Open Access Case Report

Left-Sided Inferior Vena Cava with Pancreatic Head Cancer: A Case Report

Khalid Elhattabi, Mounir Bouali, Karim Yaqine, Nassima Fakhiri, Fatimazahra Bensardi, Abdelilah Elbakouri, Abdelaziz Fadil

Asian Journal of Case Reports in Surgery, Page 17-20

Introduction: Transposition of the inferior vena cava (IVC) is a congenital anomaly of the great vessels. Left IVC is a rare malformation, it is observed in about 0.04% to 0.5% of the population.

Presentation of Case: We report the case of a 64-year-old patient, with no particular pathological antecedent, who presented a tumor of the head of the pancreas and whose radiological examinations had shown the presence of the tumor with a left variant of the inferior vena cava.

Discussion: Left transposition of the IVC can be described as a "mirror image" of the normal IVC It is secondary to a disturbance of the venous development process and is often discovered incidentally during radiological examinations. CT scan is the examination of choice to detect these vascular variations with a sensitivity and specificity for arterial anomalies of 91.6 to 98.2% and venous anomalies of 96.7 to 90% respectively.

Conclusion: It must be reported by radiologists in order to avoid hemorrhagic complications during any surgery of the retroperitoneal space.

Open Access Case Report

Typical Carcinoid of Lung – Rare Case with Review of Literature

Anand Deodhar, Dinesh Kulkarni

Asian Journal of Case Reports in Surgery, Page 25-29

Neuroendocrine tumors represent 25% of primary lung neoplasms, of which only 2% are typical carcinoid. 75% of lung carcinoids originate from Kulchitsky cells in bronchus. Typical carcinoid tumors are well differentiated with low grade malignancy. Strong and diffuse positivity for neuroendocrine markers CD 56, synaptophysin and chromogranin is exhibited by these tumor cells. Carcinoid tumors in the past were excluded from TNM staging but 7th edition of TNM staging system includes carcinoid. The patients are usually younger than for usual lung cancers. Carcinoid syndrome is usually absent when the tumor is confined to lung. Markedly different prognosis and treatment underlies the importance of accurate pathologic diagnosis of neuroendocrine tumors of lung. Typical carcinoid has a five year survival up to 95% when there is complete surgical excision.

Open Access Case Study

Open Heminephrectomy in Unilateral Duplex Collecting System and Complete Ureteral Duplication with Poorly Functioning Upper Pole: A Case Report

Yohanes Adinugroho, L. Bobby Nindra Nugraha, T. Setya Anton, Syaeful Agung Wibowo

Asian Journal of Case Reports in Surgery, Page 1-10

Aim: We report the results and experience of the Moewardi Hospital to do Physical Examination with Narcose and Heminephrectomy For Surgical Treatment Procedures Double Collecting System

Materials and Methods: Reported a 2 years old girl with double collecting system ren right with hydronephrosis upper moiety right (minimal function) + dextra hydroureter + ureterocele dextra and diagnosis of complications of chronic cystitis ureter and UK fitted. Furthermore, retrograde pyelography (RPG) was performed to obtain information on which ureteral estuary originated from superior moiety (pole) and inferior renal moiety as well as evaluation of whether or not a per-endoscopic incision was required and the boundaries of the area to be heminephrectomy. Furthermore, a heminephrectomy was planned in the upper moiety right area.

Results: Radiological examination is known to have a role in determining the presence or absence of ureteral duplication and can be done since the prenatal period. Ultrasound examination at about 20 weeks of gestation can detect the presence or absence of abnormalities in the fetal urinary tract. superior polus heminephrectomy in a system with duplicated malfunctioning, through laparoscopic ureteric ligation, or ureteral reimplantation if renal function remains good is the best management in children or patients with symptoms to resolve symptoms such as incontinence, prevent complications and maintain renal function.

Conclusion: The double collecting system is a form of congenital abnormality of the urinary system. Radiological examination is known to have a role in determining the presence or absence of duplication of the ureter and can be done since the prenatal period. Management is carried out based on the symptoms experienced by the patient and by looking at kidney function. Ureteroneocystostomy is the definitive surgical management of vesicoureteral reflux caused by ureteral duplication. If there is a case of a double collectivus system and with an ectopic ureter, then the procedure that can be given is a distal ureteroureterostomy through a laparostomy on a double J stent.

Open Access Case Study

Combined Local Flap and Split Thickness Skin Graft (STSG) as One of Reconstructive Surgery Technique for Diffuse Ankle Contracture Management (A Case Report)

Mia Rachmi Widyaningrum, Amru Sungkar

Asian Journal of Case Reports in Surgery, Page 11-16

Aims: To describe combined local flap and skin graft as one of reconstructive surgery techniques for diffuse ankle contracture management.

Case Presentation: A two years old girl with a history of exposure to hot water about one year ago. The patient was diagnosed with a diffuse right ankle contracture.Reconstruction was performed with two operation procedures. At first operation, release of contracture, excision of scar tissue and toe pinning were performed, continued with reconstruction with a local flap (advancement flap) of the inferior area of the medial trunk from the lateral side of ankle, attaching the fiber to the medial side. At second operation, we covered the defect with an intermediate split thikness skin graft.

Discussion: Contracture is the loss or lack of full range of motion of the joint either passively or actively due to joint limitations, fibrosis of the supporting tissue, muscles and skin. The main concern for contracture therapy is restoration of function by encouraging the use of limbs for ambulation and other activities. Combination between flap and skin graft could be a solution for patient with contracture. Local flap with random pattern is the most commonly used flap type. Because the process is easier, if the defect area is not too large, this local flap can even be done with local anesthesia. STSG is often used over large areas. Grafts on STSG cover all parts of the epidermis and dermis with different thicknesses. Postoperative evaluation: viable flap, STSG Take 98%.

Conclusion: Combined Local flap and skin graft is one of the therapeutic modalities for post burn contracture patients in the ankle joint area which also can prevent recontracture. Regular physiotherapy is still required after this procedure to get maximum range of movement and better walking function.

Open Access Case Study

Gas-forming Pyogenic Liver Abscess: Another Variant of Liver Abscess with High Mortality

S. Hidayatullah, H. Syafiq, H. Azmi

Asian Journal of Case Reports in Surgery, Page 21-24

Gas-forming pyogenic liver abscess (GFPLA) is uncommon and associated with high mortality if improperly treated. We experienced a case of GFPLA due to Klebsiella Pneumoniae in a 47-year-old man with newly diagnosed DM. Classical 'alveolar gas pattern' is easily identified via X-ray with similar finding on CT scan. Ultrasound-guided percutaneous drainage was performed to drain the abscess.