CRSLS : MIS case reports from SLS最新文献

Introduction: A de Garengeot's hernia is a femoral hernia containing the appendix and accounts for approximately 0.8% of all femoral hernias.

Presentation of the case: This paper describes a case of an 84-year-old female who presented with abdominal pain, believed to have an incarcerated femoral hernia. Patient underwent a hernia repair and was found to have a femoral hernia involving the appendix, a de Garengeot's hernia. The femoral hernia was repaired using a total extraperitoneal (TEP) approach.

Discussion: There are a variety of reported ways to repair a de Garengeot hernia. In this case, we discuss the successful use of the TEP approach to repairing a de Garengeot hernia.

Conclusion: Although rare, a de Garengeot hernia must remain on the differential when evaluating a patient for an incarcerated femoral hernia. A TEP approach provides the surgeon the ability to perform a variety of hernia repairs, regardless of what is encountered during the operation.

Background: Gastric outlet obstruction secondary to foregut gastrointestinal malignancies can be managed with a variety of medical, endoscopic, and surgical options. Laparoscopic gastrojejunostomy is an option for those patients who are able to tolerate an operation as a long-term palliative option. This operation may be associated with some significant postoperative technical and nontechnical complications, including delayed gastric emptying. This paper describes an incision-less, endoscopic option that we propose can be used to salvage a functionally obstructed gastrojejunostomy.

Case description: A 57-year old male patient had a history of pancreatic adenocarcinoma causing gastric outlet obstruction and underwent a previously created surgical gastrojejunostomy at an outside hospital. His procedure was complicated by anastomotic leak and essentially persistent obstructive symptoms secondary to delayed gastric emptying. Though his anastomosis was demonstrably patent, these symptoms were thought to be secondary to a functional obstruction at the gastrojejunostomy. After repeated workups and many failed attempts to treat these symptoms, he ultimately underwent endoscopic placement of an uncovered colonic stent into the efferent limb of his gastrojejunostomy. This allowed for preferential drainage of gastric contents down the efferent limb, and improvement of his delayed gastric emptying.

Conclusions: In a select group of patients with advanced foregut malignancy, and with high re-operative risks, salvage endoscopic stenting may be useful in the palliation of symptoms from a functionally obstructed gastrojejunostomy.

Objective: Endometriosis spreading to the vagina is rare, present in only 0.02% of women with symptomatic endometriosis. Suburethral lesion site is exceptional. In an extensive literature review only 4 cases of suburethral endometriosis were identified. Our objective is to present a case of primary vaginal suburethral endometriosis in a 31-year old patient who underwent laparoscopic evaluation and to perform a literature review on this topic.

Methods and procedures: Case report presentation based on information extracted from patient database. A review of literature with a Medline search using key words urethral endometriosis, suburethral endometriosis, or urethral diverticulum was undertaken.

Results: This case report describes a case of a 31-year old female patient referred for severe pelvic pain, worsening during menstruation. On physical examination a 2 cm suburethral endometriotic lesion was found as the initial presentation. Her examination was also significant for enlarged, tender uterus and adnexa. Based on examination and imaging, adenomyosis and endometriosis were suspected. Surgical evaluation revealed extensive endometriosis with lymph node involvement at laparoscopic exploration. The review of literature revealed only 4 cases where suburethral endometriosis was previously identified.

Conclusion: Primary vaginal suburethral endometriosis, although rare, could be an indication of extensive endometriosis. This case highlights the importance of careful clinical examination, surgical excision, and laparoscopic evaluation when identifying suburethral vaginal endometriotic lesions.

Epiphrenic diverticulum is a rare condition associated with esophageal motor disorder, and it is often asymptomatic, with a well-established surgical indication. The present study aims to report a case of a giant epiphrenic diverticulum in a 68-year-old male patient who, due to the symptoms, opted for surgical treatment using the daVinci® system. Robotic surgery consisting of esophageal diverticulectomy with cardiomyotomy was performed. The patient had an excellent recovery with an abbreviated hospitalization, return to food, and satisfactory routine activity.

Intussusception in adults is a rare occurrence at approximately 5% and malignancy as the cause comprises half that number. The most common malignancies found are primary adenocarcinoma, metastatic carcinoma, lymphoma, and gastrointestinal stromal tumors. Lymphoma is the second most common. The management of adult intussusception is generally surgical, which is due to the higher likelihood of malignancy being the underlying cause. The patient's history helps to direct management and the most likely underlying diagnosis. This is especially important in patients who are immunosuppressed and with a history of lymphoproliferative disease. Early management and proper surgical intervention allow for the best survival rate. Here we present a case of adult intussusception caused by a rare and aggressive type of non-Hodgkin lymphoma.

Introduction: Intercostal hernias are a rare clinical entity. They are divided into trans-diaphragmatic intercostal or abdominal intercostal hernias based upon the presence or absence of diaphragmatic injury. There are various means of repair for these hernias, including open, laparoscopic, and robotic approaches. We present the second known robotic repair of an abdominal intercostal hernia and review of the relevant literature.

