12 research outputs found
Abdominal apoplexy: rupture of short gastric artery after retching
No full textAbdominal apoplexy, or idiopathic spontaneous intraperitoneal hemorrhage (ISIH), is a rare but often fatal condition resulting from a variety of disease processes affecting abdominal vasculature. A 30-year-old woman presented with acute abdominal pain and breathlessness and was in class II hypovolemic shock. She had a history of multiple episodes of retching with non-bilious vomiting prior to that. Computed tomography (CT) reported a non-rotation of the gut, gross intraperitoneal free fluid with debris, and possible perforated appendicitis. Laparoscopy revealed a gross hemoperitoneum of 2.5 L, with bowel findings consistent with non-rotation of the gut, but technical difficulty in identifying the source of bleeding led to conversion to laparotomy. A ruptured short gastric artery was ascertained to be the source of bleeding and was successfully ligated. A retrospective review of the preoperative CT showed intraperitoneal free fluid with Hounsfield unit measurements of 48 and 52, suggestive of acute hemoperitoneum. ISIH is often a delayed diagnosis or missed diagnosis due to its low incidence. The presence of vomiting and abdominal pain with hypovolemic shock, especially in a young individual, should raise the suspicion of ISIH, which can be confirmed via early CT imaging to facilitate achieving hemostasis during surgery
Traumatic abdominal wall hernia after impact from handlebar: A case report
No full textTraumatic abdominal wall hernia (TAWH) is a rare type of hernia resulting from blunt abdominal trauma. It develops following the inertia of sudden, high-energy blunt trauma or focused low energy impact. A 22-year-old motorcyclist presented to the emergency department following a collision with an automobile. Clinical examination demonstrated a bulging mass at the lower abdomen, resulting from impact with the motorcycle handlebar. A contrast-enhanced CT scan of the abdomen revealed a disruption of both rectus abdominis muscle and linea alba at the lower abdomen with loops of small bowels and mesentery herniating through the defect, associated with multiple air pockets and pneumoperitoneum. Exploratory laparotomy showed TAWH containing loops of small bowel and mesentery in addition to mesenteric tears. Small bowel resection with primary anastomosis and repair of the anterior abdominal wall defect using interrupted polypropylene sutures was performed. The patient recovered well postoperatively and was discharged home three days later. A follow-up at 1 year showed no evidence of recurrence
Managing traumatic testicular dislocations: what we know after two centuries
No full textTraumatic testicular dislocation (TTD) is a rare consequence of blunt scrotal trauma. A 21-year old gentleman presented with inguinal pain following a motorcycle accident and physical examination revealed absence of both testes within a well-formed scrotal sac with bilateral inguinal swellings. Ultrasonography confirmed viability and location of the testes at the superficial inguinal pouch. He underwent emergent surgical reduction with orchidopexy and was discharged the next day. No evidence of testicular dysfunction or atrophy was noted at follow-up. We reviewed reports of TTDs reported in English over the last two centuries and discuss its occurrence, evolution and managemen
A Huge Primary Retroperitoneal Diffuse Large B-cell Lymphoma: A Case Report
No full textRetroperitoneal diffuse large B-cell lymphoma (DLBCL) is generally rare and often presents with late symptoms. A 60-year-old female presented with abdominal pain for 3 days with associated symptoms of altered bowel habits and constitutional symptoms. Physical examination was unremarkable. The blood investigations were generally within normal limits except for a 10-fold rise in serum CA-125. Transabdominal ultrasonography revealed an ill-defined lesion, with a cystic component within, at the inferior pole of the spleen. Computed tomography scan showed a large lobulated soft tissue tumour in the left retroperitoneal space with local infiltration to adjacent organs with multiple subcentimeter para-aortic and aortocaval lymph nodes. Laparotomy revealed a locally advanced retroperitoneal tumour measuring 10 x 10cm in size. The left retroperitoneal tumour was resected en-bloc with the left kidney, the spleen, the distal part of the pancreas and a part of the left diaphragm. Histopathological examination of the retroperitoneal tumour revealed a DLBCL (germinal centre type) as CD10, CD20, and BCL-6 were positive among all the markers, confirming the final diagnosis. She was started on CHOP regimen chemotherapy and is currently well. A complete en-bloc resection of the retroperitoneal lymphoma is recommended in fit patients with resectable retroperitoneal tumours. The decision between core needle biopsy and surgical resection should be made on a case-by-case basis following a multidisciplinary team approach discussion to achieve the best outcome for these patients
Robotic complete mesocolic excision for right colon cancer: Learning curve, training, techniques, approach, platforms, and future perspectives
No full textColon cancer has the fifth highest incidence worldwide and has the sixth highest mortality. Compared with rectal cancer, colon cancer currently has the worst 5-year overall survival for patients with stage II and III disease. Complete mesocolic excision has been developed as a standardized and optimized surgical technique for the excision of colon cancers. This technique has traditionally been performed through an open approach since laparoscopy is generally considered technically challenging. The robotic approach has been slowly implemented for colon cancer, but the newest robotic platforms allow for a safer and optimized approach for right colon cancer. Several robotic approaches have been developed and explored. The expansion of the current robotic platform ecosystem is gradually providing new outputs in the application of the robotic approach to complete mesocolic excision. This review gains an oversight of existing literature on robotic complete mesocolic excision for right colon cancer (learning curve, training, techniques, approach, platforms, and future perspectives)
Giant submandibular sialolipoma masquerading as huge goitre: a case report
