Mesogastric Region Research Articles

Gossypiboma secondary to ovariohysterectomy in a dog

In veterinary medicine, intra-abdominal foreign bodies are a possible secondary complication of surgical procedures. Gossypiboma is defined as a forgotten textile material after surgery and is considered rare in veterinary medicine because most cases go unreported. The objective of this work is to report the diagnosis of an intra-abdominal gossypiboma in a dog, secondary to theovaryhysterectomy procedure. A 10-year-old Labrador dog had been sterilized about eight years ago. During the clinical analysis, a firm-looking increase in volume was found in the right mesogastric region, without the presence of pain on palpation. For further investigation, the patient was referred for additional imaging tests, such as x-ray and ultrasound. During inspection of the abdominal cavity, a firm circular mass was observed adhered to the omentum and jejunum, caudal to the right kidney. Resection of the mass was performed, and then the mass sample was sent for histopathological examination, which revealed an encapsulated foreign body, consistent with surgical gauze. Gossypiboma is one of the possible complications in surgical procedures in the abdominal cavity, but it is rarely reported in the veterinary literature.

MACROSCOPIC AND MICROSCOPIC FEATURES OF FIREARM PENETRATING ABDOMINAL INJURIES WITH DAMAGE TO THE APPENDIX

Introduction. In the structure of combat abdominal trauma during all periods of hostilities (according to ATO/JFO data), gunshot wounds dominated, accounting for 87.1%. An analysis of the distribution of those injured with gunshot wounds by the type of projectile causing the injury showed a prevalence of shrapnel injuries over bullet wounds – more than 80%.
 The aim of the research was to analyze the macroscopic and microscopic changes in firearm penetrating abdominal injuries with damage to the appendix.
 Materials and Methods. Eight appendectomies were performed due to firearm penetrating abdominal injuries with damage to the appendix. Complaints, medical history, examination data, ultrasound examination according to the FAST protocol, and radiological examinations were studied in all injured patients. To refine the diagnosis and determine the scope of surgical intervention, the WOLF videoendoscopic system was used.
 Histological examination of the removed appendices was performed, which were stained with hematoxylin and eosin and with the Van Gieson stain. A complex of pathomorphological studies was conducted using the Primo Star microscope (Carl Zeiss) at a magnification of ×140.
 Results. All injuries occurred while wearing a bulletproof vest and were characterized as blind, with 1 (12.5%) being gunshot wounds and 7 (87.5%) being shrapnel wounds. The entrance wound in firearm blind penetrating abdominal injuries with appendix damage was located in the right hypochondriac region – 4 (50%), right flank – 1 (12.5%), right inguinal region – 2 (25%), and mesogastric region – 1 (12.5%) cases. The average size of the entrance wound on the skin was 23.3±0.4×12.4±0.3 cm. All skin wounds were outside the bulletproof vest protection area.
 The injuries to the appendix had an average size of 15.4±1.2×9.3±0.1 cm. All removed foreign bodies were larger than 1 cm in their largest dimension.
 Conclusions. In most cases of firearm penetrating abdominal injuries, damage to the appendix is noted with an entrance wound predominantly on the right side. Macroscopically, in firearm blind penetrating abdominal injuries with appendix involvement, the wound on the skin is larger than on the appendix. All foreign metal bodies removed from the abdominal cavity after firearm shrapnel blind abdominal injuries with appendix involvement were of large size. Contusional injuries to the appendix tend to undergo destructive transformation, requiring surgical treatment - appendectomy. The increased frequency of appendix injuries can be explained by the widespread use of shrapnel ammunition in abdominal injuries when personal protective equipment does not provide protection for this area.

Do Small Scars Lead to Better Results? Analysis of Long-term Outcomes and Satisfaction of Patients Undergoing Anchor-line Abdominoplasty Following Massive Weight Loss.

