The value of preoperative molecular testing in the management of Bethesda V and Bethesda VI thyroid tumors.

The incidence of thyroid cancer has increased over recent years due to the fact that several diagnostic tools, such as neck ultrasound and fine-needle aspiration, are being ever more widely adopted. Lately, another modality which might provide significant information preoperatively on the aggressiveness of a thyroid tumor, its prognosis, and its recurrence rate is molecular testing. We reviewed the literature with regard to the role of preoperative molecular testing in patients with Bethesda V and Bethesda VI thyroid nodules and its impact on choice of the optimal treatment strategy. Several molecular mutations and alterations are associated with thyroid cancer and its biological behavior, such as BRAF-V600E, RET, and TERT promoter. Although the value of preoperative molecular testing for indeterminate nodules (Bethesda III and Bethesda IV) have been analyzed in numerous studies, the impact of preoperative molecular testing on Bethesda V and Bethesda VI thyroid nodules is not adequately described in the current literature. The preoperative recognition of specific molecular mutations, such as BRAFV600E and TERT promoter mutation, might provide more individualized management for thyroid cancer patients by altering the surgical approach and the extent of surgery for patients diagnosed with a more aggressive or iodine-resistant subtype of thyroid cancer.Thyroid cancer is characterized by multiple genetic mutations and alterations and, as a result, preoperative molecular testing of malignant nodules could be a very useful tool for surgeons, enabling them to decide on the most appropriate surgical approach for each patient.

Contemporary Role of Open Left Thoracoabdominal Approach in Esophageal Malignancy Treatment.

INTRODUCTION: Despite the widespread use of minimally invasive techniques, open left thoracoabdominal esophagectomy (LTE) can offer excellent visualization and adaptability. The current study aimed to present and evaluate the outcomes related to an open LTE in esophageal malignancy treatment. METHODS: A retrospective cohort analysis of data collected from two institutions was performed, including patients with distal esophageal or junctional tumors who underwent open LTE between November 2018 and December 2023. RESULTS: Twenty-two patients were included (16 males; mean age 62.8 years). Postoperative complications occurred in eight patients (36%), with pulmonary complications being the most prevalent (seven patients; 32%). One patient experienced a clinical anastomotic leak. No reoperations or escalation to a higher level of care were required. In-hospital and 30-day mortality were zero. Tumor cells were found at the surgical margins in six patients (27%). The mean lymph node yield was 27. During the follow-up period, there were nine deaths and 11 cases of disease recurrence. Isolated locoregional recurrence was seen in five patients (23%). The one-year and two-year overall survival rates were 79% and 47%, respectively. CONCLUSION: In selected cases, open LTE remains a valid and safe operation with acceptable morbidity and oncological efficacy.

Dietary Approach of Patients with Hormone-Related Cancer Based on the Glycemic Index and Glycemic Load Estimates.

Hormone-related cancers, namely breast, endometrial, cervical, prostate, testicular, and thyroid, constitute a specific group of cancers dependent on hormone levels that play an essential role in cancer growth. In addition to the traditional risk factors, diet seems to be an important environmental factor that partially explains the steadily increased prevalence of this group of cancer. The composition of food, the dietary patterns, the endocrine-disrupting chemicals, and the way of food processing and preparation related to dietary advanced glycation end-product formation are all related to cancer. However, it remains unclear which specific dietary components mediate this relationship. Carbohydrates seem to be a risk factor for cancer in general and hormone-related cancers, in particular, with a difference between simple and complex carbohydrates. Glycemic index and glycemic load estimates reflect the effect of dietary carbohydrates on postprandial glucose concentrations. Several studies have investigated the relationship between the dietary glycemic index and glycemic load estimates with the natural course of cancer and, more specifically, hormone-related cancers. High glycemic index and glycemic load diets are associated with cancer development and worse prognosis, partially explained by the adverse effects on insulin metabolism, causing hyperinsulinemia and insulin resistance, and also by inflammation and oxidative stress induction. Herein, we review the existing data on the effect of diets focusing on the glycemic index and glycemic load estimates on hormone-related cancers.

Precision Surgery of Colorectal Liver Metastases in the Current Era: A Systematic Review.

