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Almasri MS, Hakeam HA, Alnajashi NS, Alzamil LA, Azzam AZ, Amin TM. Cytoreductive Surgery with Bidirectional Intraoperative Chemotherapy (BDIC) Using Intravenous Ifosfamide Plus Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Patients with Peritoneal Sarcomatosis: A Retrospective Cohort Study. Ann Surg Oncol 2024; 31:2368-2377. [PMID: 38172447 DOI: 10.1245/s10434-023-14786-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Peritoneal sarcomatosis (PS) is a rare tumor with limited therapeutic options. Bidirectional intraoperative chemotherapy (BDIC) using intravenous ifosfamide and doxorubicin-based hyperthermic intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery (CRS) is an emerging treatment for peritoneal malignancies. PATIENTS AND METHODS Patients with PS who underwent CRS/BDIC using intravenous ifosfamide and HIPEC from January 2017 to July 2021 were retrospectively analyzed. The last follow-up date was May 2022. RESULTS A total of 29 patients were included. Overall survival (OS) rates at 6, 12, 24, and 48 months after CRS/BDIC were 93.1%, 89.2%, 81.4%, and 73.3%, respectively. As of May 2022, 6 patients (20.6%) had died, including four (13.8%) with a proven recurrent tumor and two with incomplete tumor resection [completeness of cytoreduction (CC)-2 or CC-3]. Of the 20 patients (68.9%) with CC-0 or CC-1, 7 had locoregional tumor recurrence without distant metastasis, whereas the other 13 were alive with no evidence of recurrent tumor in May 2022. Disease recurrence rates were 15% at 6 months and 35% at 12, 24, and 48 months after CRS/BDIC. Clavien-Dindo class ≥ IIIa complications developed in 9 patients (31.0%) with no deaths. Leukopenia occurred in 5 patients (17.2%) and thrombocytopenia in 12 patients (41.3%); these hematologic abnormalities resolved. A total of 9 (31.0%) patients developed nephrotoxicity; all recovered except one, who progressed to chronic kidney disease. CONCLUSIONS CRS/BDIC using intravenous ifosfamide and doxorubicin-based HIPEC is a potentially effective treatment for PS and has an acceptable rate of complications.
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Affiliation(s)
- Mohammed S Almasri
- Department of Surgery, Academic and Training Affairs, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
| | - Hakeam A Hakeam
- Pharmaceutical Care Division, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Norah S Alnajashi
- Department of Surgery, Academic and Training Affairs, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Lana A Alzamil
- Biostatics, Epidemiology, and Science Computing Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ayman Z Azzam
- Department of Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Tarek M Amin
- Department of Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Alaswad M, Sabbah BN, Aleem MU, Naguib R, Azzam AZ, Amin TM. Treatment of recurrent malignant pheochromocytoma with a novel approach: A case report and review of literature. Int J Surg Case Rep 2024; 117:109504. [PMID: 38503158 PMCID: PMC10963217 DOI: 10.1016/j.ijscr.2024.109504] [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: 01/22/2024] [Revised: 03/03/2024] [Accepted: 03/07/2024] [Indexed: 03/21/2024] Open
Abstract
INTRODUCTION Pheochromocytomas are rare catecholamine-secreting tumors with a high potential for recurrence post-surgery, necessitating prolonged follow-up. This case highlights the diagnostic and therapeutic challenges in managing recurrent pheochromocytoma. CASE PRESENTATION A 25-year-old female, with a history of left pheochromocytoma treated with adrenalectomy a decade earlier, presented with a right adrenal mass. Despite controlled hypertension, elevated urine metanephrines suggested recurrence. Imaging showed a right adrenal mass and suspicious left paraaortic lymph nodes, confirming the diagnosis of recurrent malignant pheochromocytoma in the left adrenal bed and right adrenal gland, with metastasis to the paraaortic lymph nodes. The patient underwent right adrenalectomy coupled with cytoreductive surgery (CRS) in the form of excision of left-sided adrenal bed recurrence and left paraaortic lymph node dissection, intraoperative radiation therapy (IORT), and hyperthermic intraperitoneal chemotherapy (HIPEC). On follow-up six years later, the patient remains free from recurrence. DISCUSSION This case illustrates the importance of continued surveillance in pheochromocytoma patients, even those with a low-risk profile. The recurrence in this case, despite a smaller initial tumor size and no genetic predispositions, underscores the unpredictable nature of pheochromocytomas. The successful management with CRS, IORT, and HIPEC emphasizes the need for a personalized and multifaceted treatment approach. CONCLUSION Pheochromocytoma patients, including those initially considered low risk, require long-term monitoring due to the risk of recurrence. The utilization of CRS, IORT, and HIPEC in this case was pivotal in managing the recurrent and metastatic malignant disease effectively, demonstrating the significance of a comprehensive, multidisciplinary treatment strategy in such complex cases.
