A 23-year-old Korean female presented epigastric pain of two-months' duration. She had a laparoscopic ovarian cyst excision 8 months previously. Clinical examination was normal. An abdominal computed tomogram (CT) demonstrated a 10-cm solid mass in the distal pancreas, with signs of splenic artery and vein occlusion, gastric and transverse colon invasion. Operative findings showed a mass involving distal pancreas, invasive to the posterior wall of the antrum of the stomach and transverse colon and 4th portion of the duodenum without lymph node involvement. The surgery consisted of a distal pancreatectomy, splenectomy and combined partial resection of the stomach, transverse colon and 4th portion of the duodenum. The immunohistochemistry and histopathological features were consistent with a confirmed diagnosis of intra-abdominal desmoid type fibromatosis (DTF). The prognosis of pancreatic DTF is not known and she showed no recurrence or distant metastasis during a 3 year follow-up. Herein we report a rare case with an isolated, sporadic, and non-trauma-related DTF, located at the pancreatic body and tail.
Despite the remarkable advances of liver transplantation, infections are still the most common and often life-threatening postoperative complications. Methicillin-resistant Staphylococcus aureus (MRSA) infection frequently complicates the postoperative course of liver transplant recipients. It has been well described that MRSA associated bacteremia, pneumonia and surgical site infection are common. But, MRSA infection manifesting as pyogenic spondylodiscitis is very rare. To our knowledge, pyogenic spondylodiscitis due to MRSA in lumbar spine after living donor liver transplantation (LDLT) has not been previously reported. Here, we report a 50-year-old man who developed pyogenic spondylodiscitis caused by MRSA after LDLT. Our patient underwent LDLT for hepatitis B virus related cirrhosis. Immunosuppressive treatment was administered with basiliximab, tacrolimus, corticosteroids and mycophenolate mofetil. He discharged on postoperative the 28th day with uncomplicated course. At 1 week after discharge the patient was readmitted for abdominal pain and high fever. Bile leakage at the bilo-biliary anastomosis site was found by endoscopic retrograde cholangiopancreatography and managed successfully with endoscopic nasobiliary drainage. The culture of drained fluid showed MRSA and he was treated with vancomycin for 4 weeks. These treatments resulted in resolution of the infection. However, 1 month later the patient presented with severe back pain. At this time, MRI showed spondylodiscitis of lumbar 2-3 spine and paraspinal abscess formation. Our patient underwent surgical debridement and primary bone graft. MRSA was cultured from the abscess. Postoperatively, the patient received intravenous vancomycin for 2 weeks and revealed complete outcome with no neurological sequalae. Although molecular analysis might be needed to identify the clonality of these strains, we compared the antibiogram of these isolates. Presently he is followed up and doing well without rejection and other complications.
Single-incision laparoscopic surgery (SILS) is a rapidly evolving technique which bridges traditional laparoscopic surgery and natural orifice transluminal endoscopic surgery (NOTES). We previously published a study comparing single port laparoscopic cholecystectomy (SPLC) and three port laparoscopic cholecystectomy (TPLC). We concluded that age, sex, diagnosis, body mass index (BMI), length of hospital stay, and mobilization between SPLC and TPLC produced no effect on the surgical requirements or outcomes between the two techniques. However, there were significant differences in operating time and pain scale. Thus, in this study we aimed to analyze those factors which reduced operating time. Methods: This retrospective medical record review enrolled 49 patients who had received SPLC at Presbyterian Medical Center from April 2009 to November 2010. Patient age, sex, BMI, length of hospital stay, operating time, pathological reports, and incidents of iatrogenic gallbladder (GB) perforation and complications were assessed and analyzed. For determining those factors which necessitated long operating times, we assessed the operating times relative to incidents of iatrogenic GB perforation, pathologic report results, surgeon experience and patient BMI. Results: The ratio of men to women in the study population was 1 : 6. The average patient age was 46 years (range of 21 to 93 years). The average BMI was 24.1 (range of 18.5 to 31.5). The mean duration of hospital stay was 5.12 days (range of 2 to 15 days). The average operating time was 118 minutes (range of 75 minutes to 185 minutes). The pathologic report assessments revealed cases of acute calculous cholecystitis (n=4, 8.2%), chronic calculous cholecystitis (n=37, 76.1%) and GB polyp (n=8, 16.3%). Iatrogenic perforation of the GB occurred in 5 cases. Minor complications such as surgical site infection and umbilical skin burn occurred in 6 cases. Longer operating times were required in the GB perforation cases than in the non-perforation cases (155±21.21 minutes versus 113.9±30.71 minutes, p=0.008). Of the cases of acute and chronic calculous cholecystitis and GB polyp, those including acute calculous cholecystitits required the longest operation times. The average operating time for the first 25 cases was 134.6±33.16 minutes and the average operating time for the remainder was 100.8±20.41 minutes (p=0.001). There was no significant difference in operating time between the BMI>24 and BMI<24 groups (125.9±35.17 minutes versus 111.2±27.65 minutes, respectively, p=0.112). Conclusion: We found 3 factors related to a reduction in operation time: (i) avoidance of iatrogenic perforation of the GB, (ii) application of treatment to case of chronic calculous cholecystitis and GB polyp, and (iii) accumulation of case experience by the attending surgeon.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.