Rapunzel syndrome is an extremely rare complication of a gastric trichobezoar in. We report here the unusual case of a case of a 16 years old girl presented with severe abdominal pain and vomiting. Clinical examination revealed a malnourished girl, with presence of a mobile and sensitive abdominal mass of 20x15 cm witch filled the upper quadrant. An abdominal computed tomography scan showed a heterogeneous mass occupying the whole stomach cavity with extension into the third portion of the duodenum. A diagnostic of giant trichobezoar is suspected after further questioning reveling a trichotillomania, trichophagia and onychophagia. The removal of the trichobezoar endoscopically failed and it was possible to pull only few fibers of hair to comfort the diagnostic. She was subjected to an exploratory laparotomy. An antral gastrostomy were performed and a 25x10x7 cm trichobezoar was extracted. The patient had an uneventful postoperative outcome and was derived to psychiatry. Rapunzel syndrome is an uncommon trichobezoar, it’s commonly found in young females usually with an underlying psychiatric disorder. Management requires gastrotomy. A psychiatric assessment and a long-term follow-up are advocated as a regular part of treatment to prevent recurrence.
BackgroundLocal recurrence of colorectal cancer is a major cause of morbidity and mortality that usually implies a worse prognosis. Its etiopathogenesis is still a subject of debate. Recurrence on the perineal wound caused by anal retractor device is rarely reported.Case presentationWe present the case of a 75-year-old woman with perineal skin recurrence on the site of Lone Star Retractor™ from rectal adenocarcinoma. The patient underwent a curative proctectomy followed by a hand-sewn coloanal anastomosis using Lone Star Retractor™ 2 years ago for a tumor of the lower rectum. The recurrence was most likely caused by the seeding of exfoliated tumor cells into the perianal skin which was abraded by the retractor.ConclusionThis case is the fourth case reported in the literature and highlights the importance of the use of less traumatic endoanal retractors to prevent such perianal recurrence. Recurrence on the perineal wound caused by anal retractor device is rare but possible. Further studies are needed to define preventive measures able to reduce cutaneous implants.
HighlightsSolid-type serous cystadenoma of the pancreas is pauci-symptomatic.Preoperative diagnosis is often misdiagnosis with other solid pancreatic tumors.Laparoscopic resection is feasible for treatment with good prognosis.
Highlights
We report the clinical management challenge of synchronous abdominal aorta aneurysms (AAA) and colorectal cancer (CRC).
Management of synchronous sigmoid cancer and abdominal aortic aneurysm requires a collegiate decision which should take into consideration the aneurysm rupture risk, the malignancy stage of tumor but also the technical platform.
In such situation, the main controversy is the necessity of treating the diseases simultaneously or in two stages favouring the AAA management first.
We report the first case published in literature in which the patient was treated for colorectal cancer first by laparoscopic surgery followed by EVAR.
Nevertheless, the surgeon must adapt his technique according to the situations, and respect the oncological and functional requirements as much as possible.
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