Dinesh Alagoo, Harivinthan Sellappan, T. Maiyauen, Guang Hong Ong, Zae Szen Anderson Yong, F. Hayati
Pancreaticoduodenectomy is an extensive procedure with multiple postoperative complications which include surgical site infections, bleeding, delayed gastric emptying, and anastomotic leakage. Among all, postoperative bowel ischaemia is the rarest complication that might be difficult to diagnose and ascertain the cause. If it is left untreated, it may lead to mortality.The aim is to describe the management of bowel ischaemia post-Whipple surgery.A 76-year-old female patient underwent a Whipple procedure for adenocarcinoma of the ampulla which was complicated by postoperative bowel ischemia. A series of investigations, namely endoscopy and imaging, revealed postoperative bowel ischemia beyond the gastro-jejunostomy anastomosis. The patient underwent a series of surgeries and was eventually discharged well. The final histology was consistent with pancreatic cancer and did not require adjuvant chemotherapy.Bowel ischemia in any major surgery occurs due to thrombosis. It is multifactorial including cancer patients, complex reconstruction and major surgery. Identification of thrombosis early in the postoperative follow-up is difficult due to non-specific symptoms, postoperative paralysis of the gastrointestinal tract and modified pain reaction after analgesia. Once diagnosed, the goal is for cessation of thrombosis and fibrinolytic destruction of the thrombus.Bowel ischemia post-Whipple procedure is rare yet dreaded and requires a high level of clinical suspicion. Once diagnosed, an aggressive approach is needed, including relaparotomy and relook surgery. This complication is salvageable with a controlled fistula and adequate nutrition support.
{"title":"The unfortunate events of bowel ischaemia \u0000post-Whipple surgery","authors":"Dinesh Alagoo, Harivinthan Sellappan, T. Maiyauen, Guang Hong Ong, Zae Szen Anderson Yong, F. Hayati","doi":"10.29089/paom/177641","DOIUrl":"https://doi.org/10.29089/paom/177641","url":null,"abstract":"Pancreaticoduodenectomy is an extensive procedure with multiple postoperative complications which include surgical site infections, bleeding, delayed gastric emptying, and anastomotic leakage. Among all, postoperative bowel ischaemia is the rarest complication that might be difficult to diagnose and ascertain the cause. If it is left untreated, it may lead to mortality.The aim is to describe the management of bowel ischaemia post-Whipple surgery.A 76-year-old female patient underwent a Whipple procedure for adenocarcinoma of the ampulla which was complicated by postoperative bowel ischemia. A series of investigations, namely endoscopy and imaging, revealed postoperative bowel ischemia beyond the gastro-jejunostomy anastomosis. The patient underwent a series of surgeries and was eventually discharged well. The final histology was consistent with pancreatic cancer and did not require adjuvant chemotherapy.Bowel ischemia in any major surgery occurs due to thrombosis. It is multifactorial including cancer patients, complex reconstruction and major surgery. Identification of thrombosis early in the postoperative follow-up is difficult due to non-specific symptoms, postoperative paralysis of the gastrointestinal tract and modified pain reaction after analgesia. Once diagnosed, the goal is for cessation of thrombosis and fibrinolytic destruction of the thrombus.Bowel ischemia post-Whipple procedure is rare yet dreaded and requires a high level of clinical suspicion. Once diagnosed, an aggressive approach is needed, including relaparotomy and relook surgery. This complication is salvageable with a controlled fistula and adequate nutrition support.","PeriodicalId":38569,"journal":{"name":"Polish Annals of Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140426562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The intraoperative failure to find a macroscopically visible pathological condition within the appendix or other abnormalities of abdominal organs that could explain clinical symptoms in patients eligible for appendectomy does not prejudge the absence of underlying disease in an apparently healthy appendix.The aim of the study is to highlight the problem of possible hidden pathological conditions in a macroscopically unchanged appendix in patients scheduled for appendectomy.In this article, we present a case of female patient who was qualified to laparoscopic appendectomy due to symptoms of acute appendicitis. Although intra-operatively appendix did not show any pathological signs, histopathological examination revealed neuroendocrine tumor in the organ.This publication describes a case of the removal of a macroscopically unchanged appendix in a patient with clinical and laboratory signs of acute appendicitis. A neuroendocrine neoplasm was histopathologically revealed in the removed appendix. The correct eligibility for appendectomy can present great difficulties even for experienced surgeons. Failure to identify visible abnormalities in the appendix after ruling out other possible causes of clinical symptoms does not prejudge the absence of pathological conditions in this organ.This clinical case shows that the removal of a morphologically normal appendix in a patient eligible for appendectomy, in the absence of other intra-abdominal pathological conditions explaining the clinical signs, is not necessarily a mistake.
