Prenatal and Postnatal Manifestations of Congenital Chloride Diarrhea Due to a Heterozygote Variant of the SLC26A3 Gene: A Case Report

Congenital chloride diarrhea (CCD) is caused by a recessive mutation in the SLC26A3 gene and characterized mainly by watery diarrhea, hypochloremia and metabolic alkalosis. Various different mutations in SLC26A3 are responsible for the disease. In the prenatal period, the symptoms of CCD may include polyhydramnios, preterm labor and abdominal distension. The main feature of CCD is chloride-rich diarrhea, which leads to excessive loss of fluid and salt immediately after birth and is followed by weight loss and dehydration. Hyponatremia and hypochloremia are soon accompanied by hypokalemia and metabolic alkalosis. Untreated CCD is fatal even in the first weeks of life. Diagnosis is made by high fecal chloride concentrations in patients with serum electrolytes corrected by salt substitution and confirmed using genetic testing of peripheral blood samples. Here, we detail prenatal and postnatal manifestations of a preterm infant, born via Caesarian section, who was suspected to suffer intrauterine bowel obstruction. Upper median laparotomy was performed and no intestinal abnormalities found. The course of the neonatal period was complicated by severe diarrhea with hypochloremia, hyponatremia and metabolic alkalosis. Based on the patient's clinical picture and stool examination, a diagnosis of CCD was established. Mutation of the SLC26A3 gene was confirmed using genetic testing.

The First Case of Simultaneous Surgical Procedure for Mitral Valve Disease and Esophageal Cancer

Cardiological patients with malignant tumors belong to a complex category of patients. We present the world’s first case of simultaneous surgical treatment of severe mitral valve disease and esophageal cancer. The patient underwent simultaneous replacement of the mitral valve and the Ivor-Lewis procedure using right thoracotomy and upper midline laparotomy. The patient underwent 3 courses of chemotherapy (paclitaxel and 5-fluoroucil). Follow-up for 8 months showed no signs of tumor recurrence or cardiac problems. A dextral thoracotomy with the lung deprivation, supplemented by an upper median laparotomy, achieved us convenient access to the mitral valve and to all parts of the esophagus, including groups of compromised lymph nodes. This case demonstrates the modern possibilities of simultaneous cardio and oncosurgery that allows eliminating competitive fatal diseases in 1 surgical and anesthetic intervention.

Clinical, surgical, and radiographic aspects in a white‑eared opossum (Didelphis albiventris) with traumatic diaphragmatic hernia

This is the case of a specimen of Didelphis albiventris with signs of respiratory difficulty after a dog attack. Thoracic radiographic examination revealed pneumothorax, pulmonary contusion, and rib fracture, but no alteration compatible with diaphragmatic hernia was observed. Pneumothorax was reduced and the other alterations were treated. However, clinical manifestations persisted, and thus a contrast-gastrointestinal radiographic study was performed, showing abdominal organs in the thoracic cavity and loss of diaphragmatic line. The surgical approach was instituted, with access to the diaphragm through median laparotomy. Through the diaphragmatic rupture, present in the left antimere, there were herniated liver and gastric portions, intestinal segments, and omentum. After inspection and repositioning of the abdominal organs, the diaphragm raffia was performed with single sutures interrupted with 3-0 Nylon thread. The patient’s complete recovery occurred 14 days after the surgical procedure, with remission of clinical manifestations and normality of thoracic images in radiographic studies.

Retrograde Catheterization of the Superior Mesenteric Artery and Celiac Axis as a Bailout Technique in a Complex FEVAR

