[Iliac venous aneurysm: a case report and review of literature]

Primary iliac vein aneurisms are extremely rare being described as anomaly, without any history of trauma, cardiovascular pathology or arteriovenous fistula. This clinical condition has a high rate of potentially fatal complications: pulmonary embolism; ruptured aneurism; deep vein thrombosis. There are only 7 cases of iliac vein aneurism described in the literature. We describe an additional case of a 59-year old patient presented with abdominal pain, right lower limb edema and palpable mass in the right iliac area. Ultrasound (US) revealed a liquid formation, confirmed by computed tomography (CT). Surgical removal of the aneurism with lateral venorrhaphy was performed. Postoperative evolution was uneventful. The patient is asymptomatic during 36 month follow-up.

Duodenal gastrointestinal stromal tumor

BACKGROUND

Gastrointestinal stromal tumors (GISTs) are low-grade malignant tumors that may arise anywhere in the alimentary tract, and in the past, most of them were diagnosed as intestinal leiomyoma or leiomyosarcoma. GISTs of the duodenum make up only 4.5% of all GISTs.

MATERIALS AND METHODS

We report a patient presented with upper GI bleeding who exhibited radiological findings of a tumor in the third portion of the duodenum. The patient underwent a segmental duodenectomy. Pathological examination concluded in a GIST.

RESULTS

The patient is free of recurrence for one year after surgery.

CONCLUSIONS

Our case report, along with other, highlights that surgical resection remains the cornerstone of treatment for patients with localized disease. Along with others, we agree that from oncologic point of view, partial resection of the duodenum is an alternative to a duodenopancreatectomy.

[Recurrent Crohn's disease in the ileocolonic anastomosis complicated with duodenal fistula]

Duodenal fistulas in patients with Crohn's disease are rare, and up to one hundred cases were described in the medical literature. We report an additional case of a 40-year-old male who underwent an ileo-ascending colectomy 13 years ago for Crohn's disease and was admitted to our unit with palpable abdominal mass and persistent cutaneous fistula. Preoperative fistulography and barium enema demonstrated Crohn's disease recurrence in the site of the ileocolonic anastomosis and external fistula communicating with the pre-anastomotic ileum. At surgery, Crohn's disease recurrence in the site of ileocolonic anastomosis with ileo-cutaneous fistula was confirmed and an additional ileo-duodenal fistula was detected incidentally. The patient underwent resection of the affected bowel and simple closure of the duodenal fistula with omental pedicle graft transposition between the duodenum and the ileocolonic anastomosis. Postoperative period was uneventful. We review the literature and discuss the incidence and treatment strategy of duodenal fistulas complicating recurrent Crohn's disease in the site of the ileocolonic anastomosis. The authors highlight that simple closure of the duodenal defects is appropriate only for small duodenal fistulas and omental transposition between ileo-colonic anastomosis and duodenum during the primary and repeated resection should be considered as an effective prevention method of duodenal fistulas formation.

[Splenic abscess--etiologic, clinical and diagnostic features]

The aim of the study is to elucidate premorbid grounds, diagnostic and clinical peculiarities, as well as medical and surgical management of non-parasitic spleen abscess. We study 6 cases, with median age 56.7 years, men/women ratio--2:1. Onset-diagnosis period was of median 20 days. In 5 cases (83.3%) spleen abscess developed in immune compromised patients (diabetes mellitus, liver cirrhosis, pancreatitis) and in one case (16.7%) subsequent to blunt abdominal trauma. Clinically, patients presented fever, weight loss and pain in the left upper quadrant of the abdomen. The imaging data (USG, CT, and Rx-thoracic) performed prior to surgery confirmed the diagnosis. USG revealed splenic injury in 80%, CT had a 100% sensibility and thoracic Rx revealed left-side pleuro-pulmonary reaction in 83% of cases. Bacteriological test was positive in 50% of cases. One death was recorded in first 24 hours after surgery. The rest of the cases had a favorable evolution, although, in 2 cases a left subphrenic abscess was noticed, one requiring drainage; in one case--colonic fistula, which closed spontaneously. Although, it's a rare pathology, an early diagnosis is as important, as impossible, and it's delay exhausts the organism and increases the postoperative morbidity rate, splenectomy remaining the safest method of treatment.

