Acta Chirurgica Belgica最新文献

{"title":"Mandibular fracture manipulation and management of its post-manipulation conditions from the perspective of Ālī ibn Ābbas al-Mājūsī.","authors":"Sobhan Ghezloo, Mohammad Sadr","doi":"10.1080/00015458.2026.2714784","DOIUrl":"https://doi.org/10.1080/00015458.2026.2714784","url":null,"abstract":"<p><strong>Background: </strong>Historical descriptions of mandibular fracture treatment inform the evolution of maxillofacial surgery. Ālī ibn Ābbas al-Mājūsī's <i>Kāmil al-Ṣinā'at al-Ṭibbīyah</i> includes practical maneuvers for mandibular fractures not widely summarized in modern literature.</p><p><strong>Method: </strong>This is a textual and interpretive analysis of <i>Kāmil al-Ṣinā'at al-Ṭibbīyah</i> by Ālī ibn Ābbas al-Mājūsī, focusing on the chapter devoted exclusively to the management of mandibular fractures. To conduct this research, a version of the author's original language (Arabic) was used, and finally, to clarify the proposed maneuvers in the treatment of Mandibular fracture, interpretive anatomical reconstruction was performed using craniofacial moulage models and detailed images were recorded by the authors. The recommended medications, therapeutic and post-therapeutic measures were accurately extracted from the source under study and categorized in specific tables.</p><p><strong>Result: </strong>Close reading of al-Mājūsī's surgical chapter reveals two principal maneuvers: closed realignment for non-displaced fractures and transcutaneous/head-wrap traction with dental wiring or silk fixation for displaced fractures. Post-reduction care (immobilization, diet, topical compresses) and an asserted ∼20-day healing period are described; specific medicinal applications to reduce swelling are listed.</p><p><strong>Conclusions: </strong>Al-Mājūsī's techniques show continuity with earlier Greco-Roman practices and offer historical insight into non-invasive fracture management and immobilization methods relevant for understanding the roots of modern mandibular trauma care.</p>","PeriodicalId":6935,"journal":{"name":"Acta Chirurgica Belgica","volume":" ","pages":"1-9"},"PeriodicalIF":0.9,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Skin bridge versus conventional rods for loop enterostomies: a systematic literature review and meta-analysis.","authors":"Sascha Vaghiri, Peter C Ambe, Michaela Ramser, Hermann Kessler, Wolfram Trudo Knoefel, Dimitrios Prassas","doi":"10.1080/00015458.2026.2685679","DOIUrl":"10.1080/00015458.2026.2685679","url":null,"abstract":"<p><strong>Background: </strong>Ostomy rods are used to prevent stoma-related morbidity. However, their effectiveness remains questionable, and to date, no standard technique has been recommended. We sought to identify the most suitable method by comparing skin bridge- and conventional rod-supported loop enterostomies.</p><p><strong>Methods: </strong>In accordance with PRISMA guidelines, a systematic literature search was conducted in PubMed (MEDLINE), the Cochrane Central Register of Controlled Trials, and Google Scholar databases for all comparative studies evaluating skin bridges and conventional ostomy rods. Odds ratios (ORs) and standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated for outcomes of both methods. Risk of bias and certainty of evidence were assessed using ROBINS-I and GRADE, respectively. The study protocol was registered in PROSPERO (ID: 420251028945).</p><p><strong>Results: </strong>A total of four eligible studies encompassing 323 patients were included (skin bridge: <i>n</i> = 155, control: <i>n</i> = 168). Loop ileostomies with a skin bridge were associated with significantly lower rates of peristomal dermatitis (OR = 0.13; 95% CI [0.06-0.29]; <i>p</i> < 0.00001, I² = 0%) and mucocutaneous separation (OR = 0.12; 95% CI [0.05-0.29]; <i>p</i> < 0.00001, I² = 0%) compared with conventional ostomy rods. Other analyzed outcomes, including parastomal hernia, ostomy prolapse, ostomy retraction, ostomy stenosis, and surgical site infection did not differ significantly between the two groups. Skin bridges appear to reduce the number of ostomy wafers replaced per week and overall ostomy-related costs.