Retroperitoneal Duodenal Diverticulum Microperforation: The Role of Computed Tomography.

Duodenal diverticula are relatively common, but perforations are rare and therapy has not yet been standardized. The most common location of diverticula is the descending duodenum, usually on the lateral side next to the pancreas, so perforations present with an atypical clinical course. We present a case of a 73-year-old female patient with epigastric pain and nausea. Abdominal CT revealed an air-fluid collection near the laterocaudal border of the descending duodenum, suggestive of duodenal microperforation and incipient abscess formation. During the operation, a diverticulectomy was performed with primary duodenal closure and abdominal drainage. A diverticulum microperforation contains some extraduodenal air bubbles, no evidence of abscess, and free air in the subdiaphragmatic region. It is an imaging entity with distinct clinical and biochemical features, and radiological findings often determine the final decision on treatment.

Extreme Leukocytosis and Gangrenous Cholecystitis Associated with Cytoreductive Surgery and HIPEC-Treated Mucinos Ovary Cancer: Case Report and Literature Review.

Mucinous ovarian cancer occurs sporadically, with a frequency of approximately 3-5% among all subtypes of ovarian cancer. Extreme leukocytosis >40,000 and 50,000 has been described in most solid tumors and is associated with a poor prognosis, although there is a lack of literal data of its occurrence after cytoreductive surgery and HIPEC in the treatment of advanced mucinous ovarian cancer. There is higher risk of the occurrence of cholecystitis in oncology patients compared to the general population, although there is no formal evidence for this, and the association with ovarian cancer is accompanied by a relative risk of 1.38. Hypercalcemia-hyperleukocytosis is a syndrome associated with head and neck cancers, although, to our knowledge, it has not been described in mucinous ovarian cancer, especially after cytoreductive surgery and HIPEC.

Case report of falciform ligament abscess-The importance of early diagnosis.

Ligaments are peritoneal duplications that contain venous and lymphatic vessels that can potentially be pathways for the spread of infection. Primary inflammation of one of the peritoneal ligaments is very rare. Abscess of the falciform ligament (FLA) is a rare pathological substrate whose pathophysiology is still unknown or poorly understood, but most often occurs as a consequence of a local inflammatory process such as acute cholangitis, cholecystitis, pancreatitis or pylephlebitis. The diagnosis of the primary site of inflammation as well as FLA is established by radiological methods-ultrasound (US), computed tomography (CT) and magnetic resonance (MR), while the therapy is most often combined-conservative and surgical, but interventional radiology methods can also be used. In this report, we present a 67-year-old patient with the falciform ligament abscess that developed during epizode of acute cholecystitis with left portal vein thrombosis, which was diagnosed by US and CT and effectively managed with antibiotic treatment. FLA is a severe inflammatory condition that requires prompt diagnosis and aggressive antibiotic therapy to avoid surgical treatment.

Low-grade fibromyxoid sarcoma of the liver: A case report.

BACKGROUND: Low grade fibromyxoid sarcoma (LGFMS) is a rare and benign mesenchymal tumor with indolent course, most commonly found in young or middle-aged men. The majority of the LGFMSs are located in the trunk and deep soft tissue of the lower extremities. They appear as well circumscribed, although not encapsulated, which often leads to incomplete surgical resection. Despite their seemingly benign appearance, these tumors have aggressive behavior with high metastatic and recurrence rates. Accurate histopathologic examination of the specimen and its immunohistochemical analysis are mandatory for a precise diagnosis. CASE SUMMARY: We report a case of a 38 year-old-man who presented with jaundice and upper abdominal discomfort. Multi-detector computed tomography and magnetic resonance imaging showed a large left liver tumor mass, extending to the hepatoduodenal ligament. Left hepatectomy was performed with resection and reconstruction of hepatic artery and preservation of middle hepatic vein. Histopathologic examination confirmed the tumor being a low-grade fibromyxoid sarcoma. Three and a half years after surgery, the patient died after being diagnosed with spine metastasis. CONCLUSION: Due to poor response to all modalities of adjuvant treatment, we consider that the focus of treatment should be on surgery as the only option for curing the disease.

Seat-Belt Abdominal Aortic Injury-Treatment Modalities.

Blunt abdominal aortic injuries are extremely rare, diagnosed in less than 0.05% of all trauma admissions. Aortic injury caused by a seat belt during a car accident is often referred as "seat-belt aorta". We present a case of an 18-year-old woman, restrained back passenger involved in a vehicular collision, sustaining vertebral column and multiple rib fractures, mesenterium and colonic injury, and infrarenal aortic contusion with localized dissection and partial thrombosis.

Intrahepatic mass-forming cholangiocarcinoma and solitary hypovascular liver metastases: is the differential diagnosis using diffusion-weighted MRI possible?

Background Intrahepatic mass-forming cholangiocellular carcinoma (IMC) is the second most common primary liver tumor. The differentiation between IMC and solitary hypovascular liver metastases (SHLM) represents a diagnostic challenge due to many overlapping magnetic resonance imaging (MRI) features. Purpose To determine the value of diffusion-weighted imaging (DWI) in addition to conventional MRI for the distinction between intrahepatic mass-forming cholangiocarcinoma and solitary hypovascular liver metastases. Material and Methods Fifty-three patients with pathologically proven IMC (n = 31) and SHLM (n = 22) who had undergone MRI and DWI before surgery or percutaneous biopsy were enrolled in this study. The following MRI features were analyzed: the size and shape of the lesion, presence of capsular retraction and segmental biliary dilatation, T2-weighted (T2W) signal intensity, the presence of target sign on DWI and enhancement pattern. Apparent diffusion coefficient (ADC) values were calculated for each lesion ( b = 800 s/mm2). Univariate and multivariate logistic regression analyses were used to identify significant differentiating features between IMCs and SHLMs. Results Univariate analysis revealed that following parameters favor diagnosis of IMCs over SHLMs: lobulating shape, heterogeneous T2W signal intensity, capsular retraction, segmental biliary dilatation, target sign on DWI and rim-like enhancement on arterial phase followed by progressive enhancement in delayed phases. ADC values measured in the periphery of the lesion were significantly lower in IMCs in comparison to SHLMs. Multivariate analysis revealed that target sign on DWI was the most significant predictor of IMCs. Conclusion Qualitative DWI analysis with target sign significantly improves diagnostic accuracy for differentiation among IMC and SHLM lesions.