International Journal of Surgery Open最新文献

Introduction and Importance

Situs Inversus Totalis (SIT) is a rare congenital condition resulting in the complete reversal of thoracoabdominal solid organs. Although rare, it has a higher prevalence in males with an incidence of 1:10,000. The embryonic rotation of the midgut occurs in the opposite direction, leading to a mirror-image arrangement of all visceral organs in both the thorax and abdomen. While individuals with this condition generally live without complications, its importance lies in the differences and difficulties encountered during operative procedures, particularly organ transplantations.

Case presentation

In this article we have presented 3 cases of situs inversus with different complications, admitted in a month, an 83 year-old woman with cholecystitis, a 46 year-old woman with spontaneous peritonitis caused by peptic ulcer perforation and a 26 year-old young man with volvulus of sigmoid.

Clinical Discussion

We have provided a comprehensive description of this uncommon medical condition, including its various facets and associated complications. Medical literature has been searched to find more relevant information about SITs for better optimal planning in surgery.

Conclusion

Situs Inversus Totalis can create challenges in clinical practice, particularly in surgical procedures, due to the reversal of anatomy. Although it does not inherently cause specific complications, it can complicate the diagnosis and management of certain medical conditions. Accurate imaging is crucial for diagnosis and treatment planning. Healthcare professionals must remain vigilant and adaptable when treating patients with SIT.

Introduction

Twisted ovarian cysts are acute conditions that cause sudden pain in the lower abdomen and may occur in older people. A twisted ovarian cyst presents as a complex cyst picture on ultrasound and CT scans and may mimic malignant ovarian masses. A normal CA-125 level in an older woman with a complex ovarian cyst who presents with acute pelvic pain may indicate a twisted ovarian cyst.

Case presentation

A 62-year-old woman presented with acute pelvic pain. A CT scan revealed a cystic ovarian mass with a diameter of 15,1 cm x 10,2 cm x 11,2 cm. Additionally, thick septations and multiple projected mural nodules were detected with normal CA-125 levels.

Discussion

The patient underwent an exploratory laparotomy. Subsequently, a midline incision was made and 100 ml of hemorrhagic ascites was observed. Macroscopic examination of the left ovary revealed an ovarian cyst with necrosis and bleeding, weighing 830 g, and measuring 15 × 12 × 8 cm. Histopathological examination of the cyst revealed serous cystadenoma.

Conclusion

This case suggests that a twisted ovarian cyst may occur in old age; therefore, in older women with complaints of sudden pain in the lower abdomen, a twisted ovarian cyst should be suspected. In post-menopausal women, ovarian masses may not be indicative of a malignancy. However, a twisted benign ovarian cyst should be considered if a complex ovarian mass with acute pelvic pain and normal CA-125 levels is found.

Introduction

Laparoscopic subtotal cholecystectomy (LSC) is recognized as a safe, feasible alternative method for avoiding common bile duct injuries in 'difficult' gallbladders. We describe the details of an LSC technique that uses a linear stapler with the reconstituting method for severe cholecystitis.

Methods

We retrospectively analyzed the cases of 19 Japanese patients diagnosed with acute cholecystitis who underwent LSC (Jan. 2017–Dec. 2020). In each patient, we first attempted to perform a standard laparoscopic cholecystectomy. Four trocars were inserted in all patients. When it was extremely difficult to expose and dissect the triangle of Calot or the neck of the gallbladder due to severe inflammation and fibrosis, an LSC was performed. The gallbladder was divided downward from the gallbladder fundus to the neck. We opened the gallbladder wall at the fundus and removed all gallstones with suction and saline flushing. The gallbladder was transected by a laparoscopic linear stapler.

Results

The median operation time was 166 min; intraoperative blood loss was 35 mL. One patient (5.3%) had minor bile leakage that promptly resolved after the transpapillary approach. The median postoperative hospital stay was 7 days.

Conclusion

Using a linear stapler to divide the gallbladder neck is a simple, feasible strategy for LSCs in difficult gallbladders.

