Surgical Management of Gallstone Ileus: Approach, Outcome, Case Report, and Literature Review.

Gallstone ileus (GSI) is a condition caused by migrating gallstones lodged in the terminal ileum. Stone migration results from fistula formation, typically between the gallbladder and duodenum, termed a cholecystoduodenal fistula. This mechanical obstruction has high mortality and requires prompt intervention.

A Case of Robotic Cholecystectomy in a Patient With Decompensated Cirrhosis and Portal Hypertension.

In patients with liver cirrhosis, approximately one-third experience pigmented cholelithiasis. In parallel to this, cirrhotics consequently encounter a greater prevalence of acute cholecystitis. Traditionally, the definitive treatment for acute cholecystitis in non-cirrhotic patients is cholecystectomy.

A Delayed Presentation of Superior Mesenteric Artery Syndrome Treated With Robotic-Assisted Strong Procedure.

Superior mesenteric artery (SMA) syndrome, also known as Wilkie's syndrome, is a rare condition resulting from compression of the third portion of the duodenum between the aorta and the superior mesenteric artery. When symptomatic, this compression may result in nausea, vomiting, epigastric discomfort, and weight loss, requiring clinical attention and imaging to make the diagnosis. Typically, SMA syndrome presents in young females and is associated with an underlying condition such as anorexia nervosa, cachexia, postoperative development after scoliosis surgery, etc.

Gastric Leiomyoma Near the Gastroesophageal Junction Causing Massive Gastrointestinal Bleeding.

Leiomyomas are rare, slow-growing submucosal tumors originating from smooth muscle cells. They are typically benign when found in the gastrointestinal tract, and they present no risk for recurrence or metastasis. In this report, we describe the case of a 64-year-old female patient presenting with severe anemia, generalized fatigue, and intermittent dark tarry stools and who was found to have a bleeding gastric cardia mass one centimeter distal to the gastroesophageal junction (GEJ) on abdominal computed tomography and confirmed with an esophagoduodenoscopy.

Delayed Right Diaphragmatic Hernia With Chilaiditi Syndrome: A Case Report.

Diaphragmatic hernias can be congenital or acquired and manifest as a defect thus allowing abdominal contents to protrude into the thorax through the defect. Common presentations and symptoms can include shortness of breath, nausea, vomiting, and abdominal pain. Rarely colon or small bowel is interposed between the liver and the diaphragm, Chilaiditi sign.

Necrotizing Fasciitis of the Abdominal Wall Secondary to Complicated Appendicitis: A Case Report.

Acute appendicitis is one of the most common surgical emergencies worldwide. Many complications can occur secondary to complicated appendicitis including abscess formation, gangrene, sepsis, and perforation, rarely, leading to abdominal wall necrotizing fasciitis. The incidence of necrotizing fasciitis as a complication of ruptured appendicitis is extremely uncommon.

An Unusual Presentation of Cecal Volvulus With Internal Herniation Through the Foramen of Winslow.

Internal hernias through the Foramen of Winslow account for 0.1% of abdominal hernias and 8% of internal hernias, with a mortality rate of 36%-49%. Cecal volvulus accounts for only 1%-1.

Gabapentin as a Symptomatic Modifier in Median Arcuate Ligament Syndrome: A Case Report and Assessment of Treatment Modalities.

Median arcuate ligament syndrome (MALS) is a rare constellation of neurogenic gastrointestinal (GI) symptoms resulting from compression of the celiac trunk and celiac plexus by the median arcuate ligament. MALS is characterized by nonspecific symptoms including nausea, vomiting, diarrhea, bloating, unintentional weight loss due to food aversion, and postprandial epigastric abdominal pain. We present a case of atypical, chronic MALS that confounded clinicians for over a decade and led to various misdiagnoses, including early-onset Parkinson's disease.

Ruptured Hepatic Hemangioma in the Third Trimester of Pregnancy: A Rare Case Report.

Hepatic hemangiomas are considered the most common benign mesenchymal hepatic tumors. Most cases are asymptomatic. However, giant hemangiomas can present with a variety of clinical presentations, with a rupture being the most catastrophic outcome.

Giant Proximal Right Colon Submucosal Hematoma Leading to a Large Bowel Obstruction.

A 41-year-old female with a previous history of chronic obstructive pulmonary disease (COPD) and polycythemia presented to the emergency department with worsening shortness of breath and cough which progressed to respiratory distress requiring mechanical ventilation. During her hospital stay, she developed abdominal distention followed by a fever and a four-point decrease in hemoglobin. A non-contrasted abdominopelvic CT scan was ordered which showed a very large retroperitoneal hematoma adjacent to the right colon with subtle active bleeding.

