Hepatic focal nodular hyperplasia in a five-year-old healthy boy: A case report and literature review

Introduction: Focal nodular hyperplasia is unusually seen in a pediatric age group, with few reported cases in the literature. We report the case of a 5-year-old boy not known to have medical illnesses, who was found to have a liver mass, underwent right trisectionectomy. The purpose of this report is to familiarize the healthcare community with similar events, review the literature, and discuss recommendations for future similar cases. Case Report: A case of focal nodular hyperplasia (FNH) in a 5-year-old healthy boy who was found to have a huge liver lesion on ultrasound imaging due to a vague abdominal pain and distension. The patient underwent surgical excision of the mass due to abdominal pain, distension, and atypical features of FNH in radiological examinations. Histopathological analysis revealed a focal nodular hyperplasia. Conclusion: Focal nodular hyperplasia considered a benign lesion that has no malignant transformation. The presenting symptoms are variable, usually asymptomatic. Laboratory tests have of little significance. Imaging modalities mainly ultrasound scan initially then magnetic resonance imaging (MRI) are useful to obtain more accurate characteristic features of the lesion. Uncertain diagnostic lesion needs to be biopsied and examined under microscopy. Confirming the diagnosis will follow an acceptable conservative management approach. Surgical resection is the preferred method in uncertain, questionable, or atypical features observed in radiological imaging.

Feasibility and safety of day-surgery laparoscopic cholecystectomy: a single-institution 5-year experience of 1140 cases

Backgrounds/Aims

We report our experience with day-surgery laparoscopic cholecystectomy and assess its feasibility and safety.

Methods

Data was collected on all the patients who underwent day-surgery laparoscopic cholecystectomy between February 2009 and February 2014 at Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia. All patients had symptomatic cholelithiasis that was proven on imaging studies with clearance of the common bile duct. The patient biographical data (age, gender, American Society of Anaesthesiology status, medical comorbidities) and surgical outcomes were then obtained. There was an evaluation of the success rate of day-surgery laparoscopic cholecystectomy, reasons for unexpected admission, and the re-admission rate.

Results

A total of 1,140 patients were included in this study. The success rate for day-surgery laparoscopic cholecystectomy was 96%. The reasons for unexpected hospital admission for 46 patients (4%) included persistent abdominal pain and postoperative emesis. The postoperative re-admission rate was 0.4% (5 patients). There were no major complications, and the conversion rate was 0.5% (6 patients).

Conclusions

We suggest that day-surgery laparoscopic cholecystectomy is both safe and feasible in a local setting. Careful patient selection is essential in ensuring a high success rate.

Adrenal haemangioma

Adrenal haemangioma is a rare, benign, non-functioning neoplasm. Haemangiomas are tumours mainly affecting the liver. In 1955, Johnson and Jeppesen described the first adrenal cavernous haemangioma. Here the authors report a large adrenal haemangioma presenting in a 75-year-old woman who had experienced left flank pain for 5 months. Laboratory examinations and the plasma levels of tumour markers in the patient were within normal limits. Imaging with ultrasound and CT showed a heterogeneous 15×14×18 cm mass located in the left adrenal gland. The tumour showed irregular peripheral enhancement after bolus intravenous injection of contrast medium. The mass was removed surgically and histopathology revealed infracted cavernous haemangioma. No signs of malignancy were detected. Although rare, haemangioma should be included in the differential diagnosis of adrenal neoplasms.