1
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Sitaridis K, Domi I, Nathanailidou M, Chatzigiannis G, Boulas KA, Sourtse G, Hatzigeorgiadis A. Air in gallbladder: Emphysematous cholecystitis or else? Clin Case Rep 2023; 11:e6391. [PMID: 36998326 PMCID: PMC10043135 DOI: 10.1002/ccr3.6391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/08/2022] [Accepted: 09/16/2022] [Indexed: 03/30/2023] Open
Abstract
Gas in gallstones represents a rare but well described radiological finding. Other causes of gas in gallbladder include biliary‐enteric fistula, sphincterotomy, gas forming organisms cholangitis. However, gas in gallbladder raises suspicion of emphysematous cholecystitis which necessitates prompt diagnosis and management due to its rapid clinical course and high mortality rate.
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Affiliation(s)
| | - Iliana Domi
- Department of General SurgeryGeneral Hospital of DramaDramaGreece
| | | | | | | | - Gionous Sourtse
- Department of General SurgeryGeneral Hospital of DramaDramaGreece
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2
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Boulas KA, Nathanailidou M, Sitaridis K, Filippidis I, Tsiariglis I, Hatzigeorgiadis A. Non-worrisome scenario of acute abdomen. Clin Case Rep 2023; 11:e6390. [PMID: 36941835 PMCID: PMC10023515 DOI: 10.1002/ccr3.6390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 09/07/2022] [Accepted: 09/16/2022] [Indexed: 03/20/2023] Open
Abstract
Differential diagnosis between benign and life-threatening pneumatosis intestinalis poses a great dianostic dilemma.
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Affiliation(s)
| | | | | | - Isaac Filippidis
- Department of General SurgeryGeneral Hospital of DramaDramaGreece
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3
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Boulas KA, Nathanailidou M, Sitaridis K, Filippidis I, Tsiariglis I, Hatzigeorgiadis A. A case of right inguinal necrotizing skin and soft‐tissue infection. Clin Case Rep 2022; 10:e6349. [PMID: 36415703 PMCID: PMC9675871 DOI: 10.1002/ccr3.6349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 07/23/2022] [Accepted: 08/27/2022] [Indexed: 11/21/2022] Open
Abstract
Mesh infection is the most common complication after elective hernia repair with an increasing incidence with time.
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Affiliation(s)
| | | | | | - Isaac Filippidis
- Department of General Surgery General Hospital of Drama Drama Greece
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4
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Boulas KA, Nathanailidou M, Sitaridis K, Filippidis I, Tsiariglis I, Hatzigeorgiadis A. Intractable low back pain during acute exacerbation of systemic lupus erythematosus. Clin Case Rep 2022; 10:e6198. [PMID: 36093459 PMCID: PMC9440279 DOI: 10.1002/ccr3.6198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/08/2022] [Accepted: 05/20/2022] [Indexed: 11/11/2022] Open
Abstract
Diagnosis of acute low back emergencies during a systemic lupus erythematosus flare necessitates high clinical suspicion and early CT.
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Affiliation(s)
| | | | | | - Isaac Filippidis
- Department of General Surgery General Hospital of Drama Drama Greece
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5
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Boulas KA, Nathanailidou M, Sitaridis K, Filippidis I, Tsiariglis I, Domi I, Hatzigeorgiadis A, Jalalabadi NZ. Large papillary thyroid cancer bed recurrence causing overlying skin ulceration and bleeding. Clin Case Rep 2022; 10:e05939. [PMID: 35865773 PMCID: PMC9294519 DOI: 10.1002/ccr3.5939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/20/2022] [Accepted: 05/20/2022] [Indexed: 01/21/2023] Open
Abstract
Salvage surgery is an acceptable option for palliative treatment of thyroid bed recurrence in metastatic papillary thyroid carcinoma when other non-invasive options fail to control local skin complications.
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Affiliation(s)
| | | | | | - Isaac Filippidis
- Department of General SurgeryGeneral Hospital of DramaDramaGreece
| | | | - Iliana Domi
- Department of General SurgeryGeneral Hospital of DramaDramaGreece
| | | | - Narjes Zarei Jalalabadi
- Department of Internal Medicine, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
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6
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Xenou A, Vranou E, Boulas KA, Nathanailidou M, Kyriakidou E, Sitaridis K, Filippidis I, Hatzigeorgiadis A. Undifferentiated shock in a cirrhotic patient: Ascites matters. Clin Case Rep 2021; 9:e04880. [PMID: 34721848 PMCID: PMC8538012 DOI: 10.1002/ccr3.4880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 08/08/2021] [Accepted: 09/12/2021] [Indexed: 11/15/2022] Open
Abstract
In cirrhotic patients with undifferentiated shock, early CT with emphasis in ascitic fluid density should be performed to exclude rare causes of shock such as secondary peritonitis or hemoperitoneum.