Liver resection for colorectal liver metastases (CRLM) is widely considered the treatment with the highest curative potential. However, not all patients derive the same oncological benefit, underlining the need for better patient stratification and treatment allocation. In this context, we performed a systematic review of the literature to determine the role of RAS status in selecting the optimal surgical strategy. Evidence comparing anatomical with non-anatomical resections depending on RAS mutational status was scarce and conflicting, with two studies reporting superiority in mutated RAS (mutRAS) patients and two studies reporting equivalent outcomes. The rate of incomplete microscopic resection (R1) was found to be increased among mutRAS patients, possibly due to higher micrometastatic spread lateral to the primary lesion. The impact of R1 resection margins was evaluated separately for mutRAS and wild-type patients in three studies, of which, two indicated an additive detriment to long-term survival in the former group. In the current era of precision surgery, RAS status can be utilized to predict the efficacy of liver resection in the treatment of CRLM, avoiding a potentially morbid operation in patients with adverse tumor profiles.

The Protective Effect of Bariatric Surgery on the Development of Colorectal Cancer: A Systematic Review and Meta-Analysis.

BACKGROUND: Obesity is a known risk factor for developing colorectal cancer (CRC) and is associated with the formation of precancerous colonic adenomas. Bariatric surgery (BRS) is considered to reduce the cancer risk in morbidly obese patients. However, the currently available literature yields contradicting results regarding the impact of bariatric surgery on the incidence of CRC. METHODS: A systematic literature search of the Medline, Embase, CENTRAL, CINAHL, Web of Science, and clinicaltrials.gov databases was undertaken following the PRISMA guidelines. A random effects model was selected. RESULTS: Twelve retrospective cohort studies, incorporating a total of 6,279,722 patients, were eligible for inclusion in the final quantitative analysis. Eight studies originated from North America, while four reported on European patients. Patients in the Bariatric Surgery group exhibited a significantly reduced risk for developing colorectal cancer (RR 0.56, 95% CI 0.4-0.8, p < 0.001), while sleeve gastrectomy was found to be significantly associated with a smaller incidence of CRC (RR 0.55, 95% CI 0.36-0.83, p < 0.001), and gastric bypass and banding did not. CONCLUSIONS: A significant protective effect of BRS against the development of CRC is implied. In the present analysis, the incidence rate of colorectal cancer was approximately halved amongst the obese individuals that were operated on.

Anesthetic management of a patient with type 1 neurofibromatosis and an occult pheochromocytoma: a case report.

Neurofibromatosis type 1 is a complex genetic disorder affecting multiple organ systems. Cardiovascular manifestations include hypertension, often associated with concomitant pheochromocytoma. We present a hypertensive crisis during induction of anesthesia in a patient with neurofibromatosis type 1, scheduled for abdominal myomectomy, which revealed an undiagnosed pheochromocytoma. The case highlights the importance of assessing all patients with neurofibromatosis type 1 for pheochromocytoma, because if it is left undiagnosed, it can be disastrous in the setting of anesthesia and surgery.

Anesthetic management of a patient with type 1 neurofibromatosis and an occult pheochromocytoma: a case report

Abstract Neurofibromatosis type 1 is a complex genetic disorder affecting multiple organ systems. Cardiovascular manifestations include hypertension, often associated with concomitant pheochromocytoma. We present a hypertensive crisis during induction of anesthesia in a patient with neurofibromatosis type 1, scheduled for abdominal myomectomy, which revealed an undiagnosed pheochromocytoma. The case highlights the importance of assessing all patients with neurofibromatosis type 1 for pheochromocytoma, because if it is left undiagnosed, it can be disastrous in the setting of anesthesia and surgery.

Synchronous Sternal Metastasectomy and Total Thyroidectomy for Differentiated Thyroid Cancer: A Rare Case Report.

Bone metastases from thyroid cancer are mainly rare, while sternal metastases are extremely uncommon. Bone metastases might be either synchronous or metachronous to primary thyroid cancer. A 60-year-old male patient presented to our department with a painful, fixed and firm sternal mass. Preoperative imaging studies, such as neck ultrasound (US) and computed tomography (CT) of the chest, revealed a 6.5 cm nodule of the right thyroid lobe with high-risk malignancy characteristics and a massive metastatic mass of the anterior mediastinal, which was extended from the sternal notch to the third intercostal space. The diagnosis of papillary thyroid carcinoma with sternal metastatic lesions was established. After meticulous discussion in the multidisciplinary board of our hospital, a total thyroidectomy plus en-bloc resection of this massive sternal metastasis and adjuvant radioiodine therapy were decided. Eight months postoperatively, no recurrence has occurred in this patient. R0 resection of isolated bone metastasis of thyroid origin is still an optimal therapeutic decision for these patients. In cases of sternal metastasis, radical surgical resection with negative margins, including both resection of the lesion and reconstruction of the chest wall, in order to successfully maintain the chest wall's stability, is recommended.

