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1.  Torsion of the gallbladder in pregnancy 
Torsion of the gallbladder is a rare condition that is difficult to diagnose preoperatively, but prompt surgical intervention is necessary to avoid possible sepsis and death. A 36-year-old pregnant woman presented to Emergency Department with a constant epigastric pain at 17 weeks of gestation. Abdominal ultrasonography and magnetic resonance imaging demonstrated a distended gallbladder that contained no stones but had mild wall thickening. Laparoscopic cholecystectomy using three ports was performed under the impression of an acalculous cholecystitis. The gallbladder was found to be rotated 180 degrees clockwise on gallbladder mesentery and to be gangrenous. The postoperative course was uneventful and the patient was discharged on the 4th day after surgery. It is important to keep in mind gallbladder torsion in the differential diagnosis from acute cholecystitis when the patient has an acute onset of abdominal pain and a severely distended gallbldder. Prompt cholecystectomy via a laparoscopic approach should be performed.
PMCID: PMC3868683  PMID: 24368989
Gallbladder; Torsion abnormality
2.  Perineal accessory scrotum with a lipomatous hamartoma in an adult male 
Accessory scrotum is a rare congenital anomaly that is often associated with perineal tumor or other developmental abnormalities. Because most cases are diagnosed and treated in early childhood, little is known about the natural biologic course of this entity and associated lesions through time. We present a case of accessory scrotum associated with lipomatous hamartoma in a 46-year-old man who was born with a perineal mass. We evaluate the clinicopathologic features and discuss the pathogenesis with a review of the literature.
PMCID: PMC3868684  PMID: 24368990
Perineum; Scrotum; Abnormalities; Hamartoma; Lipoma
3.  A Peterson's hernia and subsequent small bowel volvulus: surgical reconstruction utilizing transverse colon as a new Roux-en-Y limb - 1 case 
Peterson's hernia is an internal hernia that can occur after Roux-en-Y anastomosis. It often accompanies small bowel volvulus and is prone to strangulation. Reconstruction of intestinal continuity after massive small bowel resection in a patient who undergoes near total gastrectomy and Roux-en-Y anastomosis can be difficult. A 74-year-old man who had undergone a near total gastrectomy and Roux-en-Y gastrojejunostomy for stomach cancer presented with abdominal pain. The preoperative computed tomography showed strangulated small bowel volvulus. During the emergent laparotomy, we found a strangulated Peterson's hernia with small bowel volvulus. After resection of the necrotized intestine, we made a new Roux-en-Y anastomosis connecting the remnant stomach and the jejunum with a transverse colon segment. We were safely able to connect the remnant stomach and the jejunum by making a new Roux-en-Y anastomosis utilizing a transverse colon segment as a new Roux-limb by two stage operation.
PMCID: PMC3868685  PMID: 24368991
Roux-en-Y; Gastrectomy; Hernia; Volvulus
4.  Abdominal wall defect with large duodenal disruption treated by a free tissue flap with a help of temporary expandable metallic stent 
Abdominal wall defect with large duodenal disruption after penetrating abdominal injury is a rare emergency situation that can result in life-threatening complications. We report on a 64-year-old man who had abdominal wall defect with large duodenal disruption after penetrating abdominal injury. The patient presented with intra-abdominal exsanguinating bleeding, duodenal disruption, and multiple small bowel perforation. The rarity of this complex injury and its initial presentation as a posttraumatic large duodenal disruption with abdominal wall defect warrant its description. The present case indicates that combining a free tissue flap with a covered expandable metallic stent can effectively and successfully repair an abdominal wall defect that is associated with a large duodenal disruption.
PMCID: PMC3834024  PMID: 24266016
Stents; Abdominal wall; Duodenum; Abdominal injury; Free tissue flaps
5.  Use of video-assisted thoracoscopic surgery to retrieve a broken guidewire 
Subclavian venous catheterization was once widely used for volume resuscitation, emergency venous access, chemotherapy, parenteral nutrition, and hemodialysis. However, its use has drastically reduced recently because of life-threatening complications such as hemothorax, pneumothorax. In this case, a patient admitted for a scheduled operation underwent right subclavian venous catheterization for preoperative, intraoperative, and postoperative volume resuscitation and parenteral nutrition. The procedure was performed by an experienced senior resident. Despite detecting slight resistance during the guidewire insertion, the resident continued the procedure to the point of being unable to advance or remove it, then attempted to forcefully remove the guidewire, but it broke and became entrapped within the thorax. We tried to remove the guidewire through infraclavicular skin incision but failed. So video-assisted thoracoscopic surgery was used to remove the broken guidewire. This incident demonstrates the risks of subclavian venous catheterization and the importance of using a proper and gentle technique.