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Affiliation(s)
- Antigoni Xenou
- Department of RadiologyGeneral Hospital of DramaDramaGreece
| | - Eugenia Vranou
- Department of RadiologyGeneral Hospital of DramaDramaGreece
| | | | | | | | | | - Isaac Filippidis
- Department of General SurgeryGeneral Hospital of DramaDramaGreece
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7
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Xenou A, Vranou E, Boulas KA, Nathanailidou M, Kyriakidou E, Sitaridis K, Filippidis I, Hatzigeorgiadis A. Difficult diagnosis of an air-containing, abscess-like, and mass-like pancreatic head lesion. Clin Case Rep 2021; 9:e04817. [PMID: 34603726 PMCID: PMC8465923 DOI: 10.1002/ccr3.4817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/08/2021] [Accepted: 08/29/2021] [Indexed: 11/10/2022] Open
Abstract
Duodenal diverticulosis can be a difficult CT diagnosis and should be considered in the differential diagnosis when a periduodenal mass-like structure that may contain air, air-fluid level, or oral contrast material is depicted.
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Affiliation(s)
- Antigoni Xenou
- Department of RadiologyGeneral Hospital of DramaDramaGreece
| | - Eugenia Vranou
- Department of RadiologyGeneral Hospital of DramaDramaGreece
| | | | | | | | | | - Isaac Filippidis
- Department of General SurgeryGeneral Hospital of DramaDramaGreece
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8
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Xenou A, Boulas KA, Nathanailidou M, Kyriakidou E, Paraskeva A, Triantafyllidis A, Chatzipourganis K, Hatzigeorgiadis A. An unusual case of obstructive uropathy. Clin Case Rep 2021; 9:e04569. [PMID: 34429987 PMCID: PMC8365403 DOI: 10.1002/ccr3.4569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/23/2021] [Accepted: 06/23/2021] [Indexed: 11/28/2022] Open
Abstract
Although inguinal bladder hernia associated with obstructive uropathy is an extremely rare entity, it should be suspected in elderly patients with bladder outlet obstruction presented with inguinal hernia and lower urinary tract symptoms.
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Affiliation(s)
- Antigoni Xenou
- Department of General SurgeryGeneral Hospital of DramaDramaGreece
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9
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Xenou A, Vranou E, Boulas KA, Nathanailidou M, Kyriakidou E, Sitaridis K, Filippidis I, Hatzigeorgiadis A. Procedure of choice in a patient initially operated for a suspected epithelial appendiceal neoplasm. Clin Case Rep 2021; 9:e04437. [PMID: 34267916 PMCID: PMC8271256 DOI: 10.1002/ccr3.4437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/08/2021] [Accepted: 05/11/2021] [Indexed: 11/10/2022] Open
Abstract
In patients operated for a suspected appendiceal neoplasm, radical appendectomy is the procedure of choice because it provides definitive treatment in most of appendiceal neoplasms, except from mucinous or colonic-type adenocarcinoma and NET>2 cm.
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Affiliation(s)
- Antigoni Xenou
- Department of RadiologyGeneral Hospital of DramaDramaGreece
| | - Eugenia Vranou
- Department of RadiologyGeneral Hospital of DramaDramaGreece
| | | | | | | | | | - Isaac Filippidis
- Department of General SurgeryGeneral Hospital of DramaDramaGreece
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10
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Boulas KA, Paraskeva A, Triantafyllidis A, Nathanailidou M, Chatzipourganis K, Hatzigeorgiadis A. Mystery of the lost gallstone-Part 2. Clin Case Rep 2020; 8:3623-3624. [PMID: 33364008 PMCID: PMC7752498 DOI: 10.1002/ccr3.3368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/27/2020] [Accepted: 08/30/2020] [Indexed: 11/07/2022] Open
Abstract
If gallbladder perforation occurs during cholecystectomy, every spilled gallstone should be retrieved to minimize possible late gallstone-related complications.
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11
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Triantafyllidis A, Paraskeva A, Boulas KA, Nathanailidou M, Chatzipourganis K, Hatzigeorgiadis A. Aorto-cutaneous fistula from an infected ascending aorta graft resulting in massive hemorrhage after a Valsalva maneuver for a heavy weight lift. Clin Case Rep 2020; 8:2289-2290. [PMID: 33235779 PMCID: PMC7669390 DOI: 10.1002/ccr3.3089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/23/2020] [Accepted: 06/07/2020] [Indexed: 11/07/2022] Open
Abstract
In the setting of an infected prosthetic ascending thoracic aorta, prompt and definitive surgical treatment is mandatory to avoid catastrophic bleeding complications.
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12
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Paraskeva A, Triantafyllidis A, Boulas KA, Nathanailidou M, Chatzipourganis K, Hatzigeorgiadis A. Mystery of the lost gallstone-Part 1. Clin Case Rep 2020; 8:2310-2311. [PMID: 33235788 PMCID: PMC7669422 DOI: 10.1002/ccr3.3129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 06/13/2020] [Indexed: 12/03/2022] Open
Abstract
If gallbladder perforation occurs during laparoscopic cholecystectomy, every spilled gallstone should be retrieved to minimize possible late gallstone-related septic complications.
