Open Access Case Report

Primary Hydatid Cyst of Pancreas Mimicking Mucinous Cystic Neoplasm

Zuber Ansari, Somak Das, Jayanta Biswas

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

Hydatid cyst (HC) is a major health problem in endemic countries. Primary pancreatic hydatid disease (PHC) is exceedingly rare entity which may mimic other, more commonly encountered cystic neoplasms of pancreas. We report the case of a 55-year-old female who presented with abdominal pain. The treatment consisted of a distal pancreatectomy (DP) for suspected mucinous cystic neoplasm (MCN). A diagnosis of PHC was established during the surgery. Primary PHC, though exceedingly rare, should be considered in the differential diagnosis of cystic lesions of the pancreas in patients from endemic regions.

Open Access Case Report

Digital Subtraction Venography Diagnostic for Suspected Venous Obstruction after A-V Shunt

W. Kurniadi, I. Darmawan

Asian Journal of Case Reports in Surgery, Page 12-16

Aims: To determine the diagnostic function of digital subtraction venography (DSV) in suspected venous hypertension after the A-V Shunt procedure.

Presentation of case:  Four patients were admitted to the hospital with swelling from the hand up to the shoulder and pain in the upper limb. All patients suffered from chronic renal failure   and underwent hemodialysis. The assessment was suspect venous hypertension, and each of them underwent DSV examination procedure as diagnostic support. DSV examinations showed partial obstruction of 1/3 left media subclavian vein in the first patient, partial obstruction of 1/3 left media subclavian vein in the second patient, total obstruction innominate vein in the third patient, and total obstruction of 1/3 right media subclavian vein in the fourth   patient.

Discussion: The use of digital subtraction technique may simplify imaging of the venous structures of the arm and upper mediastinum, especially in patients with compromised peripheral venous access. DSV offers more advantages than conventional venography and was recommended as diagnostic procedure for venous hypertension.

Conclusion: DSV is the gold standard for the diagnosis of central venous stenosis and obstruction; it is accurate and safe to use to diagnose venous hypertension disease. DSV can also be used to determine the next treatment.

Open Access Case Report

Chest Intercostal Drainage for Neonatal Spontaneous Pneumothorax: A Rare Case Report

Singgih Annas, Monica Bellynda, Grace Christiana Hartanto

Asian Journal of Case Reports in Surgery, Page 17-21

Background: Spontaneous Pneumothorax (SP) is only 0.05% to 0.1% of all live births with symptomatic pneumothorax and rarely occurs in term (1-2%) with the healthy condition after birth. The management of SP depends on the symptoms. If there is a sign of symptomatic pneumothorax, an intercostal catheter is needed.

Case presentation: A 2,535-gram and 48-cm-length female neonate was born by Caesarean Section from G2P1A0 37 weeks of pregnancy with severe preeclampsia. At birth, the baby did not cry immediately, with an Apgar Score of 5-7-8. After 2 hours of observation, the baby experienced rapid and deep breaths. Thorax X-Ray showed a right pneumothorax causing right pulmonary collapse and pushing the mediastinum toward the left, with normal cor configuration. The patient fell into a respiratory failure condition. It was decided to conduct a chest intercostal drainage in the right 4th intercostal space (ICS) anterior axillary line. After the chest intercostal drainage insertion, a thorax x-ray for evaluation was performed. Thorax X-Ray showed a chest tube inserted in the right 4th ICS anterior axillary line, neonatal pneumonia, normal cardiothoracic ratio, and no appearance of right pneumothorax. Four days after the chest intercostal drainage insertion, it was removed. Five days after the onset of pneumothorax, a thorax contrast CT scan was performed to investigate if there were any pulmonary abnormalities. Contrast CT scan showed no pneumothorax, or atelectasis, with normal cardiothoracic ratio. Eight days after the onset of pneumothorax, the patient was discharged with a stable condition.

Conclusion: Symptomatic spontaneous pneumothorax in a healthy neonate after birth is rare, but appropriate and adequate treatment is required. Knowing the risk factors, pathomechanism, and monitoring neonates at risk can help provide the best care for the patient. Further investigation of the risk factors for SP is needed for better monitoring, management, and outcome.

Open Access Case Report

Incarcerated Epigastric Hernia Causing Gastric Outlet Obstruction: A Case Report

Prasad Upganlawar, Maheshkumar Soni, Ritesh M. Bodade, Sharvil Thatte

Asian Journal of Case Reports in Surgery, Page 22-26

Introduction: Elective repair of epigastric hernia is a frequent minor surgical procedure. In most cases the hernial content is pre-peritoneal fat.

Presentation of case: We report a case of a patient with epigastric hernia containing part of stomach and duodenum presenting as gastric outlet obstruction.

Discussion: Epigastric hernias are often asymptomatic and rarely contain viscera, but when symptomatic and recurrent, high index of suspicion is required to rule out visceral involvement.

Conclusion: The presence of distal part of stomach and duodenum within an epigastric hernia is a very rare finding and surgeons should look out for atypical presentations in acute or chronic presentations of this seemingly ‘simple’ hernia.

Open Access Case Study

Atypical Presentation of Jejunojejunal Intussusception Due to Ectopic Pancreas in a Young Male

Bonatti Hugo, Aboubakr Khairat, Volkan Taskin

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

Background: Intussusception may be caused by a variety of conditions and more commonly involves the ileum. Jejunojejunal intussusception is a rare condition and may originate from intramural tumors. Ectopic pancreatic tissue may be found throughout the entire gastrointestinal track causing no symptoms.

Case Report: A 29 year old African American male presented with cramping abdominal pain and nausea to the emergency room. As a child he had multiple trips to the ER for abdominal pain but no diagnosis had been made. Five years earlier a small bowel intussusception was found on CT-scan but exploratory laparotomy was negative. The patient had remained asymptomatic until 3 months prior to the new episode. CT-scan showed recurrent intussusception of the proximal small bowel. An extensive work-up did not reveal diagnosis but the patient was readmitted multiple times for abdominal pain and again signs of intussusceptions were found. He underwent exploratory laparoscopy and no intussusception but a small yellowish lesion at 10cm past the ligament of Treitz was detected. A segmental jejunal resection containing the 1.5cm lesion was performed. Pathology revealed a transmural lesion consistent with ectopic pancreatic tissue. The immediate postoperative course was uneventful and the patent improved; however, he continued to have episodes of abdominal cramping but further workup was negative and we believe he suffered from a motility disorder due to the chronic dilatation of the duodenum and proximal jejunum associated with the recurrent intussusceptions.

Discussion: We present a rare case of ectopic pancreas causing recurrent jejunojejunal intussusceptions in an adult; these small lesions may be difficult to find and should be surgically removed as the recurrent obstructions may cause long term damage to the proximal intestinal segments. Laparoscopy should be the preferred approach for such cases.