Oncologic outcomes of patients with resectable primary gastric squamous cell carcinoma: a systematic review.

Background: Primary gastric squamous cell carcinoma (PGSCC) is an uncommon type of gastric malignancy estimated to comprise around 0.04-0.5% of all gastric malignancies. PGSCC's long-term survival has been quoted to range from 17-50% depending on stage, with surgery arguably representing the most useful modality for prolonging oncologic survival. Nevertheless, reliable data on its effectiveness are still lacking in the literature. Method: A systematic literature search of the Medline, Cochrane library and Scopus databases was undertaken, to identify cases of surgically managed PGSCC reporting patient-related outcomes. Results: In total, 23 case reports and 1 case series incorporating 38 patients were identified. Mean patient age was 61.2 years and the male/female ratio was 18:1. Most tumors were high-stage at the time of diagnosis, with the T4 stage predominating in the patient pool (n=15, 50%) along with a high percentage of lymphatic spread (N positive tumors, n=15, 47%). All patients underwent curative-intent surgical resection and were subsequently followed for an average of 30.7±14 months. Extrapolated survival data revealed a projected 3- and 5-year overall survival of 62.2% and 51.9%, respectively, while the 3-year probability for being disease-free was calculated to be 30.8%. T4 stage and lymphatic spread were found to be predictors of poor survival in univariate but not in multivariate analysis. Conclusion: Notwithstanding the methodological limitations inherent to the present review, the obtained results, when superimposed on existing cross-sectional survival data, suggest significantly enhanced patient survival following surgery, solidifying its role in the management of patients with PGSCC.

Colorectal Surgery in the COVID-19 Era: A Systematic Review and Meta-Analysis.

(1) Background: To determine the impact of the COVID-19 pandemic in the management of colorectal cancer patients requiring surgery and to examine whether the restructuring of healthcare systems led to cancer stage upshifting or adverse treatment outcomes; (2) Methods: A systematic literature search of the MedLine, Scopus, Web of Science, and CNKI databases was performed (PROSPERO ID: CRD42021288432). Data were summarized as odds ratios (OR) or weighted mean differences (WMDs) with 95% confidence intervals (95% CIs); (3) Results: Ten studies were examined, including 26,808 patients. The number of patients presenting with metastases during the pandemic was significantly increased (OR 1.65, 95% CI 1.02−2.67, p = 0.04), with no differences regarding the extent of the primary tumor (T) and nodal (N) status. Patients were more likely to have undergone neoadjuvant therapy (OR 1.22, 95% CI 1.09−1.37, p < 0.001), while emergency presentations (OR 1.74, 95% CI 1.07−2.84, p = 0.03) and palliative surgeries (OR 1.95, 95% CI 1.13−3.36, p = 0.02) were more frequent during the pandemic. There was no significant difference recorded in terms of postoperative morbidity; (4) Conclusions: Patients during the pandemic were more likely to undergo palliative interventions or receive neoadjuvant treatment.

Medullary thyroid carcinoma in children: current state of the art and future perspectives.

Medullary thyroid carcinoma (MTC) is a distinct type of malignant thyroid tumor in cell origin, biological behavior, and natural history. It accounts for 1.6% of all thyroid cancers and presents either sporadically or as a hereditary disease, the latter occurring as a part of multiple endocrine neoplasia (MEN) 2A and MEN2B syndromes or as a familial MTC disease with no other manifestations. The gene responsible for the hereditary form is the rearranged during transfection (RET) gene, a proto-oncogene located to human chromosome 10. Most pediatric MTC cases have been discovered after genetic testing investigations, leading to the concept of prophylactic surgery in presymptomatic patients. Therefore, the genetic status of the child, along with serum calcitonin levels and ultrasonographic findings, determine the appropriate age for prophylactic surgical intervention. Nevertheless, a diagnosis at an early stage of MTC warrants total thyroidectomy and central lymph node dissection with the addition of lateral/contralateral lymph node dissection depending on the tumor size, ultrasonographic evidence of neck disease, or calcitonin levels. Conversely, locally advanced/unresectable or metastatic MTC is primarily treated with multikinase inhibitors, while more specific RET inhibitors are being tested in clinical trials with promising results.

Reevaluating the prognostic role of BRAF mutation in colorectal cancer liver metastases.

