Robersonmejer5592
Colonic lipomatosis is defined as a poorly circumscribed, non-capsulated fat accumulation in the submucosal layer of the colonic wall. Clinical presentation varies from asymptomatic to acute surgical complications.
We report the case of a 79-year old male who arrived at the Emergency Department complaining of worsening abdominal pain, fever and nausea. A CT scan revealed a periappendicular abscess extended to the ileocecal valve and also the presence of diffuse intramural fatty tissue of the ascending colon. The patient underwent surgery and a right hemicolectomy was performed. The final histological exam confirmed the diagnosis of gangrenous appendicitis with diffuse abscessualization of the ileocecal valve and the presence of submucosal lipomatosis of the ICV extending to the ascending colon. Patient was discharged at 11th-POD.
Acute appendicitis can represent a complication, although rare, of colonic lipomatosis. The underlying mechanism can be explained by the obstruction of the stool discharge from the appendix caused by the thickened colonic wall due to lipomatosis. Despite the lack of established guidelines on the management of colonic lipomatosis, surgery remains the preferred treatment in case of acute complications.
Acute appendicitis is a rare clinical manifestation of colonic lipomatosis. As in the case of other acute complications, such as intussesception, surgery remains the preferred therapeutic approach.
Acute appendicitis is a rare clinical manifestation of colonic lipomatosis. As in the case of other acute complications, such as intussesception, surgery remains the preferred therapeutic approach.
Visceral artery aneurysms are a relatively uncommon but potentially devastating pathology. The most common site is the splenic artery followed by the hepatic (Stanley et al., 1986) [1]. In the event of rupture, mortality has been estimated at anywhere between 20% and 100% (Schweigert et al., 2011) [2]. Emergency surgery in such a scenario has previously been dependent on an open approach with high morbidity and mortality associated (Schweigert et al., 2011) [2]. The advent of endovascular techniques may improve both short and long term outcomes as highlighted in this case.
We present the case of a ruptured common hepatic artery aneurysm presenting with acute abdominal pain and haemodynamic instability. Minimally invasive surgery in the form of endovascular repair via two covered stents from the coeliac trunk in to the splenic artery (excluding flow in to the common hepatic artery aneurysm) allowed for immediate management without the significant morbidity and mortality with which open surgery is associated.
This resulted in resolution of acute haemorrhage while liver perfusion was maintained via the portal vein and arterial collaterals. Follow-up highlighted both short and medium term success.
This case highlights that endovascular management in the case of visceral artery aneurysm rupture is a viable option while also portraying several important anatomic considerations essential to hepatic perfusion.
This case highlights that endovascular management in the case of visceral artery aneurysm rupture is a viable option while also portraying several important anatomic considerations essential to hepatic perfusion.
Anorectal malignant melanoma is an uncommon and highly malignant disease with a greater incidence in females. Many patients were misdiagnosed as hemorrhoids, benign polyps, and rectal cancer. They were often diagnosed in an advanced stage. Wide local excision and abdominoperineal resection are the main treatments of rectal melanoma.
A case report is a 77-year-old man who has blood in the stool for 4 months without clinical examination. He admitted to the emergency room with sudden syndromes that related to bowel perforation. Rectal examination detected a large anorectal polyp. Computer tomography showed free air and fluid in the peritoneal cavity. He was received laparoscopic surgery and found the fishbone penetrated the sigmoid colon without polyp resection. The polyp was treated by local excision a few days later. The histology examination was a primary malignant melanoma. Due to the pigmented lesion that remained from the resected polyp's root, the abdominoperineal resection was performed as a radical treatment.
Diagnosis of anorectal malignant melanoma is difficult because of atypical signs, that are confused with bleeding hemorrhoids especially an amelanotic melanoma. Treatment is controversial, including surgery, radiotherapy, chemotherapy, and target therapy. A present case is an option in radical surgery.
Anorectal melanoma is a rare disease with poor results and prognosis. A lack of large-data leads to a missing evidence-based guideline in this disease. Early-staging diagnosis and surgical treatment help patients improve their overall survival.
Anorectal melanoma is a rare disease with poor results and prognosis. A lack of large-data leads to a missing evidence-based guideline in this disease. Early-staging diagnosis and surgical treatment help patients improve their overall survival.
Closure of the abdominal wall defect by myocuteous thigh flap is an option. The aim of this paper is to report a case of abdominal wall defect covered by bilateral anterolateral myocutaneous thigh flap.
A 45-year-old female presented with a large defect in the anterior abdominal wall. It was decided to cover the wound with bilateral anterolateral myocutaneous thigh flap as the defect was so large to be filled with a single flap. Under general anesthesia, a flap was elevated lateral to a line joining mid inguinal point to the lateral epicondyle, the flap was rotated under inguinal skin and sutured to the defect. The procedure was repeated for the contralateral side two weeks later.