</p><p><strong>Conclusions: </strong>Loop ileostomy creation with a skin bridge appears to be a safe and feasible method for preventing early ostomy-related morbidity.</p>","PeriodicalId":6935,"journal":{"name":"Acta Chirurgica Belgica","volume":" ","pages":"121-129"},"PeriodicalIF":0.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148175175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving triage and recycling of surgical waste at a pediatric hospital - a pilot study.","authors":"Weronika Kopytek, Louise Raeymaekers, Helena Reusens, Víola B Weeda","doi":"10.1080/00015458.2026.2641489","DOIUrl":"10.1080/00015458.2026.2641489","url":null,"abstract":"<p><strong>Background: </strong>Within the medical industry, operating rooms contribute significantly to greenhouse gas emissions. As a pediatric hospital, we feel highly responsible to reduce the negative impact of healthcare aimed at improving young lives. Therefore, we conducted a pilot study to assess simple waste segregation and recycling strategies aimed at reducing waste and improving sorting and recycling in our operating quarters.</p><p><strong>Methods: </strong>The study was conducted at Hôpital Universitaire Des Enfants Reine Fabiola (HUDERF)'s operating quarters and consisted of a questionnaire addressing staff opinions and waste measurements before (<i>T</i> = 0) and after (<i>T</i> = 1) a weeklong intervention: a campaign aimed at improving sorting and recycling surgical waste and reducing unnecessary opening of materials.</p><p><strong>Results: </strong>Participants agreed that a transition towards more sustainable operating quarters will be necessary. At <i>T</i> = 1, 53% of respondents considered measures for sustainable waste management were applied, versus 26% before. Fifty-one surgeries were analyzed at <i>T</i> = 0. The mean weight of waste to incinerate was 1780 gram per hernia/orchidopexy, 940 gram per circumcision, and 2150 gram per central venous catheter (CVC) placement. At <i>T</i> = 1, another 51 surgeries were analyzed. The mean weight of waste to be incinerated was 665 gram per hernia/orchidopexy, 445 gram per circumcision, and 920 gram per CVC placement.</p><p><strong>Conclusion: </strong>Simple, easy-to-implement measures introduced during a one-week campaign aimed at improved triage and diminished pre-emptive opening of sterile materials led to <i>a</i> > 50% reduction in waste to incinerate.</p>","PeriodicalId":6935,"journal":{"name":"Acta Chirurgica Belgica","volume":" ","pages":"130-135"},"PeriodicalIF":0.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147353315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breast implant-associated anaplastic large cell lymphoma following prophylactic mastectomy & breast reconstruction: a case report.","authors":"Valentine Hotome, Maxime De Fré, Filip Thiessen, Nicolas Vermeersch, Thierry Tondu, Roanne Van Steen","doi":"10.1080/00015458.2026.2688273","DOIUrl":"10.1080/00015458.2026.2688273","url":null,"abstract":"<p><strong>Background: </strong>Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare T-cell lymphoma increasingly linked to textured breast implants. It typically presents as a late-onset periprosthetic seroma and carries a generally favorable prognosis when diagnosed early. However, its pathogenesis remains incompletely understood, particularly in patients with genetic cancer predispositions.</p><p><strong>Case presentation: </strong>We report a unique case of BIA-ALCL in a 41-year-old woman who underwent bilateral prophylactic mastectomy and subsequent implant-based reconstruction due to a strong family history of breast and ovarian cancer. Ten years post-reconstruction, she presented with progressive unilateral breast swelling. Imaging suggested implant rupture with associated periprosthetic fluid. Cytology and immunohistochemistry confirmed CD30-positive, ALK-negative large T-cell lymphoma. PET-CT and MRI demonstrated disease confined to the implant capsule without lymph node involvement. Surgical management included bilateral en bloc capsulectomy. Histopathological staging revealed pT2N0M0 (Stage IB) disease due to superficial capsular infiltration. No adjuvant therapy was required because of the early intervention. Six-month follow-up imaging was negative for recurrence.