INTRODUCTION: Mutations in the BRAF proto-oncogene have been shown to predict poor patient survival following curative-intent liver surgery for metastatic colorectal cancer. The aim of the present systematic review and meta-analysis is to evaluate the effect of mutated BRAF status (mutBRAF) on the overall (OS) and disease-free survival (DFS) in these patients. METHODS: A comprehensive literature search was performed for studies reporting outcomes of patients undergoing curative-intent surgery stratified by BRAF mutation status. Subgroup analysis was performed to evaluate whether inclusion of KRAS mutation status significantly influenced the results. RESULTS: Six studies incorporating 1857 patients with known BRAF status were identified. Pooled results revealed significantly worse OS (Hazard Ratio 2.8, 95% C.I. 2.09 to 3.77) and DFS (Hazard Ratio 2.29, 95% C.I. 2.09 to 3.77) in mutBRAF patients. Subgroup analysis revealed no statistically significant impact of including KRAS status testing on the obtained results. CONCLUSIONS: Patients with metastatic colorectal cancer carrying BRAF mutations have significantly worse oncologic outcomes following surgery and more aggressive disease phenotype overall.

Giant Ovarian Thecoma Associated with Meigs Syndrome: A Striking Case.

Introduction: Meigs syndrome consists of the presence of a benign ovarian tumor, ascites and pleural effusion, and the latter two subdued after surgical excision of the ovarian tumor. Elevated Ca-125 in this context is confusing and is reported only in a handful of cases. A rare but striking case with the above features is presented herein. Case Presentation: A 46-year-old woman with a giant pelvic/abdominal mass originating from her right adnexa, ascites and pleural effusion, with elevated Ca-125 (938 IU/mL) was treated with the presumptive diagnosis of stage IV ovarian cancer. Imaging modalities showed a 22 cm solid adnexal mass and the patient underwent total abdominal hysterectomy and bilateral salpigooophorectomy, omentectomy and drainage of 4L of ascetic fluid. Surprisingly, final histopathology was negative for malignancy, characterizing the primary tumor as ovarian thecoma. Ascites and pleural effusion resolved by the seventh postoperative day, setting the diagnosis of Meigs syndrome. Discussion: Meigs syndrome accounts for 1% of all ovarian tumors, however it should be considered in the differential diagnosis when clinicians come across the classic triad of the syndrome, even when Ca-125 is elevated. These patients have normal life expectancy with meticulous management, while pathophysiology of this condition remains uncertain in various points.

Primary thyroid teratoma in adults: A case report and systematic review of the literature.

Extragonadal germ cell tumors are uncommon in adults and only 2-5% of teratomas develop in extragonadal sites. Primary thyroid teratomas represent <0.1% of all primary thyroid gland neoplasms. In the present report, a case of primary thyroid teratoma in a 65-year-old female is described. Furthermore, the current literature regarding patients who were diagnosed with primary thyroid teratoma and underwent surgical resection was systematically reviewed. A total of 15 studies of 27 patients (age range, 17-65 years). Growing mass or neck swelling were the primary symptoms in 14 patients (51.8%). Only one (5.5%) patient was preoperatively diagnosed with malignant thyroid teratoma. All patients underwent thyroidectomy, but 6 cases had more advanced surgery, including lymph node dissection. A total of 12 patients received a combination of adjuvant chemoradiation postoperatively, 10 (45.4%) patients reported recurrence of disease and 8 (29.6%) were postoperatively diagnosed with distant metastases. A total of 9 (39.1%) patients died due to progression of the disease. In conclusion, primary thyroid teratomas are rare and difficult to diagnose preoperatively. In particular, malignant cases are very aggressive tumors with a considerably poor prognosis, even after surgical resection combined with adjuvant chemoradiation.

The effect of the COVID pandemic lockdown measures on surgical emergencies: experience and lessons learned from a Greek tertiary hospital.