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13
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Blouhos K, Boulas KA, Paraskeva A, Triantafyllidis A, Nathanailidou M, Hatzipourganis K, Hatzigeorgiadis A. Understanding Surgical Risk During COVID-19 Pandemic: The Rationale Behind the Decisions. Front Surg 2020; 7:33. [PMID: 32574344 PMCID: PMC7256454 DOI: 10.3389/fsurg.2020.00033] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/11/2020] [Indexed: 12/13/2022] Open
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14
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Boulas KA, Paraskeva A, Triantafyllidis A, Hatzigeorgiadis A. A case of massive primary tumor growth in the immediate postoperative period. Clin Case Rep 2020; 8:580-581. [PMID: 32185067 PMCID: PMC7069871 DOI: 10.1002/ccr3.2679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 11/27/2019] [Accepted: 01/02/2020] [Indexed: 12/02/2022] Open
Abstract
Major surgical trauma along with discontinuation of antiangiogenic treatment can exacerbate primary tumor growth even in the immediate postoperative period.
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15
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Boulas KA, Paraskeva A, Triantafyllidis A, Hatzigeorgiadis A. Unexplained isolated acute severe thrombocytopenia after surgery for a recurrent malignant retroperitoneal tumor presenting with colon perforation: A case study of a disastrous complication. Int J Surg Case Rep 2020; 67:91-94. [PMID: 32045860 PMCID: PMC7015829 DOI: 10.1016/j.ijscr.2020.01.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/22/2020] [Accepted: 01/24/2020] [Indexed: 11/17/2022] Open
Abstract
Thrombocytopenia in cancer patients is correlated with poor prognosis. Drugs, sepsis, HIT, DIC, ITP are the most common causes of postoperative thrombocytopenia. Prompt diagnosis is essential as management varies considerably depending on etiology. Secondary ITP has not previously been associated with a retroperitoneal tumor. Kasabach-Merritt syndrome has not previously been associated with a retroperitoneal tumor.
Introduction Tumor- or treatment- induced thrombocytopenia in solid cancer patients is common. In the postoperative setting, diagnosis of thrombocytopenia become more complex as infection, sepsis, drugs and transfusion come also into the equation. Presentation of case Herein, the case an otherwise-healthy 71-year-old male patient with a sizable recurrent malignant retroperitoneal tumor under pazopanib admitted with colon perforation and submitted to emergency left colectomy with end transverse colostomy is presented. Immediate postoperative period characterized by massive primary tumor growth and isolated acute severe thrombocytopenia. The patient treated with combined prednisone, IVIg and platelets transfusion along with medication discontinuation with no response. Discussion Sepsis-, drug- and heparin-induced thrombocytopenia, disseminated intravascular coagulopathy and secondary (sepsis-, drug-, transfusion- or tumor-induced) immune thrombocytopenia (ITP) were included in the differential diagnosis. Based on exclusion, secondary drug- or tumor-induced ITP was the most prominent diagnosis. Concomitant presentation of thrombocytopenia along with massive primary tumor growth made Kasabach-Merritt syndrome also a probable diagnosis. However, neither secondary ITP nor Kasabach-Merritt syndrome has previously been associated with a retroperitoneal tumor in the literature. Conclusion Although management of thrombocytopenia depends on etiology, in our patient’s case the diagnosis of secondary ITP and directed management did not result in a successful outcome.
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Affiliation(s)
- K A Boulas
- Department of General Surgery, General Hospital of Drama, Drama, Greece.
| | - A Paraskeva
- Department of General Surgery, General Hospital of Drama, Drama, Greece
| | - A Triantafyllidis
- Department of General Surgery, General Hospital of Drama, Drama, Greece
| | - A Hatzigeorgiadis
- Department of General Surgery, General Hospital of Drama, Drama, Greece
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16
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Boulas KA, Paraskeva A, Hatzigeorgiadis A. Emergencies in an Advanced Stage Parkinson's Disease Patient. Gastroenterology 2020; 158:e1-e2. [PMID: 31326415 DOI: 10.1053/j.gastro.2019.07.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 07/15/2019] [Indexed: 12/02/2022]
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17
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Blouhos K, Boulas KA, Paraskeva A, Gravalidou I, Chatzipourganis K, Triantafyllidis A, Hatzigeorgiadis A. Preoperative endoscopic tattooing for colonic polyp localization: From blue to black. Clin Case Rep 2019; 7:2258-2259. [PMID: 31788295 PMCID: PMC6878057 DOI: 10.1002/ccr3.2428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/12/2019] [Accepted: 08/22/2019] [Indexed: 11/23/2022] Open
Abstract
When surgical polypectomy and not segmental resection is planned, preoperative endoscopic tattooing with high-volume undiluted methylene blue should be avoided as it can result in colon perforation.