{"title":"A neuroendocrine tumor in a macroscopically unchanged appendix","authors":"Wojciech Całka","doi":"10.29089/paom/178458","DOIUrl":"https://doi.org/10.29089/paom/178458","url":null,"abstract":"The intraoperative failure to find a macroscopically visible pathological condition within the appendix or other abnormalities of abdominal organs that could explain clinical symptoms in patients eligible for appendectomy does not prejudge the absence of underlying disease in an apparently healthy appendix.The aim of the study is to highlight the problem of possible hidden pathological conditions in a macroscopically unchanged appendix in patients scheduled for appendectomy.In this article, we present a case of female patient who was qualified to laparoscopic appendectomy due to symptoms of acute appendicitis. Although intra-operatively appendix did not show any pathological signs, histopathological examination revealed neuroendocrine tumor in the organ.This publication describes a case of the removal of a macroscopically unchanged appendix in a patient with clinical and laboratory signs of acute appendicitis. A neuroendocrine neoplasm was histopathologically revealed in the removed appendix. The correct eligibility for appendectomy can present great difficulties even for experienced surgeons. Failure to identify visible abnormalities in the appendix after ruling out other possible causes of clinical symptoms does not prejudge the absence of pathological conditions in this organ.This clinical case shows that the removal of a morphologically normal appendix in a patient eligible for appendectomy, in the absence of other intra-abdominal pathological conditions explaining the clinical signs, is not necessarily a mistake.","PeriodicalId":38569,"journal":{"name":"Polish Annals of Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140424925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stimulant use during pregnancy is a growing concern, particularly in the USA and Europe. This article explores anesthesia challenges in pregnant patients with substance abuse, optimizing analgesic treatment, and addressing newborns of addicted mothers. Understanding substance use differences is crucial for managing complications and providing long-term care.Investigate anesthesia management, analgesic optimization, and care for newborns of drug-addicted pregnant patients.A comprehensive literature review included articles from PubMed (from January 2009 to December 2021) and relevant Polish, English, and German literature.Opioid use by pregnant women, especially in North America, raises concerns for maternal and child health. The incidence of newborns with withdrawal syndrome is rapidly increasing. Anesthesia challenges arise in managing pregnant patients with addiction, including analgesia optimization and reducing neonatal abstinence syndrome risk. Individualized approaches like regional anesthesia minimize systemic opioids and neonatal withdrawal symptoms. Medication-assisted therapy, e.g., buprenorphine and methadone, reduces illicit opioid use and improves outcomes for mother and baby. Collaborative care among providers is essential.Managing drug-addicted pregnant women requires a multidisciplinary approach. Anesthesia providers play a crucial role in ensuring safety and pain control.