PMCID: PMC3834025  PMID: 24266017
Broken guidewire; Central venous catheterization; Complications; Subclavian venous catheterization; Video assisted thoracic surgery
6.  Xanthogranulomatous cholecystits in 2-month-old infant 
Xanthogranulomatous cholecystitis (XGC) is a rare form of chronic cholecystitis that is accompanied by xanthomatous histiocytes and chronic inflammation. A 2-month-old boy presented with a right upper abdominal palpable mass. Cholecystectomy with liver wedge resection was done, under the impression that the mass might be a hepatic tumor or liver abscess. Pathologic examination showed XGC with abscess formation. Most cases of XGC were observed in adult and only a few cases were reported in children. We describe a very rare case of XGC in infancy.
PMCID: PMC3791363  PMID: 24106687
Xanthogranulomatous cholecystitis; Cholecystitis; Infant; Cholecystectomy
7.  Preduodenal portal vein: a 3-case series demonstrating varied presentations in infants 
Preduodenal portal vein, a rare anomaly, could be found in any age groups. In pediatrics it may present with a duodenal obstruction by itself or other coexisting anomalies; however it usually present with an asymptomatic or incidental findings during other surgery in adults. This anomaly has a clinical importance due to the possibility of accidental damage to portal vein. In addition to describing a series of 3 cases with different manifestation in infants, discuss about this anomaly with a review of relevant literature.
PMCID: PMC3791364  PMID: 24106688
Preduodenal portal vein; Infant
8.  Pinch-off syndrome 
Subclavian venous catheterization was previously frequently performed, but because of life-threatening complications such as hemothorax, pneumothorax, mediastinal hematoma, and myocardial injury, its use has become less common. However, this practice has some advantages in patient mobility, secured dressing, and rapidity and adequacy of vascular access. In some situations where patient comfort is an especially important consideration, such as with totally implantable venous port insertion for chemotherapy, the subclavian route can be a good choice if an experienced and well-trained faculty is available. The authors have had recent experience with pinch-off syndrome-in other words, spontaneous catheter fracture-in 3 patients who had undergone venous port implantation through the right subclavian route. Through these cases, we intend to review the dangers of subclavian venous catheterization, the causes of pinch-off syndrome, and its clinical presentation, progress, treatments, and prevention.
PMCID: PMC3764366  PMID: 24020024
Pinch off syndrome; Subclavian venous catheterization; Spontaneous catheter fracture; Implantable venous port
9.  Endovascular repair of bilateral iliac artery aneurysm with branched iliac stents: case report and review of the current literature 
Common iliac artery aneurysm (CIA) often occurs in conjunction with an abdominal aortic aneurysm (AAA), which extends into one or both CIAs in 20% to 30% of patients. Conventional endovascular treatment includes coil embolization of the internal iliac artery (IIA), followed by extension of the main bifurcated AAA stent-graft into the external iliac artery. However, complications from intentional occlusion of unilateral or bilateral IIAs are frequent and sometimes serious. Several methods try to preserve the unilateral or bilateral IIA. Here we report a case of concomitant bilateral CIA and AAA successfully treated with bilateral branched iliac stent-grafts.
PMCID: PMC3764367  PMID: 24020025
Iliac aneurysm; Endovascular procedure
10.  Inflammatory myofibroblastic tumor mimicking hepatocellular carcinoma with dense lipiodol uptake 
Inflammatory myofibroblastic tumor (IMT) of the liver is a very rare lesion that has radiologic similarity with malignant liver tumor. Differential diagnosis of IMT from a malignant lesion of the liver is very important because surgical resection is not mandatory for IMT. Lipiodol computed tomography is a very sensitive and specific diagnostic tool for hepatocellular carcinomas (HCC). Herein, we describe a case of IMT that had dense lipiodol uptake in the tumor and mimicked HCC. To our knowledge, previously, only one case of IMT with dense lipiodol retention has been reported.
