Search

Appendiceal intussusception (AI) is an unusual and rarely reported clinical entity. It was first described by McKidd in a 7-year-old boy in 1858. Since then the literature on it has been confined to a few case reports and very small cases series, in totally about 300 cases being published. Because of variations of clinical symptoms and lack of pathognomonic sign, rarety of the pathology and diversity of causing factors, accurately detection of the presence or absence of appendiceal pathology is difficult. However, imagistic and endoscopic methods may be useful in AI detection and play a large and important role in differential diagnosis. Treatment of AI differs significantly depending on underlying pathological condition, benign or malignant.

The year 2020, for the State University of Medicine and Pharmacy „Nicolae Testemitanu” is the Anniversary, the 75th year of activity, a period in which higher medical education has provided the country with doctors, scientists, researchers, and professors of contemporary medicine. During this time, the notorious personalities of Bessarabian medicine were formed, personalities who formed the Golden Fund of the country’s intellectuals. his study contains extensive information about the makers and great illustrious surgeons of the nation, from the founding of Alma Mater to the present, who laid the foundation of modern surgery.

Type 1 and type 2 diabetes are characterized by progressive β-cell failure. Bariatric surgery, an effective treatment for morbid obesity, commonly leads to near complete resolution of type 2 diabetes (T2DM). The underlying mechanisms, however, remain unclear, most often being attributed to weight loss. Type 1 diabetes (T1D) is considered to be an autoimmune disease. The CD4 and CD8 cells play distinct and highly pathogenic roles mediating type 1 diabetes. This prospective clinical trial includes 40 patients with T2DM from 122 patients who underwent Roux-en-Y gastric bypass (RYGB) from 2009 to 2016. Duration of diabetes was 3±0,5 years, and preoperative BMI of 43,4±1,7 (range 28,7-62,1) kg/m². The blood glucose and glycosylated haemoglobin were 9,1±0,5 mmol/l and 7,1±0,2 %, respectively. A part of the small bowel was taken for the histochemical examination. We report the preliminary postoperative follow-up data of 16,9±3,4 months. BMI decreased to 29,5±1,1 kg/m², blood glucose and glycosylated haemoglobin were 5,8±0,3 mmol/l and 5,9±0,2 %, respectively. The histochemical exam emphasized the presence of a chronic inflammatory infiltrate in the lamina propria mostly constituted of CD4 and CD8 T lymphocites, the ratio of CD4/CD8 was 1/6-8. In conclusion, inflammatory mechanisms play a key role in the pathogenesis of type 1 diabetes. Both type 1 diabetes and type 2 diabetes can have a common pathogenic mechanism.

Summary Objective: Pseudomyxoma peritonei (PMP) is a rare, chronic, relapsing, diagnostically challenging, and poorly understood disease characterized by disseminated mucinous ascites and peritoneal implants. PMP usually develops secondary to mucinous neoplasms of the appendix and/or the ovary. Only few reports of limited PMP were published. Case Report: We describe the case of a 53-year-old woman who presented with a limited mucinous collection in the pelvis seen on computed tomography and who underwent surgery for mucocele of the appendix, bilateral mucinous ovarian tumors, and single mucinous implant on the great omentum 16 years previously. Serum tumor markers: CEA was elevated and CA 19-9 was within the normal range. At surgery, a wellcircumscribed collection of mucin was found in the pelvis, and removal of mucinous material with intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) and postoperative intraperitoneal irrigation with 5-fluorouracil was performed. Histological examination revealed disseminated peritoneal adenomucinosis according to Ronnett’s classification. After surgery, the patient has been free of recurrence for 2 years. Conclusion: Our case report highlights that PMP requires careful observation, as it might be detected after a long-term follow-up period post-appendectomy for appendiceal mucocele. Schlusselworter

We describe herein a case of sporadic retroperitoneal aggressive fibromatosis. A 54-year-old man with a palpable abdominal mass was referred to our hospital for investigation and treatment. Abdominal ultrasonography and computed tomography revealed a solid mass with relatively well-defined borders in the left abdominal retroperitoneum. At surgery, a large tumor (14 x 13 x 11 cm) was found, arising from the retroperitoneal space and involving the wall of jejunum. Complete removal was achieved. Histological examination of the resected specimen revealed the presence of changes consistent with aggressive fibromatosis. The patient was not scheduled for any further treatment. Two years after surgery, the patient is without any signs of recurrent disease. Although extremely rare, aggressive fibromatosis should be considered in the differential diagnosis of retroperitoneal masses. Complete surgical resection with negative pathological margins remains the first line management of these neoplasms. Careful follow-up is indicated because recurrence may occur every time after surgery.

