bluuebunny/crossref_metadata_2025_split huggingface dataset:
580 A Surgical Dilemma; Complicated Case of Dandy Walker Malformation
Authors: Chaudhary A , Salah R 
Published: August 2023

Abstract

Case summary
A 24-year-old male presented to the department with a 1-week history of sudden onset posterior headache and multiple episodes of vomiting. He reported similar episodes 8 months prior with ataxia which resolved itself. He has a past medical history of dandy walker malformation (DWM) diagnosed in early infancy and a shunt inserted at 3 months old due to hydrocephalus.
Initial blood investigations revealed extremely low platelets, low TLC and markedly raised potassium along with splenomegaly. Neurological examination was unremarkable with GCS of E4V5M6. A CT scan revealed hydrocephalus requiring revision shunt surgery. However, surgery was avoided due to the risks associated with thrombocytopenia therefore multiple specialists were consulted before a final decision could be reached.

Discussion
DWM is a rare congenital malformation typically presenting in early childhood characterised by hypoplasia of the cerebellar vermis, posterior fossa dilation and cystic enlargement of 4th ventricle. A complication of DWM is hydrocephalus, which requires surgery to correct via shunt insertion. However, this patients’ haematological instabilities risks deterioration and even death during surgery as preoperative thrombocytopenia has been associated with increased intra- and post-operative mortality. As such the patient was not advised surgery initially however the hydrocephalus was causing severe headaches to the patient ultimately making it difficult for surgeons to decide when surgery should be performed. On follow up, the patient was discharged with no shunt revision due to resolution of symptoms. This case highlighted the need for skilled physicians across multiple specialities to make a shared decision about surgical or conservative management.
621 Delayed Presentation of Retained Gallstones Post Laparoscopic Cholecystectomy - Complicated by Falciform Ligament Abscess Formation
Authors: Shulman N , Chen N 
Published: August 2023

Abstract

Case
30-year-old female presented with six days of intermittent epigastric pain, increasing severity, with associated nausea and vomiting. Past history included depression, smoking and a laparoscopic cholecystectomy and intraoperative cholangiogram (IOC) performed interstate 8mths prior for acute cholecystitis. The operation report described a normal IOC, significantly inflamed gallbladder, requiring needle decompression and retrieval of two 15-20mm gallstones from Morison’s pouch.
Investigations showed elevated white cell count(13x10^9/L) and C-reactive protein(56mg/L), with mildly cholestatic liver function tests. Computed Tomography revealed two 1.5cm lesions abutting the inferior margin of the liver; one with shadowing on Ultrasound suspicious for a gallstone, with surrounding inflammatory mass and fat stranding.
A laparoscopic exploration and removal of retained gallstone was performed. Intraoperative findings included adhesions between the gastric body and falciform ligament; with chronic abscess cavity containing pus and a 1.5cm gallstone within the falciform ligament. She recovered well and discharged with antibiotics the next day.

Discussion
Gallstone spillage occurs in 6-40% of laparoscopic cholecystectomies, potentially causing complications (abscess, fistula, or haemorrhage) in 8.5% if retained. Abscess formation (as above) is often recurrent if the gallstone is not removed, thus a laparoscopic technique is preferable.
Attempted removal during surgery and documentation of spilled gallstones in the operation report is imperative to alert medical teams to the possibility of a complication if the patient were to represent. A high level of suspicion aids in the early recognition and intervention; particularly given the time post initial operation and limitations of standard imaging in detection of retained gallstones.
779 Endoscopic Repair of a Chronic Duodenal Perforation Complicated by a Contained Collection: A Case Report
Authors: Shah S , Mohammed E , Saleem M 
Published: August 2023