</p><p><strong>Discussion: </strong>This case raises important considerations about cancer risk management in genetically predisposed individuals, especially regarding the safety profile of textured implants. Current evidence suggests a possible oncogenic interaction between hereditary susceptibility and chronic implant-associated inflammation.</p><p><strong>Conclusion: </strong>Clinicians must maintain vigilance for BIA-ALCL even in prophylactic settings, as early diagnosis and complete surgical excision remain key to favorable outcomes.</p>","PeriodicalId":6935,"journal":{"name":"Acta Chirurgica Belgica","volume":" ","pages":"164-169"},"PeriodicalIF":0.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148215838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recurrence patterns after primary surgery and neoadjuvant chemoradiotherapy for esophageal adenocarcinoma.","authors":"Andreas Bouckaert, Johnny Moons, Toni Lerut, Willy Coosemans, Jeroen Dekervel, Lieven Depypere, Yannick Mandeville, Hans Van Veer, Philippe Nafteux","doi":"10.1080/00015458.2026.2655680","DOIUrl":"10.1080/00015458.2026.2655680","url":null,"abstract":"<p><strong>Background: </strong>Our publication <i>Across the CROSS in daily practice</i> challenged the routine use of neoadjuvant chemoradiotherapy (nCRT) for locally advanced esophageal adenocarcinoma, showing a comparable 5-year overall survival after primary surgery. Disease-free survival, however, did show a tendency towards higher recurrence rates in the primary surgery group, although not reaching statistical significance. This current study aims to differentiate recurrence patterns and its final impact on overall survival.</p><p><strong>Methods: </strong>This retrospective cohort study with propensity score-matched analysis included all surgically treated patients between 2000 and 2018 with locally advanced adenocarcinoma (cT_1/2N₊ or cT_3/4N_0/+). Exclusion criteria of the CROSS trial were applied. Patients were matched on age, Charlson comorbidity score, clinical tumor length, and lymph node status. Primary end point was time to recurrence.</p><p><strong>Results: </strong>One hundred and forty-nine propensity score-matched cases were defined in each group. Primary surgery resulted in more recurrences (73.2% vs. 57.0%, <i>p</i> = 0.003). However, nCRT resulted in a shorter time to overall recurrence (6.3 vs. 11.5 months, <i>p</i> = 0.004) and locoregional recurrence (6.3 vs. 13.6 months, <i>p</i> = 0.005). Additionally, overall survival after diagnosis of recurrence was significantly shorter for nCRT than for primary surgery (6.9 vs. 9.6 months, <i>p</i> = 0.03).</p><p><strong>Conclusion: </strong>Our propensity score-matched results indicate that both overall and locoregional recurrences occur significantly earlier in nCRT patients and overall survival after recurrence is significantly shorter after nCRT. These findings might explain the comparable 5-year overall and disease-free survival of both groups.<b>Abbreviations:</b> CROSS: trial chemoradiotherapy for oesophageal cancer followed by surgery study; CT scan: computed tomography scan; HR: hazard ratio; nCRT: neoadjuvant chemoradiotherapy.</p>","PeriodicalId":6935,"journal":{"name":"Acta Chirurgica Belgica","volume":" ","pages":"146-153"},"PeriodicalIF":0.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147632118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tailored Charles' procedure and vascularized lymph node transfer for advanced stage Klippel-Trenaunay syndrome.","authors":"Pedro Ciudad, Joseph M Escandón, Juste Kaciulyte, Oscar J Manrique, Michele Maruccia, Chang-Cheng Chang, Hung-Chi Chen","doi":"10.1080/00015458.2026.2644337","DOIUrl":"10.1080/00015458.2026.2644337","url":null,"abstract":"<p><strong>Background: </strong>Klippel-Trenaunay syndrome (KTS) is primarily managed for vascular and soft-tissue abnormalities, while treatment of associated lymphedema remains poorly described. This study outlines our protocol for advanced lower-extremity lymphedema using a combined modified Charles' procedure and vascularized lymph node transfer (VLNT).