Background A hematoma that gradually increases over a chronic course of months or longer is defined as a chronic expanding hematoma (CEH). CEHs often develop in the limbs and on body surfaces that are susceptible to external stimuli. CEHs in the intrathoracic or intraperitoneal organs are uncommon, with liver CEHs being particularly rare worldwide. Case presentation A 57-year-old woman was previously diagnosed with a giant cyst in the right liver lobe, with a longer axis of approximately 15 cm. Abdominal ultrasonography findings suggested a complex cyst, and she was referred to our hospital for further inspection. Although CEH was suspected, it was difficult to exclude malignant diseases such as intraductal papillary neoplasm of the bile duct and cystadenocarcinoma. There was a possibility of malignant disease and the exclusion of surrounding organs due to tumor growth. Therefore, a right hepatectomy was performed. Pathological examination revealed a pseudocyst containing a clot, which was consistent with CEH. Conclusions CEH rarely occurs in the liver; however, it is necessary to consider CEH when a slow-growing hepatic mass that shows a mosaic pattern on magnetic resonance imaging is found.
Purpose In this retrospective study, we assessed factors that can be used to predict the need for bowel resection due to an incarcerated groin hernia. Methods We enrolled a total of 83 patients diagnosed with an incarcerated groin hernia on preoperative unenhanced computed tomography (CT) between January 2010 and December 2019 in our hospital. They were divided into two groups: those who underwent bowel resection and those who did not. The clinical findings, blood test results, and unenhanced CT values of patients were examined and compared between the two groups. The indication of intestinal resection was macroscopic necrosis or perforation of the incarcerated intestine. Results A total of 83 patients with incarcerated groin hernias were included in our study, of whom 13 (15.7%) had undergone bowel resection surgery. A univariate analysis identified a prolonged time from the symptom onset to surgery, increased white blood cell (WBC) count, increased C-reactive protein (CRP) level, decreased albumin level, and CT attenuation of the incarcerated intestinal wall at the fundus as significant predictive factors. The cut-off value for prediction of intestinal resection was 25 HU for the average CT attenuation of the incarcerated intestinal wall at the fundus and a WBC of 11,550 based on the receiver operating characteristic (ROC) curve. A multivariate analysis showed CT attenuation of the incarcerated intestinal wall at the fundus and an increased WBC count to be independent predictive factors. Conclusions Measuring unenhanced CT attenuation of the incarcerated intestinal wall at the fundus and the WBC count was suggested to be necessary for determining whether or not resection of the incarcerated intestine is required in cases of groin hernia.
Background: In this retrospective study, we aimed to assess the predictive factors for bowel resection due to strangulated small bowel obstruction (SSBO). Methods: We enrolled a total of 109 patients diagnosed with SSBO at surgery. They were divided into two groups: those who underwent bowel resection and those who did not. The clinical findings, blood test results, blood gas analysis results, computed tomography (CT) findings, and sequential organ failure assessment (SOFA) scores of the patients were examined and compared between the two groups. Results: A univariate analysis indicated significant predictive factors to be a history of abdominal surgery, prolonged time from the onset of disease to the operation, increased C-reactive protein (CRP) level, decreased albumin, SOFA score, existence of closed-loop obstruction, and reduced enhancement of the intestinal wall at CT. A multivariate analysis indicated that a reduced enhancement of the intestinal wall and the existence of closed-loop obstruction were independent predictive factors. Strangulated bowel obstruction can progress to a serious condition. It is therefore crucial to predict preoperatively those patients who are likely to require bowel resection. Conclusions: Assessing the reduced enhancement of the intestinal wall and the existence of closed-loop obstruction are required in order to determine whether or not resection of the incarcerated intestine with SSBO is necessary. Key words: strangulated small bowel obstruction, prognostic factor, bowel resection, reduced enhancement of the intestinal wall, closed-loop obstruction
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