Abdominal pain caused by thrombosis of a gastroepiploic artery aneurysm--a case report.

Symptomatic visceral aneurysms usually present with abdominal pain and shock, gastrointestinal bleeding, or hemobilia when the aneurysm ruptures. Less frequently, visceral aneurysms are found incidentally during abdominal computed tomography or angiography. Thrombosis is a frequent complication of popliteal and femoral aneurysms but is rarely seen with a visceral aneurysm. The author believes this is the first report of complete thrombosis of a gastroepiploic artery aneurysm. The patient, who was seen for abdominal pain, had a previously unrecognized aneurysm.

Portal hypertensive hemorrhage from a left gastroepiploic vein caput medusa in an adhesed umbilical hernia.

Caput medusa is a frequent incidental finding in patients with portal hypertension that usually represents paraumbilical vein portosystemic collateral vessels draining into body wall systemic veins. A symptomatic caput medusa was seen in a morbidly obese patient after an umbilical hernia repair, which was fed not by the left portal vein but by the left gastroepiploic vein, in a recurrent adhesed umbilical hernia that likely contained herniated omentum. Refractory hemorrhage from this caput medusa was successfully treated by transjugular intrahepatic portosystemic shunt creation and balloon-occluded variceal sclerosis.

Peripheral tumors of the intercostal nerves.

Fewer than 10% of primary neural tumors of the chest originate peripherally from intercostal nerves; most neural tumors of the chest arise in the mediastinum. Most patients with primary tumors of the intercostal nerve are asymptomatic. We report a case of neurilemmoma arising from an intercostal nerve in a woman seen for severe pain in the chest wall. Resecting the tumor relieved the pain. Recent medical literature describing peripheral tumors of thoracic nerves is reviewed.

Blunt rectal trauma causing intramural rectal hematoma: report of a case.

An unusual case is reported in which intramural rectal hematoma resulted from rectal insertion of a foreign body. The patient was admitted to the hospital for observation and was catheterized because of urinary retention. The patient was discharged from the hospital after four days; for the last two days of this hospital stay, the patient received a liquid diet. We conclude that for some cases of uncomplicated intramural rectal hematoma, conservative management is safe and preferable to surgically draining the hematoma, which would increase the risk of infection.

Adenoid cystic breast cancer.

BACKGROUND: Adenoid cystic carcinoma is a rare type of breast cancer that is generally reported in individual case reports or as series from major referral centers. To characterize early diagnostic criteria for adenoid cystic carcinoma and to determine whether breast-preserving surgery with radiotherapy is as effective as mastectomy for eradicating the disease, we reviewed clinical records of a large series of patients treated for adenoid cystic carcinoma of the breast at a large health maintenance organization (HMO) that includes primary care facilities and referral centers. METHODS: Using the data bank of the Northern California Cancer Registry of the Kaiser Permanente Northern California Region (KPNCR), we retrospectively reviewed medical records of patients treated for adenoid cystic carcinoma of the breast. Follow-up also was done for these patients. RESULTS: Adenoid cystic carcinoma of the breast was diagnosed in 22 of 27,970 patients treated for breast cancer at KPNCR from 1960 through 2000. All 22 patients were female and were available for follow-up. Mean age of patients at diagnosis was 61 years (range, 37 to 94 years). In 17 (77%) of the women, a lump in the breast led to initial suspicion of a tumor; in 4 (23%) of the 22 patients, mammography led to suspicion of a tumor. Median tumor size was 20 mm. Pain was a prominent symptom. Surgical management evolved from radical and modified radical mastectomy to simple mastectomy or lumpectomy during the study period, during which time 1 patient died of previous ordinary ductal carcinoma of the contralateral breast, and 7 died of unrelated disease. At follow-up, 12 of the 13 remaining patients were free of disease; 1 patient died of the disease; and 1 patient remained alive despite late occurrence of lymph node and pulmonary metastases. CONCLUSIONS: Whether breast-preserving surgery with radiotherapy is as effective as mastectomy for treating adenoid cystic carcinoma of the breast has not been determined.