Rationale: Castleman disease (CD) is a rare lymphoproliferative disease with a poorly understood etiology. The occurrence of CD in the abdominal cavity is very rare, especially in the retroperitoneal peripancreatic region. Patient concerns: A 33-year-old woman was referred to our department on March 1, 2018 for a detailed physical examination due to retroperitoneal peripancreatic lymph node enlargement over 15 days. Diagnosis: Enhanced magnetic resonance imaging of the epigastrium showed the mass with abundant blood supply is located between the liver and the stomach in the upper margin of the pancreas. Postoperative pathological examination revealed CD, type of unicentric Castleman disease. Interventions: We performed an open surgery on this patient and completely removed the mass. There was no postoperative radiochemotherapy. Outcomes: The patient was followed-up for more than 12 months after the operation and showed good recovery. Lessons: CD is a rare disorder that is hard to diagnose early and complete resection of the tumor is still the most effective treatment.
Rationale:Adenocarcinoma of the anal canal is an uncommon malignancy. Primary adenocarcinoma, in particular, is extremely rare.Patient concerns:A 61-year-old man was referred to our institution with complaints of repeated hematochezia.Diagnosis:Digital rectal examination revealed a hard palpable ulcer in the anal canal, measuring 2 cm × 2 cm in size, at the 5 o’clock direction (in the lithotomy position). The pelvic enhanced magnetic resonance imaging revealed anal verge occupying mass. A diagnosis of carcinoma of the anal canal was considered. Colonoscopic examination revealed a poorly differentiated adenocarcinoma of the anal canal.Interventions:The patient underwent abdominoperineal resection (APR) of the rectum, and was administered 6 courses of adjuvant chemotherapy with mFOLFOX.Outcomes:The patient was followed up for more than 1 year after operation, and no local recurrence or distant metastasis occurred.Lessons:The diagnosis and treatment of this disease is still a huge challenge because its incidence is very low. A study of more cases is required for uniformity in diagnosis and for the development of treatment protocols.
Rationale:Postoperative intussusception is an unusual clinical entity and is rarely encountered as a complication following gastrectomy, especially radical total gastrectomy.Patient concerns:A 74-year-old woman was admitted to our hospital with complaints of melena and hematemesis. And the endoscopic biopsy confirmed the poorly differentiated adenocarcinoma of the stomach. Radical total gastrectomy with Uncut Roux-en-Y reconstruction was performed. On the third postoperative day (POD3), the patient complained of paroxysmal pain around the umbilicus, accompanied by nausea and vomiting.Diagnosis:Retrograde intussusceptions after radical total gastrectomy with Uncut Roux-en-Y reconstruction based on exploratory laparotomy.Interventions:On POD4, the abdominal computed tomography (CT) showed small bowel dilatation and fluid accumulation in the upper abdominal cavity, as well as a small mass of soft tissue on the left side of the pelvis. Small bowel obstruction was considered, and exploratory laparotomy was performed. Retrograde intussusception started just below the jejunojejunal anastomosis with possible organic lesions, which was subsequently removed.Outcomes:The patient recovered well and was discharged 15 days after the second operation.Lessons:This case report was written for 3 purposes: to increase awareness of this complication after radical total gastrectomy with Uncut-Roux-en-Y reconstruction; to emphasize early diagnosis through clinical manifestation, physical examination, and auxiliary examination with abdominal CT; and lastly, to emphasize that a reasonable surgical procedure should be performed immediately after diagnosis.
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