</p><p><strong>Methods: </strong>KTS patients with International Society of Lymphology (ISL) stage III lower-limb lymphedema treated between 1999 and 2018 were retrospectively reviewed. All underwent a modified Charles' excisional procedure with Homans techniques and VLNT. Outcomes were assessed at least one year postoperatively, focusing on early complications and postoperative hospital admissions for residual disease or recurrent infections.</p><p><strong>Results: </strong>Twenty-two patients (14 male, 8 female) with a mean age of 21 years (range, 4-41) were included. Average time since KTS diagnosis was 14 years (range, 3-26). VLNT donor sites included groin (18.2%), supraclavicular (31.8%), and gastroepiploic (50%). Mean hospital stay was 16 days (range, 14-39). Follow-up averaged 38 months (range, 27-45). Three minor complications occurred (one wound dehiscence, one infection, one bleeding), and flap survival was 100%. Annual hospital admissions for soft-tissue infections decreased from a preoperative mean of 3.5 to 1.2 postoperatively. Patients required an average of 3.5 additional procedures (range, 2-8) to remove residual hemangiolymphangioma.</p><p><strong>Conclusions: </strong>Lymphedema in KTS presents unique challenges and differs markedly from typical primary or secondary lymphedema. Effective management requires meticulous assessment and individualized planning. In this population, functional improvement is the main objective, and extensive debulking procedures combined with physiologic reconstruction may provide meaningful clinical benefit despite limited aesthetic outcomes.</p><p><strong>Article highlights: </strong><b>Type of Research:</b> Single-center, retrospective, cohort study<b>Take Home Message:</b> In severe lymphedema of patients diagnosed with KTS, single excisional or physiological surgical treatment is insufficient to fight the totality of pathologic processes at work. A combination of varied techniques that act on different disease's features can achieve significantly better outcomes.</p>","PeriodicalId":6935,"journal":{"name":"Acta Chirurgica Belgica","volume":" ","pages":"136-145"},"PeriodicalIF":0.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147497179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intrathoracic stomach ischemia successfully treated with gastric imbrication - a case report and literature review.","authors":"Arianna Vittori, Andrés R Latorre-Rodríguez, Sumeet K Mittal","doi":"10.1080/00015458.2026.2660766","DOIUrl":"10.1080/00015458.2026.2660766","url":null,"abstract":"<p><strong>Background: </strong>The management of large paraesophageal hiatal hernias (PEH) is challenging as most patients are elderly with multiple comorbidities. Furthermore, compared to elective procedures, emergency interventions are often associated with even greater complexity. Laparoscopic PEH repair is generally considered safe and feasible, even in urgent cases; however, complications such as acute incarceration and its progression to stomach wall necrosis, which usually requires resection, carries a high risk of morbidity and mortality.</p><p><strong>Methods: </strong>We present a case of acute PEH incarceration with gastric ischemia. Additionally, we conducted a narrative literature review to examine cases of gastric ischemia secondary to acute hiatal hernia strangulation.</p><p><strong>Results: </strong>A 71-year-old man presented with abdominal pain, nausea, and retching. Computed tomography on admission revealed an intrathoracic stomach without signs of complication, while endoscopy showed an ischemic fundus. The patient underwent laparoscopic hiatal hernia repair and gastric imbrication of the ischemic area. At the three-month follow-up, the patient reported no complaints. Twenty-two fully described cases in the literature were retrieved.</p><p><strong>Conclusion: </strong>To the best of our knowledge, this is the first reported case of a patient successfully treated with laparoscopic reduction of a hiatal hernia followed by imbrication of the ischemic area. The procedure resulted in a favorable outcome without the need for resection and reconstruction. Moreover, our literature review represents the first effort to collect data on this rare and complex condition, providing further insight into its presentation and management.