Clinical application of a synthetic hybrid-scale fiber matrix in a pediatric trauma patient.

INTRODUCTION: Large soft tissue defects resulting from trauma in the pediatric population are common. MLLs are a rare subset of these injuries with no standard treatment regimen. Thorough surgical debridement of these lesions is often warranted to remove necrotic tissue and contamination, which results in a large, open soft tissue defect. STSGs may be used to provide tissue coverage; however, they have limitations, including donor site morbidity and additional surgical time and cost. CASE REPORT: A 12-year-old female with a cutaneous thermal contact burn and an MLL of the right lower medial thigh declined STSG to avoid additional operations. The wound was treated with an SHSFM that is engineered to mimic the structure and architecture of human extracellular matrix and supports cellular infiltration and proliferation with minimal inflammatory response. Over a 4-month period, the SHSFM was applied 6 times at 2- to 3-week intervals, resulting in complete regranulation and wound closure with no further surgical procedures required. CONCLUSIONS: This case demonstrates the utility of the SHSFM in the management of pediatric surgical wounds and highlights the flexibility of the SHSFM in achieving the goals of both patient and physician alike.

Ruptured gastro-intestinal stromal tumor as a surgical emergency: A case report and literature review.

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. GISTs of the small bowel are rare, and often present with an abdominal mass and/or bleeding. Chemotherapy and surgery are the mainstay of therapy. Here, we discuss an unusual case of a ruptured jejunal GIST with hemoperitoneum and recurrence despite surgical excision followed by Imatinib treatment. Forty-five cases of ruptured small intestinal GISTs were identified in the literature. Most cases were in males and were found to be at the site of the jejunum.

Large uterine leiomyoma presenting as pseudo-Meigs' syndrome with an elevated ca125: a case report and literature review.

Ascites, pelvic mass and elevated CA-125 in females carry a grim prognosis, likely an ovarian carcinoma. However, more benign etiologies such as Meigs' and pseudo-Meigs' syndrome must be considered. Pseudo-Meigs' syndrome presenting with an elevated CA-125 is rare and presents a diagnostic challenge. Medline and PubMed were queried for pseudo-Meigs' syndrome cases. We present a 35-year-old female patient who presented with abdominal swelling and weight gain. Imaging demonstrated a 29-cm large intraabdominal mass with significant ascites with elevation of CA-125. Surgical resection was performed, and pathology identified uterine leiomyoma. Twenty-one cases of pseudo-Meigs' syndrome were identified in the literature. Most patients presented with abdominal distention, and some also reported dyspnea. All patients, including our case, were treated surgically. No recurrence reported among these cases. Surgery is the mainstay for radical treatment in pseudo-Meigs' syndrome. Resolution of the ascites and hydrothorax occurs following resection of the tumor.

Extensive lymphadenopathy leading to cancerous pericardial effusion and tamponade in a T1 pancreatic head adenocarcinoma: a case report.

In 2019, Pancreatic cancer became the third leading cause of cancer related mortality in the United States of America. Pancreatic cancer is a fatal malignancy that is predominantly seen in men with advanced age with aggressive course. Ninety percent of cases are adenocarcinoma. Pancreatic adenocarcinoma is very difficult to detect as is usually asymptomatic with no early signs. At least 80% of tumors are unresectable by the time of diagnosis. Despite substantial improvement in the survival rates for other major cancer forms, pancreatic cancer survival rates have remained relatively unchanged since 1960s. Multidisciplinary therapy with a combination of chemotherapy, radiation and surgery performed at high volume centers remains the best chance for cure. We report a rare case of a small T1 pancreatic head carcinoma with underlying chronic pancreatitis presenting with cancerous pericardial effusion and tamponade. Despite the small size of the primary tumor, the extensive pattern of lymphatic occlusion can lead to mesenteric and mediastinal lymphatic spread to the pericardium. US guided emergent pericardiocentesis was performed with removal of 750 cc of serosanguinous fluid. Cytopathological examination of the fluid revealed poorly differentiated pancreatic adenocarcinoma. A Port-A-Cath was placed, and he was referred to the oncology department to start chemotherapy.

Traumatic rupture of a hemorrhagic hepatic cyst: a case presentation and literature review.

Hemorrhagic hepatic cyst with or without rupture is rare cause of acute abdomen with less than 20 cases reported in the literature. A standardardized management algorithm is currently not present, but literature suggests surgical management is ideal for definitive treatment and successful patient outcome. We report a case of a 39-year-old female with a chief complaint of sudden onset abdominal pain, nausea and vomiting. Abdominal computed tomography scan showed a large, 12-cm cyst in the right hepatic lobe with a hemorrhagic component. Successful laparoscopic operative management was conducted without post-operative complications such as recurrent bleeding. When managing patients with an acute abdomen, ruptured hepatic hemorrhagic cysts should be considered in the differential diagnosis and prompt surgical management should be considered as primary management.

Gallbladder adenosquamous carcinoma: a case report and literature review.

Representing 90-95% of all malignant gallbladder neoplasms, adenocarcinoma is by far the most common subtype. Adenosquamous carcinoma is a rare subtype, accounting for only 1-5% of all gallbladder carcinomas. These tumors have been shown to have aggressive biologic behavior, commonly extending to adjacent structures. Some studies have shown that the squamous component often displayed a greater proliferative capacity than the adenocarcinomatous component (possibly even up to twice as fast). Complete surgical resection is currently the mainstay of treatment but the prognosis is often poor. In this paper, we present a case of a 69-year-old male with an AJCC Stage IV moderately differentiated adenosquamous carcinoma of the gallbladder treated with radical cholecystectomy including liver segments IVb, V, VI.

Abdominal wall endometrioma presenting as a cystic abdominal wall mass: a case report and literature review.

Endometriosis is classically defined as 'the presence of endometrial glands and stroma outside of the uterine cavity and musculature'. Although it most commonly occurs in the pelvis, various extrapelvic locations have been reported in the literature. There seems to be a strong association between abdominal wall endometriomas and previous surgical scars. In female patients presenting with a cyclically painful abdominal wall mass, a high index of suspicion for endometrioma must be maintained, especially in the setting of previous gynecologic surgery. Although there may be a role for medical management of symptoms, the most definitive treatment of an abdominal wall endometrioma appears to be wide local excision with negative margins. This paper presents a 39-year-old female with an extensive gynecologic surgical history presenting with a 6 × 6 cm cyclically tender abdominal wall endometrioma treated with wide local excision.

Giant sliding inguinal hernia requiring intraoperative aspiration of fluid: a case report and literature review.

Giant inguinal hernias are defined as inguinal hernias that extend below the midpoint of the inner thigh when the patient is in the standing position or an anteroposterior diameter of at least 30 cm or a laterolateral diameter of ~50 cm with non-reducibility for >10 years. This article presents a 39-year-old male with a five-year history of a giant left inguinal hernia that was treated with left inguinal hernia repair with mesh, orchiectomy, complicated scrotoplasty, intraoperative ultrasound and aspiration of 3.9 L of fluid from the hernia sac. Surgical repair of giant inguinal hernias can be challenging and is associated with a variety of complications. Various modalities have been described to assist in hernia reduction including debulking, or, as in this case, aspiration of the hernia sac and a preperitoneal incision. Although the Lichtenstein tension free repair is commonly used, no standard approach has been accepted.