{"title":"Anesthesia of a drug-addicted pregnant woman. The current state of knowledge","authors":"Paweł Radkowski, Magdalena Wojtczak, Dorota Bartoś-Zdrojewska, Damian Bronisław Truszczyński, Aneta Pruszkowska","doi":"10.29089/paom/177290","DOIUrl":"https://doi.org/10.29089/paom/177290","url":null,"abstract":"Stimulant use during pregnancy is a growing concern, particularly in the USA and Europe. This article explores anesthesia challenges in pregnant patients with substance abuse, optimizing analgesic treatment, and addressing newborns of addicted mothers. Understanding substance use differences is crucial for managing complications and providing long-term care.Investigate anesthesia management, analgesic optimization, and care for newborns of drug-addicted pregnant patients.A comprehensive literature review included articles from PubMed (from January 2009 to December 2021) and relevant Polish, English, and German literature.Opioid use by pregnant women, especially in North America, raises concerns for maternal and child health. The incidence of newborns with withdrawal syndrome is rapidly increasing. Anesthesia challenges arise in managing pregnant patients with addiction, including analgesia optimization and reducing neonatal abstinence syndrome risk. Individualized approaches like regional anesthesia minimize systemic opioids and neonatal withdrawal symptoms. Medication-assisted therapy, e.g., buprenorphine and methadone, reduces illicit opioid use and improves outcomes for mother and baby. Collaborative care among providers is essential.Managing drug-addicted pregnant women requires a multidisciplinary approach. Anesthesia providers play a crucial role in ensuring safety and pain control.","PeriodicalId":38569,"journal":{"name":"Polish Annals of Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140426914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Justyna Kacperczyk, Adrian Perdyan, Klaudia Kitala-Tańska, Ewa Kania-Zimnicka, K. Osowiecka, Mateusz Wyszatycki, M. Stompór
Vitamin B12 deficiency is becoming a major problem among geriatric population worldwide. It may contribute to higher prevalence of cognitive impairment and depression, and may occur as a side effect of commonly prescribed anti-diabetic and anti-acid treatments. However, the scale of this phenomenon in Poland remains unknown.We investigated the scale of vitamin B12 deficiency across population of geriatric patients over 70 years old. Additionally, we examined the association between vitamin B12 deficiency, cognitive impairment or depression prevalence, and metformin or proton pump inhibitors intake.Based on the measured vitamin B12 serum level, we divided patients into 3 groups: (1) normal (≥300 pg/mL); (2) borderline (191–300 pg/mL), and (3) low (≤191 pg/mL). The assessment of cognitive impairment or depression was performed by using 5 distinct tests (mini-mental state examination, abbreviated mental test score, clock drawing test, and 4-item or 15-item geriatric depression scale). For statistical analysis, we used χ2 and ANOVA tests.We showed no differences in the frequency of cognitive impairment, depression, and vitamin among characterized groups. Importantly, we found that metformin intake was associated with vitamin B12 deficiency (P = 0.009), contrary to proton pump inhibitor (P = 0.53) and combined these drugs (P = 0.24).We showed a relatively high prevalence of vitamin B12 deficiency across a population of geriatric patients. A preventive vitamin B12 supplementation should be considered when treating, especially geriatric diabetic patients. Due to conflicting results of retrospective studies, prospective clinical trial should be undertaken to describe the association between vitamin B12 deficiency and prevalence of cognitive impairment or depression.
