CRSLS : MIS case reports from SLS最新文献

{"title":"Boerhaave's Syndrome Presenting in the Setting of Third-Degree Heart Block.","authors":"Jay A Redan, Taylor Croteau, Colleen Gaughan","doi":"10.4293/CRSLS.2023.00052","DOIUrl":"10.4293/CRSLS.2023.00052","url":null,"abstract":"<p><strong>Introduction: </strong>Boerhaave's syndrome, or the spontaneous transmural perforation of the esophagus, is typically thought to be due to an increase in esophageal pressure such as that which occurs during vomiting or retching. Another common etiology of esophageal perforation is esophageal instrumentation, such as during esophagogastroduodenoscopy or transesophageal echocardiography. This life-threatening condition requires prompt diagnosis and treatment to prevent patient demise. While a history of vomiting can aid in diagnosis, this history can be difficult to elicit in an unconscious patient or may be altogether absent. Additionally, Boerhaave's syndrome can present similarly to more common upper gastrointestinal or cardiac conditions. Since mortality increases with delays in diagnosis and treatment, it is imperative that clinicians maintain a high level of suspicion for Boerhaave's syndrome and initiate treatment urgently.</p><p><strong>Case description: </strong>This report presents a 76-year-old man who presented to the emergency department after a history of several syncopal episodes and was found to be in complete heart block. Two days later, he acutely developed abdominal distention and coffee ground emesis. As the medical team was able to gather more history from the patient and his family, it was revealed that he had associated vomiting with his episodes of syncope. CT scan of the abdomen and pelvis demonstrated pneumomediastinum concerning for esophageal perforation. His clinical status subsequently deteriorated. He was intubated and a temporary transvenous pacer was placed before being transferred to our facility for emergent surgery.</p><p><strong>Discussion: </strong>Complete heart block in the setting of Boerhaave's syndrome is exceptionally rare, with only 2 cases reported in the literature. The decision to place a pacemaker in the setting of esophageal perforation/sepsis is complicated and depends on the patient's bacteremia status related to noncardiac comorbidities. Clearly this case represents the need for excellent multidisciplinary decision-making processes with excellent communication between hospital staff and all caretakers. Expeditious diagnosis and treatment of esophageal perforation is essential to prevent leaking of gastric contents into the mediastinum and worsening of cardiac complications and sepsis. Additionally, critical timing of various surgical procedures, especially the need for a permanent pacemaker implant with bacteremia is a complicated process not well described in the surgical literature.</p>","PeriodicalId":72723,"journal":{"name":"CRSLS : MIS case reports from SLS","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10880586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139934549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trans Enteric Rendezvous ERCP in a Patient with Loop Duodenal Switch.","authors":"Sarah Lee, Subhash R Patil, Shilpa Lingala, Benjamin G Coombs, Rama R Ganga","doi":"10.4293/CRSLS.2023.00053","DOIUrl":"10.4293/CRSLS.2023.00053","url":null,"abstract":"<p><strong>Introduction: </strong>Performing endoscopic retrograde cholangiopancreatography (ERCP) in duodenal switch (DS) patients is challenging given their surgically altered anatomy. There have been very few reported cases of trans enteric rendezvous ERCP to relieve biliary obstruction in DS patients. More specifically, there has not been any reported cases of this procedure being performed in loop DS, also known as SADI (single anastomosis duodeno-ileostomy) or SIPS (stomach intestinal pylorus sparing procedure).</p><p><strong>Case description: </strong>This case reports describes a 50-year-old male with prior loop DS who presented with gallstone pancreatitis. He underwent a laparoscopic cholecystectomy with positive intraoperative cholangiogram requiring the need for trans enteric rendezvous ERCP.</p><p><strong>Discussion: </strong>Although never reported, trans enteric rendezvous ERCP is a feasible approach in relieving biliary obstruction in patients with loop DS anatomy.</p>","PeriodicalId":72723,"journal":{"name":"CRSLS : MIS case reports from SLS","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10880584/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139934550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uterine Fibroid-Induced Compressive Neuropathy of Lumbar Plexus and Obturator Nerve.","authors":"Pooja S Vyas, Sun Woo Kim, Julia M Castellano, Japjot K Bal, Kari M Plewniak","doi":"10.4293/CRSLS.2023.00034","DOIUrl":"10.4293/CRSLS.2023.00034","url":null,"abstract":"<p><strong>Introduction: </strong>Uterine fibroids are the most common gynecologic tumors in reproductive-aged women with a prevalence of up to 80%. Symptoms can range from heavy vaginal bleeding and bulk symptoms to, less frequently, deep vein thrombosis and bowel obstruction.