Liposarcoma is a malignant mesenchymal tumor frequently located in the retroperitoneum and rarely presents as an isolated lesion in the colon. To our knowledge, only three cases of primary colon liposarcoma have been reported in the world literature to date. In this article, we report a case of liposarcoma of the colon in a 46-year-old man. The patient presented with abdominal pain and a palpable mass. Abdominal ultrasonography and computed tomogram confirmed the presence of a large intra-abdominal fatty tissue mass, but the colon origin of the tumor was revealed only on laparotomy. During surgery, a voluminous (12 cm x 11 cm x 10 cm) lesion situated in the subserosa of the ascending colon was found, and a right hemicolectomy with radical lymph node dissection was performed. The pathological diagnosis of the resected tumor revealed primary colon liposarcoma (myxoid subtype). The postoperative course was uneventful, and the patient remained free of disease for 12 months. No adjuvant therapy was performed. Diagnostic and therapeutic problems related to this type of neoplasm as well as literature reviews are reported. Curative R0 resection remains the main treatment for primary and recurrent liposarcomas.

BACKGROUND: Abdominal complications after ventriculoperitoneal (VP) shunt placement are reported in 5–47% of cases. Abdominal cerebrospinal fluid (CSF) pseudocyst is an uncommon complication of a VP shunt, the majority being reported in children. Abdominal pseudocysts and intra-abdominal catheter migration are rare in adult patients. Ventriculoperitoneal shunt obstruction or malfunction results in elevated intracranial pressure, representing an indication for immediate intervention. METHODS: Case report. RESULTS: The authors report a case of successful laparoscopic management in a 20-year-old female patient who developed CSF pseudocyst combined with migration of the fractured catheter in the abdominal cavity nine years after VP shunting for hydrocephalus. CONCLUSIONS: Laparoscopic approach is a safe and useful treatment modality for combined peritoneal complications of VP shunt.

Vermiform appendix torsion is rare, and even more uncommon is the volvulus of appendiceal mucinous tumors. To our knowledge, only nine cases of torsion of the vermiform appendix associated with appendiceal mucinous neoplasms have been reported up to date. We report a case of secondary torsion of the vermiform appendix with mucinous cystadenoma in a 30-year-old man. The symptoms were consistent with acute appendicitis. Diagnostic laparoscopy revealed a mucinous tumor of the appendix with a 360 degrees twisted appendix. In order to avoid peritoneal dissemination open appendectomy was performed. The final pathologic diagnosis was a mucinous cystadenoma of the appendix. The postoperative recovery was uneventful. Secondary torsion of vermiform appendix with mucinous cystadenoma is a rare entity. Correct preoperative diagnosis is unlikely. Open appendectomy is the standard of care for benign mucinous appendiceal tumors. Furthermore, it is important to prevent spillage of the appendiceal mucocele content.

Gall-stone intestinal obstruction (GSO) is an unusual form of mechanical obstruction and a rare complication of cholelithiasis. The treatment options are controversial, usually the management is surgical but associated with significant morbidity and mortality. A spontaneous evacuation of the gall-stone that had induced GSO is even more exceptional, only few reports being published up to date. We report the case of an 81-year-old female patient presenting GSO admitted to our department due to abdominal pain and vomiting. Computed tomography revealed pneumobilia, distention of the ileum and a calcified mass in the small bowel lumen. The diagnosis of GSO was established, but since the gall-stone was

Acute abdominal pain with peritonitis due to sudden extravasation of lymph into the peritoneal cavity is a rare condition that is often mistaken for other causes of acute abdomen. The diagnosis of spontaneous chylous peritonitis is rarely suspected preoperatively, usually misdiagnosed with diverse common surgical emergencies. We report the case of an 81 year old female who presented with typical symptoms of acute abdomen, presumed as acute mesenteric ischemia. The diagnosis of chylous peritonitis was established during laparoscopy and treatment consisted of low fat diet and octreotide.