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18
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Blouhos K, Boulas KA, Paraskeva A, Triantafyllidis A, Kariotis I, Hatzigeorgiadis A. A misdiagnosed cause of early postoperative bowel obstruction. Clin Case Rep 2019; 7:832-833. [PMID: 30997096 PMCID: PMC6452497 DOI: 10.1002/ccr3.2052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 01/04/2019] [Accepted: 01/26/2019] [Indexed: 11/11/2022] Open
Abstract
In the setting of altered anatomy, diagnosis of superior mesenteric artery syndrome requires high clinical and imaging suspicion as the defined imaging criteria cannot be applied.
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Affiliation(s)
| | | | | | | | - Ioannis Kariotis
- Department of General SurgeryGeneral Hospital of DramaDramaGreece
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19
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Kirmanidis M, Boulas KA, Paraskeva A, Kariotis I, Barettas N, Kariotis S, Keskinis C, Hatzigeorgiadis A. Extensive colonic pneumatosis in a patient on adjuvant chemotherapy after right colectomy for primary terminal ileum lymphoma: A decision-making process between surgical and non-surgical management. Int J Surg Case Rep 2018; 52:84-88. [PMID: 30336386 PMCID: PMC6197732 DOI: 10.1016/j.ijscr.2018.09.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 09/21/2018] [Accepted: 09/29/2018] [Indexed: 02/07/2023] Open
Abstract
Pneumatosis intestinalis can be benign or life-threatening. Life-threatening causes are bowel obstruction, perforation, ischemia and severe colitis. Differential diagnosis between life-threatening and benign pneumatosis intestinalis is difficult. Early severity recognition is critical as it would dictate surgical or conservative management. Surgery is needed when worrisome clinical, laboratory and imaging findings are present.
Introduction Pneumatosis intestinalis is a rare condition that may be idiopathic or a sign of numerous underlying gastrointestinal, pulmonary and systemic diseases. Presentation of case Herein, the case an otherwise-healthy 82-year-old female patient with vague abdominal pain due to total colonic pneumatosis 20 days after completion of R-CHOP chemotherapy for a stage IIE primary non-Hodgkin’s lymphoma of the terminal ileum submitted to right hemicolectomy and ileal resection 6 months previously is presented. As no evidence of intramural bowel gas was present on pre-operative CT, pneumatosis coli considered to be secondary. As no worrisome clinical, laboratory and imaging findings were present, pneumatosis coli seemed to be benign. As no other etiologic factors identified, pneumatosis coli considered to be chemotherapy-induced. The patient treated conservatively with cessation of enteral nutrition and broad spectrum antibiotics with uneventfull recovery. Discussion Pneumatosis intestinalis can be benign or life-threatening. Bowel obstruction, perforation, ischemia and severe colitis represent the most life-threatening causes. In clinical practice it is often challenging to distinguish between life-threatening and benign pneumatosis intestinalis, a decision which should be based on the presence or absence of worrisome clinical, laboratory and imaging findings. Conclusion In analogous cases, the main dilemma for the physicians is to identify whether surgical intervention is required or not. Given the potential severity of pneumatosis intestinalis, early diagnosis and recognition of its severity is critical as it would dictate surgical or non-surgical management.
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Affiliation(s)
- M Kirmanidis
- Department of General Surgery, General Hospital of Drama, Drama, Greece
| | - K A Boulas
- Department of General Surgery, General Hospital of Drama, Drama, Greece.
| | - A Paraskeva
- Department of General Surgery, General Hospital of Drama, Drama, Greece
| | - I Kariotis
- Department of General Surgery, General Hospital of Drama, Drama, Greece
| | - N Barettas
- Department of General Surgery, General Hospital of Drama, Drama, Greece
| | - S Kariotis
- Department of General Surgery, General Hospital of Drama, Drama, Greece
| | - Ch Keskinis
- Department of General Surgery, General Hospital of Drama, Drama, Greece
| | - A Hatzigeorgiadis
- Department of General Surgery, General Hospital of Drama, Drama, Greece
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20
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Blouhos K, Boulas KA, Tsalis K, Barettas N, Paraskeva A, Kariotis I, Keskinis C, Hatzigeorgiadis A. Meckel's Diverticulum in Adults: Surgical Concerns. Front Surg 2018; 5:55. [PMID: 30234126 PMCID: PMC6129587 DOI: 10.3389/fsurg.2018.00055] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 08/15/2018] [Indexed: 12/20/2022] Open
Abstract
Since Meckel's diverticulum (MD) is rarely diagnosed in adults, there is no consensus on what type of procedure to be performed for symptomatic MD and whether to resect or not an accidentally discovered MD. Treatment of symptomatic MD is definitive surgery, including diverticulectomy, wedge, and segmental resection. The type of procedure depends on: (a) the integrity of diverticulum base and adjacent ileum; (b) the presence and location of ectopic tissue within MD. The presence of ectopic tissue cannot be accurately predicted intraoperatively by palpation and macroscopic appearance. When present, its location can be predicted based on height-to-diameter ratio. Long diverticula (height-to-diameter ratio >2) have ectopic tissue located at the body and tip, whereas short diverticula have wide distribution of ectopic tissue including the base. When indication of surgery is simple diverticulitis, diverticulectomy should be performed for long and wedge resection for short MD. When indication of surgery is complicated diverticulitis with perforated base, complicated intestinal obstruction and tumor, wedge, or segmental resection should be performed. When the indication of surgery is bleeding, wedge and segmental resection are the preferred methods for resection. Regarding management of incidentally discovered MD, routine resection is not indicated. The decision making should be based on risk factors for developing future complications, such as: (1) patient age younger than 50 years; (2) male sex; (3) diverticulum length >2 cm; and (4) ectopic or abnormal features within a diverticulum. In this case, diverticulectomy should be performed for long and wedge resection for short MD.