{"title":"Metformin intake among geriatric patients may predispose to vitamin B12 deficiency: Polish population-based study","authors":"Justyna Kacperczyk, Adrian Perdyan, Klaudia Kitala-Tańska, Ewa Kania-Zimnicka, K. Osowiecka, Mateusz Wyszatycki, M. Stompór","doi":"10.29089/paom/176287","DOIUrl":"https://doi.org/10.29089/paom/176287","url":null,"abstract":"Vitamin B12 deficiency is becoming a major problem among geriatric population worldwide. It may contribute to higher prevalence of cognitive impairment and depression, and may occur as a side effect of commonly prescribed anti-diabetic and anti-acid treatments. However, the scale of this phenomenon in Poland remains unknown.We investigated the scale of vitamin B12 deficiency across population of geriatric patients over 70 years old. Additionally, we examined the association between vitamin B12 deficiency, cognitive impairment or depression prevalence, and metformin or proton pump inhibitors intake.Based on the measured vitamin B12 serum level, we divided patients into 3 groups: (1) normal (≥300 pg/mL); (2) borderline (191–300 pg/mL), and (3) low (≤191 pg/mL). The assessment of cognitive impairment or depression was performed by using 5 distinct tests (mini-mental state examination, abbreviated mental test score, clock drawing test, and 4-item or 15-item geriatric depression scale). For statistical analysis, we used χ2 and ANOVA tests.We showed no differences in the frequency of cognitive impairment, depression, and vitamin among characterized groups. Importantly, we found that metformin intake was associated with vitamin B12 deficiency (P = 0.009), contrary to proton pump inhibitor (P = 0.53) and combined these drugs (P = 0.24).We showed a relatively high prevalence of vitamin B12 deficiency across a population of geriatric patients. A preventive vitamin B12 supplementation should be considered when treating, especially geriatric diabetic patients. Due to conflicting results of retrospective studies, prospective clinical trial should be undertaken to describe the association between vitamin B12 deficiency and prevalence of cognitive impairment or depression.","PeriodicalId":38569,"journal":{"name":"Polish Annals of Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140424160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Azliana Aziz, Yi Wee Lim, Baharudin Abdullah, Zamzuri Idris, Mei Sin Lim
Congenital transsphenoidal meningocele is extremely rare.We present a newborn who was found to have a large midline cystic mass protruding from a cleft palate.Radiological imaging showed a large cerebrospinal fluid mass herniating through a large anterior cranial fossa defect into the sphenoid sinus with extension to the nasal cavity through a cleft palate into the oral cavity.A bifrontal craniotomy and decompression of meningocele with dura repair was performed.The child was discharged healthy postoperatively and on monthly follow-up and subsequently thriving well with improving neurological recovery.
{"title":"Congenital transsphenoidal meningocele in a newborn: A case report","authors":"Azliana Aziz, Yi Wee Lim, Baharudin Abdullah, Zamzuri Idris, Mei Sin Lim","doi":"10.29089/paom/177338","DOIUrl":"https://doi.org/10.29089/paom/177338","url":null,"abstract":"Congenital transsphenoidal meningocele is extremely rare.We present a newborn who was found to have a large midline cystic mass protruding from a cleft palate.Radiological imaging showed a large cerebrospinal fluid mass herniating through a large anterior cranial fossa defect into the sphenoid sinus with extension to the nasal cavity through a cleft palate into the oral cavity.A bifrontal craniotomy and decompression of meningocele with dura repair was performed.The child was discharged healthy postoperatively and on monthly follow-up and subsequently thriving well with improving neurological recovery.","PeriodicalId":38569,"journal":{"name":"Polish Annals of Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140429396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Erjola Bolleke (Likaj), E. Likaj, S. Seferi, Kristi Saliaj, Fjorba Mana, S. Dumani, Alma Idrizi
Infective endocarditis is a potentially life-threatening condition, more prevalent among chronic maintenance hemodialysis patients, as opposed to the general population.Combined involvement of both the right and left heart chambers is exceptionally rare.Herein, we present the case of a patient on long-term maintenance hemodialysis with right and left sided infective endocarditis.We discuss potential risk factors leading to the widespread infection and emphasize the importance of an early diagnosis and prompt treatment in yielding better outcomes.The patient was treated successfully by a multidisciplinary team.