</p>","PeriodicalId":6935,"journal":{"name":"Acta Chirurgica Belgica","volume":" ","pages":"154-163"},"PeriodicalIF":0.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147697128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tailored surgical planning in TEP inguinal hernia repair: a multivariate analysis of obesity and hernia defect size.","authors":"Suleyman Atalay","doi":"10.1080/00015458.2026.2693818","DOIUrl":"10.1080/00015458.2026.2693818","url":null,"abstract":"<p><strong>Objective: </strong>This study investigates the relationship between body mass index (BMI), hernia defect diameter, and early postoperative complications in total extraperitoneal (TEP) hernia repair.</p><p><strong>Methods: </strong>Of 306 patients undergoing endoscopic inguinal hernia repair between January 2022 and December 2024, 285 patients with completed TEP procedures performed by a single surgeon constituted the final study cohort. Patients were stratified by BMI and hernia defect size. Early postoperative complications within 30 days, including seroma and hematoma, were recorded. Multivariable logistic regression analysis was conducted to identify independent predictors of early complications. All analyses were performed using SPSS version 26.0.</p><p><strong>Results: </strong>Within the 30-day postoperative period, seroma occurred in 36 patients (12.6%) and hematoma in 21 patients (7.4%). Obesity (BMI ≥ 30 kg/m²) was independently associated with increased odds of early postoperative complications (OR 2.8, 95% CI 1.3-5.9, <i>p</i> = 0.02), whereas overweight BMI was not statistically significant (OR 1.2, 95% CI 0.6-2.4, <i>p</i> = 0.34). Hernia defect size ≥ 25 mm was also identified as an independent predictor (OR 2.9, 95% CI 1.4-6.1, <i>p</i> = 0.03). Age > 65 years showed a non-significant trend toward higher complication risk (<i>p</i> = 0.08).</p><p><strong>Conclusion: </strong>Obesity and large hernia defects are independent predictors of early complications following TEP hernia repair. Focusing on these factors during preoperative planning may enhance patient safety and outcomes.</p>","PeriodicalId":6935,"journal":{"name":"Acta Chirurgica Belgica","volume":" ","pages":"1-7"},"PeriodicalIF":0.9,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148292895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of tissue-based inguinal hernia repair in Belgium: a web-based national survey.","authors":"Stijn Van Hoef, Cedric Welvaert, Mathias Allaeys, Frederik Berrevoet","doi":"10.1080/00015458.2026.2689120","DOIUrl":"10.1080/00015458.2026.2689120","url":null,"abstract":"<p><strong>Background: </strong>Inguinal hernia repair is one of the most commonly performed procedures worldwide. Several different methods for repair exist, where the preferred surgical procedure for a non-complicated unilateral inguinal hernia is still up for debate. Originally described as a tissue repair, the introduction of prostheses have led many surgeons to move away from this type of repairs. However, recently updated guidelines still recommend non-mesh treatment, in a subgroup of patients, with a preference for the Shouldice technique. Therefore, we set out to map the incidence and knowledge about tissue-based repair of a primary inguinal hernia in Belgium.</p><p><strong>Methods: </strong>We designed a voluntary, open web-based survey for both surgeons and trainees asking about their knowledge, experience and indication for tissue-based suture repair, using a Google-forms document. The survey included level of experience and surgical preference, practice of tissue-based inguinal repair, indications for tissue-based repair, and technique and knowledge about tissue-based repair. Data was collected between 1st of December 2023 and 31st of January 2024 and analyzed using Microsoft Excel (version 16.77.01).