</p><p><strong>Case description: </strong>A 32-year-old female patient presented with acute-onset of right groin and knee pain, and difficulty ambulating. A large posterior uterine fibroid was found to be compressing branches of the lumbar plexus, including the obturator nerve. The patient underwent gynecologic evaluation and an urgent laparoscopic myomectomy. Postoperatively, she had significant improvement in neurologic symptoms. She continued physical therapy for residual mild paresthesia and pain with prolonged ambulation.</p><p><strong>Discussion: </strong>Large pelvic masses such as uterine fibroids should be considered on the differential diagnosis for acute-onset non-gynecologic symptoms such as compressive neuropathy, which require urgent evaluation and possible surgical management.</p>","PeriodicalId":72723,"journal":{"name":"CRSLS : MIS case reports from SLS","volume":"10 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10627345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71489630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aberrant Vascular Anatomy During Laparoscopic Cholecystectomy: A Case Report of Double Cystic Artery.","authors":"Alison Y Zhu, Doruk Seyfi, Charbel Sandroussi, Jayantha D Abeysinghe","doi":"10.4293/CRSLS.2023.00038","DOIUrl":"10.4293/CRSLS.2023.00038","url":null,"abstract":"<p><strong>Introduction: </strong>Laparoscopic cholecystectomy is the standard surgical procedure for the management of benign gallbladder pathology. Anatomical variation, including aberrant cystic artery, increases the risk of complications during laparoscopic cholecystectomy. Obtaining a critical view of safety is important to avoid major vascular and bile duct injury.</p><p><strong>Case description: </strong>We present a case of aberrant anatomy with two cystic arteries of equal caliber in a 41-year-old female undergoing laparoscopic cholecystectomy for acute cholecystitis.</p><p><strong>Discussion: </strong>This case report aims to emphasize the importance of thorough knowledge of hepatobiliary vascular anatomy, as well as variations beyond the critical view of safety, which will contribute to the safety and success of laparoscopic cholecystectomy.</p>","PeriodicalId":72723,"journal":{"name":"CRSLS : MIS case reports from SLS","volume":"10 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10629475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71523517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mesonephric Cyst Endometrioma: Surgical Management of an Atypical Site Endometriosis.","authors":"Ripal Madnani,&nbsp;Sandip Sonara","doi":"10.4293/CRSLS.2023.00029","DOIUrl":"10.4293/CRSLS.2023.00029","url":null,"abstract":"<p><strong>Objectives: </strong>Endometriosis originating in mesonephric cyst is unusual and with unknown prevalence. Endometriotic lesion in vestigial remnant of wolffian duct (mesonephric cyst) is exceptional. In the extended literature review only three cases have been reported in animal studies, and our case reported here is the first in human beings. We present a case of mesonephric cyst endometrioma in a 37-year-old patient who was referred for severe dysmenorrhea, long duration pelvic and back pain, subfertility, severe dyspareunia, and groin discomfort. The patient underwent laparoscopic removal and we performed a literature review to gain insight about the origin and surgical management of an atypical site endometriosis.</p><p><strong>Methods and procedures: </strong>Case report presentation rests on information obtained from the patient database. We performed the literature review using a Medline search with the keywords: mesonephric cyst endometriosis, atypical location of endometriosis in vestigial remnant in wolffian duct, and Gartner duct cyst endometrioma.</p><p><strong>Results: </strong>On physical examination, fullness and tenderness in left adnexa and lateral vaginal wall fullness on left side with restricted mobility of uterus was noted. Based on the examination and imaging the left ovarian cyst and mesonephric cyst were suspected. Surgical exploration revealed the left hemorrhagic cyst with deep infiltrating endometriosis involving left ureter and left uterosacral ligament with mesonephric cyst endometriosis. The review of literature revealed three cases where ectopic endometrial tissue in mesonephric cyst remnant was found in female dogs.</p><p><strong>Conclusion: </strong>Mesonephric cyst endometrioma, although rare, can be a representative of extensive endometriosis. This case highlights an importance of careful clinical examination, correlation of patient symptoms with examination and imaging, and successful laparoscopic management of an atypical location endometriotic lesions. We completed the literature review on successful surgical management of such cases.