{"title":"Combined right and left sided endocarditis in a hemodialysis patient: A cautionary tale","authors":"Erjola Bolleke (Likaj), E. Likaj, S. Seferi, Kristi Saliaj, Fjorba Mana, S. Dumani, Alma Idrizi","doi":"10.29089/paom/176244","DOIUrl":"https://doi.org/10.29089/paom/176244","url":null,"abstract":"Infective endocarditis is a potentially life-threatening condition, more prevalent among chronic maintenance hemodialysis patients, as opposed to the general population.Combined involvement of both the right and left heart chambers is exceptionally rare.Herein, we present the case of a patient on long-term maintenance hemodialysis with right and left sided infective endocarditis.We discuss potential risk factors leading to the widespread infection and emphasize the importance of an early diagnosis and prompt treatment in yielding better outcomes.The patient was treated successfully by a multidisciplinary team.","PeriodicalId":38569,"journal":{"name":"Polish Annals of Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139809041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Erjola Bolleke (Likaj), E. Likaj, S. Seferi, Kristi Saliaj, Fjorba Mana, S. Dumani, Alma Idrizi
Infective endocarditis is a potentially life-threatening condition, more prevalent among chronic maintenance hemodialysis patients, as opposed to the general population.Combined involvement of both the right and left heart chambers is exceptionally rare.Herein, we present the case of a patient on long-term maintenance hemodialysis with right and left sided infective endocarditis.We discuss potential risk factors leading to the widespread infection and emphasize the importance of an early diagnosis and prompt treatment in yielding better outcomes.The patient was treated successfully by a multidisciplinary team.
{"title":"Combined right and left sided endocarditis in a hemodialysis patient: A cautionary tale","authors":"Erjola Bolleke (Likaj), E. Likaj, S. Seferi, Kristi Saliaj, Fjorba Mana, S. Dumani, Alma Idrizi","doi":"10.29089/paom/176244","DOIUrl":"https://doi.org/10.29089/paom/176244","url":null,"abstract":"Infective endocarditis is a potentially life-threatening condition, more prevalent among chronic maintenance hemodialysis patients, as opposed to the general population.Combined involvement of both the right and left heart chambers is exceptionally rare.Herein, we present the case of a patient on long-term maintenance hemodialysis with right and left sided infective endocarditis.We discuss potential risk factors leading to the widespread infection and emphasize the importance of an early diagnosis and prompt treatment in yielding better outcomes.The patient was treated successfully by a multidisciplinary team.","PeriodicalId":38569,"journal":{"name":"Polish Annals of Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139868868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rebecca Xin Yi Choy, Hamidah Mohd Zainal, Mohd Ali Mat Zain
Complex chest wall reconstruction after an oncological resection requires a multidisciplinary approach with the aim of curative resection.The complexity of such reconstruction is challenged by prior reconstructions that limit the options for free tissue transfer and recipient vessels for microsurgical anastomoses.We present a case of an immunocompromised patient with prior breast reconstruction for left breast carcinoma with a pedicled lattisimus dorsi flap who presents with a recurrence to the latissimus dorsi flap requiring a more extensive oncological resection.This resulted in a large chest wall defect that is reconstructed with plating and an anterolateral thigh fasciocutaneous free flap for soft tissue coverage.The radical resection allows for excellent overall survival and better quality of life.
{"title":"Chest wall reconstruction in recurrent breast carcinoma – a case report","authors":"Rebecca Xin Yi Choy, Hamidah Mohd Zainal, Mohd Ali Mat Zain","doi":"10.29089/paom/175798","DOIUrl":"https://doi.org/10.29089/paom/175798","url":null,"abstract":"Complex chest wall reconstruction after an oncological resection requires a multidisciplinary approach with the aim of curative resection.The complexity of such reconstruction is challenged by prior reconstructions that limit the options for free tissue transfer and recipient vessels for microsurgical anastomoses.We present a case of an immunocompromised patient with prior breast reconstruction for left breast carcinoma with a pedicled lattisimus dorsi flap who presents with a recurrence to the latissimus dorsi flap requiring a more extensive oncological resection.This resulted in a large chest wall defect that is reconstructed with plating and an anterolateral thigh fasciocutaneous free flap for soft tissue coverage.The radical resection allows for excellent overall survival and better quality of life.","PeriodicalId":38569,"journal":{"name":"Polish Annals of Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139818190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rebecca Xin Yi Choy, Hamidah Mohd Zainal, Mohd Ali Mat Zain
Complex chest wall reconstruction after an oncological resection requires a multidisciplinary approach with the aim of curative resection.The complexity of such reconstruction is challenged by prior reconstructions that limit the options for free tissue transfer and recipient vessels for microsurgical anastomoses.We present a case of an immunocompromised patient with prior breast reconstruction for left breast carcinoma with a pedicled lattisimus dorsi flap who presents with a recurrence to the latissimus dorsi flap requiring a more extensive oncological resection.This resulted in a large chest wall defect that is reconstructed with plating and an anterolateral thigh fasciocutaneous free flap for soft tissue coverage.The radical resection allows for excellent overall survival and better quality of life.