Abstract
Duodenal perforations are a surgical emergency with high mortality. Most perforations require open or laparoscopic surgical repair, whereby the ulcer is oversewn, sometimes using a Graham patch. However, surgery is not without complications.
We report the case of a 70-year-old man with a chronic, perforated duodenal ulcer that was repaired endoscopically. The patient presented with a 1-month history of epigastric abdominal pain, exacerbated by eating, and associated with a weight loss of 3.5 stones. Examination revealed a hard, irregular mass in the epigastrium. CT imaging showed a 6.8cm x 5.2cm x 4.1cm collection with an air-fluid level communicating with the D2 duodenum and extravasation of contrast into the collection.
The collection was unable to be drained under radiological guidance due to difficulty in visualising and accessing it. Surgical intervention was deemed difficult to due to the site and chronicity of the perforation.
The patient underwent endoscopic repair. Two interrupted sutures were placed using an Apollo overstitch system. APC was applied to the edges of the perforation and an OVESCO clip was placed ontop. Repeat CT imaging did not show any evidence of recurrent perforation.
Endoscopic repairs have mainly been performed as an adjunct to surgical repair or during ERCP procedures, primarily using endoclips. We present a case where endoscopic repair alone was successful in sealing a duodenal perforation whilst leaving the collection intact.
We believe this case is interesting and with advances in endoscopy, endoscopic repair could provide a minimal invasive option for managing duodenal perforations, especially complicated, chronic ones.
845 A Case of Testicular Salvage Following Complete Capsular Rupture Due to Direct Trauma During Ju-Jistu
Authors: Fardanesh A , Omogbehin T , Lindsay J , Sharif M , Green J 
Published: August 2023

Abstract

Background
Testicular rupture refers to injury of the tunica albuginea and subsequent extrusion of seminiferous tubules. It occurs usually in young men following high impact or sporting injuries. Prompt diagnosis is required, and treatment is time-critical to avoid testicular loss.

Clinical scenario
A 32-year-old man presented to the emergency department with scrotal pain five hours after a direct blow to the right scrotum whilst doing Ju-Jutisu. Examination revealed a tense, swollen and extremely tender right hemi-scrotum. An urgent testicular ultrasound confirmed a right complete capsular rupture with almost circumferential superior-pole tunical defect. The patient was promptly consented for scrotal exploration +/- right sided orchidectomy. Intra-operatively finding was a complete rupture of the right testes and considerable haematoma. A partial orchidectomy was performed, resecting all devitalised seminiferous tubules while the viable testicle was re-constructed with combined primary apposition of albuginea and a tunica vaginalis flap. The resulting cosmetic appearance was adequate. The patient was discharged home the following day, with antibiotics and his recovery was uncomplicated. At four weeks, the patient reported no further pain and post operative imaging was reassuring. He was pleased to avoid complete orchidectomy.

Discussion
Clinicians should have a high index of suspicion for testicular rupture following blunt trauma to scrotum. Patients are frequently anxious about loss of testes and the impact on self-image, fertility, and hormonal function. This case demonstrates that prompt urological review and early scrotal exploration can prevent testicular loss.
855 Mirror-Image Large Complex Odontomes
Authors: Budhdeo R , Graham A , Harrison M 
Published: August 2023

Abstract

Background
This report outlines a nine-year follow-up of two 10-year-old patients who attended the paediatric dental department reporting an absent mandibular first permanent molar (FPM). Both reported no pain, no familial history of hypodontia and no altered sensation in the inferior dental (ID) nerve distribution. Clinical examination revealed mandibular expansion in the unerupted tooth area.

Special Investigations
Panoramic jaw radiographs revealed extensive radio-opaque masses in the mandibular FPM area in both children, in mirror-image sites. Subsequent cone beam CT identified extensive displacement of the FPM with an associated large mixed radiopaque/radiolucent lesion in the body of mandible. Interestingly, the mandibular second permanent molar (SPM) was present in one case and absent in the other.

Diagnosis/Management
The provisional diagnosis for both cases was a complex odontome however, heavily calcified ameloblastic fibro-odontoma could not be excluded. Management involved surgical removal of the odontogenic tumour with FPM maintenance. Histopathology confirmed the diagnosis of a complex odontoma in both cases. On long-term review in both cases the FPM failed to erupt. Cystic follicular enlargement of the FPM in one case prevented eruption, and a coronectomy was performed in the other on the FPM apices were too close to the ID nerve to be extracted.

