Giant dedifferentiated liposarcoma of the gastrocolic ligament: A case report

BACKGROUND

Dedifferentiated liposarcoma (DDLS) has a worse prognosis and occurs most commonly in the retroperitoneal region and rarely in the intraperitoneal region. Histological diagnosis was revolutionized by the combined contributions of histo-immuno-chemistry and molecular biology. Aside from surgery, there is no consensus on the optimal treatment for this chemoresistant cancer.

CASE SUMMARY

A thirty-year-old black female presented with a large painful abdominal mass occupying nearly the entire abdomen and progressive weight loss was admitted for surgery. Abdominal computed tomography showed a large heterogeneous mass of the mesentery that was sized 18 cm × 16 cm in size and had heterogeneous contrast enhancement. During laparotomy, en bloc excision of the large and multilobulated gastrocolic ligament mass was performed. The initial postoperative histopathological diagnosis was undifferentiated sarcoma. Finally, the results of immunohistochemistry and molecular biology allowed us to confirm the diagnosis of DDLS. The tumour followed an aggressive evolution with diffuse metastasis, causing the death of the patient less than 5 mo after the operation.

CONCLUSION

Dedifferentiated liposarcomas are rare tumours that typically originate in the retroperitoneum but may arise in unexpected locations.

A transmural migration of a gossypiboma in the right colon responsible for a mass which mimicked an abscessed colonic tumor: A case report

INTRODUCTION

Gossypiboma or retained surgical sponge is a rare but serious complication of abdominal surgery. Clinical and radiological polymorphism of gossypiboma makes an accurate preoperative diagnosis difficult.

PRESENTATION OF CASE

We report an unusual case of a transmural migration of a gossypiboma in the right colon responsible for a mass which mimicked an abscessed colonic tumor, three years after an open myomectomy. A 40-year-old woman was admitted in emergency with generalized abdominal pain associated with fever. Initially, physical examination revealed an acute localized peritonitis in lower right quadrant. A right pericolic perforated abscess was found. A right hemicolectomy was performed. Surgical specimen dissection revealed an intracolonic surgical sponge.

DISCUSSION

Gossypiboma after laparotomy may present with symptoms of acute surgical or chronic abdominal pain. Radiographs are the most commonly used method to detect retained sponges. Surgery is the preferred method of treatment for gossypiboma.

CONCLUSION

Episodes of atypical colonic obstruction and nonspecific abdominal pain that have occurred for several years in a patient with a history of multiple abdominal surgery should be suggestive of intra-colonic migration of a gossypiboma. The most important approach to reduce the incidence of gossibypomas is prevention.

Delayed, diffuse acute peritonitis secondary to misplacement of a cystogastrostomic "pigtail" drain in an outpatient after discharge

Background and aim of the work: Pancreatic pseudocyst endoscopic drainage by pancreatogastrostomy “pigtail” drain placement is spreading worldwide, with high success-rate and low morbidity, and is increasingly performed as outpatient procedure. The paper reports an unusual very early complication of this procedure and discusses the peculiar aspects of this event in an outpatient setting. Methods: The first case of a 56-year-old outpatient developing a postoperative diffused acute peritonitis by gastric juice spilling caused by the misplacement of the distal end of two transgastric drains not reaching the pseudocyst is reported. As the case was programmed as outpatient and acute peritonitis symptoms occurred eight hours postoperatively, the patient was discharged and rehospitalized. A review of the literature of rare perforative complications of pancreatogastrostomy is performed. Results: CT scan allowed the prompt diagnosis, as it showed massive pneumoperitoneum, free fluid collection, and pigtail drain misplacement. Emergency laparoscopy allowed the removal of the two misplaced drains and gastric reparation. The procedure lasted 65 minutes, mostly needed for lavage. The patient was discharged 5 days later and outcomes are unremarkable 7 months after the procedure. Conclusion: The indication to endoscopic pancreatogastrostomy and its outpatient management should be carefully pondered. Pancreogastrostomy drain misplacement may cause a life-threatening acute peritonitis associated with early aspecific symptoms, resulting in a challenging situation, especially in an outpatient setting. CT-scan may allow prompt diagnosis and effective management by minimally invasive surgery. (www.actabiomedica.it)

Cholecystoparietal Fistula Revealed by an Epigastric Abscess

Cholecystocutaneous fistula, the ultimate complication of abscessed or overlooked acute cholecystitis, is due to perforation of the gallbladder in the abdominal wall. The authors report an unusual case of cholecystoparietal fistula revealed by an epigastric abscess. Fistulography and modern imaging tools make the diagnosis easier. Surgery is the best available treatment.