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Affiliation(s)
- Marwan Alaswad
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
| | | | | | - Rania Naguib
- Internal Medicine Department, College of Medicine, Princess NouNrah Bint Abdul Rahman University, Riyadh, Saudi Arabia
| | - Ayman Z Azzam
- Department of Surgery, Surgical Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; Department of General Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Tarek M Amin
- Department of Surgery, Surgical Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Alaswad M, Saleh T, Alaidaros F, Otry AA, Azzam AZ, Amin TM. Ancient schwannoma in the right iliac fossa: A case report and review of literature. Radiol Case Rep 2024; 19:1195-1199. [PMID: 38259703 PMCID: PMC10801131 DOI: 10.1016/j.radcr.2023.12.028] [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: 10/01/2023] [Revised: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
Ancient schwannomas are a rare variation of schwannomas, with the distinction being based on histopathological examination of the excised specimen. On histopathological examination, ancient schwannomas exhibit degenerative changes such as calcification, hyalinization, and cystic necrosis, along with S100 positivity. Complete surgical excision is the mainstay treatment for ancient schwannomas and carries a favorable prognosis. Recurrence is the most common complication, often arising from incomplete surgical excision. Herein, we present a case of a 41-year-old male who presented to our center as a case of a retroperitoneal mass for further investigations and diagnostic workup. Imaging showed a retroperitoneal mass in the right iliac fossa. We proceeded with ultrasound guided needle biopsy, and examination of the specimen confirmed the diagnosis of ancient schwannoma. Subsequently, the patient underwent surgery, and complete surgical excision was achieved. On follow-up 3-months later, the patient is doing well, and no signs of recurrence were found.
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Affiliation(s)
- Marwan Alaswad
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Tariq Saleh
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | | | - Ayman Z. Azzam
- Department of Surgery, Surgical oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- Department of General Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Tarek M. Amin
- Department of Surgery, Surgical oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Alaswad M, ElKordy F, Jaamour HW, Otry AA, Azzam AZ, Amin TM, Khoja HA. A 51-Year-Old Woman with Advanced Peritoneal Mesothelioma and Stage 3b Chronic Kidney Disease Treated with Cytoreductive Surgery and Bidirectional Intraperitoneal Cisplatin and Ifosfamide Chemotherapy: A Case Report. Am J Case Rep 2023; 24:e941726. [PMID: 38093612 PMCID: PMC10728880 DOI: 10.12659/ajcr.941726] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/07/2023] [Accepted: 11/03/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Malignant mesotheliomas are rare, yet highly malignant tumors. Mesotheliomas are tumors that develop from mesothelial surfaces, with the pleura being the most common, followed by the peritoneum. The diagnosis of malignant peritoneal mesothelioma (MPM) is usually established when the disease is advanced, owing to the nonspecific clinical appearance and abdominal symptoms. Initially, MPM was treated with palliative systemic chemotherapy, with or without palliative surgery. However, cytoreductive surgery (CRS) combined with bidirectional intraoperative chemotherapy (BDIC) has recently emerged as a treatment option for MPM. BDIC creates a bidirectional chemotherapy gradient in the peritoneal tumor cells through the simultaneous use of intraperitoneal and intravenous chemotherapy. CRS, combined with BDIC (CRS-BDIC), allows the complete elimination of residual tiny tumor cells after complete removal of the visible tumor nodules. CASE REPORT Herein, we present a case of a 51-year-old woman with MPM and chronic kidney disease (CKD) stage 3b. Her treatment consisted of neoadjuvant chemotherapy and immunotherapy, followed by CRS-BDIC using intraperitoneal cisplatin and doxorubicin, and intravenous ifosfamide. The surgery was successful, with no immediate complications or decline in the patient's kidney function. On follow up 2 months later, the patient denies suffering any chemotherapy-related adverse effects, and her kidney profile remains stable. CONCLUSIONS In conclusion, nephrotoxicity, a known adverse effect of cisplatin and ifosfamide, might not be a contraindication for the use of these potentially nephrotoxic drugs in CRS-BDIC in patients with renal impairment.