Effectiveness of Bariatric Surgery in Increasing Kidney Transplant Eligibility in Patients with Kidney Failure Requiring Dialysis.

Purpose: Severe obesity can increase risk of complications after kidney transplantation. There is a paucity of literature on bariatric surgery outcomes in renal transplant candidates. The objective of this study was to analyze outcomes of bariatric surgery as a weight reduction strategy for patients with kidney failure to enhance eligibility for kidney transplantation.

Significance of Lung Weight in Cellular Ex Vivo Lung Perfusion.

Background: Currently, pulmonary edema is evaluated via surgical inspection and palpation in donor lungs, and there is no quantitative standard diagnostic tool for evaluating pulmonary edema in donor procurement and ex vivo lung perfusion (EVLP). The purpose of this study was to investigate the significance of lung weight at the donor hospital and lung weight during EVLP as a complementary parameter of transplant suitability in EVLP.

Materials And Methods: Twenty-one of rejected human lungs were perfused in cellular EVLP.

Impact of da Vinci Xi robot in pulmonary resection.

Background: This study sought to evaluate the impact of a da Vinci Xi surgical robot on perioperative outcomes after pulmonary resections.

Methods: A retrospective analysis of prospectively collected STS data was performed at a single institution for patients who underwent elective lung resections from 2012 to 2019. Patient outcomes were compared at three different time periods: before the adoption of the robot technology (predominately VATS), during the initial robot experience (the first 18 months), and after the mature robot experience (the second 18 months).

Selective Recruitment of Large Lower Lobe Atelectasis on Donor Back Table in Rejected Donor Lungs.

Background: Large atelectatic areas in donor lungs are frequently resistant to standard recruitment maneuvers, producing a tenaciously low PO/FiO ratio. The aim of this study is to investigate the optimal protocol for the recruitment of large atelectatic areas in the context of ex vivo lung perfusion (EVLP).

Methods: Seventeen rejected lungs with large lower lobe atelectasis (≥40%) were divided into 2 groups: manual resuscitation (n = 5) and selective recruitment (n = 12).

Mucinous Histology Signifies Poor Oncologic Outcome in Young Patients With Colorectal Cancer.

Background: The incidence of colorectal cancer in the young (under age 40) is increasing, and this population has worse oncologic outcomes. Mucinous histology is a potential prognostic factor in colorectal cancer, but has not been evaluated specifically in young patients.

Objective: The objective of the study was to determine factors associated with poor outcome in young patients with colorectal cancer (≤40 years) and to determine relationships between mucinous histology and oncologic outcomes in this population.

Lipid metabolism and functional assessment of discarded human livers with steatosis undergoing 24 hours of normothermic machine perfusion.

Normothermic machine perfusion (NMP) is an emerging technology to preserve liver allografts more effectively than cold storage (CS). However, little is known about the effect of NMP on steatosis and the markers indicative of hepatic quality during NMP. To address these points, we perfused 10 discarded human livers with oxygenated NMP for 24 hours after 4-6 hours of CS.

Developing a protocol for normothermic ex-situ limb perfusion.

Background: Ischemia time represents a significant limitation for successful extremity transplantation because of the rapid deterioration of ischemic muscle. Normothermic ex-situ preservation is an emergent method to prolong the organ viability following procurement, by replicating the physiologic conditions. The aim of this study was to develop an ex-situ normothermic limb perfusion system to preserve the viability and function of porcine limbs for 12 hours following procurement.

Comparison of normothermic and hypothermic perfusion in porcine kidneys donated after cardiac death.

Background: Normothermic machine perfusion (NMP) is an alternative strategy for preserving kidneys donated after cardiac death (DCD). The relative efficacy of prolonged NMP compared to hypothermic machine perfusion (HMP) in DCD kidneys with moderate ischemic injury is undetermined. This study compares NMP and HMP kidney preservation in a porcine DCD model.

Management of Crohn's Disease in the New Era of Gut Rehabilitation and Intestinal Transplantation.

Despite recent therapeutic advances, patients with Crohn's disease (CD) continue to experience high recurrence with cumulative structural damage and ultimate loss of nutritional autonomy. With short bowel syndrome, strictures, and enteric fistulae being the underlying pathology, CD is the second common indication for home parenteral nutrition (HPN). With development of intestinal failure, nutritional management including HPN is required as a rescue therapy.