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Introduction and Importance: Type 1 gallbladder perforation (GBP) in the free abdominal cavity causes pan-peritonitis, which is both rare and difficult to diagnose., Case Presentation: An 80-year-old man presented to our hospital with acute left upper abdominal pain. Twenty days prior to presentation, he had been admitted for 12 days with coronavirus disease 2019 (COVID-19). The patient had mild cholecystitis and received conservative therapy for COVID-19. Upon readmission, his abdomen was flat and soft except for local peritonitis in the left upper abdomen. An emergency laparoscopy revealed a perforation in the ventral wall of the gallbladder neck discharging pus under the lateral lobe of the liver without a gastrointestinal perforation. Therefore, a laparoscopic cholecystectomy and intra-abdominal lavage were performed. Based on the clinical and pathological findings, the GBP was suspected to be a rupture of the abscess in the Rokitansky-Aschoff sinus observed on magnetic resonance imaging during the first admission., Discussion: In this case, acute cholecystitis was suppressed by conservative therapy, leaving adhesions of the surrounding tissue and viscus to the gallbladder fundus and body as well as an abscess in the wall of the neck. This was the cause of the GBP and resulted in local peritonitis within the left upper abdomen., Conclusion: Type 1 GBP develops suddenly and cannot be predicted. In cases of acute cholecystitis once suppressed by conservative therapy and accompanied by cystic formation in the gallbladder wall, early cholecystectomy is recommended considering the risk of GBP., Competing Interests: Conflict of interest statement There are no conflicts of interest., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Thoracic combined spinal epidural anaesthesia offers the ideal perioperative anaesthesia and analgesia. A 78-year-old female presented to our hospital with a hypertensive emergency, non-ST elevation myocardial infarction and pulmonary effusion. Then the patient had abdominal pain, constipation and vomiting. When examined, there was significant abdominal distention. During a colonoscopy, there was a fungating mass lesion 20 cm from the anal verge. A biopsy was taken and showed intramucosal adenoma within tubulovillous adenoma with high-grade dysplasia. The patient underwent exploratory laparoscopy and laparotomy (sigmoidectomy, colostomy) under thoracic combined spinal epidural anaesthesia at T9-T10 interspinous space. The patient was classified as ASA5 according to the American Society of Anesthesiologists physical status. The guidelines recommend utilizing regional anaesthesia instead of general anaesthesia for compromised elderly patients. In our case, we report the first case in Palestine of an ASA5 patient who successfully underwent abdominal surgery under thoracic combined spinal epidural anaesthesia., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Objectives: Chronic pelvic pain (CPP) accounts for 15 to 40 % of exploratory laparoscopies. An exploratory laparoscopy was performed to exclude the presence of peritoneal endometriosis in patients experiencing significant impairment of their quality of life., Methods: This retrospective observational study was carried out in a tertiary referral center for endometriosis. Forty-six patients with CPP, including a non contributive clinical examination and additional investigations, underwent exploratory laparoscopy. They were divided into three subgroups : patients with a history of endometriosis (group 1), those with another non-gynecological concomitant etiology of CPP (group 2) and those without any primary etiological diagnosis (group 3). We report the observed endometriosis lesions, surgical techniques applied and histopathological results., Results: Exploratory laparoscopy revealed endometriosis lesions in 93.5 % of cases. Endometriosis lesions were found in 85 % of cases in group 1 (n = 20), 100 % in group 2 (n = 6) and 80 % in group 3 (n = 20)., Conclusion: Exploratory laparoscopy maintains a fundamental role in the diagnosis of patients with CPP, enabling simultaneous visualization and surgical treatment of endometriosis lesions.

