Acta Chirurgica Belgica最新文献

Background: Retroperitoneal hemorrhage is a life-threatening entity that can result from a range of etiologies. Rupture of an abdominal aortic aneurysm (AAA) is the most common vascular emergency associated with high morbidity and mortality. However, not all retroperitoneal hemorrhages result from this vascular emergency. Adrenal hemorrhage, though rare, represents an important, often under-recognized and potentially fatal alternative diagnosis. The diagnostic challenge is further compounded when such adrenal pathology occurs in the presence of a concurrent AAA, as overlapping clinical and radiologic features can obscure the true source of bleeding. This coexistence can lead to misdiagnosis, delays in appropriate treatment, and complex decision-making in the acute care setting.

Case report: A man in his 70s presented with hemodynamic collapse and right-sided flank pain, initially raising concern for a ruptured abdominal aortic aneurysm (AAA). Imaging revealed both an infrarenal AAA and a large retroperitoneal mass consistent with a hemorrhaging adrenal lesion. Due to diagnostic uncertainty and persistent hemodynamic instability, the patient underwent emergency endovascular aortic repair (EVAR) followed by selective arterial embolization of the adrenal lesion. Postoperative recovery was favorable, with resolution of hemodynamic instability and planned delayed adrenalectomy.

Conclusion: This case report illustrates the diagnostic complexity and clinical challenge posed by simultaneous adrenal hemorrhage and AAA. Adrenal tumors can cause life-threatening retroperitoneal hemorrhage. Timely recognition via high-resolution imaging and a flexible interventional approach tailored to the evolving clinical picture are key to successful management. Clinicians should remain vigilant for alternative bleeding sources, even in the context of known vascular disease.

Intracardiac tumors in children are rare, mostly benign, and occasionally related to genetic syndromes (p.e. tuberous sclerosis or Gorlin syndrome). Echocardiography, CT and MRI are the golden standard for diagnosis and surgical removal is indicated when the tumor is symptomatic by hemodynamic interference. We present 4 cases of infants with an intracardiac tumor, all of them needing surgical removal.

Aim: To highlight the practice of plastic surgery in Greece during the nineteenth century, its possibilities, limits, and novelties, which mark the beginning of Greek plastic surgery.

Materials and methods: Study of nineteenth century Greek medical literature and medical archive kept today in National Library of Greece, which are for the first time brought to light.

Results: Greek physicians tried to use skin grafts in order to reconstruct facial trauma, deformities, and treat oncological patients. Greek physicians kept up to date and followed the international achievements in plastic surgery at the time.

Conclusion: The most prominent figure of Greek surgery during the nineteenth century, Professor Theodoros Aretaios (1829-1893), played a leading role in the development of Greek plastic surgery.

Background: Gastric metastases from breast cancer are rare clinical entities that often mimic primary gastric malignancies, leading to diagnostic delay. Invasive lobular carcinoma (ILC), due to its diffuse growth pattern and loss of E-cadherin expression, demonstrates a higher propensity for metastasizes to the gastrointestinal tract.

Methods: Clinical data for this study were retrospectively collected from the hospital's electronic clinical program.

Results: The authors report the case of a 42-year-old woman with bilateral stage IV ILC who subsequently developed bilateral ovarian and gastric metastases. We discuss the clinical, histopathologic, and imaging features, with emphasis on differential diagnosis and therapeutic strategies considering current evidence.

Conclusion: This case highlights the diagnostic challenge of gastric metastases from ILC, which may present many years after the initial diagnosis. Definitive diagnosis requires immunohistochemistry to distinguish metastatic breast carcinoma from primary gastric carcinoma. Systemic therapy remains the mainstay of treatment, while surgical intervention should be reserved for selected palliative indications. Increased awareness of this rare manifestation is crucial to avoid misdiagnosis and optimize multidisciplinary management.

Background: Laparoscopic hiatal hernia repair is considered the golden standard. Since its entrance in the mid-'00s, robotic surgery has been available in every modern operating center. The aim of this systematic review and meta-analyses is to compare laparoscopic versus robotic surgical hiatal hernia repair regarding clinically relevant postoperative complications, using the Clavien Dindo score 3.

Methods: After registration in PROSPERO, a literature review was performed following the PRISMA flow diagram, resulting in eleven studies. Their quality was assessed using the Newcastle-Ottowa scale. Risk of bias was assessed using the ROBINS-I tool. Statistical analysis was performed using Python. The primary outcome was Clavien Dindo score 3, the secondary outcomes were mortality, intraoperative complications, postoperative complications, length of stay and operation time.

Results: Eleven studies (182.467 patients in total, 12.056 robotic surgical repairs) were analyzed. The meta-analysis showed no statistically significant result between CD score 3 (OR = 0,68 (95% CI 0,27 - 1,72)). From the investigated secondary outcomes, only intraoperative complications showed a significant difference favoring robotic repair (OR = 0,41 (95% CI 0,22 - 0,76) and p-value = 0,005).