Introduction: A retrograde approach of the celiac trunk (CT) and superior mesenteric artery (SMA) to catheterize the visceral vessels during a fenestrated endovascular aortic reparation (FEVAR) is a feasible option when standard access techniques have failed. Report: In this report we describe a patient with a previous endoluminal repair of an infrarenal aortic aneurysm, complicated by a persistent type 1a endoleak despite treatment with endoanchor fixation. A decision was made to proceed with a proximal 4 vessel FEVAR to treat the type 1a endoleak. Due to angulation of the mesenteric vessels, and a rotation of the fenestrated stent graft during deployment, the CT and SMA were unable to be catheterized. A decision was made to perform a median laparotomy for retrograde access of the aforementioned vessels, allowing successful catheterization and stenting. The patient was discharged 30 days following the procedure, without any major post-operative complications. Follow up at 6 weeks with a contrasted enhanced computerized tomography scan showed a stable repair with no residual type 1a endoleak. Discussion: Catheterization of the target vessels during a FEVAR can be difficult, especially in patients with challenging anatomy. Prolonged surgical time in an attempt to catheterize the vessels can result in increased morbidity for the patient, and ultimately may result in the procedure being abandoned or conversion to an open repair of the aneurysm. Retrograde access of the target vessels as a bailout measure during fenestrated stent graft repair due to failure of an antegrade approach has rarely been reported in the literature. Only a few cases are described in the available literature, however, none of them describe retrograde approach of both the CT and SMA as described in this case. A median laparotomy for retrograde access is a feasible alternative in these situations, and should be considered if the patient is suitable.

A case of a common bile duct stone that formed around a fish bone as a nidus after distal gastrectomy with Roux-en-Y reconstruction

Background The presence of a foreign body in the common bile duct (CBD) is a rare phenomenon. Thus, the route and mechanism of its migration remain difficult to fully clarify, especially for cases that occur after gastrectomy with Roux-en-Y reconstruction. Herein, we present a case of a CBD stone that formed around a fish bone as a nidus subsequent to distal gastrectomy with Roux-en-Y reconstruction. Case presentation A 70-year-old man was admitted to our hospital due to repeated episodes of epigastralgia. He had undergone distal gastrectomy with Roux-en-Y reconstruction for gastric cancer approximately 10 years prior. Blood tests revealed obstructive jaundice, hepatobiliary dysfunction, and inflammation. Multi-plane reconstructed computed tomography (CT) revealed a CBD stone with a needle-shaped calcification density at the center, oriented along the length of the CBD. Surgery was performed using an upper median laparotomy approach. Lithotomy with choledochotomy was performed to remove one fragile bilirubin stone that had formed around a 3-cm, needle-shaped fish bone. A choledochoduodenal fistula was not detected intraoperatively. A review of the imaging of a prior examination revealed that the formation of the CBD stone around the fish bone was observable on a follow-up CT performed approximately 2 years prior. However, no clinical symptoms associated with the migration of the fish bone to the CBD were reported and the fish bone was not detected at that time. Conclusion In this case, transpapillary migration of the fish bone could only be speculated in the absence of an observable fistula, choledochostomy, or any clinical symptoms. Our case is clinically relevant as cholangitis developed after CBD stone formation around the fish bone that acted as a nidus.

Prevention of ventral hernias using a new technique for accessing the abdominal cavity through the midline of the abdomen with dissection of the navel and umbilical ring: comparison with traditional laparotomy

The problem of postoperative ventral hernias remains relevant due to the high frequency of their development — in 7–24% of patients. Aim. To evaluate the effectiveness of prevention of postoperative ventral hernias using a new technique of access to the abdominal cavity in comparison with traditional laparotomy. Materials and methods. The proposed new technique of access to the abdominal cavity along the midline of the abdomen with dissection of the navel and umbilical ring was carried out in accordance with the method developed by us, registered by the patent of the Russian Federation. For the final analysis, 134 patients were selected, divided into group 1 (n = 67), in which the median access was performed using a new technique, and group 2, in which the traditional median access was performed with the left umbilical ring bypass (n = 67). The initial parameters of patients, characteristics during and after surgery were evaluated. The duration of follow-up after surgery was 24 months. Results. Groups 1 and 2 were comparable by gender, age, body mass index, and the presence of comorbidities. In 79% of patients in group 1 and in 67% of patients in group 2 (the difference is not significant), indications for surgery were malignancies of the abdominal cavity. The groups did not differ in the types of median laparotomy, the time of surgery, the amount of blood loss, the time of removal of postoperative sutures, and the duration of hospitalization. All patients were followed up for 24 months. Postoperative ventral hernia developed in one patient (1.5%) in group 1 and in 5 (7.5%) patients in group 2 within 12 to 24 months after surgery. There were no statistically significant differences in the frequency of hernia development (Mantel — Cox test, p = 0.100) Conclusion. A new method of median laparotomy in the treatment of patients with planned surgical pathology of the abdominal cavity is characterized by a low rate of postoperative hernia development.