Although exploratory laparoscopy in patients with advanced ovarian cancer is a diagnostic tool for determining treatment strategy, its safety has not been completely investigated. We report a case involving a severe abdominal abscess following an exploratory laparoscopy. A 65-year-old woman with advanced ovarian cancer developed a large abdominal abscess following exploratory laparoscopy and neoadjuvant chemotherapy. Emergent laparotomy was performed; while massive bowel adhesion surrounding the abscess did not allow for genital organ resection, an incision in the left port area was made to drain the abscess. The patient's chemotherapy was delayed because she experienced sub-ileus, postoperatively. Only a limited number of studies have been conducted on the safety of these techniques. This intense infection case emphasizes the need for further investigations into the safety of exploratory laparoscopy in patients with progressive diseases under heterogeneous conditions in real-world settings., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Ethics Committee of the Institutional Review Board of Kagoshima University Graduate School of Medical Sciences issued approval 230340. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Fukunishi et al.)

Appendiceal signet ring cell carcinoma is an exceedingly rare neoplasm which makes up only 4% of carcinomas of the appendix. It is a rare cause of abdominal pain which can mimic acute appendicitis. This case reports a 77-year-old female who presented to the emergency room with a complaint of right lower quadrant abdominal pain. After exploratory laparoscopy and histopathological studies, the patient was found to have peritoneal carcinomatosis and appendiceal signet ring cell carcinoma. This diagnosis unfortunately carries a relatively poor prognosis due to its aggressive nature. This study discusses the etiology, prevalence, clinical findings, and treatment of a rare cause of abdominal pain. This report sheds light on the importance of early detection and treatment of appendiceal signet ring cell carcinoma., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Ina et al.)

Introduction: Fallopian tube leiomyoma is an uncommon, benign gynecologic tumor that originates from the smooth muscle of the fallopian tube or vascular cells supplying the fallopian tube., Case Presentation: In this study, we report a case of a patient with fallopian tube leiomyoma. What makes this instance even more unique is the association of the leiomyoma with cystic degeneration, manifesting as a large abdominopelvic cystic mass. CT scan suspected that the mass might be an ovarian cystadenoma. However, ultrasonography, a widely used diagnostic tool, effectively assisted the clinicians in confidently ruling out the possibility that the tumor was originating from the ovaries. Ultimately, the patient underwent exploratory laparoscopy and the pathologic diagnosis was fallopian tube leiomyoma with cystic degeneration. To our knowledge, no instance of a fallopian tube leiomyoma of this size with cystic degeneration has been reported. Thus, it is worth mentioning., Conclusion: In summary, fallopian tube leiomyomas are classified as uncommon benign gynecologic tumors, which pose challenges in clinical diagnosis. The combined use of multiple imaging modalities may be more helpful in the proper diagnosis of this disease entity., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Spigelian hernias are an uncommon type of primary ventral hernia and are defined as a defect in the Spigelian aponeurosis (fascia). Herein, we present an uncommon case of Spigelian hernia to highlight the potential complications of these hernias and the need for surgical management. This is a case report of an 86-year-old gentleman presenting post-fall with an acute rib fracture and an incidental Spigelian hernia seen on a CT trauma pan scan. The Spigelian hernia surgical treatment was planned for elective management due to the anesthetic risks associated with an elderly patient and acute rib fractures. Ultimately, the patient developed a large bowel obstruction secondary to the Spigelian hernia and required emergency operative management to relieve the obstruction. The patient had an uncomplicated recovery following his emergency surgery. This case report highlights the importance of assessing anesthetic risks versus surgical risks when it comes to surgical planning. Clinicians should recognize occult hernias and continue ongoing clinical reviews with a high index of suspicion, as symptoms of Spigelian hernia obstruction might be non-specific., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Huynh et al.)

