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Background Tumor-produced high molecular weight insulin-like growth factor-II (big insulin-like growth factor-II) is considered to cause non-islet cell tumor hypoglycemia. This paper presents a case of surgically resected retroperitoneal liposarcoma that produced big insulin-like growth factor-II. Case presentation Here, we report the case of a 62-year-old woman who presented with an abdominal mass and hypoglycemia. Non-islet cell tumor hypoglycemia due to retroperitoneal liposarcoma was suspected. After complete resection of the tumor, the patient’s hypoglycemia improved and big insulin-like growth factor-II disappeared in the molecular weight analysis of serum insulin-like growth factor-II by western blotting. The patient had no tumor recurrence or reappearance of hypoglycemia 16 months after the operation without any adjuvant therapy. Conclusions Although insulin-like growth factor-II-producing tumors are generally large and difficult to operate on, surgical resection is currently the most effective and only treatment; thus, it is essential to attempt resection aggressively.

Aim: Mucosal melanomas are highly malignant tumors that are of great interest for their aggressive behaviour and unfavourable prognosis, which could be the result of many reasons. In this paper, we describe a retrospective study performed to investigate the characteristics and prognoses of gastrointestinal mucosal melanomas in a Chinese population to help future clinicians recognize the prognosis of this disease. Methods: We retrospectively studied 49 patients diagnosed with gastrointestinal mucosal melanomas. Multivariate analysis of prognosis and overall survival (OS) was performed using the Cox proportional hazards model. Results: The multivariate analysis showed that the condition of the primary or metastatic tumor and tumor location were independent factors that affected the prognosis of patients with gastrointestinal mucosal melanomas. Patients with metastatic tumors had a better prognosis than patients with primary tumors, and tumors that occurred in the lower gastrointestinal tract had a better prognosis than those that occurred in the upper gastrointestinal tract. Conclusion: Tumor location and the condition of the primary or metastatic tumor may be independent factors that affect the prognosis of patients with gastrointestinal mucosal melanomas.

The COVID-19 pandemic has forced education to transform into a virtual platform. The decreased number of open cases performed by general and vascular surgical trainees necessitates the supplementation of intraoperative education with digital technologies. We present the benefits and drawbacks of recording, editing, and uploading surgical procedures for educational use. In this paper, we describe an educational video of an antegrade mesenteric bypass to treat chronic mesenteric ischaemia. Fomenting a common practice of filming surgeries is a step towards creating a high-definition video library for surgical trainees to familiarize themselves with procedures and/or enhance their learning, especially during mandated social distancing.

Purpose: This paper evaluates the outcomes of parathyroidectomy for primary hyperparathyroidism with negative localization studies. Methods: All patients with primary hyperparathyroidism with negative preoperative ultrasound and MIBI scan who underwent parathyroidectomy were retrospectively included. Three groups were defined. Group 1 included the patients with negative ultrasound and MIBI. Group 2 included the patients with negative ultrasound and positive MIBI. Group 3 included the patients with positive ultrasound and negative MIBI. Results: In Group 1, 51% and 86% of patients had one adenoma and atypical localizations respectively. Unique adenoma and atypical localizations were showed in 87% and 93% of patients in Group 2 respectively. In Group 3, 83% and 17% of patients had one adenoma and atypical localizations respectively. No cervical hematoma was noted. Transient recurrent laryngeal nerve palsy occurred in 2 patients. Seven patients required postoperative calcium supplementation for 2 to 5 months, and one had recurrent hypercalcemia at follow-up. Cure rate was 98,3%. Conclusion: When US and MIBI were negative, multiple lesions and atypical localizations were frequent. The success rate and postoperative complications were not affected with this event.

Subungual exostosis (SE) is a rather uncommon benign bony outgrowth of the distal phalanx of the toes, affecting mainly adolescents and young adults. While inherently painless, it grows progressively and leads to nail deformity which eventually produces pain and has negative impact on the quality of life of the affected individual. The present paper presents a step-by-step guide to the in situ split-thickness toenail bed graft technique. The outcome of our case was in line with the current literature, the preservation of the nail led to a highly satisfactory cosmetic result, while no recurrence of the lesion was reported.

