Search

Highlights • Extrathoracic SFTs are not common, our case is a rare pelvic localization of this disease. • The pre-operative diagnosis is difficult because clinical symptoms, physical examination and imaging are not diagnostic. • SFT should be considered in the differential diagnosis of any mesenchymal lesion arising from the gastrointestinal tract., Introduction Solitary fibrous tumors (SFTs) are rare spindle cells neoplasms most likely arising from mesenchymal cells. Usually they involve the pleura. Even if extra-thoracic SFTs are rare, lately they are diagnosed with increased frequency. Case presentation We describe the case of giant pelvic and retroperitoneal neoplasm, a rare solitary fibrous tumor, in a 51-year-old man that was admitted for abdominal pain. Discussion On CT a SFT appears usually as a smooth, lobulated mass with occasional calcifications, but the imaging differential diagnosis with other mesenchymal tumors is very difficult, if not impossible. Conclusion The histological and immune-histochemical features of SFTs are helpful for the differential diagnosis. The malignant potential of this cancer is low, but it is very important to perform an optimized surgery and a close follow up in the patient. We believe that this case is particularly interesting and complex because of the difficulty of predicting the future biological behavior.

Highlights • Malrotation of gut is a congenital anomaly of foetal intestinal rotation and is very rare and often silent in adults. • We performed a laparotomic Ladd’s procedure in a case of 44 year old woman with acute abdominal pain. • Intestinal malrotation is a rare entity and adult presentation is even rarer. • Some cases are asymptomatic, but when symptomatic a volvulus should be promptly suspected to avoid complications such as bowel ischemia., Introduction Malrotation of gut is a congenital anomaly of foetal intestinal rotation and it is mostly discovered in early childhood as acute intestinal obstruction. This condition is very rare and often silent in adults. Presentation of case We present a case of 44-year-old woman admitted with acute abdominal pain. The abdominal CT scan showed ileal conglomerate loops with thickened walls filled of liquid in the right iliac side. Laparotomic Ladd's procedure was performed successfully with division of Ladd's band, adhesiolysis, reconstruction of Treitz's ligament, small bowel resection and Merckel's diverticulum removal. The patient made an unremarkable recovery. Discussion We discuss the rarity of intestinal malrotation in adulthood and made a literature review comparison of the therapeutic options available. Conclusion Intestinal malrotation is a rare entity and adult presentation is even rarer. Some cases are asymptomatic, but when symptomatic a volvulus should be promptly suspected to avoid complications such as bowel ischemia.

Left side gallbladder is a rare anatomical anomaly reported in the literature. It is associated with various anatomical variations of the biliary way and intrahepatic portal supply. Most of the time, it is discovered as an incidental finding during intervention for cholecystectomy, exposing patients and surgeons to high risk of complication. To prevent this, we analyze the critical aspects that must be known to perform safe interventions either in the normal setting or in the emergency setting. Different theories are proposed to describe this anomaly, but a debate is still open. Reviewing the literature and analyzing the different processes of formation, we create a classification that can explain how this anomaly can occur, dividing into four variation types.