Introduction and Importance: Hernias containing the vermiform appendix are very rare. The more common of these have eponyms, such as Amyand's hernia (incidence of 0.5-1 %) and de Garengeot's hernia (incidence of 0.8-1 %). Laparoscopic port site hernias containing the vermiform appendix are even more obscure with only seven previously reported cases., Presentation of Case: A 71-year-old male presented with a palpable, non-reducible right lateral periumbilical mass, diagnosed preoperatively as an irreducible hernia at a port site from prior laparoscopic surgery. He had previously undergone laparoscopic bilateral inguinal hernia repairs with the 10 mm right lateral periumbilical port site defect within the musculoaponeurotic abdominal wall., Discussion: There are recommendations regarding the closure of most 10-12 mm port sites, and all 15 mm port sites, given most port site hernias are associated with larger trocars. It is reasonable to conclude that if our patient's 10 mm right lateral periumbilical port site received fascial closure, the resultant hernia may have been prevented., Conclusion: Fascial closure of port sites >5 mm poses an easy and effective way to reduce risk of port site hernias as well as other potential complications, therein reducing readmission, need for additional surgery, and improving patient quality of life., Competing Interests: Conflict of interest statement This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Bouveret syndrome (BS) is a rare but serious complication of gallstone ileus that can cause gastric outlet obstruction secondary to a gallstone impacted in the pylorus or proximal duodenum. Gallstones pass from the gallbladder to the GI tract via a cholecystoenteric fistula that forms as a result of chronic inflammation and adhesions between the biliary system and GI tract. Although the case we are presenting is of a 53-year-old Hispanic male, females and the elderly are particularly at an increased risk of this condition. BS can present as typical mechanical obstruction symptoms that include nausea, vomiting, and diffuse abdominal pain. The vague symptoms patients present with makes the diagnosis difficult and often delayed, which can be fatal. In our case, the diagnosis of BS was supported by a CT with contrast, MRI, and an esophagogastroduodenoscopy (EGD) study. Our patient underwent an exploratory laparotomy after the diagnosis was made, and the stone was removed. Here, we aim to raise awareness of the importance of early recognition, and immediate action in establishing an early diagnosis of BS in patients presenting with nonspecific abdominal symptoms, which can prevent mortalities., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Ibrahim et al.)

Chlamydia trachomatis infections may occur in multiple organs, including the lungs, lymph nodes, peritoneal cavity, and genitourinary systems. This disease results in significant ascites, the swelling of lymph nodes, and elevated tumor markers (CA125), sometimes mimicking an ovarian malignancy. At our hospital, we often perform examination laparoscopic surgery in cases of suspected gynecologic cancers before initial treatment. In this paper, we report the case of a 19-year-old woman who came to our hospital because of an ovarian tumor and ascites. There was no history of sexual intercourse (self-reported). We suspected ovarian cancer from image inspections, so we performed laparoscopic surgery for diagnosis. The final pathological diagnosis was acute-to-chronic inflammation of the bilateral fallopian tubes, and a cytologic examination of the ascites was negative for malignant cells. The C. trachomatis antigen was positive on vaginal examination after the operation. Based on this result, we diagnosed this patient with C. trachomatis infection. Chlamydia peritonitis should be a differential diagnosis for cancer peritonitis in juvenile patients with abnormal ascites. Exploratory laparoscopy should help confirm the pathological diagnosis.