BACKGROUND: The COVID-19 pandemic caused a rise in healthcare demands leading to significant restructuring of hospital emergency departments worldwide. The aim of the present study is twofold: firstly, to discern any differences in regard to reason for surgical emergency department (SED) attendance and hospital admission during the pandemic and pre-pandemic eras in Greece, and secondly, to assess the impact of the lockdown measures implemented during the pandemic on SED patient attendance. METHODS: Since the beginning of the COVID-19 pandemic in Greece (1 March 2020) and up to 15 December 2020, the charts of all adult patients arriving at the SED of the third surgical department of the "Attikon" University Hospital (a tertiary referral center for surgical and COVID-19 cases) were retrospectively reviewed and broken down in four periods reflecting two nationwide lockdown (period A 1/3/2020 to 30/4/2020 and period D 16/10/2020 to 15/12/2020) and two interim (period B 1/5/2020 to 15/6/2020 and period C 15/9/2020 to 30/10/2020) periods. Demographic and clinical data were compared to those obtained from the same time periods of the year 2019. RESULTS: The total number of patients attending the SED decreased by 35.9% during the pandemic (from 2839 total patients in 2019 to 1819 in 2020). During the first lockdown, there was statistically significant reduction of motor vehicle accidents (p=0.04) and torso injuries (p=0.01). Contrarily, the rate of head injuries (p<0.001) and abdominal pain (p=0.04) were significantly increased. The same effect was observed regarding the rate of hospital admissions (p=0.002), although in terms of absolute numbers, admissions remained unchanged. During the second lockdown, there was a reduction in the number of perianal abscess cases (p=0.04) and hernia-related problems (p=0.001). An increase in the rate of fall injuries was also demonstrable (p=0.02). Overall, application of the lockdown led to a significant decrease in minor (p<0.001) and torso (p=0.001) injuries. CONCLUSION: The burden of the new COVID-19 disease has left a noticeable imprint in the function of emergency departments worldwide. In Greece, SED attendance was significantly reduced during the pandemic, an effect that was even more pronounced during the lockdown implementation; nevertheless, the overall rate of hospital admissions remained the same, denoting that patient care was not altered.

Optimal extent of initial parathyroid resection in patients with multiple endocrine neoplasia syndrome type 1: A meta-analysis.

BACKGROUND: Hyperparathyroidism is an almost universal feature of multiple endocrine neoplasia type 1 syndrome. We present a systematic review and meta-analysis of the postoperative outcomes of patients undergoing initial operative treatment of primary hyperparathyroidism complicating multiple endocrine neoplasia 1. METHODS: A comprehensive literature search was performed with a priori defined exclusion criteria for studies comparing total parathyroidectomy, subtotal parathyroidectomy, and less than subtotal parathyroidectomy. RESULTS: Twenty-one studies incorporating 1,131 patients (272 undergoing total parathyroidectomy, 510 subtotal parathyroidectomy, and 349 less than subtotal parathyroidectomy) were identified. Pooled results revealed increased risk for long-term hypoparathyroidism in total parathyroidectomy patients (relative risk 1.61; 95% confidence interval, 1.12-2.31; P = .009) versus those undergoing subtotal parathyroidectomy. In the less than subtotal parathyroidectomy or subtotal parathyroidectomy comparison group, a greater risk for recurrence of hyperparathyroidism (relative risk 1.37; 95% confidence interval, 1.05-1.79; P = .02), persistence of hyperparathyroidism (relative risk 2.26; 95% confidence interval, 1.49-3.41; P = .0001), and reoperation for hyperparathyroidism (relative risk 2.48; 95% confidence interval, 1.65-3.73; P < .0001) was noted for less than subtotal parathyroidectomy patients, albeit with lesser risk for long-term for hypoparathyroidism (relative risk 0.47; 95% confidence interval, 0.29-0.75; P = .002). CONCLUSION: Subtotal parathyroidectomy compares favorably to total parathyroidectomy, exhibiting similar recurrence and persistence rates with a decreased propensity for long-term postoperative hypoparathyroidism. The benefit of the decreased risk of hypoparathyroidism in less than subtotal parathyroidectomy is negated by the increase in the risk for recurrence, persistence, and reoperation. Future studies evaluating the performance of less than subtotal parathyroidectomy in specific multiple endocrine neoplasia 1 phenotypes should be pursued in an effort to delineate a patient-tailored, operative approach that optimizes long-term outcomes.

Intestinal erosions following inguinal hernia repair: a systematic review.