Highlights • Laparoscopic liver surgery is evolving and its spread is now starting to take place. • Three-dimensional reconstruction imaging still remains a scarcely used technique. • Considering the difficulty of liver resection surgery, a precise knowledge of the patient’s anatomy is essential in the preoperative planning of the intervention. Three-dimensional reconstruction imaging provides useful information in addition to conventional imaging, allowing a more accurate preoperative planning, and being used as a navigation instrument during liver resection. • The use of three-dimensional reconstruction imaging allows to predict the precise location and direction of anatomical structures with high approximation, allowing to reach a high degree of precision surgery., Introduction The use of three-dimensional image reconstruction in liver surgery is well-known and has got many applications: It was first developed for vein reconstruction in liver transplantation and for liver volumetry to prevent post hepatectomy liver failure (PHLF) after major resections. There are many other advantages described in the literature provided by three-dimensional reconstruction, however its diffusion is currently limited. Clinical case We present the case of a woman with a single colon cancer metastasis in segment 5 of the liver. Using CT scan images we created a three dimensional reconstruction of the patient’s liver and its inners structures. The rendering was used to hypothesize the plan of dissection and to predict the pedicles that needed to be dissected during the procedure. Discussion We try to demonstrate that, thanks to three dimensional image reconstruction, all the structures that need to be dissected could be effectively located prior to the the surgery with a high grade of approximation. Furthermore the 3D reconstruction could be used as a step by step guide during the whole surgical procedure, showing all the pedicles To be encountered and dissected at every stage. Conclusion 3d reconstruction of the liver is a valid aid in the interpretation of preoperative imaging and intraoperative ultrasound, both for the surgeon and for the entire equipe, facilitating comprehension of patient’s liver anatomical features. It allows to predict the location and direction of the pedicles that need to be dissected and resected with high approximation, in order to achieve a more precise and tailored surgery.

Background SARS-CoV-2 infection has spread worldwide, and the pathogenic mechanism is still under investigation. The presence of a huge inflammatory response, defined as “cytokine storm,” is being studied in order to understand what might be the prognostic factors implicated in the progression of the infection, with ferritin being one of such markers. The role of ferritin as a marker of inflammation is already known, and whether it changes differently between COVID and non-COVID patients still remains unclear. The aim of this retrospective analysis is to understand whether the inflammatory process in these two types is different. Methods In this retrospective analysis, we compared 17 patients affected by SARS-CoV-2, who had been admitted between February and April 2020 (group A) along with 30 patients admitted for acute surgical disease with SARS-CoV-2 negative swab (group B). A further subgroup of Covid negative patients with leukocytosis was compared to group A. Results In group A, the median (interquartile range) serum ferritin was 674 (1284) ng/mL, and it was double the cutoff (300 ng/mL) in 9 out of 17 (52%). The median (IQR) value of ferritin level in the total blood samples of group B was 231, and in the subgroup with leucocytosis, 149 (145). Group A showed a significantly higher ferritin median level compared to the entire group B (two-tailed Mann-Whitney test, p p Conclusions The role of iron metabolism appears to be directly involved in COVID infection. On the other hand, in the acute inflammation of patients admitted for surgery, and probably in other common phlogistic processes, iron modifications appear to be self-limited. However, our finding suggests the use of ferritin as a marker for COVID infection.

Highlights • Left side gallbladder is more often discovered intraoperatively. • A lot of anatomical variations are described. • The three-dimensional reconstruction can better highlight intra and extraparenchimal anatomy. • The knowledge of this anomaly could be useful both in cholecystectomy technique and liver resection., Introduction Left sided gallbladder is a rare congenital abnormality more often discovered as incidental finding during laparoscopic cholecystectomy requiring surgical challenge to prevent complication. We present a case of a true left sided gallbladder treated with laparoscopic cholecystectomy. Case A 90 y/o woman with acute abdominal pain was hospitalised and underwent a laparoscopic cholecystectomy. A preoperative CT scan didn't show the variation. Intraoperative finding revealed a true left sided gallbladder that was carefully dissected at the Calot's triangle with identification of the cystic duct and artery. After a complete separation of the gallbladder from the liver, the cystic duct and the artery were safely clipped and transected. CT scan reconstruction reveal agenesis of the right superior sector with simultaneous absence of the right biliary duct. Discussion True left sided gallbladder is defined as one attached in the left of the ligamentum teres and falciform ligament. This abnormality predispose to a numerous anatomical variation. Unfortunately its finding is more often incidentally during intervention and recognition of such variation could be difficult that can be of high risk for surgical injury. Conclusion Left sided gallbladder presents a significant challenge to the surgeon and makes it even more difficult to avoid postoperative complications. Therefore, a careful dissection of Calot’s triangle and the complete mobilisation of the gallbladder should be done before clipping the cystic duct and artery. However, if a preoperative finding suggests a left sided gallbladder, then an in-depth preoperative anatomical study is advocated.