No full textBackground: Sialolipoma is a rare tumour which may arise from both major and minor salivary glands and has recently been described as a variant of salivary gland lipomatous lesions. Case presentation: We report a 54-year-old male who presented with a 7-year history of large right anterior neck swelling. He was clinically euthyroid and had no compressive or infiltrative symptoms. He sought medical attention due to the discomfort exerted by the weight of the mass and was keen for excision. The swelling appeared like a goitre but physical examination proved otherwise. Imaging was suggestive of a benign tumour arising from the right parapharyngeal fossa. The mass was surgically excised and was noted to be adherent to part of the submandibular gland. Histopathological examination revealed a new variant of benign adipocytic tumour of salivary gland or sialolipoma arising from the submandibular gland. Besides being the largest sialolipoma to be reported, there are also no reports of giant submandibular sialolipomas masquerading as a huge goitre in appearance. Conclusion: Submandibular sialolipomas can present in really large sizes and appear as a giant goitre. It is important to differentiate between benign lipomas from liposarcomas and tailor the management accordingly. Surgical enucleation is the preferred choice of treatment for these benign tumours with low recurrence rates
Surgery for deep infiltrating rectal endometriosis-Selecting the right approach
No full textEndometriosis involving the bowel is a form of deep infiltrating endometriosis (DIE). The endometriotic lesions can infiltrate the bowel layers mimicking a malignancy. The majority of bowel involvement happens in the colon and rectum. We report our experience in surgically managing rectal endometriosis in two patients, one via a conservative approach and the other with a more radical approach and their associated short-term and long-term outcomes are observed. In principle, surgery remains the mainstay of treatment in managing rectal DIE with adjuvant hormonal therapy. The selection of surgical approach should be based on disease factors such as the size of the lesions and extent of the disease, patient factors including fitness for surgery and expectations as well as logistics and resource limitations
Knowledge, attitudes and practices of using Indocyanine Green (ICG) fluorescence in emergency surgery: an international web-based survey in the ARtificial Intelligence in Emergency and trauma Surgery (ARIES)—WSES project
No full textFluorescence imaging is a real-time intraoperative navigation modality to enhance surgical vision and it can guide emergency surgeons while performing difficult, high-risk surgical procedures. The aim of this study is to assess current knowledge, attitudes, and practices of emergency surgeons in the use of indocyanine green (ICG) in emergency settings. Between March 08, 2023 and April 10, 2023, a questionnaire composed of 27 multiple choice and open-ended questions was sent to 200 emergency surgeons who had previously joined the ARtificial Intelligence in Emergency and trauma Surgery (ARIES) project promoted by the WSES. The questionnaire was developed by an emergency surgeon with an interest in advanced technologies and artificial intelligence. The response rate was 96% (192/200). Responders affirmed that ICG fluorescence can support the performance of difficult surgical procedures in the emergency setting, particularly in the presence of severe inflammation and in evaluating bowel viability. Nevertheless, there were concerns regarding accessibility and availability of fluorescence imaging in emergency settings. Eighty-seven out of 192 (45.3%) respondents have a fluorescence imaging system of vision for both elective and emergency surgical procedures; 32.3% of respondents have this system solely for elective procedures; 21.4% of respondents do not have this system, 15% do not have experience with it, and 38% do not use this imaging in emergency surgery. Less than 1% (2/192) affirmed that ICG fluorescence changed always their intraoperative decision-making. Precision surgery effectively tailors surgical interventions to individual patient characteristics using advanced technology, data analysis and artificial intelligence. ICG fluorescence can serve as a valid and safe tool to guide emergency surgery in different scenarios, such as intestinal ischemia and severe acute cholecystitis. Due to the lack of high-level evidence within this field, a consensus of expert emergency surgeons is needed to encourage stakeholders to increase the availability of fluorescence imaging systems and to support emergency surgeons in implementing ICG fluorescence in their daily practice
Head-down tilt lithotomy position and well-leg compartment syndrome: An international survey of current practice
No full textAim: Well-leg compartment syndrome (WLCS) is a serious complication of prolonged surgery in the head-down tilt lithotomy (HDTL) position associated with increased postoperative morbidity and mortality. However, there is a lack of awareness and clinical guidance regarding prevention of WLCS. The aim of this study was to assess current HDTL-related practices and occurrence of WLCS among a global cohort of clinicians. Method: An international online survey of clinicians was conducted between July and December 2023. Data analysis involved descriptive statistics, machine learning techniques and qualitative content analysis. Results: A total of 595 clinicians from 71 countries and 14 specialities participated. Most (98%) reported routine use of HDTL, 27% of whom did not implement any preventive strategies. 'Leg rest' was the most reported preventive measure (41%), commonly initiated after 2 or 3 h of HDTL (79%), for 10-15 min (56%). Overall, 170 cases of WLCS were reported by 21% of respondents. The majority reported unilateral WLCS (81%) following a laparoscopic procedure (63%) performed in HDTL (64%). Only 28% of respondents discussed WLCS during consent for operations in HDTL. Machine learning identified 'duration of uninterrupted HDTL' as a positive predictor of the occurrence of WLCS (p < 0.001). Content analysis demonstrated that clinician perspectives and practices regarding WLCS are significantly influenced by personal experience, mostly due to a poor evidence base and lack of standardized institutional policies. Conclusion: Perioperative practices during procedures in HDTL vary substantially, and are primarily informed by clinician experience and preferences. There is a need for evidence-based consensus on best practices to enhance safety during procedures in HDTL
A prognostic model for use before elective surgery to estimate the risk of postoperative pulmonary complications (GSU-Pulmonary Score): a development and validation study in three international cohorts
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