Background: The early diagnosis of occult peritoneal metastasis (PM) remains a challenge due to the low sensitivity on computed tomography (CT) images. Exploratory laparoscopy is the gold standard to confirm PM but should only be proposed in selected patients due to its invasiveness, high cost, and port-site metastasis risk. In this study, we aimed to develop an individualized prediction model to identify occult PM status and determine optimal candidates for exploratory laparoscopy., Method: A total of 622 colorectal cancer (CRC) patients from 2 centers were divided into training and external validation cohorts. All patients' PM status was first detected as negative on CT imaging but later confirmed by exploratory laparoscopy. Multivariate analysis was used to identify independent predictors, which were used to build a prediction model for identifying occult PM in CRC. The concordance index (C-index), calibration plot and decision curve analysis were used to evaluate its predictive accuracy and clinical utility., Results: The C-indices of the model in the development and validation groups were 0.850 (95% CI 0.815-0.885) and 0.794 (95% CI, 0.690-0.899), respectively. The calibration curve showed consistency between the observed and predicted probabilities. The decision curve analysis indicated that the prediction model has a great clinical value between thresholds of 0.10 and 0.72. At a risk threshold of 30%, a total of 40% of exploratory laparoscopies could have been prevented, while still identifying 76.7% of clinically occult PM cases. A dynamic online platform was also developed to facilitate the usage of the proposed model., Conclusions: Our individualized risk model could reduce the number of unnecessary exploratory laparoscopies while maintaining a high rate of diagnosis of clinically occult PM. These results warrant further validation in prospective studies., Clinical Trial Registration: https://www.isrctn.com, identifier ISRCTN76852032., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Zhang, Qin, Li, Zhang, Luo, Wu, Li, Han, Wang and Wang.)

A diagnosis of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis is difficult to establish in elderly patients. Herein, we report a case of acute cholecystitis mimicking sepsis in an elderly patient with ANCA-associated vasculitis. A 99-year-old woman was transferred to a rural community hospital on account of anorexia and hypotension; there, she was initially diagnosed with sepsis and treated accordingly. However, she developed new-onset right upper quadrant tenderness on indirect fist percussion of the liver, and Murphy's sign was positive. While imaging did not reveal any findings suggestive of cholecystitis, the high index of suspicion for cholecystitis prompted an exploratory laparoscopy. Intraoperatively, the gallbladder wall was found to be inflamed, necessitating laparoscopic cholecystectomy. Histopathologic examination of the resected gallbladder showed neutrophilic infiltration and fibrinoid necrosis of the arterial walls. Perinuclear ANCA titers were elevated. These findings were consistent with a diagnosis of ANCA-associated vasculitis, and treatment with prednisolone markedly improved her condition. This case shows the difficulty encountered in differentiating between sepsis and ANCA-related vasculitis based on clinical features and relatively non-invasive diagnostic strategies alone. This study highlights the utility of invasive diagnostic procedures (e.g., biopsy) in elderly patients in whom a diagnosis of ANCA-associated vasculitis is difficult to establish., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Ohta et al.)

Peritoneal cancer is a rare disease that typically affects middle-aged women. Sclerosing mesenteritis can have a benign or malignant etiology. Although computed tomography (CT) scan and magnetic resonance imaging have been used to differentiate these two diseases, the findings are not always conclusive. Here, we report the case of an older woman who presented with acute abdominal pain. She was initially diagnosed with sclerosing mesenteritis, but the final diagnosis was peritoneal cancer. The initial treatment included antibiotics, non-steroidal anti-inflammatory drugs, and prednisolone. Tamoxifen was administered due to persistent symptoms, which were alleviated. However, the patient's cancer antigen 125 levels were elevated, and there were changes in the peritoneal CT findings. The patient was diagnosed with primary peritoneal cancer based on further investigation of the peritoneum using positron emission tomography-CT and a biopsy. This case report describes the diagnostic process regarding the differentiation between sclerosing mesenteritis and primary peritoneal cancer when the CT findings mimic those of sclerosing mesenteritis in general medicine., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Mouri et al.)

