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Saudi Arabia's obesity prevalence is 19.2% among men and 21.4% among women. Treatment includes lifestyle modifications, medication, and bariatric surgery. Procedures reach up to 1200 annually in our center. Porto-mesenteric venous thrombosis associated with venous mesenteric ischemia and bowel necrosis is a rare complication that necessitates an early workup and management. A 29-year-old Saudi male underwent laparoscopic sleeve gastrectomy. Post-surgery, he experienced abdominal pain, nausea, and vomiting, exacerbated by eating and smoking. Abdomen computed tomography scans revealed engorged portal veins, congested mesenteric veins, and small bowel thickening. He underwent exploratory laparoscopy shifted to laparotomy with resection of an infarcted omentum and 1 m of jejunal small bowel loop, and was discharged postoperatively after 7 days. Porto-mesenteric venous thrombosis is a rare complication after laparoscopic sleeve gastrectomy, requiring early diagnosis and appropriate treatment. Patients present with non-specific symptoms, necessitating high suspicion for computed tomography recommendations. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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.

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. [ABSTRACT FROM AUTHOR]

Hereditary multiple exostosis (HME) is a rare skeletal genetic disorder with multiple and disseminated osteochondromas. Costal localization is found in 40% of cases. Surgery for asymptomatic lesions remains controversial, but some lesions can be life-threatening. We report the case of a 10-year-old girl with HME, who developed a sharp costal exostosis compressing the hepatic parenchyma, for which a prophylactic resection was decided. The complete excision of the lesion was performed through extraperitoneal approach under video-assisted laparoscopy control, without short- and mid-term complication. To our knowledge, our case is the first in the literature where exostosis threatens the hepatic parenchyma.

Foreign body (FB) ingestion is commonly encountered in a clinical setting. However, the presence of perforation resulting from the ingested FB is an occurrence that is rarely seen. The most common cause of FB perforation is known to be fish bone. It is important to emphasize that the complications resulting from fish bone ingestion may lead to findings such as acute abdomen signs that can also be interpreted as other medical conditions, including acute appendicitis, acute diverticulitis, or peptic ulcer perforation. Thus, the differential diagnosis should be made, and the patient should be managed accordingly. In cases where the patient presents with acute abdomen signs but there are no clinical findings that may explain the initial diagnosis of the patient, a complete surgical exploration should be performed. We present a 50-year-old male patient who presented to the emergency room with complaints of abdominal pain. Following a thorough clinical examination and blood investigations, it was revealed that he had acute abdomen signs and a high level of C-reactive protein and because of these findings, exploratory laparoscopy was decided to be performed. Intraoperatively, the FB was removed and the site of perforation was repaired with primary closure. [ABSTRACT FROM AUTHOR]

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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.

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.

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.)

• Gastric neuroendocrine neoplasms (g-NENs) represent the most frequent digestive NENs and are increasingly recognized thanks to diffusion of upper gastrointestinal endoscopy. • g-NENs can be sporadic or associated with multiple endocrine neoplasia type 1 (MEN-1) and present with a functional Zollinger-Ellison syndrome. • We described a case of a 60 years old Caucasian male came to emergency room with diffuse abdominal pain and leukocytosis on blood tests. • At the level of the pyloric portion we found irregularly thickened walls associated with a small fluid collection and bubbles of free air. On exploratory laparoscopy we found a large perforation (about 5 cm of size) in the first duodenum portion. • Histological examination revealed a gastric NET perforation as a consequence of hypergastrinemia secondary to gastrinoma. 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). 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. 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. 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. [ABSTRACT FROM AUTHOR]

Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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.)

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. 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. 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. 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. • CT-scan alone provides a middling diagnostic power to detect bowel involvement (sensitivity 57.5%, specificity 72.2%). • The combination of CT with EXL provides a higher diagnostic power (sensitivity 94.3% and accuracy of 71%). • The integrated diagnostic flow-chart using CT-scan and EXL, improves the diagnostic power to detect bowel involvement. [ABSTRACT FROM AUTHOR]

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.)

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. 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. 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. 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. • Laparoscopic port site hernias containing the vermiform appendix are very rare. • Fascial closure of >5 mm port sites may reduce the risk of port site hernias. • Review, education, and revision of guidelines for port site closure following laparoscopic and robotic-assisted procedures to improve patient outcomes and quality of life. [ABSTRACT FROM AUTHOR]

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.)

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. [ABSTRACT FROM AUTHOR]

Hereditary multiple exostosis (HME) is a rare skeletal genetic disorder with multiple and disseminated osteochondromas. Costal localization is found in 40% of cases. Surgery for asymptomatic lesions remains controversial, but some lesions can be life-threatening. We report the case of a 10-year-old girl with HME, who developed a sharp costal exostosis compressing the hepatic parenchyma, for which a prophylactic resection was decided. The complete excision of the lesion was performed through extraperitoneal approach under video-assisted laparoscopy control, without short- and mid-term complication. To our knowledge, our case is the first in the literature where exostosis threatens the hepatic parenchyma. [ABSTRACT FROM AUTHOR]

Over the last few decades, advanced and relatively high-tech medicine, traditionally associated with the human field, is now an available, accepted and widely utilised by many veterinary practitioners worldwide. Up until now, these procedures had been reserved for those practicing in veterinary teaching hospitals and private referral institutions. One of the most exciting of these procedures is the implementation of rigid diagnostic and interventional endoscopy and endosurgery in our daily caseload. [ABSTRACT FROM AUTHOR]

The laparoscopic approach of pediatric surgery emergencies represents a specific preoccupation in hospitals everywhere in the world. Nowadays, when confronted with this pathology, pediatric surgeons are able to apply certain well-defined therapeutic protocols, depending on the technical equipment at their disposal and their laparoscopic expertise and training. We hereby present some of the surgical pediatric emergencies that have been subjected to minimally invasive celioscopic techniques, in the Department of Pediatric Surgery "Maria Sklodowska Curie" Hospital, from August 1999 to July 2007. Out of 83 exploratory laparoscopies, 12 were performed for emergency pathology, other than acute appendicitis (in its various forms, including peritonitis) or acute cholecystitis. However, during the above-mentioned period, the number of therapeutic laparoscopies for emergencies has grown significantly (239 from a total of 663 laparoscopies), reflecting to a large extent the activity of a clinic with an emergency surgery profile. The authors conclude that exploratory laparoscopies in pediatric surgery emergencies are suited for surgical teams with a solid experience in celioscopy and a certain professional maturity, necessary to correctly appreciate the surgical and anesthetic risks involved by each individual case. It is not recommended that inexperienced laparoscopic surgeons embark on the "adventure" of this minimally invasive approach for this type of pathology. Only when the training and learning process is fully and correctly completed, specialists are offered the advantage of continuing a celioscopic exploration by performing a minimally invasive therapeutic procedure, even for a pediatric emergency case. [ABSTRACT FROM AUTHOR]