Mucinous cystadenocarcinoma of the appendix with invasion of the anterior abdominal wall and cutaneous fistula development is a rare condition. To the best of the authors' knowledge, five such cases have been reported in the medical literature.The patient was a 68-year-old man who presented with a mass growing through the incisional scar and a skin fistula with mucinous discharge 1 year after appendectomy via McBurney's incision. Carcinoembroyonic antigen and carbohydrate antigen 19-9 concentration was elevated. Abdominal computed tomography scan revealed a mass in the cecum with involvement of the abdominal wall. Right hemicolectomy with en bloc abdominal wall implant and skin fistula resection with clear margins was performed.The patient received intraperitoneal intra- and postoperative chemotherapy. Gross examination of the specimen showed a mass emerging from the remnant stump of the appendix. The patient showed no relapse 1 year after surgery. Clinical, paraclinical features, and treatment options are discussed with review of the literature.

An extra-adrenal paraganglioma is a rare tumor derived from the chromaffin cells of sympathetic ganglia. This report documents a rare case of nonfunctional extra-adrenal paraganglioma in a 20-year-old woman with persistent flank pain. Ultrasonography and computed tomography revealed a solid mass with calcification in center, measuring 7 x 6 x 6 cm, and localized in the left upper para-aortal retroperitoneal region. Absence of typical clinical symptoms made a correct preoperative diagnosis unlikely. Tumor was successfully removed through a midline laparotomy incision, and pathological analysis of the surgical specimen revealed a paraganglioma. After 12 months, the patient is still in a good health, asymptomatic, and without evidence of tumor recurrence. This case emphasizes the necessity to include extra-adrenal paraganglioma in the differential diagnosis and management of retroperitoneal tumors, despite its rarity.

Lipoma of the colon is a relatively rare benign tumor. A case with intermittent subacute colon obstruction due to a giant lipoma of the cecum is reported. A 51-year-old woman presented with intermittent, abdominal crampy pain in the right upper and lower quadrants, accompanied by alternative episodes of diarrhea and constipation. She had had similar symptoms over the last three months. A double-contrast barium enema showed a large (approx. 7 cm in diameter) polypoid mass occluding the lumen of the cecum and the ascending colon. Colonoscopy revealed a submucosal mass suspected of benign tumor but too large for endoscopic resection. Surgery revealed a hard elongated mass in the right colon, which telescoped into the transverse colon and caused colo-colonic intussusception. Right hemicolectomy was performed and pathology documented a mature, submucosal lipoma of the cecum. Six years after the surgery, the patient has not showed any of the previous symptoms. Along with a review of the literature, the incidence, diagnosis complications and treatment of colonic lipomas are discussed.

We report a case of recurrent thrombocytopenia associated with symptomatic enlargement of an accessory spleen, 2 years after splenectomy, in a 36-year-old man with posthepatitic liver cirrhosis. The patient suffered three episodes of variceal bleeding, but the esophageal varices were not eradicated by two sessions of endoscopic injection sclerotherapy and endoscopic band ligation. Abdominal ultrasonography and computed tomography showed a giant accessory spleen (6 × 6 × 5 cm), gallbladder stones, and complete postsplenectomy splenomesoportal thrombosis. Subsequent 99mTc scintigraphy confirmed the presence of a functioning residual splenic nodule. Thus, we performed gastroesophageal devascularization (Hassab-Paquet procedure) with accessory splenectomy and cholecystectomy, after which the platelet count normalized and no further variceal bleeding occurred during 17 months of follow-up. To our knowledge, this is the first report in the English medical literature of accessory splenectomy for recurrent thrombocytopenia in a patient with liver cirrhosis.