Discussion
These cases highlight the importance of monitoring dental eruption patterns in childhood. Despite the mirror image diagnosis, multiple factors were considered when identifying treatment options for each individual patient. Aetiological questions regarding this particular odontogenic tumour type are raised by the presence or absence of the SPM.
857 Congenital Pulmonary Airway Malformation: A Case Report of Concealed Malignancy
Authors: Ahmed R , Staunton L , Ryan R 
Published: August 2023

Abstract

Introduction
Congenital pulmonary airway malformation (CPAM) is a developmental disorder in which hamartomatous lesions arise in the lower respiratory tract. Large population data suggests the incidence to be between 0.87 and 1.92/10,000 live births. Adults most often present with persistent cough or recurrent LRTIs. Their rarity can lead to misdiagnosis as a cystic lesion.
Surgery is the intervention of choice for symptomatic patients. The role of expectant management in asymptomatic patients remains controversial. In adults, resection may be favoured as these lesions are prone to infection and malignancy develops in approximately 1%.

Method
We present the case of a 44-year-old woman, with shortness of breath and pleuritic chest pain. CT revealed a 9.7 x 5.4cm lucent lesion in the left lower lobe, initially identified as a large bulla or parenchymal cyst. Decision to resect was made post discussion with the patient, who was keen to proceed to surgery, due to ongoing symptoms.

Results
A left lower lobectomy was performed via VATS. She was discharged on post-operative day 6, made an excellent recovery on 6-week follow-up and has entered surveillance. Histopathology revealed that the cyst was partially lined with respiratory epithelium and palisading histiocytes; favouring a CPAM type 1 diagnosis. Microscopically, there were foci of mucinous lepidic adenocarcinoma.

Conclusions
It is important to consider CPAM in the differential for cystic lung diseases. Surgical resection should be considered for CPAM regardless of symptoms, due to the uncertainty in diagnosis from imaging alone and the potential for malignant change.
862 Successful Surgical Management of Chylothorax Secondary to Gorham-Stout Disease
Authors: Hyland L 
Published: August 2023

Abstract

Introduction
Gorham-Scout Disease (GSD) is a rare skeletal disorder of unknown aetiology characterised by progressive osteolysis and excessive lymphovascular proliferation. Chylothorax is a severe and life-threatening complication of GSD that confers a poor prognosis. Literature review reveals only one previous case of successful surgical management for chylothorax secondary to GSD.

Case presentation
A teenage asylum seeker presented with a large left pleural effusion on a background of chronic left flank collection secondary to lymphovascular malformation. Cytological analysis of the fluid drained from chest drain insertion confirmed a chylothorax. A posterior rib excision biopsy helped to confirm the diagnosis of GSD. She had VATS ligation of the thoracic duct and talc pleurodesis, however, due to recollection and ongoing symptomatic discomfort, she subsequently underwent left thoracotomy, decortication of lung and pleurectomy. These surgical interventions helped to stabilise the chylothorax with ongoing management for GSD related to radiotherapy and pain control via the administration of bisphosphonates.

Conclusions
GSD is a rare disease that can develop a number of severe complications including a chylothorax. Management via surgical and radiotherapeutic techniques can provide long term remission, however, other modalities may be needed in order to optimise analgesic requirements.
870 Benign Cystic Mesothelioma- a Rare Intra-Abdominal Tumour
Authors: Karagiannidis G , Powell A , Toquero L 
Published: August 2023

Abstract

Introduction
Benign cystic mesothelioma is a rare intra-abdominal tumour affects primarily women who are in reproductive. Since this pathology has a rare occurrence, a similar presentation, and similar imaging features, the diagnosis is based on histologic findings and there is no current standard treatment for this condition.

Presentation of case
In this case report, a 40-year-old female patient presented in the Emergency Department with a five-day history of right-sided, migratory, abdominal pain. She was systemically well, and her inflammatory markers were unremarkable. The patient was investigated for appendicitis, with a CT scan showing a multi-loculated cystic structure below the liver. Her case was discussed with the Basingstoke Peritoneal Malignancy Institute who felt this may demonstrate benign cystic peritoneal mesothelioma. As per their advice, and the thoughts of the local MDT team, the patient underwent a diagnostic laparoscopy, and the cystic mass was removed. The diagnosis of benign cystic peritoneal mesothelioma was then confirmed by histology.

Discussion
Based on literature, this is a rare and asymptomatic form of mesothelioma.Imaging is able to provide suspicion of this type of benign mesothelium, but only histological examination can provide a definitive diagnosis. Additionally, on review there are no guidelines regarding management and no standard treatment for this condition. The only effective treatment for a benign cystic mesothelioma is surgery, but no evidence-based strategies exist.

