Non-alcoholic steatohepatitis mimicking liver metastasis in obesity surgery.

We describe a case of non-alcoholic steatohepatitis detected incidentally during laparoscopic Roux-en-Y gastric bypass (LRYGBP). A 51-year-old female patient was scheduled for elective LRYGBP. Her weight was 144.9 kg and her body mass index was 56. Liver function tests showed mild elevation in alanine transaminase. The patient had a history of hypertension and insulin resistance and had no history of alcohol abuse. During LRYGBP, the gross appearance of the liver resembled metastatic lesions but the histology confirmed the diagnosis of non-alcoholic steatohepatitis. The appearance of the liver necessitated taking biopsies, which showed Von Meyenburg complexes and moderate macrovesicular steatosis. This patient made an uneventful recovery and was discharged 2 days postoperatively.

Spontaneous Massive Intrarenal Hemorrhage in a Patient With De Novo Ureteropelvic Junction Obstruction.

This case represents an even rarer presentation of ureteropelvic junction obstruction (UPJO), that of a spontaneous life-threatening hemorrhage into the renal pelvis of a patient with previously unknown UPJO. Unique to this patient was the emergent nature of the presentation, requiring life-saving surgery. A review of the literature follows a discussion of the case.

A case report of one of the largest {3.63kg} renal tumour removed in the Western Hemisphere. A combined Uro vascular approach for complete removal.

INTRODUCTION: This paper describes the technique employed for the removal of the largest renal tumour in the Western Hemisphere and the second largest in the World. It is a road map for Surgeons in Training and should be of interest to other Surgeons/Urologists. This tumour weighed 3.63kg; the world's largest weighed 5.44kg. PRESENTATION OF CASE: A 52year old male presented with a one year history of progressive weight loss, a gradually enlarging abdomen and no other admissible symptom, including no haematuria. The mass started on his left side of the abdomen. CT scans showed a large tumour arising from the left kidney. DISCUSSION: A combined Urological and vascular approach was chosen in view of the CT scans images of huge renal veins and collateral vessels. The left pleural cavity was elevated by the mass pushing on the left diaphragm and the heart was also displaced cranially as the mass made its own space. Bowels were displaced as the giant mass reached into his pelvis. A thoraco abdominal supra12 rib bed approach was adopted. The rib was not resected nor was the pleural cavity opened. Histological diagnosis was renal leiomyosarcoma. CONCLUSION: Large renal tumours or masses are best approached by the Urologist with an experienced vascular/general surgeon as assistant as well as a skilled anesthetist/Intensivist. Optimisation, critical care and early mobilization of the patient by a dedicated nursing staff are essential to minimize complications and ensure a successful end result. The success of this operation underscores what is possible in developing countries.