{"title":"Chest wall reconstruction in recurrent breast carcinoma – a case report","authors":"Rebecca Xin Yi Choy, Hamidah Mohd Zainal, Mohd Ali Mat Zain","doi":"10.29089/paom/175798","DOIUrl":"https://doi.org/10.29089/paom/175798","url":null,"abstract":"Complex chest wall reconstruction after an oncological resection requires a multidisciplinary approach with the aim of curative resection.The complexity of such reconstruction is challenged by prior reconstructions that limit the options for free tissue transfer and recipient vessels for microsurgical anastomoses.We present a case of an immunocompromised patient with prior breast reconstruction for left breast carcinoma with a pedicled lattisimus dorsi flap who presents with a recurrence to the latissimus dorsi flap requiring a more extensive oncological resection.This resulted in a large chest wall defect that is reconstructed with plating and an anterolateral thigh fasciocutaneous free flap for soft tissue coverage.The radical resection allows for excellent overall survival and better quality of life.","PeriodicalId":38569,"journal":{"name":"Polish Annals of Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139877975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Limy bile or milk of calcium bile caused due to precipitation of calcium salts in bile is an extremely rare condition of gall bladder, wherein the lumen of gall bladder is filled with chalky white paste like material. Not many cases have been reported till date.In this exceptional case, we tried to correlate the radiological and surgical findings with the histopathology.We hereby present an interesting case of a 59-year-old male who presented with dyspepsia and painful abdomen and was finally diagnosed with limy bile syndrome.The etiology of this rare entity is not fully understood, but it certainly has strong association with impacted stone at the neck of gall bladder and hyperparathyroidism. Females are more commonly affected than males. Patients usually present with complaints of painful abdomen and are commonly diagnosed radiologically, as a radiopacity in gall bladder. Cholecystectomy is the preferred method of treatment for this unusual condition and histopathologically chronic cholecystitis is seen along with presence of slender needle shaped crystals of calcium salts.A thorough evaluation of the clinicoradiological and histopathological findings can sometimes bring to light many uncommon variants of common looking pathologies.
{"title":"Limy bile syndrome or milk of calcium bile: An unexpected encounter","authors":"Mitali Madhumita Rath, Rashmi Patnayak, Sambit Kumar Mohanty, Brundaban Nahak, Manoranjan Mohapatra","doi":"10.29089/paom/175881","DOIUrl":"https://doi.org/10.29089/paom/175881","url":null,"abstract":"Limy bile or milk of calcium bile caused due to precipitation of calcium salts in bile is an extremely rare condition of gall bladder, wherein the lumen of gall bladder is filled with chalky white paste like material. Not many cases have been reported till date.In this exceptional case, we tried to correlate the radiological and surgical findings with the histopathology.We hereby present an interesting case of a 59-year-old male who presented with dyspepsia and painful abdomen and was finally diagnosed with limy bile syndrome.The etiology of this rare entity is not fully understood, but it certainly has strong association with impacted stone at the neck of gall bladder and hyperparathyroidism. Females are more commonly affected than males. Patients usually present with complaints of painful abdomen and are commonly diagnosed radiologically, as a radiopacity in gall bladder. Cholecystectomy is the preferred method of treatment for this unusual condition and histopathologically chronic cholecystitis is seen along with presence of slender needle shaped crystals of calcium salts.A thorough evaluation of the clinicoradiological and histopathological findings can sometimes bring to light many uncommon variants of common looking pathologies.","PeriodicalId":38569,"journal":{"name":"Polish Annals of Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139830927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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