Conclusions
It is critical to publish more case reports on this condition once it is diagnosed in order to formulate guidelines and to advance towards a possible effective treatment solution.
915 Obturator Hernia: A Case Report of Intestinal Obstruction in a 79yo Male with Challenging Diagnosis and Non-Standardised Treatment
Authors: Finch B , Chishti I 
Published: August 2023

Abstract

Introduction
Obturator Hernia (OH) is a rare condition that accounts for &lt;1% of all abdominal wall hernias but is associated with the highest mortality and morbidity. OH in men are especially rare, with a male:female ratio of 1:14. Early surgical intervention is often delayed due to clinical and radiological diagnostic difficulties. At present, there are no international guidelines for treatment or best surgical approach to manage this condition.

Case Presentation
We present the case of an emaciated 79-year-old male with a 12-day history of right iliac fossa pain radiating to the right thigh, with a 2-day history of absolute constipation, vomiting and significant weight loss. This patient had a surgical history of elective right open inguinal hernia, on background of moderate-COPD. CT imaging revealed small bowel obstruction secondary to a small right obturator hernia containing a loop of small bowel. The patient underwent an exploratory laparotomy with intra-operative findings of 1cm defect in the right obturator foramen containing viable small bowel with incidental finding of right-sided femoral hernia; both defects corrected with PDS interrupted sutures. Iatrogenic perforation of the small bowel during hernia-reduction resulted in small bowel resection with primary anastomosis. The patient developed ileus requiring TPN post-operatively. During follow-up, there was no evidence of recurrence or further complications.

Conclusion
OH diagnosis is challenging owing to its rarity and non-specific presentation. Surgical intervention is the only definitive management for OH, thus awareness of this condition is crucial to allow an earlier approach and attempt to mitigate the associated high morbidity and mortality rates.
921 Cutaneo-Gastric Conduit Fistula Formation Following Oesophagectomy: A Rare Presentation of Anastomotic Leak
Authors: Campbell M , Gregorios C , Konstantinos P , Lamb G , Moorthy K , Bansi D , Ibrahim M A H 
Published: August 2023

Abstract
Anastomotic leak is a significant contributor towards postoperative morbidity and mortality following oesophagectomy occurring between 5-30%. Clinical presentation as cutaneo-gastric conduit fistula is extremely rare as reported in the present study.
A 60-year-old woman with previous right thoracotomy and lobectomy due to pneumonia underwent an Ivor Lewis oesophagectomy for a gastro-oesophageal junction adenocarcinoma. The operation was complicated by extensive adhesiolysis and 2.5L of blood loss requiring intra-operative transfusion. Postoperatively the patient developed acute respiratory distress syndrome (ARDS) from which she subsequently recovered. The integrity of the anastomosis was confirmed by oral contrast swallow and CT, after which the patient was discharged. Two weeks later, the patient was readmitted with right-sided chest pain and a swelling at the distal end of the thoracotomy scar. A purulent collection was identified and drained under interventional radiology. A repeat CT revealed the presence of a cutaneo-gastric conduit fistula originating from the anastomosis site. This was managed with endoscopic gluing of the gastric conduit wall defect and the application of a self-expanding metallic stent (SEMS) that was secured with an Apollo overstitch system to prevent migration. The patient was discharged with follow-up endoscopy confirming closure of defect.
This report highlights the rare complication of cutaneo-gastric conduit fistula after oesophagectomy, associated risk factors and the successful management with SEMS application secured with Apollo overstitch.
933 Inguinal Bladder Hernia: Case Report and Literature Review
Authors: Ravi V , Wilkins A 
Published: August 2023

Abstract

Background
Partial bladder herniation into the inguinal canal has an incidence of 1-3%. Most patients are asymptomatic, and diagnosis is made incidentally upon imaging or during surgical repairs. Complete herniation of the bladder and distal ureters is rare, and few cases of resultant acute kidney injury or hyperkalaemia have been reported. This case presentation includes preoperative and intra-operative images, and literature review.

