Acta Chirurgica Belgica最新文献

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: 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: 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: 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: Ovarian torsion is a rare but important cause of acute abdominal pain in paediatric and adolescent populations. Delayed diagnosis can lead to loss of ovarian function, with non-specific symptoms often complicating timely identification. Ultrasound is the primary diagnostic tool, but its sensitivity varies.

Aims: This study reviews the clinical presentation, diagnosis, and outcomes of paediatric and adolescent ovarian torsion cases over an 8-year period.

Methods: A retrospective analysis of 23 ovarian torsion cases in patients under 16 years treated within NHS Lothian between January 2016 and January 2024 was conducted. Data on patient demographics, clinical symptoms, imaging findings, and surgical interventions were collected.

Results: All patients presented with abdominal pain, with 91% also reporting nausea and/or vomiting. Ultrasound confirmed torsion in 80% of cases. Surgical intervention showed 56.5% of ovaries were necrotic or ischaemic, though no significant correlation was found between raised inflammatory markers and necrosis. Ovarian-sparing surgery was performed in 82.6% of cases, with good follow-up outcomes.

Conclusion: Ovarian torsion remains a diagnostic challenge due to its non-specific symptoms. Ovarian preservation is achievable in most cases. Prompt diagnosis and intervention are critical.

Background: Adrenal myelolipomas are benign tumors composed of mature adipose tissue and hematopoietic elements, such as myeloid and erythroid cells. They are often asymptomatic and do not require treatment unless complications arise.

Methods: A case description and brief review of the literature is performed.

Results: This case report outlines the hospital course and management of a 77-year-old woman who was admitted to the emergency department with hemorrhagic shock after a traumatic fall. A full body computed tomography (CT) scan revealed a voluminous mass in the right adrenal gland with an active hemorrhage in the right hypochondrium. After reviewing her medical records, it became clear that the hemorrhage arose from a pre-existing adrenal myelolipoma, discovered nine years earlier. Additionally, she sustained multiple fractures including right-sided rib fractures, a compression fracture of L1, and a complex fracture of the right scapula, accompanied by a significant hematoma. The clinical approach included initial stabilization, embolization procedures to control the hemorrhage, and comprehensive follow-up care.

Conclusion: This case illustrates that timely recognition and management of traumatic hemorrhage from pre-existing masses, such as an adrenal myelolipoma, are crucial for improving patient outcomes and minimizing complications such as hypovolemic shock.

Background: Laparoscopic cholecystectomy (LCCE) has been the standard treatment for acute cholecystitis since the 1980s, but it may pose a significant hazard for high-risk patients. Endoscopic gallbladder drainage (EUS-GBD) using lumen-apposing metal stents (LAMS) offers a minimally invasive alternative for these patients. While LAMS is effective, the need for subsequent LCCE and long-term outcomes remains under investigation. This study aims to retrospectively assess the safety and feasibility of cholecystectomy after LAMS placement in a series of patients initially deemed unfit for surgery.

Methods: A retrospective review included patients who underwent LCCE following EUS-GBD with LAMS between January and September 2024 was conducted. Data on demographics, procedural details, technical success, and postoperative outcomes were retrieved.

Results: Eight patients with acute cholecystitis underwent gallbladder drainage with transduodenal LAMS placement. Two required ICU care for sepsis but recovered. All eight subsequently underwent elective LCCE with 100% technical success. LAMS placement facilitated faster resolution of cholecystitis, resulting in a clear visualization of Calot's triangle, allowing precise dissection and closure of the cholecystoduodenostomy without complications. The median interval between LAMS placement and LCCE was 117.5 days (111 days excluding one outlier). LCCE was performed in a median operative time of 49 min. No conversions to open surgery or postoperative complications occurred, and the median postoperative hospitalization was 2 days.

Conclusion: Interval LCCE following EUS-GBD is a safe and effective option for managing acute cholecystitis in high-risk patients, with outcomes comparable to standard LCCE. Randomized controlled trials are necessary to establish definitive guidelines for this approach.