</p><p><strong>Results: </strong>A total of 122 respondents filled out the questionnaire, 47 trainees and 75 surgeons, of which 4 were discarded due to inaccurate data. Only 15 out of 71 surgical respondents still performed a non-mesh based repair in an elective setting, where the Shouldice repair was the preferred technique (<i>n</i> = 12, 80%). Knowledge about tissue-based mesh was rated mainly moderate (43.7%) and a non-mesh based repair was still considered an option when faced with fecal contamination (54.9%). Upon patient's request, 67.7% respondents would convince patients of mesh superiority. Among surgical trainees eighteen respondents (38.3%) had never seen a tissue based repair before and 36.1% respondents said tissue-based repair was not taught in their current or previous hospital(s). Most surgical trainees (48.9%) had basic knowledge and know a single technique. Considering indications for primary tissue repair, 57.4% mentioned a contaminated field as a valid indication. Comparable to the surgeon's response, 66% of surgical trainees would convince the patient of mesh superiority when asked for a pure tissue-based repair.</p><p><strong>Conclusion: </strong>Our survey confirms the declining rate of tissue based repairs, with only 7% of surgical respondents performing sufficient procedures to allow for equivocal result compared to mesh-based repairs. Centralizing these procedures into specific hernia centers might allow for an increased case-load and dedicated training pathways giving trainees and future surgeons proper training.</p>","PeriodicalId":6935,"journal":{"name":"Acta Chirurgica Belgica","volume":" ","pages":"1-8"},"PeriodicalIF":0.8,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148222384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adrenal tumor bleeding versus ruptured abdominal aortic aneurysm: a diagnostic dilemma in retroperitoneal hemorrhage.","authors":"Maud A M Vesseur, Ine Rochus, Lee Bouwman, Ozan Yazar","doi":"10.1080/00015458.2026.2619484","DOIUrl":"10.1080/00015458.2026.2619484","url":null,"abstract":"<p><strong>Background: </strong>Retroperitoneal hemorrhage is a life-threatening entity that can result from a range of etiologies. Rupture of an abdominal aortic aneurysm (AAA) is the most common vascular emergency associated with high morbidity and mortality. However, not all retroperitoneal hemorrhages result from this vascular emergency. Adrenal hemorrhage, though rare, represents an important, often under-recognized and potentially fatal alternative diagnosis. The diagnostic challenge is further compounded when such adrenal pathology occurs in the presence of a concurrent AAA, as overlapping clinical and radiologic features can obscure the true source of bleeding. This coexistence can lead to misdiagnosis, delays in appropriate treatment, and complex decision-making in the acute care setting.</p><p><strong>Case report: </strong>A man in his 70s presented with hemodynamic collapse and right-sided flank pain, initially raising concern for a ruptured abdominal aortic aneurysm (AAA). Imaging revealed both an infrarenal AAA and a large retroperitoneal mass consistent with a hemorrhaging adrenal lesion. Due to diagnostic uncertainty and persistent hemodynamic instability, the patient underwent emergency endovascular aortic repair (EVAR) followed by selective arterial embolization of the adrenal lesion. Postoperative recovery was favorable, with resolution of hemodynamic instability and planned delayed adrenalectomy.</p><p><strong>Conclusion: </strong>This case report illustrates the diagnostic complexity and clinical challenge posed by simultaneous adrenal hemorrhage and AAA. Adrenal tumors can cause life-threatening retroperitoneal hemorrhage. Timely recognition <i>via</i> high-resolution imaging and a flexible interventional approach tailored to the evolving clinical picture are key to successful management. Clinicians should remain vigilant for alternative bleeding sources, even in the context of known vascular disease.</p>","PeriodicalId":6935,"journal":{"name":"Acta Chirurgica Belgica","volume":" ","pages":"100-105"},"PeriodicalIF":0.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145997163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}