Colorectal liver metastasis (CRLM) is the most common lesion diagnosed in the liver worldwide and new therapies have been proposed over the last decades. On the leading edge of these therapies, radiofrequency ablation (RFA) has been increasingly applied for treatment these lesions. The procedure can be done by percutaneous approach guided by CT, or during open or laparoscopic surgery. Although findings in preliminary reports suggest that this procedure is both safe and effective, only a few studies have been published. We present a 69-year-old female, previously submitted to two hepatic resections and one RFA for treatment of CRLM, who developed an abdominal wall recurrence due to neoplastic seeding after RFA procedure. In the published literature thus far, some risk factors have been associated with neoplastic seeding following RFA, like subcapsular location, multiple electrode placements, multiple RFA treatments and poor tumor differentiation grade. Technical features like access through normal liver substance and tract needle ablation may play a role in mitigating the risk of this complication. Although it seems to be a safe procedure, only a few retrospective papers have been published its rare complications and outcomes. Nevertheless, patients with localized disease may benefit from surgical resection.

Situs inversus is a rare congenital disorder characterized by mirror image of the internal organs’ arrangements. Laparoscopic cholecystectomy in such patient is considered challenging. In this paper, we present a 64-year-old female which is known to have situs inversus. She underwent uneventful laparoscopic cholecystectomy. Technical difficulty is an obstacle in these patients and modification of the surgical steps will facilitate the operation.

Background Bilateral ligamentum teres (BLT) hepatis is a very rare anomaly defined as the connection of the bilateral fetal umbilical veins to both sides of the paramedian trunk, and it has never been reported in the English literature. Case presentation A 72-year-old man who presented with obstructive jaundice was referred to our hospital. Contrast-enhanced computed tomography revealed that the patient had right-sided ligamentum teres (RSLT) and left-sided ligamentum teres (LSLT). The umbilical portion of the left portal vein, which the LSLT connected, became relatively atrophic in this patient. The RSLT attached to the tip of the right anterior pedicle and formed the umbilical portion of the right portal vein. The patient was diagnosed with perihilar cholangiocarcinoma which had invaded the root of the posterior branch of the bile duct, LHD, and intrapancreatic bile duct. The central bisectionectomy, in which the liver parenchyma was resected along the RHV on the right side and the LSLT on the left side, and caudate lobectomy combined with pancreatoduodenectomy were performed. The presence of the patient with BLT is important for ascertaining the mechanism of the development of RSLT. Two umbilical veins are present initially during the embryonic stage. In general, the right-sided vein disappears, and the atrophic left-sided vein remains connected to the left portal vein originating from the vitelline vein. Several papers on the mechanism of the development of RSLT have been published. Some authors have mentioned that a residue of the right umbilical vein and the disappearance of the left umbilical vein are the causes of RSLT. On the other hand, some authors have asserted that RSLT is the result of atrophy of the medial liver area. The presence of BLT in patients indicates that the mechanism of the development of RSLT is characterized by a residue of the right umbilical vein and the disappearance of the left umbilical vein. Conclusions The mechanism and origin of RSLT can be understood through cases of BLT, and surgeons must pay attention to anomalies of the portal and hepatic veins in patients with abnormal ligamentum teres.

Background Rectal duplication cysts are rare gastrointestinal congenital duplicate cysts with various clinical presentations that require different management. Case presentation We present a case of a lady with a double rectal duplicate cyst which was found incidentally on a follow-up CT abdomen and pelvis scan. The patient initially had a mucocele excision, and following that, she had a non-contrast CT abdomen and pelvis to investigate post-operative pain. The CT scan revealed a single rectal duplicate cyst. She had a posterior approach excision to have it removed, and only intra-operatively, she was found to have a double rectal duplicate cyst. She had them both removed via a midline incision running from the perineal pigmentation and extending until the coccyx. She had another follow-up CT which showed complete excision of the cysts. Conclusions After a thorough review of the literature regarding rectal cysts, there was no mention of a double rectal duplicate cyst. The purpose of this paper is to point out the various potential presentations of a rectal cyst as well as the idea that a double cyst is managed effectively in a similar way as the single one.

