Open Access Case Report

A Rare Case of Large Retroperitoneal Schwannoma

Panagiotis Tsintavis, Ilias Galanis, Christophoros Theodoropoulos, Eleni Papagianni, Georgios Stylianidis, Georgios Floros

Asian Journal of Case Reports in Surgery, Page 1-5

Aims: The aim of this manuscript is to present a rare case of a schwannoma in the retroperitoneal space.

Case: We present the case of a 61-year-old female with a retroperitoneal tumor which proved to be a schwannoma. After incomplete surgical excision, a second surgical exploration, due to tumor relapse, was conducted a year later.

Discussion: Schwannomas or Neurilemmomas are mesenchymal tumors arising from Schwann cells of peripheral nerve sheaths. The first tumors of peripheral nerves were described in 1910 by Jose Verocay, but it was not until 1935 that Arthur Purdy Stout used the term Neurilemmoma. Retroperitoneal space is an unusual location of schwannomas and their presence may only be expressed by insidious onset of nonspecific symptoms like vague abdominal pain. Definite diagnosis of schwannomas is only made post-operatively, by histopathological examination of the specimen.

Conclusion: Schwannomas, even if they are infrequent, should be included in the differential diagnosis of any retroperitoneal abdominal mass.

Open Access Case Report

The Homodigital Island Flap: A Good Result of Fingertip Injuries Reconstruction on Single Center Hospital

Affandi Wiramur, Amru Sungkar, Muhammad David Perdana Putra, Ikhdin Saadhi

Asian Journal of Case Reports in Surgery, Page 6-10

Aims: To report a case of fingertip injuries reconstructed with homodigital island flap technique.

Case Description: A 49-year-old man presented with a phalangeal defect of the 2nd finger of the right hand. There were skin and soft tissue losses without bone and tendon exposed. The operation was performed under general anesthesia and with a tourniquet applied to the upper arm. The flap was marked up lateropalmarly on the proximal basal phalanx at the radial side. After the tourniquet had been released and complete hemostasis carried out, the flap was rotated into the defect and fixed. The donor site defect was covered with a full-thickness skin graft. During the follow-up, the island flap showed a good outcome. The skin graft also healed well. Sensibility and vascularization were good.

Discussion: Treatments for fingertip injuries available cover a broad range of techniques with no single recommended reference standard for treatment. Island flaps are axial pattern flaps that maintain blood flow through a specific vascular pedicle. Island flaps may be considered the ideal choice for soft tissue coverage and reconstruction of fingertip defects when the preservation of length and maximal function are desired, and critical structures are exposed or injured. The advantage of the homodigital island flap is that it is a local flap technique with a reliable blood supply and provides stable coverage with an inconspicuous donor site. Besides, this technique does not need postoperative immobilization of other fingers and has a slight aesthetic removal defect. Using this technique can cause irritation to digital nerve for a few weeks, but this usually resolves completely.

Conclusions: Homodigital island flap is a useful and safe reconstruction option for fingertip injuries, considering its advantages and negligible donor site.

Open Access Case Report

Endoscopic Underrunning Suture for Post Splenectomy Gastric Necrosis

D. S. Sanjay, S. Sarmukh, H. Azmi

Asian Journal of Case Reports in Surgery, Page 18-22

Aim: Gastric necrosis post splenectomy carries a high risk of mortality and should be identified and diagnosed early.

Presentation of Case: We would like to report a case of a 57 years-old lady who was involved in an alleged motor vehicle accident (MVA) sustaining a grade V splenic injury and then underwent an exploratory laparotomy with splenectomy.

Discussion: Emergency splenectomies have been known to carry devastating complications such as gastric necrosis, pancreatic duct injury causing fistula and overwhelming post-splenectomy infection (OPSI). Gastric necrosis is a rare event, only reported in less than 1% of splenectomies.

Conclusion: We advocate that endoscopy is a safe and feasible method in diagnosing the extent of gastric necrosis and able to manage the bleeding from the slough from gastric mucosa by using endoscopic clips and by injecting adrenaline. However, in case of extensive bleeding from the gastric mucosa, an exploratory laparotomy with on table endoscopic underruning suture at the source of bleeding at the gastric fundus can help to avoid a partial gastrectomy.

Open Access Case Study

Abdominal Distension due to Large Omental Cyst

Andreas Skarpas, Athanasios Zoikas, Georgios Vletsis, Emmanouela Griva, Nikolaos Nikitakis, Velimezis Giorgos

Asian Journal of Case Reports in Surgery, Page 11-17

Omental and mesenteric cysts are both rare entities, mostly found in children. Incidence rate in adults is between 1/100,000-1/250,000. Upon clinical examination they usually display symptoms of abdominal distension, with or without a palpable mass. Reported cases in the literature usually display symptoms of abdominal distension, abdominal pain, and painless mass, or possible ascites [1]. Differentiation from ascites or tuberculosis should be done. Treatment for this condition is complete surgical resection. We describe the clinical presentation of a 58 y.o man with abdominal distension for the last six months. The computer tomograph (CT) scan revealed an intra-abdominal mass 15,0x14,0 cm, with well differentiated borders. Histopathological diagnosis was confirmed as lymphangioma of the omentum.

Open Access Case Study

A Rare Case of Large Hydatid Cyst at Atypical Location: Case Study

Ashwani K. Dalal, Usha R. Dalal, Jadi Vishnu Vardhan, Shreya Dhawan, Harsh Dahiya, . Arun

Asian Journal of Case Reports in Surgery, Page 23-26

Hydatiddisease also know as Echinococcosis and caused by Echinococcus granulosus and Echinococcus multilocularis, which cause Cystic echinococcosis (CE) and alveolar echinococcosis (AE). Most common site for Hydatid cyst is liverandlungor both sites. But it can grow at unusual sites like bone, muscle, except hair and nail.  Present case was a 65 years male who came with complaints of gradually increasing swelling of left thigh for last 9 months. There was recent onset of pain while changing posture from sitting to standing. USG (Ultrasonography) showed a hypoechoic lesion extending from groin to mid-thigh. MRI showed multiple round to oval cystic mass lesionsin adductor muscle of left thigh with thin walled daughter cysts suggestive of Hydatid disease. Hydatid Serology was negativewith no eosinophilia on hemogram. Albendazole was started 2 weeks preoperatively. Patient underwent enbloc excision and Histopathology report conformed the diagnosis hydatid disease. Patient was put on albendazole 400 mg for 14 weeks. Post-operative follow-up for one year showed no recurrence.

Conclusion: Hydatid cyst of a thigh muscle is a very rare condition and its diagnosis would require a high index of suspicion. The results of hydatid serology in cases of Musculo-skeletal organs could be negative but radiology imaging of the thigh including ultrasound scan, computed tomography scan and magnetic resonance imaging scan would tend to demonstrate features of the lesion that would be suggestive of Echinococcus disease of the thigh. Treatment of the disease does involve utilization of albendazole treatment for many weeks and complete excision of the lesion taking care to avoid spillage of the contents of the cyst.