Conclusion: Robotic hiatal hernia repair shows less intraoperative complications in comparison to laparoscopic repair. With the current available literature, no difference in Clavien Dindo score 3 is seen. To investigate the full potential of robotic surgery, prospective studies should be performed with surgeons who have passed their learning curve. Subgroup analyses regarding giant hiatal hernia and redo surgery should be performed. A uniform definition of 'giant' hiatal hernia is needed.

Background: Flexible intramedullary nailing is a minimally invasive method used for pediatric tibial shaft fractures stabilization.

Case presentation: A seven-year-old boy sustained a midshaft oblique tibial fracture due to a fall from one meter height and was treated by closed reduction and intramedullary nailing. On the first postoperative day, a swelling of the proximal half of the lower leg occurred and progressed to compartment syndrome. The lower leg was edematous, firm and painful on palpation, and the pain at rest was out of proportion to injury. CT angiography showed a posterior tibial artery pseudoaneurysm and no signs of deep venous thrombosis. He was successfully treated by pseudoaneurysm evacuation and saphenous vein patch repair of the posterior tibial artery. Postoperative course was uneventful.

Conclusion: Vascular complications after flexible intramedullary nailing in children are rare and require early recognition. In this case, treatment by open surgical technique was successful.

Background: Recurrent pyloric stenosis (RPS) is a very rare condition that occurs after an initially successful pyloromyotomy for hypertrophic pyloric stenosis. Over the last decade, the number of reported cases of recurrent pyloric stenosis has increased considerably. Given the rarity of this condition and the paucity of literature on the subject, there is a certain diagnostic difficulty, particularly at ultrasound level, where it is difficult to differentiate a true recurrence of pyloric stenosis from an initial incomplete pyloromyotomy.

Methods: A systematic literature review was performed to characterize the diagnosis of RPS and to report on all cases previously described in literature.

Results: We identified a total of 15 patients (median age of 19 days at first pyloromyotomy; average of 31 days of symptom-free interval before RPS; 66.7% male). Eleven cases fulfilled the 3 Kuckelman criteria for RPS (weight gain, 3 weeks resolution of symptoms, restenosis on imaging). The length of the pylorus on ultrasound appears to increase or remain above 18 mm for RPS, where normally it should decrease immediately after pyloromyotomy. RPS seems to occur more frequently when the first pyloromyotomy is performed at an early age.

Conclusion: Hypertrophy of the pyloric muscle is a progressive entity, and if operated upon too early can favor recurrence. The diagnosis of a RPS can be made through the combination of clinical criteria and ultrasound, specifically length measurements of the pylorus. Additional studies need to be performed to confirm our findings and to define strategies to reduce risks for RPS.

Background. The work of the anatomist surgeon Joseph Maclise has been forgotten by history. His contributions are unknown to younger generations. This study aims to analyze his legacy, focusing on the surgical anatomy of hernias. Results. This is the first study to analyze Maclise's work from a surgical, rather than an artistic, perspective, focusing on the pathology of hernias. His life was marked by a lack of academic and/or institutional recognition. He was forgotten by the Royal College of Surgeons a decade before his death. He collaborated with Morton on his treatise on surgical anatomy. His work was fundamental to the training of surgeons for at least three decades and served as a bridge between two continents. In the field of hernias, he simplifies knowledge for surgeons, shows each type of hernia in anterior and posterior approaches, and describes the region as a single space where all hernias appear. Conclusion. Maclise was an exemplary Victorian surgeon who cultivated many fields of practice (surgical anatomy, comparative anatomy and naturalism, experimental anatomy and physiology, embryology, art and painting), committed to the advancement of science in his time. His surgical anatomy of hernias facilitated the visual understanding of this pathology for surgeons of several generations.

Objectives: Lungs are the second most frequent site of colorectal cancer metastases. Complete resection of isolated lung metastases is recommended in the current guidelines because of the high long-term survival rate and low morbidity-mortality. The aim of this study is to determine prognostic factors for lung metastasectomy in order to better select patients who will benefit from surgical resection.

Methods: This single-center retrospective study is based on the medical data of patients operated for resection of colorectal lung metastases between 2004 and 2023.

Results: A total of 109 patients were selected, and four had to be excluded. The univariate analysis revealed factors influencing the survival: primary cancers that were metastatic at diagnosis, high preoperative CEA rate, the number and size of metastases, hilar lymph node involvement, invasion of the resection margins and poorly differentiated histological grade. A multivariate analysis including only the pre-operative factors was performed: CEA (p < 0.001), the size (p = 0.003) and number (p = 0.038) of metastases and the metastatic stage of the primary cancer at diagnosis (p = 0.052).

Conclusions: The 5-year survival rate in this study is 55%. Survival can be evaluated by four preoperative factors: CEA rate, size and number of metastases and metastatic status of the primary cancer. These factors can be combined to form a survival score, each factor being worth one point. Patients with a score of 0 have a 5-year survival of around 90%, while patients with a score of 3 have a 5-year survival of around 10%. This score could be used to select patients eligible for surgery.