left gluteal region that turned out to be a PCACC and analyze the differential diagnosis, radiology, histopathological findings and successful treatment with a wide local excision. Current literature on the subject is also presented and discussed
Spontaneous Splenic Rupture Secondary to Infectious Mononucleosis
No full textSpontaneous splenic rupture (SSR) is a relatively rare but potentially lethal complication of infectious mononucleosis (IM). While SSR is extremely rare in patients with proven IM, it is the most lethal complication of the infection (9% mortality rate) and can present completely asymptomatically or with abdominal pain and hemodynamic instability. As adolescents and young adults are the most affected population group, with this case report, we intend to raise the vigilance of any doctor treating those patients in the emergency department. We present the case of a 16-year-old patient with an atraumatic splenic rupture and hemoperitoneum secondary to an Epstein–Barr virus (EBV) infection. The patient underwent an exploratory laparotomy, and a splenectomy was performed. This case demonstrates that, even if SSR in patients with IM is extremely rare, it should always be considered in a patient with a relevant clinical presentation
Small Bowel Obstruction Masking a Perforated Dermoid Ovarian Cyst
No full textA 58-year-old female presented with abdominal pain, vomiting and constipation. Laboratory tests indicated elevated white blood cell count and C-reactive protein levels. Imaging via CT scan revealed a large cystic mass in the right ovary, abscesses and generalized small bowel distension, which initially raised suspicion of the existence of ovarian cancer with peritoneal carcinomatosis. Despite conservative management, the patient’s condition did not improve, prompting a laparotomy. Intraoperative findings included generalized peritonitis, significant small bowel dilation due to inflammatory adhesions and a perforated dermoid ovarian cyst. The cyst was resected and a prophylactic ileostomy was installed. Histopathological examination confirmed the diagnosis of a benign dermoid ovarian cyst. This case illustrates the rare presentation of a perforated dermoid cyst mimicking peritoneal carcinomatosis and emphasizes the importance of considering such complications in the differential diagnosis of bowel obstruction and peritoneal disease. Early recognition and appropriate surgical intervention are crucial for optimal outcomes
A Unique Case of Unilateral Pseudogynecomastia
No full textBackground/Objectives: Gynecomastia is a common condition characterized by the benign enlargement of male breast tissue, often resulting from hormonal imbalances. A rare variant, unilateral pseudogynecomastia, involves enlargement due to adipose tissue accumulation without glandular proliferation and can be associated with occupational factors. Methods: We report the case of a 45-year-old male mechanic presenting with unilateral enlargement of the left breast. The patient reported daily microtrauma on his left axilla and chest wall. The clinical evaluation and imaging revealed lipomatosis with pronounced fibrous tissue and no glandular tissue involvement. The hormonal assays were within the normal limits. The patient underwent surgical excision of excess adipose tissue using the Kornstein technique, preserving the nipple–areola complex. Results: The histopathological examination confirmed the absence of malignancy. The postoperative recovery was uneventful, and the follow-up examination at 12 months demonstrated a symmetrical breast appearance with no recurrence. This case underscores the importance of differentiating pseudogynecomastia from true gynecomastia and recognizing potential occupational risks. Surgical management using techniques that preserve the nipple–areola complex can achieve excellent cosmetic outcomes
Spontaneous Transvaginal Small Bowel Evisceration After Laparoscopic Hysterectomy
No full textVaginal cuff dehiscence can be a rare complication of total hysterectomy, with an estimated prevalence of 0.032% to 1.25% and a high mortality rate of 6 to 10%. Dehiscence is also reported in cases following total laparoscopic hysterectomy, with a prevalence of 0.87%. This case report details the emergency management of a 59-year-old female who complained of abdominal and pelvic pain and the feeling of a foreign body in her vagina. The patient reported a history of laparoscopic total hysterectomy 6 months prior to presenting at the Emergency Department. A clinical examination revealed small bowel loops protruding through the vagina. The patient underwent exploratory laparotomy through a Pfannenstiel incision, and the terminal ileum was found prolapsing through the vaginal cuff. The bowel loops were identified as viable and the vagina was sutured. The patient had an unremarked post operative course. This case report showcases that in patients with transvaginal evisceration, immediate surgical management is crucial in order to avoid serious life threatening complications, and both surgeons and gynecologists should remain vigilant regarding this pathology
The Challenging Management of Short Bowel Syndrome
No full textA 62-year-old female presented to the Emergency Department of the General Hospital of Katerini, Greece, complaining of abdominal pain, fever, and general discomfort. Laboratory tests indicated an elevated white blood cell count and an elevated C-reactive protein level. A computed tomography (CT) scan revealed dilated small bowel loops and free intraperitoneal fluid. During laparotomy, extensive ischemia and necrosis of both the small and large bowel were discovered, and a resection of the small bowel and the right colon was performed, leaving the patient with only 90 cm of small intestine and a jejunocolic anastomosis. Postoperative management was particularly challenging, requiring a multidisciplinary approach, an intensive care unit stay, reoperations due to anastomotic leaks, continuous parenteral nutrition and electrolyte management, and aggressive antibiotic treatment for persistent bacterial infections. This case report highlights the importance of appropriate management of this life-threatening complication following extensive bowel resection