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Affiliation(s)
- Marwan Alaswad
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Fadwa ElKordy
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Heba W. Jaamour
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Ayman Z. Azzam
- Department of Surgery, Surgical Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- Department of General Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Tarek M. Amin
- Department of Surgery, Surgical Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Hatim A. Khoja
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Amin T, Azzam AZ, AlBatati SK, AlHossan AM. Adamantinoma Metastasis to the Pelvis and Ovaries: A Case Report and Literature Review. Cureus 2023; 15:e50087. [PMID: 38186466 PMCID: PMC10770573 DOI: 10.7759/cureus.50087] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2023] [Indexed: 01/09/2024] Open
Abstract
Adamantinoma, constituting a minute fraction of primary bone tumors, poses a diagnostic challenge due to its ambiguous histogenesis. This report outlines a distinctive case involving a 27-year-old female with a history of right tibial adamantinoma, presenting with bilateral pulmonary emboli and metastasis to the ovaries and pelvic lymph nodes. Following en bloc resection five years earlier, the patient underwent debulking surgery with hyperthermic intraperitoneal chemotherapy (HIPIC) and intraoperative radiotherapy (IORT) as a palliative measure. The procedure achieved substantial pelvic tumor reduction, and subsequent follow-ups indicated a favorable postoperative trajectory. This case underscores the rarity of adamantinoma metastasis to the ovaries and pelvis, being the first reported instance, shedding light on the challenges and potential benefits of a multimodal palliative approach. Further research is warranted to refine treatment strategies for metastatic adamantinoma and enhance patient outcomes.
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Affiliation(s)
- Tarek Amin
- Surgical Oncology Department, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Ayman Z Azzam
- General Surgery Department, Faculty of Medicine, Alexandria University, Alexandria, EGY
- Surgical Oncology Department, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Saud K AlBatati
- Orthopedic Surgery, King Fahad Military Medical Complex, Dhahran, SAU
- College of Medicine, Alfaisal University, Riyadh, SAU
| | - Abdullah M AlHossan
- Orthopedic Surgery, King Fahad Military Medical Complex, Dhahran, SAU
- College of Medicine, Alfaisal University, Riyadh, SAU
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Almesned R, Azzam AZ, Aldeheshi A, Amin TM. Bidirectional Intraoperative Chemotherapy Using Cisplatin and Ifosfamide for Intraperitoneal Mesothelioma in Severe Renal Impairment: A Case Report. Am J Case Rep 2023; 24:e938192. [PMID: 36964641 PMCID: PMC10052470 DOI: 10.12659/ajcr.938192] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND Malignant peritoneal mesothelioma (MPM) is an aggressive neoplasm with a poor prognosis. Bidirectional intraoperative chemotherapy (BDIC) using concurrent intraperitoneal and intravenous chemotherapy in combination with cytoreductive surgery (CRS) is an emerging treatment option for selected cases of MPM. It is a locoregional treatment that involves intraoperative chemoperfusion of heated chemotherapy. The administration of systemic along with intraperitoneal chemotherapy allows for a bidirectional chemotherapy gradient in peritoneal tumor cells. The aim of this treatment is eradication of microscopic residual cancer cells after major removal of macroscopic tumor nodules. To date, there is no consensus on the chemotherapeutic regimen that can be used in BDIC to manage MPM in patients with severe renal impairment. Administering intravenous ifosfamide with hyperthermic intraperitoneal cisplatin and doxorubicin is a promising regimen in treating peritoneal mesothelioma. Nephrotoxicity is a dose-limiting adverse effect of cisplatin and ifosfamide. Therefore, dose adjustment is required in patients with renal impairment. CASE REPORT In this report, we describe a 46-year-old female patient with recurrent MPM and severe renal impairment. Her treatment was managed with hyperthermic intraperitoneal cisplatin and doxorubicin along with intravenous ifosfamide following CRS. The cisplatin dose was reduced to 50% and the ifosfamide dose was reduced by 25%. The patient tolerated the procedure well, without deterioration in her renal function. At her 9-month follow-up, she did not report experiencing chemotherapy-related adverse effects, and her kidney function remained stable. CONCLUSIONS Severe renal impairment might not be a contraindication to using potentially nephrotoxic chemotherapeutic agents in CRS-BDIC.
