A fecalith mimicking a bladder calculus secondary to an appendicovesical fistula: a case report.

An appendicovesical fistula is defined as an abnormal communication between the appendix and the urinary bladder, with only a few cases reported in the literature. It is very challenging to make an early diagnosis, due to the inability of conventional imaging modalities to detect this unique pathology. The symptoms are often mild, and there are not any specific signs or symptoms that might suggest this type of anomalous communication. We report a case of a 27-year-old male patient who presented difficulty for initiating urination, dysuria, and persistent urinary tract infections. An abdominal x-ray showed a large calculus inside the bladder. A cystoscopy was performed, where the tip of the appendix was seen protruding inside the bladder with a large fecalith adhered to the bladder wall. An appendectomy and partial cystectomy with primary repair were auspiciously achieved. A review of the literature is also presented.

Splenic Primary Solid Tumors : Does a Preoperative Histopathology Diagnosis Really Matter?

BACKGROUND: The present study aims to present a case series of patients who underwent splenectomy for splenic primary solid tumors without preoperative histopathologic diagnosis. METHODS: From 2013 to 2019, 12 patients underwent splenectomy for solid primary splenic tumors at 3 different academic medical centers. All electronic medical records were retrospectively reviewed. RESULTS: Seven (58.3%) patients were women, and 5 (41.6%) were male. The median age was 48 years (range: 25-72 years). In 8 (66.6%) patients, a conventional approach was performed. In 2 (16.6%), a hand-assisted laparoscopic surgery procedure was completed, and in other 2 (16.6%) patients, a laparoscopic approach was auspiciously achieved. Median operative time was 135 minutes (range: 60-210 minutes), and median blood loss was 500 mL (range: 200-1500 mL). Procedure-related morbidity was found in 2 (16.6%) patients, and the mortality rate was 0%. The final histopathologic diagnosis was lymphoma in 5 (41.6%) patients, lymphangioma in 3 (25%) patients, hamartoma in 2 (16.6%) patients, angiosarcoma, and sclerosing angiomatoid nodular transformation (SANT) in 1 (8.3%) case each. CONCLUSION: Splenectomy should be the treatment of choice when encountering a primary splenic tumor without the need for preoperative fine-needle aspiration biopsy, avoiding the complications this technique entails.

Bowel obstruction as a serious complication of patients with femoral hernia.

PURPOSE: The implications of bowel obstruction occurring secondary to femoral hernia have not been discussed in the literature recently. Thus, we report our experience of treating patients with femoral hernias complicated by bowel obstruction versus patients with femoral hernias not complicated by bowel obstruction. METHODS: The subjects of this retrospective study were patients admitted to our hospital for the treatment of femoral hernias between 2016 and 2019. We used the Fisher and Student's T test to compare the preoperative characteristics, treatment, and outcomes of patients with bowel obstruction versus those without bowel obstruction. RESULTS: A total of 53 patients (mean age, 66.9 ± 15.1 years) were treated, 18 (33.9%) of whom underwent elective surgery and 35 (66%) of whom required emergency surgery (p = 0.001). The mean time between the development of symptoms and hospitalization was 4.5 ± 3.1 days for the patients with bowel obstruction and 1.6 ± 3.2 days for those without bowel obstruction (p = 0.001). The length of hospital stay was 11.1 ± 21.1 days for the patients with bowel obstruction and 1 ± 1.8 days for those without bowel obstruction (p = 0.028). Overall morbidity and mortality rates were 13.2% and 5.6%, respectively. CONCLUSION: Femoral hernias causing bowel obstruction are associated with greater time between the development of symptoms, hospitalization, and with a longer hospital stay.

An Inflammatory Myofibroblastic Tumor of the Appendix Mimicking an Appendicular Malignant Lesion.

Inflammatory myofibroblastic tumor (IMT) is a very rare lesion of unknown etiology. Cases of IMT involving the appendix are exceptional, and they can mimic malignant appendicular tumors. We present a case of a 65-year-old man who presented to our emergency room on septic shock and acute abdomen secondary to visceral perforation. The patient underwent exploratory laparotomy; massive bowel dilatation was encountered, along with 3 L of purulent intraperitoneal fluid and a perforated appendicular mass of 6 cm. An appendicectomy was performed. Histopathologic examination established the diagnosis of inflammatory pseudotumor with appendiceal perforation. This study constitutes the 14th confirmed case report of an appendicular IMT. It is important to include IMT in differential diagnoses of appendicular masses to avoid excessive resections.

Acute Colonic Volvulus in a Mexican Population: A Case Series.