Case description: A 54-year-old morbidly obese male was found to have an abdominal intercostal hernia on the right between the 9^th and 10^th ribs. His symptoms were significant for a large, tender right chest wall mass. Through a three-port approach, polypropylene mesh and circumferential sutures were used to create a double-wall of reinforcement to secure the area of weakness.

Discussion: This rare case of an intercostal hernia utilized robotic-assisted laparoscopic repair and led to a favorable outcome, whereby the patient reported significant improvement in pain, comfort, and quality of life. Thus, minimally invasive robotic surgery for this complex structural pathology can be safer and have less complications than other current treatments.

Secondary distal plasmacytoma that arise from multiple myeloma is a common hematological malignancy that manifests in later stages of the disease. These plasmacytomas are known to cause extensive systemic organ damage. When extramedullary plasmacytomas reach the gallbladder or biliary ducts, expansion can mimic acute acalculous cholecystitis or cholangiocarcinoma. We report a case of a 56-year-old female with a history of aggressive course IgA κ chain multiple myeloma who presented with right upper quadrant abdominal pain with nausea and vomiting for one week duration. Her laboratory panel revealed liver function tests consistent with gallbladder etiology. Abdominal ultrasound and CT showed no evidence of cholelithiasis precluding to acute acalculous cholecystitis. Initial medical management did not show any improvement. A robotic cholecystectomy was performed, and a pathology review of the specimen found a neoplastic stricture of the gallbladder fundus, the histological evaluation of which revealed plasmacytoid cells originating from her primary multiple myeloma diagnosis. The patient's condition declined following surgery, postoperative presentation included metastatic liver thrombosis mimicking cholangiocarcinoma and the patient later expired with palliative care.

Background and Objectives: Less than 300 cases of a De Garengeot's hernia have been published. This rare femoral hernia with the vermiform appendix included appears almost exclusively on the right side, mainly in females, and it generally debuts as an incarcerated femoral hernia. Although most of the times there is a concomitant appendicitis, clinical signs of peritonitis are absent. The wide use of radiologic exams has not favored its preoperative diagnosis, but been usually found incidentally during a surgical emergency. The best surgical approach to a De Garengeot's hernia is not totally defined and many critical questions still remain unanswered. Open surgery is considered the standard treatment procedure, but since the emergence of laparoscopy for incarcerated hernias, this is certainly an option. Methods: We report the successful laparoscopic management of an 83-year-old woman who had been operated on her right inguinal hernia, with a Rutkow-Robbins' technique, 4 months earlier. She had noticed the protrusion of a lump in her right inguinal region for 2 months. Radiological studies were not conclusive. With a miss diagnosis of a recurrent incarcerated inguinal hernia, a minimal invasive endoscopic approach was performed. A representative case of this fully laparoscopic TAPP procedure is presented. Results: The patient made an uninterrupted recovery. She left the hospital the day after in a stable condition and has enjoyed good health since. Conclusion: A fully laparoscopic TAPP approach seems perfectly safe and feasible to treat this entity, and could be considered the first line alternative when enough expertise is available.

Colorectal cancer prevention relies on effective screening through colonoscopy and polypectomy. Several techniques and methods have been described to manage complex colonic polyps such as the ones that are endoscopically unresectable. Across time, we have been able to perform less invasive techniques that include different types of colonic resections, ranging from partial thickness, full-thickness and, segmental colectomies, however, none has proven to be the treatment of choice for these lesions. The technique presented here is an attractive alternative to segmental colectomy using a robotic platform to perform a full-thickness resection.

Introduction: A parastomal hernia (PSH) is an abnormal herniation of an intra-abdominal organ or other tissue through an intentionally created fascial defect at an ostomy site. PSHs commonly involve reducible mobile segments of omentum, intra-abdominal fat, and bowel. However, PSHs may rarely involve fixed intra-abdominal organs such as the stomach. Case Description: A 68-year-old female underwent emergent Hartmann procedure for Hinchey III diverticulitis and subsequently developed a large reducible parastomal hernia. She was scheduled for an elective laparoscopic colostomy reversal. Prior to her scheduled reversal, the patient presented to the ED with anorexia, lack of colostomy output, emesis, and pain localized to her left lower quadrant. She was found to have gastric outlet obstruction secondary to herniation of the stomach through the left lower quadrant colostomy site. The patient was admitted and treated conservatively with resolution of her symptoms, but due to the high likelihood of recurrence, the decision was made to proceed with laparoscopic Hartmann colostomy reversal with coloproctostomy and primary closure of the fascia without mesh. Conclusion: The contents of a PSH can become incarcerated causing obstruction, strangulation, necrosis and even perforation over time. Fortunately, in this case, herniation of the stomach was recognized early. The patient underwent repair of the hernia defect in order to prevent recurrence of gastric herniation and its potential detrimental complications. The decision regarding the technical aspects of ostomy reversal in terms of mesh selection require further study. In our case, mesh was not used due to patient-specific factors and comorbidities.