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Affiliation(s)
- Razan Almesned
- Department of Urology, King Faisal Specialists Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ayman Z Azzam
- Department of Surgical Oncology, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Department of General Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ayman Aldeheshi
- Anatomical Pathology Section, Department of Pathology & Lab Medicine, King Faisal Specialists Hospital and Research Center, Riyadh, Saudi Arabia
| | - Tarek M Amin
- Department of Surgical Oncology, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Jaber HD, Magableh HM, Jaber MD, Magableh AM, Ghazal FH, Azzam AZ, Amin T. A Rare Case of Guillain-Barré Syndrome Post-gastrojejunostomy and Literature Review. Cureus 2023; 15:e35889. [PMID: 37033568 PMCID: PMC10080972 DOI: 10.7759/cureus.35889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2023] [Indexed: 03/10/2023] Open
Abstract
Guillain-Barré syndrome (GBS) is a rare immune-mediated neuropathy causing destruction of the peripheral nervous system, with molecular mimicry playing a major role in its pathophysiology. Despite its rarity, it is considered the most common cause of acute flaccid neuromuscular paralysis in the United States. Although diagnosing GBS depends on the clinical presentation of the patient, cerebrospinal fluid sampling, nerve conduction studies, electromyography, magnetic resonance imaging, and ganglioside antibody screening can be used to confirm the diagnosis and rule out other differentials. Here, we report a rare case of GBS as a postoperative complication after a successful gastrojejunostomy to excise an adenocarcinoma in the second part of the duodenum. Such a complication is rare and not fully understood yet.
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Magableh HM, Jaber HD, Magableh AM, Alrabiah MA, Dahhan AF, Azzam AZ, Amin T. Rosai-Dorfman Disease: Case Series and Literature Review. Cureus 2023; 15:e35193. [PMID: 36960255 PMCID: PMC10030647 DOI: 10.7759/cureus.35193] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2023] [Indexed: 02/22/2023] Open
Abstract
Rosai-Dorfman Disease (RDD), also known as sinus histiocytosis with massive lymphadenopathy, is an uncommon histiocytic condition characterized by massive histopathological aggregation of CD1-a negative, CD68-positive, and S100-positive histiocytes. It was initially described by Destombes in 1965 under the term "adenitis with lipid excess." However, it is named after Rosai and Dorfman who reported further histopathological features of the disease in 1969. The diagnosis of this non-Langerhans cell histiocytosis can be challenging and requires high clinical suspicion. The diagnostic process usually involves imaging, tissue biopsies, and genetic testing as needed. In this case series, we are presenting three cases of rare disease. Case 2 had both nodal and extranodal forms, which makes this case rarer than cases 1 and 3, which present with extranodal lesions.
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Affiliation(s)
| | - Hamzh D Jaber
- College of Medicine, Alfaisal University, Riyadh, SAU
| | | | | | | | - Ayman Z Azzam
- Department of Surgical Oncology, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, SAU
- Department of General Surgery, Faculty of Medicine, Alexandria University, Alexandria, EGY
| | - Tarek Amin
- Department of Surgical Oncology, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, SAU
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Almasri MS, Alfehaid ON, Azzam AZ, Amin T. Left Femur Neck Fracture and Left Eye Esotropia as Initial Clinical Presentations of Gastric Cancer in a 54-Year-Old Female Patient: A Case Report and Review of Literature. Cureus 2021; 13:e20645. [PMID: 35106203 PMCID: PMC8786579 DOI: 10.7759/cureus.20645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2021] [Indexed: 01/10/2023] Open
Abstract
Although the incidence of gastric cancer has decreased worldwide, it is still among the most common cancers worldwide. Usual manifestations of gastric cancer include gastrointestinal-related symptoms such as weight loss and abdominal pain. Isolated symptomatic bony metastasis at initial presentation is very rare. Here, we present an infrequent case of a middle-aged lady who presented with a left femur neck fracture and left eye esotropia as the initial presenting clinical manifestations of gastric cancer. She was found to have an isolated bone metastasis seen throughout the body skeleton with no extraosseous metastasis. The patient was treated conservatively and received external beam radiation therapy as part of palliative therapy. This report signifies the importance of considering the diagnosis of gastric cancer in middle-aged patients with isolated symptomatic bone metastasis. It also reviews the overall poor prognosis of such cases and recommends further studies on the role of chemotherapy and radiation therapy in such cases.