[Mucinous cystadenocarcinoma of the appendix complicated with spontaneous cutaneous fistula]

Mucocele of the appendix is a relatively rare disease characterized by a cystic dilatation of the appendiceal lumen with stasis of mucus inside. Appendiceal mucocele with a cutaneous fistula is an extremely rare clinical entity, only four such cases being described in the medical literature. We report an additional case of cystadenocarcinoma of the appendix with spontaneous cutaneous fistula. The patient is an 80-year old woman, who originally presented with a skin ulcer in the right lower abdominal quadrant with mucus discharge during the last month. Abdominal ultrasonography and computed tomography demonstrated cystic mass with mixed echogenity and density originating from the appendix, involving the abdominal wall, without signs of ascites or metastasis. A right hemi-colectomy, lymphadenectomy and resection of the skin fistula was performed. The histological findings revealed moderately differentiated mucinous cystadenocarcinoma of the appendix. The postoperative period was uneventful and the patient discharged on the 11th POD. During 12 month follow-up period the patient is free of disease recurrence. The authors present the literature review, diagnostic features and the treatment policy of this extremely rare condition.

[Intrabiliary rupture of the hydatic cyst complicated with acute pancreatitis]

Acute pancreatitis is a rare complication of hydatidosis, and only few reports were published previously. We report a case of a 17-year-old man, with recurrent liver hydatid cyst, who presented with severe upper abdominal pain, vomiting, jaundice. Amylase and bilirubin were elevated. Abdominal CT scan showed a cystic lesion in the dome of the liver and a diffusely swollen pancreas. At endoscopic retrograde cholangiopancreatography (ERCP) the common bile duct was dilated with fragments of hydatid membrane. A sphincterotomy was performed and hydatid membranes were extracted, after which the patient made an uneventful recovery and the level of amylase and bilirubin normalized. After two weeks a new episode of hydatid rupture occurred with clinical presentation of cholangitis. Emergency surgery was performed, which consisted of cystectomy, suture of intracavitary bile fistula, omentoplasty, choledochotomy with extraction of the hydatid membranes and common bile duct drainage. There were no relapses during 5 years follow-up. This case report highlights that ERCP and sphincterotomy are considered the procedures of choice in acute pancreatitis induced by biliary rupture of the hydatid cyst and surgical treatment is considered to be the only definitive treatment of the hydatic cystic lesion of the liver with intrabiliary rupture.

[Emphysematous necrotizing pancreatitis]

The authors present an additional case of emphysematous necrotizing pancreatitis caused by Escherichia coli. Emphysematous necrotizing pancreatitis represents a rare and potentially life-threatening infection and is characterized by gas formation within or around the pancreas. A 26-year-old man presented with severe upper abdominal pain and vomiting, 7 hours from onset. Acute pancreatitis was initially diagnosed based on high amylase level, abdominal ultrasonography and primary CT scan. On the 7th day he developed fever, increasing abdominal pain and shortness of breath. On the second abdominal CT scan, the pancreatic bed was filled with gas. The diagnosis of emphysematous necrotizing pancreatitis was confirmed at laparotomy. The patient was treated successfully by extensive pancreatic necrosectomy, open packing and scheduled repeated debridements. Culture from the lesser sac, and retroperitoneal space, examined for aerobes and anaerobes, revealed growth of Escherichia coli. The authors analyze and discuss pathogenesis, diagnosis and treatment of emphysematous necrotizing pancreatitis. Based on the available data and this case, early surgical debridement and appropriate antibiotics appear to be the preferred treatment.

[Organized pancreatic necrosis resembling retroperitoneal tumor]

This paper presents the case of a 29 years old patient who has an organized pancreatic necrosis, presenting preoperative differential diagnosis problems and surgical technique difficulties, revealing the fact that, in this particular case, paraclinical investigations have an orientative value, and are not offering information regarding etiology, and do not allow to establish a preoperative strategy. Tumor resection was performed; final diagnosis was established by histological examination. The follow-up period was uneventful.

Primary retroperitoneal mucinous cystadenoma. A case report and brief review of the literature

Retroperitoneal mucinous cystadenomas are extremely rare tumors found exclusively in women. An additional case of retroperitoneal mucinous cystadenoma histologically confirmed in a 41-year- old woman is reported herein. Computed tomographic (CT) scanning showed a cystic mass, 21 x 16 cm in size, in the right retroperitoneal space. Removal of the cystic tumor was performed without any other additional procedures, and further histological diagnosis was confirmed as primary mucinous cystadenoma of borderline type. Histologic findings suggested that the tumor developed from mucinous metaplasia of the coelomic mesothelium. Clinicopathological features, diagnostic findings, therapeutic options and the outcome are analyzed in this paper having reviewed the cases reported in world literature.