A case of bladder and pelvic dead space inflammation successfully treated with endoscopic ultrasound drainage.

Key Clinical Message: Interventional endoscopic ultrasound (EUS) is effective not only for biopsy, but also for abscess drainage. We report the first use of EUS to drain inflammation of the bladder and pelvic dead space through the ileal conduit. EUS-guided drainage is effective in treating postoperative abscesses and should be employed more routinely. Abstract: The patient was a 77-year-old man with a vesicoureteral fistula. An ileal conduit was placed after abdominoperineal resection and partial bladder resection for local, postoperative recurrence of rectal cancer. During postoperative chemotherapy, the patient developed a high-grade fever and after a thorough examination, he was diagnosed with bladder and pelvic dead-space inflammation. All urine flowed through the ileal conduit, and it was assumed that secretions from the residual bladder and prostate gland had accumulated in the bladder and pelvic cavity, resulting in infection. A transcutaneous drain was inserted through the perineum and the infection was controlled, but it flared up again after the drain was removed. We concluded that long-term drainage was necessary and successfully controlled the infection by placing a plastic stent through the ileal conduit into the bladder and pelvic dead space under ultrasound endoscopy. This is the first report of ultrasound endoscopic drainage of an abscess through the ileal conduit.

Effective treatment of gallbladder neuroendocrine carcinoma with nivolumab.

An 89-year-old patient with gallbladder neuroendocrine neoplasms (GB-NENs) and lung cancer metastasis underwent nivolumab monotherapy, resulting in tumor shrinkage. Surgery and adjuvant nivolumab showed efficiency despite low expression of PD-L1.

The first case of splenic flexure volvulus treated with reduced port surgery using single-incision laparoscopy.

INTRODUCTION: Splenic flexure volvulus (SFV) is a rare disease. We encountered a case of SFV, caused by congenital anomalies and persistent constipation. CASE PRESENTATION: A 43-year-old woman with a 35-year history of persistent constipation presented to the emergency department with acute lower abdominal pain. She had no past surgical history, and her vital signs were stable. A contrast-enhanced computed tomography (CE-CT) scan confirmed the SFV diagnosis. We initially performed endoscopic repositioning. To prevent recurrence, a laparoscopic left hemicolectomy was then carried out using reduced port surgery (RPS). She experienced no postoperative complications and was discharged seven days post-surgery. DISCUSSION: While SFV is typically managed through endoscopic repositioning followed by definitive surgical intervention to prevent recurrence, we successfully employed RPS in this case. Patients with SFV might be prime candidates for RPS due to the non-attachment of the descending colon to the retroperitoneum. Additionally, since SFV is a benign condition that doesn't necessitate lymph node dissection, it aligns well with the capabilities of RPS. Postoperatively, the patient experienced improved constipation symptoms. We hypothesize that this SFV was a result of a combination of factors: intestinal over-length, chronic constipation, and the loose adhesion of the descending colon to the retroperitoneum. CONCLUSION: This case demonstrates that RPS can be efficacious in treating SFV.

Two cases of splenic neoplasms with differing imaging findings that required laparoscopic resection for a definitive diagnosis.

INTRODUCTION AND IMPORTANCE: Splenic tumors are rare and are sometimes found incidentally. In such cases, laboratory tests and imaging studies should be performed based on the diagnostic algorithm to determine whether the tumor is benign or malignant. However, we clinicians sometimes encounter challenging cases. Herein we experienced two challenging cases of splenic tumor which we could not correctly diagnosis preoperatively. CASE PRESENTATION: Case 1: A female in her 80s presented to our surgical department to undergo follow-up examinations for Stage IIIa ascending colon cancer. A follow-up CT scan showed marked enlargement of the splenic tumor which suggested metastatic cancer. We performed laparoscopic splenectomy. Case 2: A healthy female in her 50s presented to our internal medicine department to undergo a workup after multiple splenic tumors. A follow-up CT scan showed that the tumors had grown slightly. We could not completely rule out a malignant tumor. She rejected further follow-up study and chose splenectomy. CLINICAL DISCUSSION: We experienced two cases of splenic hemangioma with different clinical presentations and imaging findings. Although some studies have reported that biopsying a splenic tumor is a safe and effective way of distinguishing among splenic tumors, in our country splenic biopsies are seldom performed due to fears of causing intraabdominal bleeding or tumor dissemination. Clinicians should consider whether it would be better to perform follow up with a biopsy or splenectomy as a definitive treatment on a case-by-case basis. CONCLUSION: Laparoscopic splenectomy can be used for definitive management in cases involving malignancy or an uncertain etiology.

Ascending colon stenosis caused by repeated diverticulitis that clinically mimicked advanced colon cancer: A case report.

INTRODUCTION: We experienced a rare case of right-sided large bowl obstruction (LBO) of the colon caused by chronic diverticulitis, which was challenging to diagnose. PRESENTATION OF CASE: A young male was admitted to our department with a fever, diarrhea, and right-sided lateral abdominal pain for several days. CT showed a thickened ascending colon wall with stenosis and adjacent retroperitoneal inflammation without marked diverticula. The next day, he developed severe abdominal pain, and perforation was suspected. We chose the "interval definitive surgery"; at that time, intestinal decompression and laparoscopic drainage. Colonoscopy showed an edematous membrane, but no cancerous lesions or diverticula. Hemi-colectomy was performed after 10 days' nutritional therapy. No postoperative complication occurred. The histopathology showed that the pathogenesis was chronic diverticulitis. DISCUSSION: There have been few reported cases of right-sided LBO caused by diverticulitis, but it is important to be aware that benign disease, such as chronic diverticulitis, can cause LBO. Initial conservative therapy and nutritional therapy produced a correct diagnosis and good outcomes. CONCLUSION: Performing "interval surgery" allowed us to make an accurate diagnosis and may help to prevent surgical complications in rare cases of right-sided LBO due to diverticulitis.

The first case of POEMS syndrome with synchronous breast cancer: What are the associated diagnostic challenges?

Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal gammopathy, Skin changes (POEMS) syndrome is a rare plasma cell disorder that causes a paraneoplastic syndrome. We report the first case of POEMS syndrome with synchronous breast cancer. The patient was at risk of being misdiagnosed with metastatic cancer, and it is important to emphasize that physical examinations provided vital diagnostic clues.

Primary rectal diffuse large B-cell lymphoma associated with ulcerative colitis: a case report.

We need to be aware of primary intestinal lymphoproliferative disease (PILD) associated with ulcerative colitis (UC). We should carefully monitor UC patients, particularly patients who meet the following conditions; a previous Epstein-Barr virus infection, treatment duration ≧4 years, male, and age ≧50 years.