PURPOSE: Colonic volvulus constitutes a significant cause of large bowel obstruction in adults. Most studies of colonic volvulus come from high endemic zones and are limited by the small number of patients. In our region, there is a shortage of studies concerning this disorder, and treatment of colonic volvulus remains controversial. METHODS: This is a retrospective study of 34 patients who presented with colonic volvulus at a single academic institution in a 4-year period and their respective treatment and outcomes. RESULTS: A total of 34 patients, 17 males (50%) and 17 females (50%), with a mean age of 55 ± 23.9 years underwent treatment for colonic volvulus. Twelve patients (35.3%) underwent initial decompression, followed by a Hartman procedure in 4 patients (11.7%) and sigmoid resection with primary anastomosis in 3 patients (8.8%), with 3 fatalities (8.8%) following initial decompression. Two patients (5.8%) were lost to follow-up. Twenty-two patients (64.7%) underwent emergency surgery, of whom 16 (47%) underwent a Hartman procedure, with colorectal anastomosis in 9 patients (26.4%), with 3 fatalities (8.8%) immediately after the first procedure. Four patients (11.7%) were lost to follow up after the Hartman procedure. Of the 6 remaining patients (17.6%), of the emergency surgical group, 3 patients (8.8%) had an initial sigmoidectomy and primary anastomosis, and the remaining 3 patients (8.8%) had a cecal volvulus with a right hemicolectomy performed with primary anastomosis in 2 patients (5.8%) and with a fatality in the remaining patient, on whom a terminal ileostomy was performed for damage control. The mean hospital stay was 5.7 days, with an overall mortality rate of 23.5%. CONCLUSION: Acute colonic volvulus in our region is not as uncommon as in other parts of the world. This disorder must be suspected when a patient presents with abdominal pain, abdominal distension, and bean sign on plain X-rays and/or a whirl sign on computed tomography scan.

Cholecystoenteric fistula with and without gallstone ileus: A case series.

BACKGROUND: A cholecystoenteric fistula (CEF) is an uncommon complication of gallstone disease. The aim of this study was to present our experience of a series of patients with CEF, presenting with or without gallstone ileus, along with their surgical outcomes. METHODS: From 2015 to 2018, 3245 consecutive patients underwent cholecystectomy for gallbladder disease at our institution, of which 15 were diagnosed with a CEF. All electronic medical records were retrospectively reviewed. RESULTS: Fifteen patients presented with CEF. Ten patients presented cholecystoduodenal fistula, four patients cholecystocolonic, and one patient cholecystogastric counterparts. Twelve patients were female. The median patient age was 61 years (range 33-86 years). Five patients presented with gallstone ileus treated by laparotomy and enterolithotomy. In ten patients, a laparoscopic approach was attempted, but conversion to open surgery was necessary for eight of them. The median operative time was 140 min (range 60-240 min), and the median operative blood loss was 50 mL (range 10-600 mL). The procedure-related morbidity and mortality rates were 13.3% and 6.7%, respectively. CONCLUSIONS: There is no consensus on the best treatment modality for a CEF, as the treatment outcome is mostly dependent on the surgeon's expertise and the patient's condition. Not all CEFs are accompanied by gallstone ileus. For such case, the main purpose is to resolve the intestinal obstruction and, unless necessary, avoidance of the gallbladder area.

Mirizzi syndrome from type I to Vb: a single center experience.

OBJECTIVES: The present study describes a cohort of patients diagnosed with Mirizzi syndrome from type I to Vb, over a period of four years. It aimed to identify diagnostic and management pitfalls of Mirizzi syndrome, as well as their concomitant cholecystobiliary or cholecystoenteric fistulas. MATERIAL AND METHODS: We retrospectively reviewed all electronic medical records of patients who underwent surgery for Mirizzi syndrome at a single institution. RESULTS: Twenty-two patients (0.6%) were diagnosed with Mirizzi syndrome. Most of the patients were females (n=19, 86.3%). Mean age was 43.8 years (range: 21-71 years). Ultrasound was performed in all (100%) patients. Six (27.2%) patients had a CT scan and six (27.2%) patients had endoscopic retrograde cholangiopancreatography. Overall preoperative diagnosis was achieved on 36.6% (n=8) of the patients. There were the same total and partial cholecystectomies, accounting for ten (45.5%) cases each, one hepaticojejunostomy with cholecystectomy (4.5%), and one enterolithotomy (4.5%). Laparoscopic cholecystectomy was attempted in 15 (68.1%) patients, with conversion to open surgery in 93.3% (n=14) of the patients. An open approach was made in five (22.7%) cases. Four (18.1%) patients were reported as MS type I, both types II and III each account for 22.7% (n=5) of the cases, there was only one (4.5%) patient with type IV, and seven (31.8%) patients with type V. CONCLUSION: There are limited studies of patients with Mirizzi syndrome, including type V classification, and when this syndrome is suspected, a preoperative diagnosis should be made to avoid bile duct injuries or lesions to adjacent organs.

Experience of the hernia and wall department in the management of abdominal wall endometriosis for 9 years.