PMCID: PMC3729993  PMID: 23908967
Inflammatory myofibroblastic tumor; Lipiodol CT; Liver
11.  Open surgical decompression of celiac axis compression by division of the median arcuate ligament 
Median arcuate ligament syndrome is a rare cause of abdominal pain which results from compression of the celiac artery (CA) or rarely, the superior mesenteric artery by a ligament formed by the right and left crura of the diaphragm. We report a case of open surgical decompression of the CA by division of the median arcuate ligament for a 37-year-old female patient who had suffered from chronic postprandial epigastric pain and severe weight loss. We described clinical features, characteristic angiographic findings and details of the surgical procedure for the patient with this rare vascular problem.
PMCID: PMC3729994  PMID: 23908968
Median arcuate ligament; Celiac artery stenosis
12.  Primary leiomyosarcoma of the thyroid 
A 56-year-old male with primary leiomyosarcoma of the thyroid is presented. The paucity of diagnostic maneuvers, including tumor markers, fine needle aspiration, and frozen section biopsy, are stressed, in addition to the fulminate course of the disease.
PMCID: PMC3699687  PMID: 23833760
Thyroid; Leiomyosarcoma
13.  Acute gastric volvulus treated with laparoscopic reduction and percutaneous endoscopic gastrostomy 
Acute gastric volvulus requires emergency surgery, and a laparoscopic approach for both acute and chronic gastric volvulus was reported recently to give good results. The case of a 50-year-old patient with acute primary gastric volvulus who was treated by laparoscopic reduction and percutaneous endoscopic gastrostomy is described here. This approach seems to be feasible and safe for not only chronic gastric volvulus, but also acute gastric volvulus.
PMCID: PMC3699688  PMID: 23833761
Stomach volvulus; Intestinal volvulus; Laparoscopy; Endoscopy; Gastrostomy
14.  Adenocarcinoma arising from Meckel's diverticulum in the ileum with malrotation of the midgut 
Meckel's diverticulum (MD) is a true congenital diverticulum that is remnant by incomplete obliteration of the omphalomesenteric duct. It is the most common congenital anomaly of the gastrointestinal tract, with an estimated prevalence of 2% (0.3% to 3% in autopsy studies). About 90% of MD occurs within 100 cm of the ileocecal valve. A primary malignant tumor arising within an MD is extremely uncommon. Malignancies are reported to account for only 0.5% to 3.2% of the complications. Carcinoids are the most common malignant tumors occurring in MD. Adenocarcinomas are extremely uncommon and very poor prognosis has been reported. We report a case of radiographically diagnosed chronic inflammatory mass caused by adenocarcinoma arising from MD in the ileum with malrotation of the midgut incidentally discovered at exploration.
PMCID: PMC3671006  PMID: 23741695
Meckel diverticulum; Adenocarcinoma; Intestinal malrotation
15.  Laparoscopic repair of parastomal and incisional hernias with a modified Sugarbaker technique 
A parastomal hernia is the most common surgical complication following stoma formation. As the field of laparoscopic surgery advances, different laparoscopic approaches to repair of parastomal hernias have been developed. Recently, the Sugarbaker technique has been reported to have lower recurrence rates compared to keyhole techniques. As far as we know, the Sugarbaker technique has not yet been performed in Korea. We herein present a case report of perhaps the first laparoscopic parastomal hernia repair with a modified Sugarbaker technique to be successfully carried out in Korea. A 79-year-old woman, who underwent an abdominoperineal resection for an adenocarcinoma of the rectum 9 years ago, presented with a large parastomal and incisional hernias, and was treated with a laparoscopic repair with a modified Sugarbaker technique. Six months after surgery, follow-up with the patient has shown no evidence of recurrence.