</p>","PeriodicalId":72723,"journal":{"name":"CRSLS : MIS case reports from SLS","volume":"10 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/44/33/e2023.00029.PMC10558092.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41161454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transplant Ureter Inguinal Herniation Treated by Robotic Inguinal Hernia Repair.","authors":"Diego Laurentino Lima,&nbsp;Valentina Viscarret,&nbsp;Raquel Nogueira,&nbsp;Kara Watts,&nbsp;Flavio Malcher","doi":"10.4293/CRSLS.2023.00020","DOIUrl":"10.4293/CRSLS.2023.00020","url":null,"abstract":"<p><strong>Introduction: </strong>We report the case of a transplanted ureter obstructed by an inguinal herniation treated by a robotic-assisted approach.</p><p><strong>Case report: </strong>This is a case of a 63-year-old male who had a kidney transplant with a graft on the left pelvis in September 2014, and presented to the clinic for evaluation of bilateral inguinal hernia. On physical examination he had bilateral palpable inguinal hernias, with the right one larger and only partially reducible. Computed tomography scan showed portion of urinary bladder and transplant ureter in the left inguinal hernia and mild hydroureteronephrosis in the transplanted kidney. Patient underwent catheterization of the transplant ureter where indocyanine green was injected for proper transplant ureter identification with the Firefly filter and robotic assisted hernia repair. Surgery was uneventful and patient was discharged home the same day with no further complications.</p><p><strong>Conclusion: </strong>The robotic approach using the Firefly filter was shown to be safe during the dissection to avoid injury to the transplant ureter.</p>","PeriodicalId":72723,"journal":{"name":"CRSLS : MIS case reports from SLS","volume":"10 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/bd/e3/e2023.00020.PMC10516261.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41173632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Jejunal Intussusception Secondary to Pancreatic and Gastric Heterotopia in a 23-Year-Old.","authors":"Caline McCarthy,&nbsp;Amendha Ware,&nbsp;Jay A Redan","doi":"10.4293/CRSLS.2023.00018","DOIUrl":"10.4293/CRSLS.2023.00018","url":null,"abstract":"<p><strong>Introduction: </strong>Pancreatic and gastric heterotopias are a rare presentation of pancreatic and gastric tissues located outside their expected location. The most common site of heterotopic pancreas is the gastric antrum, and the most common site of heterotopic gastric mucosa is the proximal esophagus. The two tissues rarely present simultaneously. Although lead-point intussusception secondary to simultaneous heterotypic gastric and pancreatic tissue is extremely rare, its management strategy is the same as other pathological lead-point intussusception.</p><p><strong>Case description: </strong>This report presents a 23-year-old female who presented to the emergency department with abdominal pain, vomiting, and gastrointestinal bleeding. Computed tomography scan revealed features of distal small bowel intussusception secondary to a solid mass lead point. Following laparoscopic assisted small bowel resection and incidental appendectomy, histopathology evaluation confirmed the diagnosis of heterotopic pancreatic and gastric tissue as the lead point. The patient had an uneventful postoperative period and was discharged in stable condition, free of symptoms.</p><p><strong>Discussion: </strong>Lead point intussusception of the jejunum in adults due to combined heterotopic tissue is extremely rare, with no reported cases in the literature. Prompt diagnosis and management are essential, with delays in treatments leading to a risk of perforation and mortality. If diagnosed, minimally invasive surgical approaches can treat obstruction and improve intraoperative and postoperative outcomes.</p>","PeriodicalId":72723,"journal":{"name":"CRSLS : MIS case reports from SLS","volume":"10 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4c/12/e2023.00018.PMC10476238.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10171804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Swiss LithoClast® Trilogy Lithotripter for Use in Robotic Pyelolithotomy.","authors":"Micah Levy,&nbsp;Chih Peng Chin,&nbsp;Krishna T Ravivarapu,&nbsp;Osama Al-Alao,&nbsp;Francisca Larenas,&nbsp;Michael A Palese","doi":"10.4293/CRSLS.2023.00027","DOIUrl":"10.4293/CRSLS.2023.00027","url":null,"abstract":"<p><strong>Introduction: </strong>The Boston Scientific Swiss LithoClast® Trilogy lithotripter was intended for use in percutaneous nephrolithotomy. We performed, to our knowledge, the first two robotic pyelolithotomies using the Trilogy lithotripter for intracorporeal lithotripsy.