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Dynamic Radiology of the Abdomen: Normal and Pathologic Anatomy,

Para-duodenal hernia (PDH) represents rare clinical entities based on few literatures. We report five cases of Para-duodenal hernia, all occurring in male patients ranging from 34 to 75 years of age. The patients had varied manifestations presenting with abdominal pain with or without vomiting and nausea and with or without signs of intestinal obstruction. CT images showed cluster of dilated bowel segments with displaced mesenteric vessels at hernial orifice. Laparoscopic surgical approach was adopted, and the patients were discharged about a week later without further complications. We hope to raise awareness about the management of this rare clinical entity and the benefits of CT imaging and laparoscopic surgery as standard approaches.

/pdf/para-duodenal-hernia-a-report-of-five-cases-and-review-of-1yfznu506j.pdf

Para-duodenal hernia: a report of five cases and review of literature.

Paraduodenal hernias (PDH), also called mesocolic hernias, account for up to 53% of all internal hernias, but they cause only 0.2–0.9% of all cases of intestinal obstruction. This is the first systematic review of all reported cases so far, investigating their clinical presentation, radiological imaging, and treatment outcomes. After a detailed search in PubMed and Medline, using the keywords “paraduodenal hernia”, 115 studies matched our criteria. A review of these reports was conducted and the full texts were examined. A total of 159 patients were included in our analysis, with 69.8% and 30.2% of them suffering from either a left or a right PDH, respectively. Mean age at diagnosis was 44.1 years, with a 2/1 male/female ratio. PDH were associated with non-specific symptoms and signs; abdominal pain being the most common. Computed tomography (CT) scan of the abdomen was the most frequently used diagnostic modality. Regardless of PDH localization, all patients were operated on, with approximately one-third of them undergoing a laparoscopic operation, which was associated with a significantly decreased morbidity rate as well as length of hospital stay, compared with the open repair. PDH are not usually associated with specific symptoms and signs; thus, they constitute a diagnostic challenge, requiring a high level of knowledge and clinical suspicion. Undoubtedly, CT scan of the abdomen is the gold standard diagnostic tool. Their operative repair is mandatory, with the laparoscopic approach demonstrating significant advantages over the open repair, seeming to be the optimum treatment strategy.

Paraduodenal hernias: a systematic review of the literature

Duplex appendix is very rare (incidence 0.004%) but has clinical relevance given the frequency of appendicectomies performed. Failure to recognise duplication can result in failure of treatment and medico-legal consequences. A review of published cases was undertaken to identify factors that may help in managing this rare condition. All English and non-English publications were identified in PubMed, Embase and Cochrane databases. Patient demographics, intraoperative findings, anatomical details and histopathology were analysed. A total of 141 cases were identified [male/female ratio 1.4:1, median age 20 years (range foetus to 69 years)]. Duplication of the appendix ranges from branching of the appendix trunk to a fully matured appendix located elsewhere along the colon. Most can be categorised by the Cave–Wallbridge classification. There were 22 Type A, 8 Type B1, 46 Type B2 and 10 Type C cases (Cave–Wallbridge). There were six cases of horseshoe and two cases of triple appendix. Six reports gave anatomical descriptions that could not be classified by Cave–Wallbridge categories and in 11 cases there were no anatomical descriptions. An anteriorly placed appendix, away from the convergence of the taenia, or a normal appendix in the presence of convincing clinical or radiological signs of appendicitis should instigate a careful examination of the caecal pole and possible exploration of the retrocaecal space for appendiceal duplication. If the patient had previous surgery for congenital abnormalities, Type B1 or Type C duplication should be considered.

Appendiceal Duplication: A Comprehensive Review of Published Cases and Clinical Recommendations

// Fan Feng 1,* , Yangzi Tian 2,* , Zhen Liu 1,* , Guanghui Xu 1 , Shushang Liu 1 , Man Guo 1 , Xiao Lian 1 , Daiming Fan 1 and Hongwei Zhang 1 1 Department of Digestive Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China 2 Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China * These authors have contributed equally to this work Correspondence to: Hongwei Zhang, email: // Keywords : gastrointestinal stromal tumor, colon, feature, prognosis Received : November 30, 2015 Accepted : April 16, 2016 Published : May 05, 2016 Abstract Background: Due to the extremely rare incidence, data about colonic GISTs are limited. Therefore, aim of the present study was to explore clinicopathological characteristics and prognosis of colonic GISTs. Patients and Methods: Colonic GISTs cases were obtained from our center and from case report and clinical studies extracted from MEDLINE. Clinicopathological features and survivals were analyzed. Results: There were 79 colonic GISTs patients with a female predominance. The median age was 66 years (range 0.17-84). The median tumor size was 5.8 cm (range 0.5-29). The most common location was sigmoid colon (45.8%), followed by transverse colon (19.5%). The majority of colonic GISTs were high risk (70.8%). Mitotic index was correlated with gender ( P = 0.002) and tumor size ( P = 0.005), and tumor location was correlated with age ( P = 0.017). The five year DFS and DSS were 57.4% and 61.6%, respectively. Mitotic index and NIH risk classification were associated with prognosis of colonic GISTs. However, mitotic index was the only independent risk factor. The distribution of tumor size and NIH risk classification were significantly different between colonic and gastric GISTs (both P = 0.000). The DFS and DSS of colonic GISTs were significantly lower than that of gastric GISTs ( P = 0.012 and P = 0.002, respectively). Conclusions: The most common location for colonic GISTs was sigmoid colon. Most tumors were high risk. Mitotic index was the only independent risk factor for prognosis of colonic GISTs. Colonic GISTs differ significantly from gastric GISTs in respect to clinicopathological features. The prognosis of colonic GISTs was worse than that of gastric GISTs.