PMCID: PMC3671007  PMID: 23741696
Laparoscopy; Abdominal hernia; Surgical stomas; Surgical procedures; Minimally invasive
16.  Gastrojejuno-colic fistula after gastrojejunostomy 
Gastrojejunocolic fistula is a rare condition after gastrojejunostomy. It is severe complications of gastrojejunostomy, which results an inadequate resection or incomplete vagotomy during peptic ulcer surgery. The symptoms are diarrhea, upper abdominal pain, bleeding, vomiting and weight loss. A 55-year-old man with chronic diarrhea and weight loss for 6 months visited Dankook University Hospital. The patient had received a truncal vagotomy and gastrojejunostomy for duodenal ulcer obstruction 15 years previously. The patient underwent gastroscopy and upper gastrointestinal series evaluations, which detected the gastrojejunocolic fistula. After improving of malnutrition, an exploratory laparotomy was undertaken, which revealed that the gastrojejunostomy site and the T-colon formed adhesion and fistula. En block resection of the distal stomach and T-colon included the gastrojejunocolic fistula, and Roux-en-Y gastrojejunostomy was performed. Recovery was uneventful and the patient remained well at the follow-up. We report a gastrojejunocolic fistula, which is a rare case after gastrojejunostomy.
PMCID: PMC3616280  PMID: 23577321
Gastrojejunocolic fistula; Gastrojejunostomy; Peptic ulcer disease
17.  Right side fixation of sigmoid colon with a hepato-sigmoidocolic fistula in patient with hepatocellular carcinoma and midgut malrotation 
The location of the sigmoid colon varies within the abdominal cavity, but its mesocolon is fixed to the left side. Right side fixation of the sigmoid colon is a very rare congenital positional anomaly. In addition, it has been reported that hepatocolic fistula is also a very rare disease that may present lower gastrointestinal bleeding. Here, the authors describe a case of a 71-year-old man who underwent surgery for hepato-sigmoidocolic fistula complicated by hepatocellular carcinoma and the right side fixation of the sigmoid colon.
PMCID: PMC3616281  PMID: 23577322
Right side fixation of sigmoid colon; Hepato-sigmoidocolic fistula; Hepatocellular carcinoma; Midgut malrotation
18.  Biliary injury after cholecystectomy in a patient with severe right liver atrophy 
We report a case of bile fistula after cholecystectomy in a patient with severe right liver atrophy, which was managed by endoscopic nasobiliary drainage and conservative treatment. The patient was a 76-year-old man with a sudden onset in the right flank and abdominal pain. Computed tomography revealed calculous cholecystitis and severely atrophied right lobe of the liver. Gallbladder was located in the superior-posterior portion of the liver as opposed to the normal position. The patient underwent cholecystectomy and showed massive bleeding and bile leakage at the gallbladder bed during operation. A bile fistula was detected three days after surgery, which was managed by interventional bile drainage. Right liver agenesis or severe atrophy is rare. Additionally, the report of combined bile duct injury after cholecystectomy in these settings is extremely rare.
PMCID: PMC3594646  PMID: 23487411
Biliary injury; Liver; Atrophy
19.  Endovascular abdominal aortic aneurysm repair in patients with renal transplant 
The repair of abdominal aortic aneurysm (AAA) in patients with functioning renal transplant is critical because it is important to avoid ischemic and reperfusion injury to the transplanted kidney. Endovascular aneurysm repair (EVAR) avoids aortic cross clamping and can prevent renal graft ischemia. Here we report the endovascular management and outcome of AAA in two renal transplant patients using a bifurcated aortic stent graft. One patient underwent EVAR using a small amount of contrast (30 mL) due to decreased renal function resulting from chronic rejection. Another patient had EVAR performed with iliac conduit because of the heavily calcified, stenotic lesion of external iliac artery. EVAR in patients with a renal transplant is a feasible option without impairing renal arterial flow.
PMCID: PMC3594647  PMID: 23487478
Abdominal aortic aneurysm; Kidney transplantation; Endovascular procedures
20.  Primary mesenteric carcinoid tumor 
Primary mesenteric carcinoid tumor is very rare, although secondary mesenteric involvement is common, reported as 40% to 80%. And distant metastasis rate reported as 80% to 90%, when the size is larger than 2 cm. We present a case of very rare primary mesenteric carcinoid tumor showing benign character though large size. The patient visited St. Vincent's Hospital, The Catholic University of Korea with increasing palpable abdominal mass. At laparotomy, a well encapsulated mass arising from the mesentery near the ligament of Treitz was found without any adjacent organ invasion or distant metastasis. The mass was measured as 8.2 × 7.3 cm and histopathologically benign character. At 11 months of follow up, the patient was recurrence free.