More than 700,000 pacemakers (PMs) are implanted worldwide each year, with more than 250,000 deployed in the United States. Leadless cardiac pacemakers (LPCs) are an alternative to conventional pacemakers because they do not require permanent transvenous leads while alleviating bradyarrhythmias. An innovation in the field of pacing systems called ‘dual chamber pacing system’ has received US Food and Drug Administration (FDA) approval which is a safe, non-invasive, and efficacious procedure as documented by a landmark clinical study. It succeeded in its pre-established safety and performance goals, with definite procedural success, atrial pacing and reliable atrioventricular (AV) synchrony. Despite its hailing success, the system continues to undergo transformation and development, and requires further longitudinal data to reaffirm its safety and efficacy.

Introduction

and importance: Ileosigmoid knotting (ISK), also known as double volvulus or compound volvulus is a rare cause of intestinal obstruction in which small bowel or sigmoid colon wrap around each other, causing double loop obstruction and frequently leading to bowel strangulation. This study aimed to determine the characteristics, presentation, morbidity, and mortality associated with ISK at University Hospital.

Methods

A retrospective medical record review of all patients operated for ISK between January 2018 and January 2023. A data collection format that was tested on five patients was used to collect data on sociodemographic characteristics, clinical presentation, preoperative investigations, preoperative stabilization, intraoperative findings, type of surgical procedure performed, and patients’ treatment outcomes.

Outcomes

A total of 29 patients were operated on for ISK during the study period. Of these, the medical records of 25 patients were retrieved, reviewed, and analyzed. Males were commonly affected with a male-to-female ratio of 2:1(16:9). The peak age for ISK was between 30 and 50 years. The mean age of the patients was 42.6 years (SD ± 15.9) and ranged from 20 to 70 years. Only one of the patients had comorbidity (retroviral infection). The average duration of illness was 1.6 days (SD ± 0.65), and the majority (23, 92%) presented within 48 h. Four-fifth (20, 80%) of patients are from the rural areas and the majority of them (15 (75%)) presented later than 24 h, while 3 (25%) of patients from urban settings presented within 24 h. Abdominal pain was present in all patients followed by vomiting (24, 96%), abdominal distention (22, 88%), and failure to pass feces or flatus (15, 52%). Four (16%) of the patients were in shock at the presentation. The leading abdominal findings were guarding (25, 100%), tenderness (24, 96%), rebound tenderness (21, 84%), and hyper-tympanic abdomen (11, 44%). On digital rectal examination, a stool was found in more than half (17, 68%), followed by an empty rectum (7, 28%) and blood in 2 (8%) of the patients. Preoperative imaging (plain abdominal x-ray) was done in 13 patients with symptoms of obstruction and with no features of diffuse peritonitis.

Conclusion

The performance of prompt, individualized surgical treatment in conjunction with the use of advanced measures of critical care to combat the disastrous consequences of multiple organ failures may contribute greatly to improving the survival rate of victims of this dreadful entity.

Introduction and importance

Fibroids are common benign neoplasms of the uterus, exciting in >70% of women. Also, in 0.3–15% of pregnant. They are classified into submucosal, intramural, and subserosal. The diagnosis depends on ultrasound imaging, while the treatment depends on surveillance, drugs, and surgery.

Case presentation

A 43-year-old nulligravida at 19 weeks’ gestation complained of increased unresponsive subacute pain that started for 3 weeks. She was apprehensive and pale and had digestive disturbances. The physical examination showed tenderness, and the size of the uterus was equivalent to 36 weeks. The radiological investigations showed a live fetus and a well-defined subserosal fibroid measuring 20 × 19 cm, connected to the uterus by a peduncle with torsion signs on echo-Doppler. A myomectomy was done and we had good outcomes for both the mother and fetus.

Clinical discussion

Many factors get together and make our case extraordinary; the rapid increase in size, the size of the fibroid, the pregnancy, the torsion, and the lack of equipment in our area that forced us to treat the patient urgently by laparotomy, which had risks on both the mother and the fetus.

Conclusion

This case highlights that even though laparoscopy is the best choice to treat fibroids during pregnancy; laparotomy is a good choice and has good outcomes for both the mother and the fetus in low-income countries. In addition, Fast diagnosis and treatment also are important to get the best results, especially in complicated situations.