Retroperitoneal Duodenal Foreign Body Perforation - A Novel Laparoscopic Approach-Juniper Publishers

JUNIPER PUBLISHERS- OPEN ACCESS JOURNAL OF CASE STUDIES

Retroperitoneal Duodenal Foreign Body Perforation - A Novel Laparoscopic Approach

Authored by Sunder Balasubramaniam

  

Abstract

Gastrointestinal perforation from foreign bodies can lead to life threatening sepsis, and pose a significant challenge given the need to drain the septic source as well as safely extract the offending object. A 71-year-old Chinese lady presented with abdominal pain without peritonitis or fever. A computed tomographic (CT) scan of the abdomen revealed two contiguous retroperitoneal abscesses with a 4cm fishbone. One of the cavities was surrounding the right external iliac artery and had a visible connection from the third portion of the duodenum to the superior abscess cavity. 

She underwent radiology-guided drainage of the collections, followed by a gastrografin swallow which did not demonstrate a leak. Retrieval of the fishbone was first attempted endoscopically by placing a 5 mm laparoscopic port into the cavity to insufflate it with gas, followed by introduction of a flexible choledochoscope. Unfortunately, the bone could not be visualised, and the procedure was converted to open retroperitoneal approach via a 4 cm incision. The bone was successfully retrieved, and a repeat CT done post-operatively showed near resolution of the abscess and complete removal of the fishbone. The patient was fit for discharge on the 4th post-operative day.

To our knowledge, this is the first such report of retroperitoneal abscess due to a foreign body managed by minimally invasive techniques. Fluoroscopic extraction by the radiologist was considered in this case but deemed unsuitable due to the risk of fragmentation and having pieces left behind. The retroperitoneal approach combined with interventional radiology allowed us to avoid the morbidity of laparotomy and speed the patient’s recovery.

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Juniper Publishers Myocardial Infarction video article from

Juniper Publishers Myocardial Infarction video article from

Management of Primary Pulmonary Synovial Sarcoma: A Case Report from Northern Pakistan and Review of Literature- Juniper Publishers

JUNIPER PUBLISHERS- OPEN ACCESS JOURNAL OF CASE STUDIES

Management of Primary Pulmonary Synovial Sarcoma: A Case Report from Northern Pakistan and Review of Literature

Authored by Hadia Fatima

  

Abstract

Primary pulmonary synovial sarcoma is a rare lung tumor and has mesenchymal origin. It is difficult to diagnose clinically and should be differentiated from other primary and metastatic lung tumors. The definitive diagnosis should be made via careful histopathological evaluation along with immunohistochemistry. Cytogenetic studies detect SYT-SSX-1 variant which has got diagnostic and prognostic value. The disease has poor outcome and complete cure is difficult to achieve. We hereby report a case of 40 year old female who was diagnosed and treated for metastatic primary pulmonary synovial sarcoma at Atomic Energy Cancer Hospital, NORI.

Introduction

Primary pulmonary synovial sarcoma (PPSS) is an extremely unusual malignancy associated with aggressive behavior and poor clinical outcome [1]. The tumor originates from mesenchymal cells [1]. Synovial sarcomas make up to 8% of soft tissue sarcomas most commonly seen in extremities [1]. Pulmonary sarcomas are even rare making up to just 0.1-0.5% of primary lung malignancies [2]. The differential diagnosis includes metastatic sarcomas and another primary lung cancer [3]. Primary pulmonary synovial sarcoma behaves like soft tissue synovial sarcoma [4]. PPSS may arise from lung parenchyma, pleura, chest wall and mediastinum [5].

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Open Access Journal of Case Studies-Juniper Publishers

JUNIPER PUBLISHERS-OPEN ACCESS JOURNAL OF CASE STUDIES

Juniper Online Journal of Case Studies (JOJCS)

Journal of Case reports is an international, peer reviewed open access journal, focussed on bringing out premium quality case reports in all areas of basic medical sciences and clinical specialities.‘JOJCS’ aims to serve as a repository of medical case reports that can go a long way in enriching the professional knowledge of medical practitioners around the world.

JOJCS strives to encourage the publication of high quality case reports, by providing a platform for sharing unique, rare, and unusual cases and clinical scenarios that enhance the understanding of the disease process, its diagnosis, treatment options and clinico-pathologic correlations. JOJCS functions as an invaluable resource for young professionals, to understand the intricacies associated with medical cases, and stay abreast of the latest advancements in their field, thereby creating an edge for themselves.

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Endoscopic Ear Surgery Juniper Publishers