PMCID: PMC3566469  PMID: 23397044
Carcinoid tumor; Mesentery; Neoplasms
21.  Two cases of mucinous adenocarcinoma of the stomach mistaken as submucosal tumor 
A gastric carcinoma with the endoscopic features resembling submucosal tumor (SMT) is rare, and reportedly account for only 0.1% to 0.63% of all resected gastric carcinomas. The preoperative diagnosis of SMT-like gastric carcinoma is challenging, and thus, diagnosis is usually made intraoperatively or postoperatively. Furthermore, mucinous adenocarcinoma is an uncommon histologic subtype of gastric carcinoma characterized as an elevated lesion resembling SMT due to abundant mucin pools in submucosa. Here, we report two cases in which a gastric mucinous adenocarcinoma was mistaken as a SMT.
PMCID: PMC3566470  PMID: 23396274
Submucosal tumor; Gastric neoplasms; Adenocarcinoma; Mucinous
22.  Generalized peritonitis arising from small bowel metastasis in a lung cancer patient 
Symptomatic gastrointestinal metastasis from lung malignancy is rarely reported. In this report, we present a case of lung adenocarcinoma with acute abdominal pain from small bowel perforation. The patient underwent small bowel resection and the final diagnosis was metastatic adenocarcinoma originating from lung. Immunohistochemistry was positive for thyroid transcription factor-1 and cytokeratin 7 (CK7), and negative for CK20. We present this rare case and briefly review the literature.
PMCID: PMC3539111  PMID: 23323237
Lung cancer; Gastrointestinal tract; Metastasis; Immunohistochemistry
23.  Repair of a postappendectomy massive ventral hernia using tissue expanders 
Reconstruction of large abdominal wall defects is a challenging problem. Various reconstructive techniques have been described in the surgical literature each with its advantages and disadvantages. In this report we describe our experience in treating a patient with large abdominal wall defect by staged abdominal wall reconstruction utilizing prosthetic mesh in conjunction with tissue expanders. A 41-year-old male presented with abdominal pain. Exploratory laparotomy showed perforated appendicitis with intraabdominal abscess of 1,500 mL. Postoperatively, he developed intraperitoneal sepsis. To prevent abdominal compartment syndrome, he was reoperated and left with "open abdomen". After several open abdomen lavages, his abdominal wall defect was allowed to granulate. After epithelization of the defect, the abdominal wall was reconstructed using prosthetic mesh and tissue expanders. The tissue expansion process was well tolerated. We suggest that the use of tissue expanders provides reliable and well-vascularized soft-tissue coverage in abdominal wall reconstruction.
PMCID: PMC3539112  PMID: 23323238
Abdominal hernia; Tissue expander; Reconstruction
24.  Metastatic leiomyosarcoma of the intrapancreatic bile duct 
We report the case of a patient with a history of surgically treated pulmonary leiomyosarcoma, presenting with recurrent acute cholangitis and metastatic leiomyosarcoma of the common bile duct. Preoperative examinations had revealed a high grade malignant neoplasm and bilateral lung metastases. The patient underwent pylorus-preserving pancreaticoduodenectomy and survived for 5.5 years after the first diagnosis.
PMCID: PMC3539113  PMID: 23323239
Leiomyosarcoma; Neoplasm metastasis; Common bile duct
25.  Heart-shaped pedunculated lipofibroma of the coccygeal area in a neonate 
Pedunculated lipofibroma is a rare benign hamartomatous condition that is characterized by ectopic adipose tissue in the dermis and a solitary form of nevus lipomatosus cutaneous superficialis. We describe here a neonate with congenital pedunculated lipofibroma. The lesion was removed by simple excision.
PMCID: PMC3539114  PMID: 23323240
Pedunculated lipofibroma; Nevus lipomatosus cutaneous superficialis; Neonate

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