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Azzam AZ, Alsinan TA, Alrebeh GA, Alhaider T, Alnaqaeb LJ, Amin TM. Lemmel Syndrome as a Rare Cause of Prolonged Right Hypochondrial Pain: A Case Report. Cureus 2021; 13:e20093. [PMID: 35003949 PMCID: PMC8723720 DOI: 10.7759/cureus.20093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2021] [Indexed: 12/03/2022] Open
Abstract
Lemmel syndrome is a rare cholestatic disease caused by a periampullary duodenal diverticulum (PAD) compressing the common bile duct (CBD) or pancreatic duct, which results in acute abdominal pain and/or obstructive jaundice in the absence of other pathology explaining the symptoms. It can be easily misdiagnosed unless carefully detected by abdominal ultrasound (US), barium studies, computed tomography (CT) scan, esophagogastroduodenoscopy (EGD), magnetic resonance cholangiopancreatography (MRCP), and endoscopic retrograde cholangiography (ERCP), which is also the treatment modality of choice. We herein report a case of a 62-year-old male presenting with prolonged hypochondrial pain. He was diagnosed with Lemmel syndrome after performing US, barium meal, CT scan, EGD, and MRCP that was managed successfully by ERCP with sphincterotomy and stent placement.
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Azzam AZ, Azzam KA. Hepatocellular Carcinoma Migrating to the Right Atrium through the Inferior Vena Cava. Sultan Qaboos Univ Med J 2018; 18:e118-e119. [PMID: 29666697 PMCID: PMC5892805 DOI: 10.18295/squmj.2018.18.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/14/2018] [Accepted: 01/25/2018] [Indexed: 02/05/2023] Open
Abstract
Interesting Medical Image
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Affiliation(s)
- Ayman Z. Azzam
- Department of General Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Department of Surgical Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
- Corresponding Author’s e-mail:
| | - Kareem A. Azzam
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
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Azzam AZ, Azzam KA, Amin T. Removal of Nasogastric Tube Accidentally Stitched to Roux-en-Y Oesophagojejunostomy Following a Radical Gastrectomy for Stomach Cancer: Case report and review of the literature. Sultan Qaboos Univ Med J 2018; 18:e110-e111. [PMID: 29666693 PMCID: PMC5892801 DOI: 10.18295/squmj.2018.18.01.020] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 12/30/2017] [Accepted: 01/18/2018] [Indexed: 02/05/2023] Open
Abstract
Nasogastric tubes (NGTs) are important for feeding, stenting and decompression after gastrointestinal surgeries, particularly in the upper gastrointestinal tract. Resistance in the removal of a NGT is a rare surgical complication and may be due to a knot in the tube or a stitch anchoring the tube to an anastomosis. We report a 41-year-old male patient who was admitted to the King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia, in 2015 with stomach cancer. He underwent a radical total gastrectomy with a Roux-en-Y oesophagojejunostomy. One week after the surgery, removal of the NGT was attempted; however, this was very difficult and the proximal end of the tube was cut off as a temporary measure. Six weeks later, an upper gastrointestinal tract endoscopy revealed that the distal end of the NGT had been accidentally stitched to the Roux-en-Y oesophagojejunostomy. The stitch was removed and the rest of the NGT was successfully extracted using a snare.
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Affiliation(s)
- Ayman Z. Azzam
- Department of General Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Department of Surgical Oncology, Oncology Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
- Corresponding Author’s e-mail:
| | - Kareem A. Azzam
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Tarek Amin
- Department of Surgical Oncology, Oncology Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
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Azzam AZ, Tanaka K. Adoption of new selection criteria on living donor liver transplantation for hepatocellular carcinoma and their impact on the outcome. Hepatogastroenterology 2011; 58:1873-6. [PMID: 22234056 DOI: 10.5754/hge10367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND/AIMS In cadaveric liver transplantation, the Milan criteria have been accepted as the selection criteria for HCC in considering organ allocation. However, the situation in LDLT is different. METHODOLOGY This is a retrospective study on 518 recipients who underwent LDLT. The exclusion criteria included HCC with extrahepatic spread and HCC extending to the major hepatic vessels detected during the preoperative evaluation. RESULTS HCC was the indication in 96 patients (18.5%); 52/96 patients (54.2%) fulfilled Milan criteria and 44/96 patients (45.8%) did not. The 5-year survival rate among patients fulfilling Milan criteria was 40/52 (77.0%) while for those who did not 30/44 (68.0%). Although these results show better survival rates among patients with HCC within the Milan criteria, they are insignificant (p=0.01) and they clearly demonstrate that patients with HCC outside the Milan criteria have nearly the same survival rate as patients with HCC within Milan criteria. CONCLUSIONS Transplantation is the best treatment option for patients with HCC if a careful search reveals no extra-hepatic disease. The application of the Milan criteria for all patients with HCC would have denied many patients who can survive after transplantation. In LDLT programs, where the patient has a special living donor, the Milan criteria are not necessarily relevant.
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Affiliation(s)
- Ayman Z Azzam
- Department of General Surgery, Alexandria University, Alexandria, Egypt.
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