Introduction: and importance Postpartum retroperitoneal hematoma is a birth canal injury that is difficult to diagnose because of its invisibility. Secondary infections of these hematomas are rare, and their diagnostic and management strategies have not been fully elucidated. We present two cases of postpartum retroperitoneal hematomas with infection, which were successfully treated with minimally invasive surgery., Case Presentation: Case 1 was of a 2X-year-old woman who presented with complaints of fever; a provisional diagnosis of chorioamnionitis and Streptococcus pyogenes -induced sepsis was made. Case 2 was of a 3X-year-old woman who underwent uterine artery embolization and manual removal of the placenta for suspected placenta accreta. Both cases were diagnosed with adnexal hematomas, and antibiotic therapy failed in both patients. Therefore, we performed exploratory laparoscopy and made a diagnosis of retroperitoneal hematomas with infection; laparoscopic drainage resulted in rapid resolution of the clinical symptoms and abnormal blood test results., Clinical Discussion: Once an abscess develops, antibiotic treatment has a limited effect, and surgical drainage should be performed. Management of retroperitoneal hematomas is difficult, especially when complicated by an infection., Conclusion: Minimally invasive procedures involving laparoscopy could be beneficial for the management of postpartum retroperitoneal hematomas complicated by an infection., Competing Interests: None to declare., (© 2021 The Authors.)

A 24-year-old man presented with anal bleeding after accidentally falling on a table leg. Computed tomography showed free air in the bladder and around the rectum with a high-density area without intraperitoneal free air. The patient was suspected of having extraperitoneal bladder perforation with rectal impalement, and he underwent transanal rectal repair, colostomy, and urethral catheter placement after intraperitoneal bladder perforation was excluded by exploratory laparoscopy. Postoperative course was uneventful, and the urethral catheter was removed 19 days after surgery. Three months after the operation, colostomy reversal was performed, and the patient did not experience any complications., Competing Interests: The authors declare no conflicts of interest., (© 2021 The Authors.)

Dieulafoy's lesion is a rare cause of gastrointestinal bleeding. Produced by the erosion of aberrant vessels in the submucosa, usually at the gastric level. The jejunal location is unusual. Its diagnosis is complicated by the intermittent characteristic of bleeding, initially recommending the endoscopic approach. It is an unusual entity that must be taken into account in the differential diagnosis of gastrointestinal bleeding. Massive bleeding can occur, compromising the life of the patient. Initial endoscopic/radiological management is recommended, reserving the surgical approach for refractory bleeding for less invasive treatments., (Copyright: © 2021 Permanyer.)

Introduction: Neuroendocrine tumors (NETs) represent uncommon neoplasms with different characteristics. They can be asymptomatic and benign or they can also proliferate and manifest themselves with neoplastic mass symptoms such as intestinal occlusion or with carcinoid syndrome. Gastric neuroendocrine neoplasms (g-NENs) are the most frequent digestive NENs while duodenal neuroendocrine neoplasms (d-NENs) may be sporadic or associated with multiple endocrine neoplasia type 1 (MEN-1) and present a functional syndrome (e.g. gastrinoma with Zollinger-Ellison syndrome)., Presentation of Case: We report a case of duodenal perforation due to a unknown gastrinoma responsible of Zollinger-Ellison Syndrome. He underwent an emergency contrast enhanced CT abdominal scan that showed a perforation. We performed a distal gastrectomy. The histopathological examination revealed a g-NET configuring a possible picture of Zollinger-Ellison Syndrome., Discussion: The management of NETs is diffulcult and controversial because of their rarity. It is useful to know the pathologic assessment of tumor differentiation and/or grade, evaluate surgical resectability and control the carcinoid syndrome symptoms., Conclusion: This case report shows that gastric NETs can be found in cases of duodenal perforation. Our future goal is to evaluate the possibilities to diagnose the Zollinger Ellison Syndrome as early as possible and to treat it with targeted therapy in order to prevent its related complications., (Copyright © 2020. Published by Elsevier Ltd.)