Case presentation
A 73-year-old gentleman with longstanding bilateral inguinal hernia, benign prostatic hyperplasia, type 2 diabetes mellitus, and obesity presented with new-onset lower urinary tract symptoms and intermittent pain over his right inguinal hernia. His PSA (Prostate-Specific Antigen) was raised, and imaging identified bilateral hydronephrosis, and right inguinal hernia containing distal ureters and bladder. He was added to the waiting list for elective hernia repair.
Whilst awaiting repair, he was admitted with acute kidney injury and hyperkalaemia, which was managed with cardiac protection, urethral catheterisation, hydration, and serial blood tests. After stabilization, he underwent an open right inguinal hernia repair with mesh. His acute kidney injury resolved; however he failed trial without catheter (TWOC), and was discharged with a catheter pending TWOC clinic review. General Surgical Follow up is planned to discuss left inguinal hernia repair.

Conclusion
Awareness of bladder herniation into the inguinal canal is essential to avoid iatrogenic injury. Careful pre-operative planning and correction of physiological abnormalities is vital to ensure good surgical outcome. More unusual sequelae of untreated hernias are likely to become more frequent, if fewer elective hernias are performed.
982 Abdominal Wall Reconstruction Following Full Thickness Bilateral Rupture of the Rectus Abdominis
Authors: Suhail D , Smith O , Lim P , Chintapatla S 
Published: August 2023

Abstract

Introduction
Rupture of the rectus abdominis is a rarely seen condition and there is no consensus its management.

Case Description
A 20-year-old male presented with severe lower abdominal pain that occurred during exercise (i.e., ‘burpees’). MRI revealed full-thickness bilateral rupture of the rectus abdominis. Abdominal wall reconstruction involved bilateral rectus muscle repair using plastic surgical techniques and placement of a biosynthetic mesh (Phasix ST from BD) in the retrorectus plane. Postoperatively, our patient could walk pain-free at 3 weeks, jog pain-free at 10 weeks, and run up to 2 miles at 25 weeks.

Literature Review
There is no consensus on how to manage this rare injury or whether surgical or conservative treatment yields better results. Pubmed, Medline and Embase databases were searched to identify relevant studies using the following MeSH terms, “rectus abdominis” and “rupture”, as well as their free text counterparts. The search resulted in 391 articles. Manual cross-referencing was performed, limiting the included articles to 8 for review. 6 out of the 8 selected articles discussed management using conservative means, while only 2 cases were managed surgically. Interestingly, no other exercise-related cases in the literature were managed surgically. Instead, all exercise related cases were managed conservatively, while traumatic cases were managed surgically. Among both surgically and conservatively treated patients, all patients returned to normal levels of activity.

Conclusions
Full-thickness, bilateral rupture of the rectus abdominis can occur during exercise. Intervention depends on the size and severity of the injury, but surgical and conservative treatment yield similar results.
1001 A Case Report on Popliteal Artery Occlusion After a Low-Energy Trauma Years After Total Knee Arthroplasty
Authors: Kocyigit G Z , Yilmaz S , Usmanov N , Bertan T , Colkusu M , Guler İ , Singa D 
Published: August 2023

Abstract

Aim
To highlight the significance of dislocated total knee arthroplasty, which is more likely to happen after a low-energy trauma and can result in limb-threatening neurovascular complications and compartment syndrome, we present a case of mild trauma that resulted in the co-occurrence of the occlusion of the left popliteal artery and vein 10 years after the implantation.

Method
Three weeks after a low-energy fall on her knee at home, a 69-year-old woman presented to our orthopedics clinic with swelling, paresthesia, and paralysis in her left leg. She had edema and significant ecchymosis, and the tibial pulses in her left knee had vanished. She had uneventful bilateral knee arthroplasty surgery on her right and left knees six and ten years ago, respectively. Her medical history is significant for type 2 diabetes mellitus and hypertension. Doppler ultrasound and CT angiography showed occluded popliteal artery and vein. Following thromboembolectomy by cardiovascular surgeons, orthopedic surgeons underwent lower leg preventative fasciotomy under general anesthesia by creating two longitudinal incisions on either side of the tibia.

Results
Doppler ultrasonography on the fifth follow-up day revealed biphasic flow in the posterior tibial artery and monophasic flow in the dorsal tibial artery, however, the paralysis and paresthesia were still present. Ultimately, unilateral above-knee amputation was performed.

Conclusions
Due to the high level of concern for vascular injury and compartment syndrome, we advise physicians to consider popliteal artery injury while treating patients who underwent total knee arthroplasty years ago and present with minimal trauma.