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Affiliation(s)
| | | | - Konstantinos Tsalis
- Fourth Surgical Department, George Papanikolaou Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Barettas
- Department of General Surgery, General Hospital of Drama, Drama, Greece
| | | | - Ioannis Kariotis
- Department of General Surgery, General Hospital of Drama, Drama, Greece
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21
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Blouhos K, Boulas KA, Paraskeva A, Kariotis I, Barettas N, Hatzigeorgiadis A. Obstructive jaundice as primary presentation of a stage IIE Non-Hodgkin lymphoma: A decision making process between advanced lymphoma and locally advanced/metastatic pancreatic adenocarcinoma. Int J Surg Case Rep 2018; 44:226-229. [PMID: 29547849 PMCID: PMC5857486 DOI: 10.1016/j.ijscr.2018.02.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 02/23/2018] [Accepted: 02/26/2018] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Secondary pancreatic tumors are uncommon and account for 2-5% of pancreatic cancer. Tumors characterized most commonly with pancreatic involvement are lymphoma, renal cell and lung carcinomas. PRESENTATION OF CASE A 76-year-old female patient with obstructive jaundice as the primary symptom and inguinal lymphadenopathy is presented. Imaging revealed a bulky solitary solid pancreatic head mass along with paraaortic and mesenteric lymphadenopathy. The absence of a previous history of malignancy and the presence of a dominant pancreatic mass along with distal lymphadenopathy confined differential diagnosis to advanced secondary pancreatic lymphoma, which is the most common secondary pancreatic tumor, and locally advanced/metastatic pancreatic adenocarcinoma. Pathologic confirmation with excisional biopsy of an enlarged inguinal lymph node and EUS-FNB of the pancreatic head mass confirmed the diagnosis of secondary Non-Hodgkin pancreatic lymphoma allowing initiation of induction chemotherapy. DISCUSSION Secondary pancreatic lymphoma can be seen up to 30% of patients with advanced lymphoma; although the head of the pancreas is the most common location, obstructive jaundice is not the predominant symptom as obstruction of the common bile duct is usually absent. In the setting of a solitary nodular type pancreatic mass, key imaging findings highly suggestive of secondary pancreatic lymphoma and not of adenocarcinoma are the absence of vascular invasion, bile and pancreatic duct obstruction, and the presence of lymphadenopathy below the level of the left renal vein. CONCLUSION When a secondary pancreatic tumor is highly suspected pathologic confirmation is always needed before initiation of induction or palliative chemotherapy.
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Affiliation(s)
- K Blouhos
- Department of General Surgery, General Hospital of Drama, Drama, Greece
| | - K A Boulas
- Department of General Surgery, General Hospital of Drama, Drama, Greece.
| | - A Paraskeva
- Department of General Surgery, General Hospital of Drama, Drama, Greece
| | - I Kariotis
- Department of General Surgery, General Hospital of Drama, Drama, Greece
| | - N Barettas
- Department of General Surgery, General Hospital of Drama, Drama, Greece
| | - A Hatzigeorgiadis
- Department of General Surgery, General Hospital of Drama, Drama, Greece
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Blouhos K, Boulas KA, Tsalis K, Barettas N, Aftzoglou M, Hatzigeorgiadis A. Recurrence of a pT2N0cM0 Lower Third Gastric Cancer with No. 6 Lymph Node Micrometastasis after R0 Extended Surgery. Should Adjuvant Therapy be Performed in Conventionally Node-Negative but Micrometastasis-Positive pT2 Gastric Cancer? J Gastrointest Cancer 2017; 48:89-93. [PMID: 26907363 DOI: 10.1007/s12029-016-9811-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
| | | | - Konstantinos Tsalis
- D' Surgical Department, G. Papanikolaou Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Barettas
- Department of General Surgery, General Hospital of Drama, Drama, Greece
| | - Michail Aftzoglou
- Department of General Surgery, General Hospital of Drama, Drama, Greece
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Blouhos K, Boulas KA, Hatzigeorgiadis A. Clinical significance of lymph nodes micrometastasis in conventionally node-negative advanced gastric cancer. Updates Surg 2017; 69:425-426. [PMID: 28210961 DOI: 10.1007/s13304-017-0420-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 02/06/2017] [Indexed: 01/08/2023]
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Blouhos K, Boulas K, Tsalis K, Hatzigeorgiadis A. The isoattenuating pancreatic adenocarcinoma: Review of the literature and critical analysis. Surg Oncol 2015; 24:322-8. [DOI: 10.1016/j.suronc.2015.09.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 09/13/2015] [Accepted: 09/30/2015] [Indexed: 02/07/2023]