Migración de funduplicatura gástrica con perforación intratorácica

The laparoscopic antireflux surgery is considered the gold standard for the treatment of gastroesophageal reflux disease and hiatal hernia. The postoperative results show a low associated morbidity and mortality and good satisfaction in the medium long term. We present the clinical case of a 53-year-old patient who underwent Nissen-Rossetti laparoscopic fundoplication who, on the twelfth postoperative day, presented with mediastinitis associated with sepsis due to intrathoracic perforation of the gastric fundoplication migrated to the chest. The patient was operated on urgently, performing thoracic drainage, supra-umbilical median laparotomy and primary closure of the perforation. The postoperative period is characterized by a 23-day stay in the intensive care unit and by necrotizing pneumonia, lung abscesses, and left pleural empyema. Ten years after the episode, the patient is asymptomatic and has no signs of clinical recurrence. The laparoscopic antireflux surgery is considered the gold standard for the treatment of gastroesophageal reflux disease and hiatal hernia. The postoperative results show a low associated morbidity and mortality and good satisfaction in the medium long term. We present the clinical case of a 53-year-old patient who underwent Nissen-Rossetti laparoscopic fundoplication who, on the twelfth postoperative day, presented with mediastinitis associated with sepsis due to intrathoracic perforation of the gastric fundoplication migrated to the chest. The patient was operated on urgently, performing thoracic drainage, supra-umbilical median laparotomy and primary closure of the perforation. The postoperative period is characterized by a 23-day stay in the intensive care unit and by necrotizing pneumonia, lung abscesses, and left pleural empyema. Ten years after the episode, the patient is asymptomatic and has no signs of clinical recurrence. Although the incidence of early complications in antireflux surgery is relatively low, it is mandatory to suspect them in a patient with sepsis due to mediastinitis and recent surgery. In front of extremely serious situations, it is necessary to intervene urgently, although the surgical re-exploration of the hiatus is considered a complex surgery with a high risk of iatrogenesis.

Complications associated with closure of the linea alba using a combination of interrupted vertical mattress and simple interrupted sutures in equine laparotomies

Objectives(1) Evaluate the occurrence and variables associated with incisional morbidities (IMs) after ventral median laparotomy when using interrupted vertical mattress sutures (IVMS) and (2) determine the occurrence of abdominal bandage-associated complications in horses.MethodsOccurrence of IM and bandage-associated complications were determined after single laparotomies (SL group; n=546 horses) and repeat laparotomies (RL group: multiple laparotomies within four weeks; n=30 horses) in horses that survived ≥7 days postoperatively. Univariate analysis and multivariate logistic regression were performed to evaluate variables associated with IM.ResultsThe IM rate was 9.52 per cent in the SL group and 33.33 per cent in the RL group. The actual infection rate was 5.31 per cent in the SL group and 26.67 per cent in the RL group. Overall, long-term clinically relevant wound complications was 1.68 per cent. After multivariate analysis, increased anaesthesia duration was associated with IM and performing an enterotomy and postoperative intravenous lidocaine administration were associated with incisional infection in the SL group; no parameter remained significant in the RL group. Bandage-related complications were recorded in 2.95 per cent of the cases.ConclusionsThese results suggest that the use of IVMS for closure of the linea alba is another viable option for closure and that an abdominal bandage does not appear to cause significant complications.

Pleuroperitoneal true diaphragmatic hernia of the liver in a cat

A 2-year old female domestic shorthair cat was referred with intermittent vomiting. Laboratory analyses revealed only an elevated alanine aminotransferase activity. Plain thoracic radiographs showed a right-sided transdiaphragm protrusion of a liver lobe into the thoracic cavity. On abdominal ultrasound the diaphragm and liver parenchyma also presented a bulge towards the thoracic cavity. By cranial median laparotomy herniation of the quadrate liver lobe through the right aspect of the diaphragm into the thoracic cavity was confirmed. The protruding quadrate liver lobe was covered by intact parietal peritoneum. Following relocation of the liver lobe the defect was closed. Postoperatively the intermittent vomiting stopped. The purpose of this case report was to present plain radiography and abdominal ultrasonography as effective tools in the diagnosis of this rare and usually asymptomatic true herniation case along with its operative treatment.