Objective: This study investigates the diagnostic power of CT scan combined with exploratory laparoscopy (EXL) at identifying large bowel involvement in patients with stage IIIC-IV primary Epithelial Ovarian Cancer (EOC) by comparing with the macroscopic surgical findings at laparotomy., Methods: All patients with FIGO Stage IIIC-IV EOC who had Visceral Peritoneal Debulking (VPD) were included in the study. Results of CT scan, EXL and laparotomy (LPT) with regards to the bowel involvement were prospectively recorded in an ad hoc study form. Setting LPT findings as the gold standard, positive and negative predictive value (PPV/NPV), sensitivity, specificity and accuracy of CT and EXL were calculated. In addition, the diagnostic power of the combination CT scan + EXL was investigated., Results: Ninety-four out of 177 patients (53.2%) had a bowel resection during VPD. CT-scan alone had sensitivity, specificity, PPV, NPV and accuracy of 56.7%, 72.4%, 70.8%, 58.5% and 63.8% respectively. EXL alone 84.4%, 93.8%, 93.8%, 84.3%, 88.8%. CT combined with EXL detected bowel involvement with a sensitivity, specificity, PPV, NPV and accuracy of 87.5%, 70.4%, 77.8%, 82.6% and 79.6% and respectively. The combined tests showed a statistically significant improvement vs. CT scan alone (p < 0001) in sensitivity, NPV and accuracy, with non-significant difference in specificity and PPV., Conclusions: CT-scan alone shows a limited diagnostic power at detecting large bowel involvement in patients with stage IIIC-IV EOC. The combination of CT scan with EXL increases the diagnostic power and enables to appropriately plan the bowel resection and consent the patients., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Introduction and Objectives: Recurrent abdominal pain is defined as > 3 episodes of abdominal pain accompanied by affectation of the daily activity, during > 3 months. Our objective is to analyze the role of diagnostic and/or therapeutic laparoscopy., Material and Methods: A descriptive, retrospective study from 2004 to 2016. Patients: <14 years with DAR who underwent laparoscopy. Variables: age, sex, history, surgical findings, histology and follow-up., Results: 55 patients. Mean age: 10.7 years. Female 63, 6%. Probability of allergic comorbidity: 27.27% [16.138-40.962] (CI 95%). Probability of subsequent psychological comorbidity: 12.72% [5.27 -24.48] (95% CI). Histological changes 31/55 (56.36%): lymphoid nodular hyperplasia 10/31, appendicular inflammation 7/31, fecalite 3/31, carcinoid tumor 1/31, appendicular fibrosis 3/31, Meckel diverticulum 1/31, association of several of the above 8/31. Macroscopic alterations 31/55 (56.36%): appendicular pathology 10/31, adhesions 5/31, lymph nodes 2/31, ileitis 2/31, tubal cysts 1/31, Meckel 1/31 diverticulum, several of the previous ones 10/31. Remission of symptoms: 30/55 (54.54%). In some cases, with partial improvement (4/55) or persistence of symptoms (21/55), organic and/ or psychological cause was demonstrated (16/25)., Conclusions: Recurrent abdominal pain seems to have a significant association with an allergic or psychological history. Exploratory laparoscopy is a useful diagnostic and therapeutic technique.

Anti-N-methyl-d-aspartate receptor (NMDAR) limbic encephalitis is the most common form of paraneoplastic encephalitis that is associated with teratomas. Because tumor removal leads to better clinical outcomes, it is essential to reveal the location of the teratomas. This is the first reported case of anti-NMDAR encephalitis associated with teratoma of the fallopian tube. Salpingo-oophorectomy improved neurological symptoms and immunohistochemical examinations indicated the expression of NMDAR on neuroglial cells within the fallopian tube teratoma. Teratomas of the fallopian tube cause anti-NMDAR encephalitis; the imaging analysis and exploratory laparoscopies of the fallopian tube as well as of the ovary should be considered. Surgical removal of both fallopian tubes and ovaries with a normal appearance should be considered for patients in whom immunotherapy is not effective., (© 2017 Japan Society of Obstetrics and Gynecology.)

Pediatric ovarian torsion is an infrequent diagnosis and it often mimics acute appendicitis. Most cases are due to underlying ovarian pathology and if left untreated, ovarian torsion may eventually cause peritonitis. Emergency exploratory laparoscopy represents a valuable diagnostic and therapeutic tool in suspected ovarian torsion.