Surgical management of adrenal myelolipoma: a series of 10 patients and review of the literature.

AIM: Adrenal myelolipomas have been conventionally described as asymptomatic tumors that are easily diagnosed and can be managed conservatively. The purpose of this study is to evaluate the role of surgery in the management of these lesions. METHODS: The clinical presentation, the operative treatment and histopathological features of 10 patients with myelolipoma over a 13-year period in a tertiary care Center are presented. RESULTS: Eight patients (80%) were symptomatic: 7 patients presented with non-specific abdominal pain, whereas 1 patient presented urgently due to intraperitoneal hemorrhage. Investiga-tion of concurrent medical conditions revealed hypertension (7 patients), diabetes mellitus (2 patients), obesity (4 patients) and nephrolithiasis (1 patient). Seven patients underwent adrenalectomy by open approach (4 through the anterior and 3 through the posterior route) and 3 by laparoscopic method. There was no postoperative morbidity and mortality and all patients are currently symptom free. CONCLUSIONS: Although myelolipomas are considered as innocent benign growths, they may present with acute clinical symptoms. Surgical therapy is a safe and definitive treatment option for both symptomatic and ''asymptomatic'' lesions providing definitive diagnosis and alleviating the patients' symptoms along with the emotional burden due to tumor presence.

Retroperitoneal perforation of a duodenal diverticulum with colonic necrosis -- report of a case.

Primary duodenal diverticula are usually asymptomatic. About 115 perforations have been reported, but none with right colon necrosis. We report a 45-year-old woman, with a five days history of high fever along with epigastric and periumbilical pain. Physical examination revealed right upper and lower quadrant tenderness with peritoneal signs. White blood cell count was 11 500/mm (3) while biochemical and hepatic biology tests were normal. Abdominal radiographs showed no pathologic findings. Ultrasound disclosed fluid in the lower pelvis. Computerized tomography revealed fluid collection in the right hepatorenal space. Intraoperative findings included purulent fluid in the lower pelvis, segmental necrotic changes of the right colon, and a perforated diverticulum on the antimesenteric border of the third part of the duodenum. Surgery consisted of right hemicolectomy and ileo-transverse anastomosis, diverticulectomy, and decompressive lateral duodenostomy at the second duodenal portion. The patient had an uneventful postoperative course. A contrast study from the duodenostomy tube on the 6 (th) postoperative day showed no leakage or obstruction. Duodenostomy tube was removed on the 14 (th) postoperative day. Histology confirmed the diagnosis of a primary duodenal diverticulum.

Elective neurectomy during open, "tension free" inguinal hernia repair.

Chronic postoperative inguinal pain syndromes are potentially debilitating sequelae following elective inguinal hernia repair. Diagnosis and definitive treatment constitute challenging issues for both the surgeon and the patient. In this prospective trial, we evaluated the impact of elective iliohypogastric and ilioinguinal nerve resection on the incidence of pain, numbness, and sensory loss following anterior, "tension-free" herniorrhaphy. One hundred ninety-one patients were enrolled and were reviewed 1 month, 6 months, and 1 year postoperatively. Pain, numbness, or any loss of sensation were recorded and categorized on a "mild," "moderate," or "severe" scale. No persistent pain syndrome was encountered. Numbness was found in 9.42% of the patients at the first month and in 6.28% of the patients after 1 year. Sensation loss (1.04%) was never bothersome or incapacitating at the end of the follow-up period. Elective neurectomy is safe to perform, well tolerated by patients, and is not associated with chronic postoperative inguinal pain.