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Blouhos K, Boulas KA, Tsalis K, Hatzigeorgiadis A. Management of afferent loop obstruction: Reoperation or endoscopic and percutaneous interventions? World J Gastrointest Surg 2015; 7:190-195. [PMID: 26425267 PMCID: PMC4582236 DOI: 10.4240/wjgs.v7.i9.190] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 06/21/2015] [Accepted: 07/23/2015] [Indexed: 02/06/2023] Open
Abstract
Afferent loop obstruction is a purely mechanical complication that infrequently occurs following construction of a gastrojejunostomy. The operations most commonly associated with this complication are gastrectomy with Billroth II or Roux-en-Y reconstruction, and pancreaticoduodenectomy with conventional loop or Roux-en-Y reconstruction. Etiology of afferent loop obstruction includes: (1) entrapment, compression and kinking by postoperative adhesions; (2) internal herniation, volvulus and intussusception; (3) stenosis due to ulceration at the gastrojejunostomy site and radiation enteritis of the afferent loop; (4) cancer recurrence; and (5) enteroliths, bezoars and foreign bodies. Acute afferent loop obstruction is associated with complete obstruction of the afferent loop and represents a surgical emergency, whereas chronic afferent loop obstruction is associated with partial obstruction. Abdominal multiple detector computed tomography is the diagnostic study of choice. CT appearance of the obstructed afferent loop consists of a C-shaped, fluid-filled tubular mass located in the midline between the abdominal aorta and the superior mesenteric artery with valvulae conniventes projecting into the lumen. The cornerstone of treatment is surgery. Surgery includes: (1) adhesiolysis and reconstruction for benign causes; and (2) by-pass or excision and reconstruction for malignant causes. However, endoscopic enteral stenting, transhepatic percutaneous enteral stenting and direct percutaneous tube enterostomy have the principal role in management of malignant and radiation-induced obstruction. Nevertheless, considerable limitations exist as a former Roux-en-Y reconstruction limits endoscopic access to the afferent loop and percutaneous approaches for enteral stenting and tube enterostomy have only been reported in the literature as isolated cases.
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Blouhos K, Boulas KA, Tsalis K, Barettas N, Aftzoglou M, Hatzigeorgiadis A. Report of two Cases with Metastasis in Lymph NodesAlong the Posterior Leaf of the Bursa Omentalis at the Area of the Pancreatic Body, an Area not Routinely Examined in Standard Gastrectomy Plus Bursectomy for Advanced Gastric Cancer. J Gastrointest Cancer 2015; 47:436-441. [PMID: 26334194 DOI: 10.1007/s12029-015-9756-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Konstantinos Blouhos
- Department of General Surgery, General Hospital of Drama, End of Hippokratous Street, 66100, Drama, Greece
| | - Konstantinos A Boulas
- Department of General Surgery, General Hospital of Drama, End of Hippokratous Street, 66100, Drama, Greece.
| | - Konstantinos Tsalis
- D' Surgical Department, "G. Papanikolaou" Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Barettas
- Department of General Surgery, General Hospital of Drama, End of Hippokratous Street, 66100, Drama, Greece
| | - Michail Aftzoglou
- Department of General Surgery, General Hospital of Drama, End of Hippokratous Street, 66100, Drama, Greece
| | - Anestis Hatzigeorgiadis
- Department of General Surgery, General Hospital of Drama, End of Hippokratous Street, 66100, Drama, Greece
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Hatzigeorgiadis A, Boulas KA, Barettas N, Blouhos K. Bilateral primary spontaneous pneumothorax in an otherwise-healthy overweight young man. J Surg Case Rep 2014; 2014:rju076. [PMID: 25084792 PMCID: PMC4118078 DOI: 10.1093/jscr/rju076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Bilateral primary spontaneous pneumothorax (BPSP) is a rare condition, accounting for ∼1.6% of spontaneous pneumothoraces. Patients with primary spontaneous pneumothorax have typically low body weight. BPSP in overweight/obese patients is an exceptionally rare event. The present report describes a case of an otherwise-healthy 20-year-old male patient with BMI 29.8 kg/m2 presented to our hospital owing to low-intensity chest pain and shortness of breath 7 days after the onset of symptoms. Plain chest X-ray revealed the presence of bilateral pneumothorax. Chest tubes were inserted on both sides. During hospitalization, a computed tomography demonstrated multiple blebs on the surface of the upper lobes of both lungs. Hereupon, the patient referred to a tertiary center and underwent elective single-stage minimally invasive bilateral video-assisted thoracoscopic surgery. The present case report shows that BPSP in overweight/obese patients is an existing condition.