BACKGROUND: Abdominal wall endometriosis is a rare pathological entity. It presents as a tumor with pain, erythema, which worsens with Valsalva maneuvers. OBJECTIVE: To show the experience and results in the management of the department of hernias and abdominal wall in a hospital of second level and to present review of the literature. METHOD: The files of patients treated in the department of hernias and abdominal wall, surgically treated with preoperative clinical and postoperative histopathological diagnosis of abdominal wall endometriosis were taken. The data was described using measures of central tendency and percentages. RESULTS: Twenty-nine patients were identified, with an average age of 32.75 years, 68.9% reported cyclic catamenial pain associated with a tumor in the abdominal wall; a preoperative clinical diagnosis of abdominal wall endometriosis was made in 89.75%. Only one patient was reported with histopathological diagnosis of fibrolipoma. The totality of the patients referred cesarean section as previous surgery. No recurrences were reported. CONCLUSIONS: Abdominal wall endometriosis is the presence of ectopic endometrial tissue in any layer of the abdominal wall. Patients with this diagnosis are referred to the general surgeon presenting a tumor, however, the preoperative diagnosis rate is erroneous in most cases. Abdominal wall ultrasound is useful in diagnosis; tomography and magnetic resonance determine the extent of the disease. The treatment must be related to the extension of the disease and its recurrence is associated with the presence of positive margins.

ANTECEDENTES: La endometriosis de pared abdominal es una enfermedad rara, se presenta como una tumoración con dolor, eritema, y que empeora a las maniobras de Valsalva. OBJETIVO: Mostrar la experiencia y los resultados en el manejo del departamento de hernias y pared abdominal en un hospital de segundo nivel y presentar una revisión de la literatura. MÉTODO: Se tomaron los expedientes de pacientes tratadas en el departamento de hernias y pared abdominal, intervenidas quirúrgicamente con diagnóstico clínico preoperatorio e histopatológico posoperatorio de endometriosis de pared abdominal. Los datos se describieron usando medidas de tendencia central y porcentajes. RESULTADOS: Se identificaron 29 pacientes, con una edad promedio de 32.75 años. El 68.9% reportó dolor cíclico catamenial asociado a tumoración de pared abdominal; se hizo diagnóstico clínico preoperatorio de endometriosis de pared abdominal en el 89.75%. Solo una paciente se reportó con diagnóstico histopatológico de fibrolipoma. La totalidad de las pacientes refirió operación cesárea como cirugía previa. No se reportaron recurrencias. CONCLUSIONES: La endometriosis de pared abdominal es la presencia de tejido endometrial ectópico en la pared abdominal. Las pacientes con este diagnóstico son referidas al cirujano general por presentar tumoración, sin embargo, la tasa de diagnóstico preoperatorio es baja en la mayoría de los casos. El ultrasonido es de utilidad en el diagnóstico; la tomografía y la resonancia magnética determinan la extensión de la enfermedad. El tratamiento debe relacionarse con la extensión de la enfermedad y su recurrencia se asocia con la presencia de márgenes positivos.

A giant splenic hamartoma associated with hematologic disorders: A case report.

INTRODUCTION: Splenic hamartoma is a primary benign tumor of the spleen, with approximately 150 cases documented in the literature to date, with only a few cases associated with symptoms and hematologic disorders. PRESENTATION OF CASE: A 49-year-old female with no past medical history, presented to the emergency department complaining of a three-month history of intermittent abdominal pain and 12 kg of weight loss. Physical examination revealed abdominal distension and a big palpable and painless mass on the left side of her abdomen measuring 14 cm. Laboratory tests were significant for anemia and thrombocytopenia, with levels of 9.7 g/dL and 47 × 109/L respectively. Ultrasonography showed splenomegaly with a hypoechoic splenic mass and the computed tomography showed a 14 cm splenic mass with heterogeneous enhancement during the arterial phase. A laparotomy with splenectomy was unremarkably accomplished. Histological examination revealed abnormal red pulp proliferation and showed unorganized sinusoid-like vascular channels, compatible with splenic hamartoma. The patient was discharged on postoperative day 3 without complications. She was seen at the ambulatory clinic 6-months after the surgical procedure with a normal blood count. DISCUSSION: Although splenic hamartoma is very rare, it must be included in the differential diagnosis of splenic mass-forming lesions. This type of tumor has some specific radiological features. However, the diagnosis of this disease must be based on clinical features and confirmed by pathology. CONCLUSION: In patients with splenic tumors, splenectomy is indicated in cases where malignancy cannot be excluded, when symptoms occur, or in the rare cases of consequent hematologic disorders.

[Clinical experience of early percutaneous drainage of amebic hepatic abscess]. / Experiencia clínica con la punción temprana del absceso hepático amebiano.

BACKGROUND: Amebic hepatic abscesses are a frequent illness in Mexico, where these are different from those of the rest of the world. The treatment that we use should also be different. We propose new indications for percutaneous drainage in this pathology. In our hospital we found a high incidence in laparotomies, morbidity and lengthy hospitalization for this illness. METHODS: We studied 29 cases of hepatic abscesses treated at our hospital from January 2002 to May 2004. Patients received the conventional treatment and we compared this group with another group of 22 patients who had drainage before 48 h of hospitalization, during the period from June 2004 to August 2005. RESULTS: Both groups showed similar characteristics. The first group was drained only in 13.79% of cases, the second in 100%. In the first group, 44.82% had surgery and in the second group 4.5% had surgery. Length of hospitalization in the first group was 11.96 days and in the second, 4.76 days. CONCLUSIONS: We still have no clear indications of when to opportunely drain a hepatic abscess.