Introduction: Retrobulbar hemorrhage is a rare, progressive, sight-threatening emergency. Standardized treatment algorithms for it exist in the literature; however, their efficiency is uninterpretable in most nonophthalmic settings. This paper reviews retrobulbar bleeding, the pathophysiology of vision loss, and the therapeutic modalities and their efficacy in addressing such visual damage. Case Report: We present the unfortunate case of an 82-year-old male with coronary artery disease on anticoagulants who presented for a vitrectomy for a vitreous hemorrhage secondary to eccentric disciform degeneration under general anesthetic with an accompanying retrobulbar block. He subsequently developed a retrobulbar hemorrhage at some point post-operatively. He presented to his surgeon 18-hours after the operation with no light perception on ophthalmologic examination as well as facial ecchymosis and proptosis. Efforts to reduce his intraocular pressure were successful, but there was no return of vision. Conclusion: Retrobulbar hemorrhage can be a devastating visual event. Standardized treatment algorithms have been described, however, the effectiveness or need of such treatments can only best be evaluated by an ophthalmologist and are often performed too late to provide meaningful recovery

Gallbladder small cell carcinoma (SCC) comprises only 0.5 % of all gallbladder cancer and consists of aggressive tumors with poor survival outcomes against current treatments. These tumors are most common in elderly females, particularly those with cholecystolithiasis. We report the case of a 79-year-old woman with gallbladder small cell carcinoma. The patient had intermittent right upper quadrant abdominal pain and was admitted to our hospital due to suspected acute cholecystitis. She regularly received medical treatment for diabetes, hypertension, and dyslipidemia. On initial laboratory evaluation, the levels of aspartate aminotransferase (AST), total bilirubin, and C-reactive protein (CRP) were markedly elevated. She underwent computed tomography (CT) for screening. CT images showed a thick-walled gallbladder containing multiple stones and multiple 3-cm-sized round nodular lesions, which were suggestive of metastatic lymph nodes. After percutaneous transhepatic gallbladder drainage was performed, endoscopic ultrasound-guided fine needle aspiration of enlarged lymph nodes resulted in a diagnosis of small cell carcinoma or adenocarcinoma. However, we could not identify the primary lesion before the surgery because of no decisive factors. We performed cholecystectomy because there was a possibility of cholecystitis recurrence risk and also partial liver resection because we suspected tumor invasion. The final pathological diagnosis was neuroendocrine carcinoma of the gallbladder, small cell type. The tumor stage was IVb, T3aN1M1. The patient died 13 weeks after the surgery. In the present paper, we review the current available English-language literature of gallbladder SCC.

Intrascrotal lipoblastoma is a rare pediatric benign soft tissue neoplasm, and only 11 cases have been reported. The accurate preoperative diagnosis is difficult because of its rarelity and the similarity with the other soft tissue tumors. Among them, accurate preoperative diagnosis had been made in only one case. Thus, almost all of the cases had required inguinal mass excision (and orchidectomy in one case). In this paper, we discuss the accurate preoperative diagnosis of intrascrotal lipoblastoma and subsequent simple tumorectomy via minimal invasive scrotal skin incision, in 1-year-old boy. On physical examination, intrascrotal extra-testicular lobulated mass was palpated on the right scrotum. An ultrasonography revealed the well-circumscribed, iso-echoic, scant blood-flow, and lobulated tumors with each lobules of 1 to 4 cm in diameter, and the tumor located outside of the tunica vaginalis testis. The serum values of alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin (b-hCG) were within normal limit. The preoperative diagnosis of intrascrotal lipoblastoma was made, and the mass was excised via minimal scrotal incision. The right testicle and epididymis were normal. The lesion consisted of the distinct two lobulated tumors, and microscopic examination confirmed the diagnosis of intrascrotal lipoblastoma. The postoperative course was uneventful without evidence of recurrence. A rare intrascrotal lipoblastoma is seldom made accurate preoperative diagnosis; however, the accurate preoperative suspicion of this tumor leads to the minimal invasive tumorectomy via scrotal skin incision and favorable postoperative recovery without recurrence.