Several studies have demonstrated that training with a laparoscopic simulator improves laparoscopic technical skills. We describe how to build a homemade, low-cost laparoscopic training simulator (LABOT) and its validation as a training instrument. First, sixty surgeons filled out a survey characterized by 12 closed-answer questions about realism, ergonomics, and usefulness for surgical training (global scores ranged from 1&mdash, very insufficient to 5&mdash, very good). The results of the questionnaires showed a mean (&plusmn, SD) rating score of 4.18 &plusmn, 0.65 for all users. Then, 15 students (group S) and 15 residents (group R) completed 3 different tasks (T1, T2, T3), which were repeated twice to evaluate the execution time and the number of users&rsquo, procedural errors. For T1, the R group had a lower mean execution time and a lower rate of procedural errors than the S group, for T2, the R and S groups had a similar mean execution time, but the R group had a lower rate of errors, and for T3, the R and S groups had a similar mean execution time and rate of errors. On a second attempt, all the participants tended to improve their results in doing these surgical tasks, nevertheless, after subgroup analysis of the T1 results, the S group had a better improvement of both parameters. Our laparoscopic simulator is simple to build, low-cost, easy to use, and seems to be a suitable resource for improving laparoscopic skills. In the future, further studies should evaluate the potential of this laparoscopic box on long-term surgical training with more complex tasks and simulation attempts.

Objective: Older patients with cancer value functional outcomes as much as survival, but surgical studies lack functional recovery (FR) data. The value of a standardized frailty assessment has been confirmed, yet it's infrequently utilized due to time restrictions into everyday practice. The multicenter GOSAFE study was designed to (1) evaluate the trajectory of patients' quality of life (QoL) after cancer surgery (2) assess baseline frailty indicators in unselected patients (3) clarify the most relevant tools in predicting FR and clinical outcomes. This is a report of the study design and baseline patient evaluations. Materials & Methods: GOSAFE prospectively collected a baseline multidimensional evaluation before major elective surgery in patients (≥70 years) from 26 international units. Short−/mid−/long-term surgical outcomes were recorded with QoL and FR data. Results: 1003 patients were enrolled in a 26-month span. Complete baseline data were available for 977(97.4%). Median age was 78 years (range 70–94); 52.8% males. 968(99%) lived at home, 51.6% without caregiver. 54.4% had ≥ 3 medications, 5.9% none. Patients were dependent (ADL < 5) in 7.9% of the cases. Frailty was either detected by G8 ≤ 14(68.4%), fTRST ≥ 2(37.4%), TUG > 20 s (5.2%) or ASAIII-IV (48.8%). Major comorbidities (CACI > 6) were detected in 36%; 20.9% of patients had cognitive impairment according to Mini-Cog. Conclusion: The GOSAFE showed that frailty is frequent in older patients undergoing cancer surgery. QoL and FR, for the first time, are going to be primary outcomes of a real-life observational study. The crucial role of frailty assessment is going to be addressed in the ability to predict postoperative outcomes and to correlate with QoL and FR.

Introduction Posterior right diaphragmatic hernia is rare in newborn patients but when present, is accompanied by high mortality. Pulmonary hypoplasia seems to be the main cause of death but the presence of liver involvement remains one of the reasons for poor prognosis even when intrauterine surgery is performed. Case Description In this article, we will present a rare case that was diagnosed by chance in a 65-year old adult presenting with an adenocarcinoma of the rectosigmoid junction and a right Bochdalek hernia with liver herniation and modification of the hepatic vein outflow with a natural right to left shunt. Discussion Diaphragmatic repair was performed on the patient with a mash and simultaneous colorectal resection. Intraoperatively, the exceptional natural modification of the hepatic outflow and alteration of the caval system was evident. Conclusion This case report represent an extremely rare anatomic variation and could be useful to give new important information on the evolution that occur in foetal life.