[Nontraumatic digestive surgical emergencies in elderly patients at the Cocody University Hospital Center in Abidjan, Côte d'Ivoire: etiology and outcome]

OBJECTIVES

The purpose of this retrospective report is to describe etiologies and therapeutic outcomes of nontraumatic abdominal surgical emergencies in elderly patients.

MATERIAL AND METHODS

The charts of patients aged 60 years or more who underwent emergency surgery for nontraumatic abdominal disorders at a Teaching Hospital in Abidjan, Cote d'Ivoire from August 1998 to July 2008 were reviewed. Demographic data, clinical findings, operative protocols, and postoperative outcomes were noted.

RESULTS

A total of 137 patients with a mean age of 68.3 years (range, 60-93 years) underwent emergency surgery for nontraumatic abdominal disorders during the study period. The underlying etiologies were strangulated hernia (n = 40), abdominal parietal abscess (n = 6), bowel obstruction (n = 32), acute diffuse peritonitis (n = 29), acute appendicitis (n = 23), acute cholecystitis (n = 6) and massive rectorragy from colonic diverticulitis (n = 1). Coexisting medical problems (n = 84) were noted in 69 patients. Surgical procedures were tailored to operative findings. Twenty-seven patients were admitted to the intensive care unit in the immediate postoperative period. Mean hospital stay was 7.7 days (range, 2-23 days). Surgical complications included wound infection (n = 14), stoma-related complications (n = 7), digestive fistula (n = 4), scrotal hematoma (n = 5) and postoperative evisceration (n = 2). The mortality rate was 10.21% (n = 14) mainly due to postoperative peritonitis.

CONCLUSION

The findings of this study indicated that most nontraumatic abdominal surgical emergencies in elderly patients were related to complications of neglected or undiagnosed preexisting disease. Prognosis was related to the stage of the disorder, initial surgical management, and deterioration of the coexisting medical problems.

[Colonoscopic perforation: 6 cases in Abidjan, Cote d'Ivoire]

OBJECTIVES

The purpose of this report is to describe diagnostic and therapeutic management of colonoscopic perforation and identify risk factors.

MATERIAL AND METHODS

The charts of 6 patients who underwent surgery for colonoscopic perforation between January 2003 and December 2008 were reviewed. Study data included patient age, indication for colonoscopy, operative findings, repair technique, and outcome.

RESULTS

All 6 perforations occurred during diagnostic colonoscopy. There were 5 females and 1 male. Endoscopy was performed by an experienced operator in 5 cases and by a training fellow in 1. Preparation of the colon was considered as good in 5 cases. The operator reported procedural problems in only 1 case. Diagnosis of perforation was immediate in 5 cases and delayed for 30 hours in 1. The lesion was located in the sigmoid colon in 5 cases and transverse colon in 1. All patients underwent laparotomy. The repair technique consisted of simple closure in 2 cases, closure with colostomy in one, and bowel resection with anastomosis (n=2). Two deaths occurred intraoperatively in I case and postoperatively in 1. The patient who died intraoperatively had not yet undergone repair when death occurred. In both patients who died, laparotomy was performed late in the presence of co-morbidity.

CONCLUSION

Colonic perforation is a rare but severe iatrogenic complication following colonoscopic examination. Early recognition and treatment are essential to optimize outcome. Prevention depends on training to obtain skillful advancement technique.

[Gunshot wound to gravid uterus: a case report]

The authors report the case of a 24-years old pregnant woman gravida 2 para 1 who sustained a gunshot injury at 23 weeks gestation. The bullet injured the rectosigmoid jonction, the jejunum and traversed the uterine cavity with resultant of fatal injury of the fetus. Laparotomy was required for treatment of the maternal injuries. Although a fetus demise was delivered by caesarian section a review of literature indicated that operative delivery should be avoided when the fetus has died already and the gravid uterus don't impaired the surgeon's ability to repair other visceral injuries. But the patient should be followed closely for signs of coagulopathy and intra uterine infection.