</p><p><strong>Case description: </strong>Two cases are presented involving a 65-year-old female with a complete left staghorn calculus and hydronephrosis secondary to a left ureteropelvic junction (UPJ) obstruction, and a 69-year-old male with a large left staghorn calculus and multiple large left sided simple renal cysts. In both cases, a robotic pyelolithotomy was scheduled for stone removal along with concurrent UPJ repair and cyst decortication respectively. Following pyeloplasty and cyst decortication respectively, and following stone visualization, the 2.4-mm Trilogy probe was inserted into the 12-mm assistant port and under direct visualization the stone was fragmented and removed using Trilogy's built-in mechanisms. Both patients were treated successfully without complications and were found to be stone-free on follow-up.</p><p><strong>Conclusion: </strong>The Trilogy lithotripter may be an effective tool for stone management when introduced during robotic pyelolithotomy and provides additional optionality when manual extraction poses challenges.</p>","PeriodicalId":72723,"journal":{"name":"CRSLS : MIS case reports from SLS","volume":"10 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/79/22/e2023.00027.PMC10476237.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10522983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic-Assisted Repair of a Ureterosciatic Hernia with Combined Ureteral Stenting.","authors":"Jeremy Fridling,&nbsp;Brendan Gontarz,&nbsp;Joshua Stein,&nbsp;Vladimir Daoud","doi":"10.4293/CRSLS.2023.00015","DOIUrl":"https://doi.org/10.4293/CRSLS.2023.00015","url":null,"abstract":"<p><p>Pelvic floor hernias represent a rare type of hernia and a rare etiology of pelvic symptoms. The rarest type of pelvic floor hernias are sciatic hernias, which present with a variety of symptoms depending on the hernia contents and location. Many different treatment approaches are described in the literature. A 73-year-old female presented to our outpatient minimally invasive surgery (MIS) clinic with one year of colicky left flank pain. She had previously presented to an emergency department, at which time a computed tomography (CT) scan demonstrated left-sided hydronephrosis in the setting of a left-sided ureterosciatic hernia. She was asymptomatic and had no palpable hernia bulge. An operative repair was offered based on her prolonged symptoms. The patient was brought electively to the operating room with minimally invasive and urological surgeons. A left ureteral stent was placed over a guidewire. A robotic repair was performed with a round piece of biosynthetic mesh, secured in place with fibrin glue. Sciatic hernias are an extremely rare etiology of pelvic symptoms and require a high index of suspicion to identify. Obstructive and neuropathic symptoms may be intermittent, so diagnosis is often made using CT imaging. We report a successful treatment with pre-operative ureteral stenting followed by a robotic repair using biologic mesh secured with fibrin glue fixation. We believe this is a durable repair although acknowledge that longer follow-up is needed to establish the longevity of our treatment modality.</p>","PeriodicalId":72723,"journal":{"name":"CRSLS : MIS case reports from SLS","volume":"10 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/89/8b/e2023.00015.PMC10258871.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10069577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incarcerated Epiploic Appendix in a Spigelian Hernia Treated by Robotic-Assisted Surgery.","authors":"Diego L Lima,&nbsp;Analena Alcabes,&nbsp;Valentina Viscarret,&nbsp;Raquel Nogueira,&nbsp;Flavio Malcher","doi":"10.4293/CRSLS.2023.00008","DOIUrl":"https://doi.org/10.4293/CRSLS.2023.00008","url":null,"abstract":"<p><strong>Introduction: </strong>We report a case of a patient who presented with incarceration of the epiploic appendix in a spigelian hernia, subsequently treated by a robotic-assisted surgical approach.</p><p><strong>Case description: </strong>This is a case of a 52 year-old male patient who presented with nausea and two-week history of worsening left lower quadrant pain. On examination, the patient had an irreducible left lower quadrant mass. Computed tomography scan showed an epiploic appendagitis in a left Spigelian hernia. The patient underwent a robotic transabdominal preperitoneal hernia repair successfully and was discharged home the same day.</p><p><strong>Conclusion: </strong>The robotic platform was a safe and effective approach to treating the patient with no postoperative complications.</p>","PeriodicalId":72723,"journal":{"name":"CRSLS : MIS case reports from SLS","volume":"10 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b7/2e/e2023.00008.PMC10258872.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10069578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}