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Affiliation(s)
| | | | - Nikolaos Barettas
- Department of General Surgery, General Hospital of Drama, Drama, Greece
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Blouhos K, Boulas KA, Salpigktidis I, Barettas N, Hatzigeorgiadis A. Ectopic spleen: An easily identifiable but commonly undiagnosed entity until manifestation of complications. Int J Surg Case Rep 2014; 5:451-4. [PMID: 24973525 PMCID: PMC4147574 DOI: 10.1016/j.ijscr.2014.05.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 05/14/2014] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Ectopic spleen is an uncommon clinical entity as splenectomy for treatment of ectopic spleens accounts for less than 0.25% of splenectomies. The most common age of presentation is childhood especially under 1 year of age followed by the third decade of life. PRESENTATION OF CASE The present report refers to a patient with torsion of a pelvic spleen treated with splenectomy. The patient exhibited a period of vague intermittent lower abdominal pain lasted 65 days followed by a period of constant left lower quadrant pain of increasing severity lasted 6 days. On the first 65 days, vague pain was attributed to progressive torsion of the spleen which resulted in venous congestion. On the last 6 days, exacerbation of pain was attributed to irreducible torsion, infraction of the arterial supply, acute ischemia, strangulation and rupture of the gangrenous spleen. Diagnosis was made by CT which revealed absence of the spleen in its normal position, a homogeneous pelvic mass with no contrast enhancement, free blood in the peritoneal cavity, and confirmed by laparotomy. DISCUSSION Clinical manifestations of ectopic spleen vary from asymptomatic to abdominal emergency. Symptoms are most commonly attributed to complications related to torsion. Operative management, including splenopexy or splenectomy, is the treatment of choice in uncomplicated and complicated cases because conservative treatment of an asymptomatic ectopic spleen is associated with a complication rate of 65%. CONCLUSION Although an ectopic spleen can be easily identified on clinical examination, it is commonly misdiagnosed until the manifestation of complications in adulthood.
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Affiliation(s)
| | | | - Ilias Salpigktidis
- Department of General Surgery, General Hospital of Drama, Drama, Greece.
| | - Nikolaos Barettas
- Department of General Surgery, General Hospital of Drama, Drama, Greece.
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Hatzigeorgiadis A, Boulas KA, Barettas N, Papageorgiou I, Blouhos K. Tube pancreatico-duodenostomy for management of a severe penetrating pancreaticoduodenal injury. JOP 2014; 15:250-253. [PMID: 24865536 DOI: 10.6092/1590-8577/2499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 05/14/2014] [Indexed: 06/03/2023]
Abstract
CONTEXT Optimal management of penetrating pancreaticoduodenal injuries and better outcomes are associated with simple, fast damage control surgery and shorter operative time. The performance of pyloric exclusion and tube duodenostomy has markedly decreased. However, there is still a trend toward their performance in cases of delay duodenal repair or severe pancreaticoduodenal injury. CASE REPORT The present report describes a case of a hemodynamically stable patient with a single penetrating gunshot trauma causing an AAST-OIS grade III pancreatic head injury and grade IV injury of the second portion of the duodenum. The patient was treated in our Level IV rural trauma center and submitted to primary closure of the posterolateral duodenal wall (the laceration of the contralateral inner medial duodenal wall could not be repaired), external duodenal and pancreatic drainage, and duodenal decompression by tube pancreatico-duodenostomy (insertion of a 18 Fr Foley catheter through the laceration of the pancreatic head toward the duodenal lumen), tube cholangiostomy, and pyloric exclusion accompanied with a feeding jejunostomy. CONCLUSIONS Tube pancreatico-duodenostomy, which is described for the first time in the literature, turned out to be effective and can be considered as an option in pancreaticoduodenal trauma when the inner medial duodenal wall cannot be repaired.
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Blouhos K, Boulas KA, Tsalis K, Hatzigeorgiadis A. Jejunal Pouch Recurrence after Extended Surgery for Gastric Cancer: Report of a Case. J Gastrointest Cancer 2014; 45 Suppl 1:148-50. [DOI: 10.1007/s12029-014-9602-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Blouhos K, Boulas KA, Katsaouni SP, Salpigktidis II, Mauroeidi B, Ioannidis K, Hatzigeorgiadis A. Connecting tube colonic erosion and gastrocolic fistula formation following late gastric band erosion. Clin Obes 2013; 3:158-61. [PMID: 25586631 DOI: 10.1111/cob.12023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 05/10/2013] [Accepted: 06/02/2013] [Indexed: 12/23/2022]
Abstract
Band erosion is a rare complication of laparoscopic adjustable gastric banding (LAGB) with a reported prevalence varying from 0.3% to 14%. Intraluminal colonic erosion of the connecting tube is very rare, as only isolated cases have been described. Consequently, simultaneous gastric band erosion and connecting tube colonic erosion is an extremely rare event. Herein, we present a case of a woman with morbid obesity, who submitted to LABG 4 years ago. The patient presented with symptoms and signs of right lower quadrant peritonitis. Computed tomography (CT) demonstrated migration of the band into the gastric lumen, inflammation around the intra-abdominal course of the connecting tube and an inflammatory mass surrounding the tube at the right lower quadrant. Laparotomy revealed the eroded band, the eroded transverse colon from the connecting tube, a gastrocolic fistula along the course of the tube and a right lower quadrant phlegmon. The connecting tube was mobilized from the surrounding adherent tissues, the gastric band removed, the stomach and colon walls closed, and the gastrocolic fistula excised. To our knowledge this is the second case of concurrent band erosion and connecting tube colonic erosion along with gastrocolic fistula formation in a patient with morbid obesity treated with LAGB.
