Open Access Case Report

Percutaneous Extraction of a Foreign Body in an Obstructed Transplanted Kidney

Abdolsalam Ahmadi, Akbar Jalal, Mohamed Mubarak, Husain Al Aradi

Asian Journal of Case Reports in Surgery, Page 1-6

Aim: To address the possibility of an iatrogenic obstruction in a transplanted kidney and evaluate the efficacy of prompt percutaneous access in managing the condition.

Case Presentation: We present a case of a 64-year-old male, who is known case of renal transplant for nine years with hydronephrosis of the transplanted kidney, scheduled for a nephrostomy. During the procedure, the access Peel-Away sheath got displaced into the transplanted kidney and was difficult to visualize on KUB fluoroscopy due to its radiolucency. Successful intervention was carried out using percutaneous renal access with an endoscopic grasper.

Discussion: Percutaneous renal access is a minimally invasive method used in a variety of urological procedures. It is associated with several complications such as post-operative sepsis, hemorrhage and injuries to the collecting system. Prompt management of such complications is required to avoid undesired consequences. There have not been any reported incidences of nephrostomy access sheath displacement into a hydronephrotic transplanted kidney. Nevertheless, a similar incident that involved the displacement of a PCN catheter inside the abdominal cavity and within the bowel was reported.

Conclusion: Percutaneous renal access is a safe and efficient method to identify and remove foreign bodies in transplanted kidneys.

Open Access Case Report

A Rare Large Cystic Tumour of Pancreas – A Case Report and Literature Review

Maheswaran Pitchaimuthu, Selvakumar Balakrishnan

Asian Journal of Case Reports in Surgery, Page 24-30

Pancreatic Neuroendocrine tumours usually manifest as solid tumours. Cystic Pancreatic Neuroendocrine tumours are rare entities, which pose diagnostic challenges. Their clinical and pathological features are not well characterized. Here, we report a cystic Pancreatic Neuroendocrine tumours case, together with literature review, highlighting the features of this tumour. A 62-year-old female presented with vague abdominal symptoms and was subsequently found to have large cystic lesion arising from the head of pancreas, compressing the portal and superior mesenteric vein. She underwent pylorus preserving pancreatico-duodenectomy. Histology confirmed grade III Pancreatic Neuroendocrine tumours. No postoperative complications were observed. It is not yet confirmed whether cystic Pancreatic Neuroendocrine tumours are due to necrosis/degeneration of solid Pancreatic Neuroendocrine tumours or a distinct clinical entity with different characteristics. Irrespective of this discussion, cystic Pancreatic Neuroendocrine tumours shows clinically and pathologically distinct features.  Awareness and proper recognition will help in their diagnosis. Resection is the treatment of choice. Further genetic/molecular studies will much more characterize this tumour, thereby broadening the treatment options.

Open Access Case Study

Acute Mitral Regurgitation after Blunt Chest Trauma: A Case Report

Luan Nguyen Thanh, Trung Tran Minh, Tien Tran Quyet

Asian Journal of Case Reports in Surgery, Page 7-11

The most common cardiac injury following trauma is myocardial contusions. Traumatic valve injury is a rare clinical condition and most commonly involves the aortic valve, with isolated mitral valve injury being scarce. We herein describe the clinical, para clinical and surgical characteristics of a 27-year-old male patient who suffered from an acute mitral valve regurgitation after blunt chest trauma during a traffic accident with an oriented review of the literature. The patient was successfully treated by urgent mitral valve replacement and postoperative V-A mode extracorporeal membrane oxygenation ECMO support that turned out necessary in the postoperative period.

Open Access Case Study

The Ileosigmoid Knot as a Rare Cause of Intestinal Occlusion: Report of Two Cases

Fatimazahra Bensardi, Bassam Daif, Ahmed Ballati, Mohamed Ouchane, Othmane Elyamine, Mounir Bouali, Abdelilah Elbakouri, Khalid Elhattabi, Abdelaziz Fadil

Asian Journal of Case Reports in Surgery, Page 12-17

The ileo-sigmoid knot is a rare cause of intestinal obstruction, which usually requires emergency life-saving surgery. In this condition the ileum and sigmoid colon are twisted around each other in a knot, causing strangulation. We here report 2 cases with ileo-sigmoid knot. In both cases, the diagnosis was only made intraoperatively. Resection and colostomy were made, with the latter closed later. Both showed good prognoses. Physicians should be aware that ileo-sigmoid knot may be hidden behind intestinal obstruction.

Open Access Case Study

A Rare Presentation of an Obstructing Metastatic Neuroendocrine Carcinoma of the Distal Ileum: A Case Report

Islam Khaled, Hany Soliman, Amal Farid, Amr Dorgham

Asian Journal of Case Reports in Surgery, Page 18-23

Aims: The aim of the study is to demonstrate a case report on a rare presentation of an obstructing metastatic neuroendocrine carcinoma of the distal ileum.

Study Design: Case report.

Place and Duration of Study: Saudi German Hospital, Jeddah, Saudi Arabia (Departments of General Surgery, Medical Oncology and Pathology).

Background: Neuroendocrine carcinomas typically originated from cells of the endocrine and nervous systems. It can emerge from any part of the gastrointestinal tract and are rarely encountered in the small intestine. It is characterized by being extremely malignant disease with a poor outcome. The presence of metastatic neuroendocrine carcinomas in gastrointestinal system with a primary origin in the small intestine is really an exotic event.

Case Report: A 60-year-old woman attended the Emergency Department with the complaints of repeated vomiting, abdominal distention, pain and constipation, which had been present for 3 days. A CT scan of the abdomen was ordered and revealed a 2.4 cm focal obstructing thickening involving the terminal ileal loops with mesenteric lymph nodes in close vicinity to the lesion. Therefore, an exploratory laparotomy was commenced and resection of the involved segment with an adequate safety margin of more than 5 cm both proximally and distally was obtained together with removal of the mesentery with its contained lymph nodes.

The liver was grossly cirrhotic and involves multiple focal lesions that were palpable on its surface and documented later by an MRI, which confirmed metastatic lesions. The histopathology report confirmed a grade II invasive neuroendocrine Carcinoma of small intestine with 1/4 positive lymph node and the target neoplastic cells showed diffuse positive staining for neuroendocrine markers.

Conclusion: Metastatic obstructing NECs are rarely discovered. These poorly differentiated tumours usually arise in the oesophagus and large bowel. In addition, the disease presents with intestinal obstruction and liver metastatsis, which necessitate post-operative adjuvant chemotherapy.