Laparoscopic Resection of Para-Aortic Mass at the Aortic Bifurcation: An Atypical Presentation of a Tailgut Cyst.

We review the case of a 43-year-old white male who presented with an enlarging pulsatile mass in the periumbilical region. Diagnostic imaging revealed an 8-cm heterogeneous mass abutting the left iliac artery at the aortic bifurcation. Due to the patient's persistently elevated blood pressure and elevated serum and urine catecholamines, a neuroendocrine tumor was suspected. Laparoscopic resection was performed and was well tolerated. However, the mass was characterized as a tailgut cyst upon pathological examination. This case highlights the utility of laparoscopy for the removal of large para-aortic masses, which can be achieved in a safe fashion by an experienced surgeon. In addition, this case highlights the importance of differential diagnoses in surgeries due to the occurrence of unexpected outcomes.

Iatrogenic Right-Sided Diaphragmatic Hernia After Colonoscopy.

Congenital diaphragmatic hernias (CDH) occur as a result of genetic and environmental factors that occur during the early stages of fetal development. Overall, CDH are considered to be quite rare and are often discovered when patients are neonates. The patient in this case underwent a routine colonoscopy for high-risk polyps but then developed the sudden onset of cramping abdominal pain and PO (per os) intolerance. She was found to have a right-sided diaphragmatic hernia which ultimately required operative intervention. Retrospectively, a close review of prior imaging revealed a potential diaphragm defect. Post-colonoscopy diaphragmatic hernias are very rare and right-sided ones are rarer, making this case report an important addition to the literature.

Postoperative Quality of Life in Patients with Hidradenitis Suppurativa Utilizing the Hidradenitis Suppurativa Burden of Disease Tool.

Background Hidradenitis suppurativa (HS) severely impacts patients' quality of life (QoL). Surgery has shown potential in improving a patient's QoL in severe disease. Previous studies have evaluated QoL after surgery, but lack a disease-specific questionnaire to better evaluate the unique burden of disease that patients with HS experience. Objective To measure postoperative QoL in patients with HS using a modified version of the disease-specific questionnaire, the Hidradenitis Suppurativa Burden of Disease (HSBOD) Tool. Methods A retrospective study was conducted using 19 patients who underwent surgery for HS. A demographic form and a 19-item disease-specific questionnaire were emailed to patients who consented to complete the survey. Patient-reported outcomes were recorded on a 0-100 scale (100 representing the highest burden of disease). Results Of the 24 patients that received the survey, 19 completed it in its entirety. The mean±SD Burden of Disease (BoD) score for each of the five domains assessed by the survey were: symptoms and feelings (62±27), daily activities (65±30), leisure (57±31), work and school (48±32), and personal relationships (56±27). Pearson's correlation between the number of surgeries each patient underwent and their reported BoD scores were not significant. BoD scores were significantly higher in the symptoms and feelings domain for complex closure compared to both secondary intention and split-thickness skin grafting (STSG). Conclusion Despite having surgery, patients with hidradenitis still report impaired QoL. Further study is ongoing to determine how these measures compare to baseline preoperative values. This instrument provides a valuable tool to determine QoL in patients with hidradenitis.