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Affiliation(s)
- K Blouhos
- Department of General Surgery, General Hospital of Drama, Drama, Greece
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Blouhos K, Boulas KA, Salpigktidis II, Konstantinidou A, Ioannidis K, Hatzigeorgiadis A. Total Reconstruction of the Afferent Loop for Treatment of Radiation-Induced Afferent Loop Obstruction with Segmental Involvement after Pancreaticoduodenectomy with Roux-en-Y Reconstruction. Case Rep Oncol 2013; 6:424-9. [PMID: 24019782 PMCID: PMC3764962 DOI: 10.1159/000354576] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
As the literature on afferent loop obstruction (ALO) after pancreaticoduodenectomy (PD) is very limited, standardized rules for its management do not exist. Herein, we report the case of a 65-year-old male patient with chronic ALO who had undergone PD with single Roux-en-Y limb reconstruction and adjuvant chemoradiation therapy for pancreatic head adenocarcinoma 2 years earlier. The patient was brought to the operating room with the diagnosis of radiation enteritis of the afferent loop with segmental involvement and concurrent hepaticojejunostomy (HJ) and pancreaticojejunostomy (PJ) stricture. Complete mobilization of the afferent loop, removal of the affected segment and reconstruction were performed. Reconstruction of the afferent loop was a one-way option for the surgeons because the Roux-en-Y reconstruction limited endoscopic access to the afferent loop, and the segmental radiation injury of the afferent loop ruled out bypass surgery. However, mobilization of the affected segment through a field of dense adhesions and revision of the HJ and PJ were technically demanding.
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Blouhos K, Boulas KA, Tselios DG, Katsaouni SP, Mauroeidi B, Hatzigeorgiadis A. Surgically proved visually isoattenuating pancreatic adenocarcinoma undetected in both dynamic CT and MRI. Was blind pancreaticoduodenectomy justified? Int J Surg Case Rep 2013; 4:466-9. [PMID: 23562894 DOI: 10.1016/j.ijscr.2013.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 02/03/2013] [Accepted: 02/13/2013] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Visually isoattenuating pancreatic adenocarcinoma is defined as a mass not directly visible on CT and recognizable only by secondary imaging signs. The frequency of isoattenuating pancreatic adenocarcinomas at dynamic-enhanced CT has been reported to range from 5.4% to 14%. Furthermore, 80% of the visually isoattenuating pancreatic adenocarcinomas are detectable in dynamic-enhanced MRI. Consequently, a pancreatic adenocarcinoma undetected in both the above imaging studies is an exceptionally rare event. PRESENTATION OF CASE The present report describes a case of a histologically proved 3.5cm pancreatic adenocarcinoma undetected in both dynamic-enhanced CT and MRI. The patient presented with progressive jaundice over the preceding 20 days. Initial abdominal CT showed a dilated pancreatic and common bile duct without demonstration of a lesion responsible for the clinical and imaging findings. Additional diagnostic work-up with dynamic CT and dynamic MRI failed to reveal a definitive mass. ERCP revealed an irregular interruption of the pancreatic and distal common bile duct with upstream dilation. Blind radical pancreaticoduodenectomy was performed. Histologic examination showed a pT3pN1MO pancreatic ductal adenocarcinoma of the head/neck. DISCUSSION Isoattenuating pancreatic adenocarcinoma patients represent a small but meaningful subset of patients with pancreatic cancer, as they have better survival. The more favorable postsurgical survival makes it even more imperative to correctly diagnose their cases at early stages by obtaining further diagnostic work-up with dynamic pancreatic CT, dynamic MRI and endoscopic ultrasound. CONCLUSION When the above studies fail to unmask the lesion, blind pancreaticoduodenectomy should be based on strong clinical suspicion and secondary imaging findings.
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Blouchos K, Boulas KA, Tselios DG, Hatzigeorgiadis A, Kirtsis P. Iatrogenic vas deferens injury due to inguinal hernia repair. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/s13126-012-0052-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Boulas K, Blouhos KA, Hatzigeorgiadis A. Acute massive gastric dilation: an unusual presentation of metastatic urinary bladder cancer. Ann Gastroenterol 2013; 26:183. [PMID: 24714843 PMCID: PMC3959946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 09/26/2012] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Konstantinos A. Blouhos
- Department of General Surgery, General Hospital of Drama, Drama, Greece,
Correspondence to: Konstantinos A. Boulas, MD, Department of General Surgery, General Hospital of Drama, End of Hippokratous Street, 66100 Drama, Greece, Tel.: +30 6937 265675, Fax: +30 2513 501559, e-mail:
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