Peptic ulcers generally appear in the stomach and the first segment of the duodenum as a result of mucosal erosion caused by pepsin and gastric acid secretion, with up to 70% of these occurring amongst patients aged 25-64. Currently, endoscopic procedures combined with proton pump inhibitors are considered the gold standard for managing complicated peptic ulcers, leaving surgical management as an option for endoscopic management failure or in scenarios such as incoercible bleeding, perforation, penetration and intestinal occlusion. Penetration of a gastric ulcer to adjacent organs is a rare complication; penetration to the liver and endoscopic diagnosis is even rarer. We have presented the case of a 54 year old diabetic male, who presented to the emergency room with upper gastrointestinal bleeding due to a chronic duodenal ulcer, with haemodynamic instability, requiring surgical management, revealing penetration to the liver with rupture of the right hepatic artery. The patient successfully recovered after surgery and was discharged 7 days after surgical intervention. We did not find any similar case reports in the current literature
This paper covers 1,150 proximal gastric vagotomies (PGV) performed from August 1970 to February 1986 on 1,017 duodenal ulcers (DU) and 133 gastric ulcers (GU) types II and III (178 emergency cases). Our technique is described: no isolation of vagal trunk and branches, double and simultaneous ligature and section of the epiploon sheets and control of vagal denervation completeness with pH direct mucosa test. Mortality is 0.1 % in 972 elective PGVs (2 nonrelated deaths among 178 emergency cases) and morbidity is minimal and temporary. Follow-up covers 81 % (mean, 84 months) and involves an interview, X-ray examination, endoscopic control and acid secretory output valoration (69%). Visick stages: 82, 10, 5 and 4% (in cases operated on more than 10 years ago, the Visick stages are: 69, 22, 3 and 6%). Recurrences: 19 DUs (94% inadequate vagotomies) and 15 ‘new GU’ (adequate secretory denervation and 3 of 4 are pyloric stenoses only dilatated). We have only 1 DU recurrence in 489 PGVs with pH over 6.4 at all five gastric mucosa points.
Meckel´s diverticulum is an abnormality in the development of the gastrointestinal system, its origin and clinical significance was first described by Johan Friedrich Meckel in 1809. It is a remnant of the omphalomesenteric duct which is usually observed following the rule of 2’s, located 2 feet proximal to the ileocecal valve, before 2 years of age in approximately 2% of the population, and is twice as common in male population. It is considered a true diverticulum because it presents all the histopathological layers of the bowel; 6% of the cases present with heterotopic tissue, mainly pancreatic, gastric, colonic or jejunal. We present the case of a 37-year-old patient who presented with acute onset epigastric pain which migrated to the right iliac fossa, he had a history of chronic non-steroidal anti-inflammatory drugs (NSAIDs) usage for articular pain. He underwent abdominal contrast tomography (CT) scan with double iodine contrast enhancement, which revealed the presence of a perforated Meckel´s diverticulum in the antimesenteric portion of the terminal ileum. The patient underwent laparoscopic diverticulectomy with no complications and was discharged 72 hours after the procedure. Histopathological confirmation of a perforated meckel’s diverticulum with heterotopic gastric mucosa confirmed the clinical suspicion of perforation secondary to chronic NSAIDs usage.
Choristoma is a term which refers to the presence of histologically normal tissue in a heterotopic location; hepatic choristoma is a condition in which hepatic tissue can be found in abnormal locations above or below the diaphragm, the gallbladder wall being the most frequent heterotopic site for implantation, this disease is usually asymptomatic and is rarely detected preoperatively with imaging studies due to a general lack of knowledge of this entity. We present the case of a 37 year old male patient who presented with acute abdominal pain in the right upper quadrant, colicky in nature, accompanied by nausea and vomiting; a HIDA 99 mTc scan revealed gallbladder diskynesia as well as a radiolucent bilobulated image. Upon laparoscopy, we encountered two masses on the superoanterior gallbladder wall and Hartmann´s pouch, which upon histopathological specimen examination revealed the presence of hepatic choristoma. This entity should be considered whenever a soft tissue mass is reported on the anterior gallbladder wall on imaging studies; It has been reported that hepatic choristoma is at higher risk for development of hepatocellular carcinoma and should be removed en bloc with the gallbladder.
ndometriosis is defined as the presence of tissue which is histologically similar to the endometrium in locations outside the uterus. It affects women of reproductive age mainly and represents one of the main causes for hysterectomy and infertility amongst women. It has a broad spectrum of symptoms which make for a challenging diagnosis. Extragenital endometriosis affects up to 37% of all patients, and intestinal endometriosis has been observed in up to 12% of women affected by the disease, mainly involving the recto-sigmoid colon, ileocecal region and cecal appendix. Intestinal symptoms such as changes in depositional rhythm, diarrhoea and constipation are frequent and can evolve to acute abdominal obstruction in advanced stages of the disease. Authors present the case of a 51-year-old female that presented to the emergency room with abdominal, colic type, diffuse pain in the left flank, early satiety and postprandial fullness, CT scan revealed the presence of a lobed and septate mesenteric cystic tumor, of approximately 15.5 cm in diameter. Serum oncological markers were found to be within normal parameters. The patient underwent laparoscopic resection of the tumor with trans-operatory study, which ruled malignancy out and confirmed the presence of endometriotic tissue. The patient was discharged 72 hrs after surgery and prescribed anastrozole 1 mg orally every 24 hours. Follow up with Abdominal CT scan was performed 6 and 18 months later, showing no evidence of recurrence; the patient remains asymptomatic 18 months after surgery.
Bacteria of the genus Actinomyces are non-spore-forming filamentous, Microaerophilic or strict anaerobic, Gram-positive bacilli, mainly belonging to the human commensal flora of the oropharynx, gastrointestinal tract, and urogenital tract; Actynomicosis israelii is most frequently isolated in human infection by this bacteria (90% of the cases), and is a very rare, generally a polymicrobial granulomatous infection which affects the cervicofacial (55% of all cases), abdominopelvic (22%) and thoracic (15%) regions, causing formation of abscesses, woody fibrosis and sinus discharge of characteristic sulfur granules. We present the case of a 42 year old patient with no prior medical history who presented to the emergency room with acute onset abdominal pain in the lower right quadrant, leukocytosis and neutrophilia, as well as ultrasonographic images which suggested acute appendicitis, the patient underwent laparoscopic appendectomy and cultures of abscesses surrounding the appendix were positive for A. israelii, which was also isolated in the histopathological specimen. The patient underwent antimicrobial treatment with ampicilin-sulbactam for a three month period postoperatively.
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