/pdf/clinicopathological-features-and-prognosis-of-mesenteric-4jy276v0yf.pdf

Clinicopathological features and prognosis of mesenteric gastrointestinal stromal tumor: evaluation of a pooled case series

Paraduodenal hernia is a rare congenital anomaly that arises from an error of rotation of the midgut. The duodenum and the small intestine become trapped in a sac which is lined by the peritoneum, behind the mesentery of the colon, either to the right or left of the midline. It is therfore a rare and potentially life-threatening condition that can cause intestinal obstruction progressing to strangulation and perforation. We report a case of a 55-year-old patient presenting a left paraduodenal hernia diagnosed intraoperatively after being operated on in the emergency setting for acute abdomen. The small bowel was twisted upon its mesentery and was entrapped in a large left paraduodenal space. Fortunately, once the bowel was reduced from the paraduodenal space, the blood flow was reestablished and the small bowel resumed a proper functioning. The mouth of the sac was obliterated by suture opposition to the posterior wall. The patient's subsequent hospital course was uneventful, and he was discharged in satisfactory condition 4 days postoperatively.

Left paraduodenal hernia: A rare cause of acute abdomen.

Gastrointestinal stromal tumors (GISTs) represent the majority of primary non-epithelial neoplasms of the digestive tract, most frequently expressing the KIT protein detected by immunohistochemical staining for the CD117 antigen. Extragastrointestinal stromal tumors (EGISTs), neoplasms with immunohistological features overlapping those of GISTs, are found in the abdomen outside of the gastrointestinal tract with no connection to the gastric or intestinal wall. We report the clinical, macroscopic and immunohistological features of an EGIST arising in the lesser omentum of a 58-year-old woman. This is a very rare location of intra abdominal stromal tumors.

Stromal tumor of the lesser omentum : a case report.

La duplication appendiculaire est une malformation tres rare. Elle se rencontre chez les enfants exceptionnellement chez les adultes. Sa decouverte est souvent fortuite a l'occasion d'une laparotomie ou laparoscopie pour une autre pathologie. Nous rapportons un cas particulier d'un patient qui a beneficie d'une appendicectomie il y'a 3 mois qui est admis aux urgences pour un syndrome appendiculaire recidivant avec aux explorations radiologique et chirurgicale la presence d'une appendicite retrocoecale.

Duplication appendiculaire révélé à l’occasion d’un syndrome appendiculaire récidivant

Background: Spontaneous rupture of a hepatic hydatid cyst resulting in biliary peritonitis is an infrequent but severe complication that requires urgent surgical intervention and has high rates of morbidity and mortality. There are very few reported cases of this complication in the medical literature. 
Case Presentation: We present an unusual case of a 64-year-old male who presented with acute peritonitis due to biliary peritonitis resulting from the spontaneous rupture of a large hydatid cyst of the liver, as seen on contrast-enhanced computed tomography, which also showed intraperitoneal fluid. During the operation, approximately 4L of infected bile was found in the peritoneal cavity, and a cystobiliary communication was observed with rupture of the anterior wall of the cyst. Treatment involved unroofing the cyst and closing the communication. The patient was free of recurrence and in good health after 6 months of follow-up. 
Conclusion: Although this complication is rare, it should be considered in the differential diagnosis of acute abdominal pain in patients living in endemic areas.

Spontaneous Intraperitoneal Rupture of Hydatid Cysts of the Liver with Encapsulating Peritonitis: A Case Report

Intussusception is an invagination of
a segment of the gastrointestinal tract into an adjacent one. Jejunojejunal
intussusception is a rare complication of jejunostomy tube placement with an
incidence of 1%. We are reporting a case of 35-year-old man who was suffering
from severe oral, lesions due to Ingestion of acide agents. He received Witzel
jejunostomy for early feeding. Ileus developed postoperatively and plain X-ray
of the abdomen showed distended small bowel loop. Abdominal computed tomography
revealed target sign as well as the feeding tube in a dilated jejunum and
intussusception was diagnosed. Exploratory laparotomy was required due to failure
of expectant therapy. Reduction of intussusception was done during exploratory
laparotomy. The jejunostomy feeding was continued and the postoperative course
was uneventful.

/pdf/jejunojejunal-intussusception-following-jejunostomy-2yyhpzsqro.pdf

Jejunojejunal Intussusception following Jejunostomy

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