PURPOSE: To sum all available evidence regarding mesh or mesh fixation material intestinal erosion following inguinal hernia repair and identify the parameters that lead to early (< 6 months) versus late (> 6 months) symptom presentation. METHODS: A systematic literature search of the MEDLINE, Scopus and Google Scholar databases was undertaken to identify relevant studies published up to June 2020. RESULTS: A total of 54 case reports or cases series, incorporating 57 intestinal erosions were identified. Overall, 13 patients (23%) experienced early intestinal erosions occurring during the first 6 postoperative months while the remaining 44 events (67%) occurred after 6 months. Patients presented most commonly with symptoms of acute obstruction (n = 18, 31.5%), followed by signs of a palpable inguinal mass in 15 patients (26.3%). The late presentation group exhibited significantly more cases of mesh erosion when compared to the early presentation group (100% versus 46.2%, respectively, p < 0.001). Conversely, early presenting cases were more often associated with mesh fixation material erosion (53.8% versus 6.8% in the late group, p < 0.001) and were more likely to develop symptoms of acute intestinal obstruction (61.5% versus 22.8%, p = 0.01). An open primary procedure was more common in late presenting cases (65.9% versus 7.7%, p < 0.001) while early presentation was linked to minimally invasive primary procedures (92.3% versus 34.2%, p < 0.001). Bowel resection was more frequently required in late presenting cases (84.1% versus 46.2%, p = 0.009). CONCLUSIONS: Intestinal erosion from prosthetic material is a rare complication of hernia repair leading to considerable morbidity. Prompt operative repair is key in avoiding catastrophic consequences.

Comparison of the laparoscopic versus open surgery in patients aged over 75 years old with colorectal cancer. Short- and Mid-term outcomes.

PURPOSE: The benefit of minimally invasive surgery in colorectal cancer patients has been established, however it is not clear whether these advantages apply to older patients as well. The aim of this study was to review short- and mid-term outcomes in elderly patients, over the age of 75 years, with colorectal cancer. METHODS: This was a retrospective study of selected patients over the age of 75 who underwent laparoscopic and open surgery for colorectal cancer between February 2013 and January 2018 in a tertiary referral center. All patients were categorized in two groups: Group 1 included patients who had open procedure (OP) and Group 2 those who underwent laparoscopic procedure (LP). Demographic, clinical, short- and midterm postoperative data were collected and analyzed between the two study groups. RESULTS: A total of 78 patients were included in our cohort; 39 (50%) were operated with LP. The LP was equally safe in comparison with the OP, considering the similar postoperative complications [9 patients (34.6%) in LP and 5 patients (18.5%) in OP (p=0.224)], including anastomotic leakage in 2 patients (7.7%) in LP and 1 patient (3.7%) in OP group (p=0.61). The median postoperative hospital stay favored the laparoscopic approach (6 days in LP group and 8 days in OP group; p=0.001). The number of harvested lymph nodes were without statistically significant differences [LP group retrieved 20.0 nodes in comparison with 20.5 nodes in OP group (p= 0.816)]. The overall survival analysis showed no difference between the two approaches in 12 and 24 postoperative months (p=0.098 and 0.387, respectively).

Epiploic Appendagitis Causing Small Bowel Obstruction: A Pleasant Surprise.

INTRODUCTION: Epiploic appendagitis is a rare cause of acute abdominal pain, mimicking acute diverticulitis or appendicitis. Epiploic appendagitis causing small bowel obstruction is highly unusual, and only a handful of such cases have been reported so far. Case Report. A 69-year-old man presented with diffuse abdominal pain and vomiting over the last 12 hours. Clinical examination, laboratory, and imaging investigations showed small bowel obstruction, and after 12 hours of conservative management, surgical exploration was decided. During surgery, a dilated terminal ileum bowel loop was found densely adhered to the sigmoid colon, attached to an inflamed epiploic appendix. The small bowel was mobilized and freed, and the inflamed epiploic appendix was resected. The postoperative course was uneventful, and the patient was discharged on the 5th postoperative day. CONCLUSION: Epiploic appendagitis, although a rare clinical entity, may explain small bowel obstruction symptoms.

Cyst of the Canal of Nuck in adult females: A case report and systematic review.

Defects in the Canal of Nuck are rare abnormalities of the female genitalia, which are typically detected and repaired in young age. In the present report, a case of a Nuck cyst in a 40-year old female patient is described. Additionally, the current literature concerning cases of women with hydrocele of Nuck canal was systematically reviewed. A total of 16 case reports of 16 patients with Nuck hydrocele (mean age of 35.18 years), have been reported to date. A right inguinal mass was noted in 13 patients (81.3%) whereas in 3 patients a left-sided mass was noted. The surgical approach was open in 13 cases and laparoscopic in 3 cases. Two cases underwent hydrocelectomy and inguinal ring ligation, whereas in 7 cases a simple cystectomy was performed. In 2 cases the round ligament was excised along with the hydrocele. In one of these 2, ligamentum rotundum necrosis and presence of a haemorrhagic cyst of the canal of Nuck were identified. Hernia repair and hydrocelectomy was performed in 5 cases. A cyst of the Canal of Nuck is relatively rare, but should be considered during the diagnosis of inguinal masses in female patients.