Lower abdominal wall defects can be reconstructed by the use of the combined technique of sublay technique, intraperitoneal mesh placement, pedicled great omentum flap and rotation skin graft, also tensor fascia lata has been proven to be a safe and versatile flap.
Bilateral anterolateral myocutaneous thigh flap is practical whenever indicated. It is best suited for covering of the lower abdominal defects.
Bilateral anterolateral myocutaneous thigh flap is practical whenever indicated. It is best suited for covering of the lower abdominal defects.
The occurrence of synchronous abdominal aorta aneurysms and colorectal cancer represents a real management challenge. Up till now, there is no evidence-based consensus recommendation in the surgical management of such patients. Herein we reported the clinical management challenge of synchronous abdominal aorta aneurysms (AAA) and colorectal cancer (CRC).
78-year-old man was admitted in our structure for acute abdominal pain, vomiting and constipation. His past medical history included type 2 diabetes, arterial hypertension and a stable infra-renal aortic aneurysm documented 2 years ago. Physical examination found a stable patient with blood pressure and heart rate within normal range, pulsatile mass along with abdominal distension with vital signs within normal limits. Abdominal CT scan and subsequent CT angiogram confirmed an 88 × 75 mm infra-renal aortic aneurysm concomitant with considerable lumen reduction due to asymmetric wall thickening of the sigmoid. Colonoscopy combined with biopsy examination confirmed structuring irregular sigmoid adenocarcinoma Therefore we report a case of a large AAA and concomitant sigmoid adenocarcinoma tumor causing stricture.
In such situation, the main controversy is the necessity of treating the diseases simultaneouslor in two stages favoring the AAA management first. To our best knowledge, we report the first case published in literature in which the patient was treated for colorectal cancer first by laparoscopic surgery followed by AAA management with EVAR.
In this case report, we highlight some tricks required in performing laparoscopic sigmoid colectomy for patient with large AAA to prevent per-operative pitfalls. Evidence-based consensus is required to determine the optimal surgical treatment.
In this case report, we highlight some tricks required in performing laparoscopic sigmoid colectomy for patient with large AAA to prevent per-operative pitfalls. Evidence-based consensus is required to determine the optimal surgical treatment.The proliferation of Advanced Vehicle Technologies (AVTs) has generated both excitement and concern among researchers, policymakers, and the general public. An increasing number of driver assistance systems are already available in today's automobiles; many of which are expected to become standard. Therefore, synthesizing the available evidence specific to the safety of AVTs is critical. The goal of this scoping review was to summarize this evidence with a focus on AVTs that require some driver oversight (i.e., Levels 0-3 as per the Society of Automotive Engineers (SAE) levels of automation taxonomy). A scoping review of research literature on AVTs was conducted for studies up to March 2018. Inclusion criteria consisted of any study with empirical data of AVTs that included male and female drivers aged 16 years and older, healthy people (i.e., without impairments), passenger vehicles, driving simulators and/or large databases with road safety information that could be analyzed for the purpose of examining AVThaving a positive effect on driving safety, although the nature and design of studies varied widely. Our examination of this evidence highlights the opportunities as well as the challenges involved with investigating AVTs. Ensuring such technologies are congruent with the needs of drivers, particularly younger and older driver age groups, who are known to have a higher crash risk, is critical. With automotive manufacturers keen to adopt the latest AVTs, this scoping review highlights how testing of this technology has been undertaken, with a focus on how new research can be conducted to improve road safety now and in the future.
To examine the quadriceps strength (QUADS) on the surgical (SURG) and non-surgical (Non-SURG) limbs in adolescent male and female athletes at pre-operative (PRE), 12 weeks post-operative (12WK), and return to sport (RTS) time points following ACL injury and reconstruction.
Prospective cohort study design.
Clinical Research Laboratory.
66 adolescent athletes.
Isokinetic QUADS of the SURG and Non-SURG limbs at the PRE, 12WK, and RTS time points were assessed and compared between each time point.
Both male and female participants had significantly lower 12 WK QUADS in the SURG limb than the PRE QUADS, but the RTS QUADS was significantly greater than the 12WK QUAD (p<0.05). However, only female participants had greater RTS QUADS as compared to the PRE QUADS (p<0.001). For the Non-SURG limb, only male participants had a significant improvement over time (PRE vs RTS; p<0.001).
Adolescent males and females differ in their QUADS recovery across the continuum of care following ACLR. Clinicians should consider this pattern of recovery when treating adolescent males and females.
Adolescent males and females differ in their QUADS recovery across the continuum of care following ACLR. Clinicians should consider this pattern of recovery when treating adolescent males and females.