Do smaller scars lead to higher patient satisfaction? The aim of this study is to analyze long-term satisfaction of patients who underwent abdominoplasty after massive weight loss. Patients inclusion criteria: no previous abdominal remodeling procedures, previous bariatric surgery followed by a weight loss of at least 30 kg, weight stability for at least one year, good understanding of the Italian language and standardized pre- and postoperative photographs. We divided the population in 2 groups based on the surgical procedure: group 1, conventional abdominoplasty, and group 2, anchor-line abdominoplasty. All patients presented scars in the epigastric and mesogastric region resulting from previous laparoscopic or laparotomic bariatric surgery and/or other laparoscopic or laparotomic procedures. At least 2 years after surgery, we administered the Italian version of the post-operative BODY-Q module and the SCAR-Q questionnaire. We enrolled 20 males and 69 females aged between 25 and 55 years, with a mean follow-up of 2 years. Analyzing the questionnaires, it resulted that patients undergoing anchor-line abdominoplasty were significantly more satisfied in the body perception of the result (p = 0.035) and in the satisfaction with abdomen domain (p = 0.0015) compared to the conventional abdominoplasty group. Scars assessment with the SCAR-Q did not show any significant differences between the groups. Despite its long scars, the anchor-line pattern shows an overall higher satisfaction, due to the possibility of reducing the abdomen both cranio-caudally and circumferentially. These findings might be an important guide when approaching abdominoplasty in post-bariatric patients, debunking the myth "shorter is better". This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Gastrointestinal Stromal Tumor in a Patient with Neurofibromatosis Type I: Diagnosis after Intestinal Occlusion Secondary to Adhesions after an Episode of Pancreatitis

Introduction: Gastrointestinal stromal tumors (GIST), although relatively rare, account for 80% of mesenchymal tumors of the digestive tract. They manifest in any part of the alimentary tract and are derived from Cajal cells. They may occur sporadically or be associated with familial syndromes such as neurofibromatosis type I. The clinical picture is variable, and they are often diagnosed incidentally. The diagnosis requires imaging tests associated with histopathological and immunohistochemical analysis. The best strategy for treatment is surgical resection and cases should be analyzed individually to verify additional advantages with the association of systemic therapy. This study aims to present an unusual case of GIST associated with neurofibromatosis type I in a patient with incidental diagnosis after semi-intestinal occlusion secondary to an episode of pancreatitis, in addition to performing a literature review on the subject. Case report: A 49-year-old woman with a history of severe pancreatitis presented with intestinal obstruction approximately 8 months after this episode. Abdominal computed tomography revealed a heterogeneous formation in the mesogastric region, measuring 6.6 x 5.1 x 5.3 cm. She underwent surgical resection and histopathological and immunohistochemical studies confirmed the diagnosis of GIST. Six months after diagnosis, the patient is in good general condition and is on systemic therapy. Conclusion: GIST are rare tumors, but their diagnosis should come to mind in patients with neurofibromatosis type 1 with abdominal masses.

Desmoid-type fibromatosis of transverse mesocolon

Desmoid tumors represent a rare disease. The recommendations for treatment and approach of these neoplasms are sparse. There are no specific imaging or clinical features which turns the diagnosis difficult. A 53-year-old male patient presented with complaints of peri-umbilical abdominal pain associated with a palpable mass. CT scan revealed a heterogeneous mass with soft tissue density and well-defined contour with approximately 8.5×7×5.3 cm localized in the mesogastric region with apparent origin in the transverse colon. The purposed etiology was of GIST. Colonoscopy was normal. The patient was submitted to surgery which revealed a mass with bright and smooth surface that was in relation with the mid portion of the transverse colon, we performed a right extended hemicolectomy. The postoperative was uneventful. Pathology evaluation revealed a desmoid-type fibromatosis. The accurate etiology of desmoid tumors is still unknown. Desmoid tumors are rare with an annual incidence of 2-4 cases per million people. They typically are slow growing fibrous soft tissue tumors with a benign behavior, however show local aggressiveness with a high ability for recurrence, complete surgical resection with clear margins is crucial.

Результати діагностики гострого апендициту у вагітних

The purpose of the study was to evaluate the diagnostic effectiveness of clinical symptoms of acute appendicitis in non-pregnant and pregnant women at different stages of gestation. Materials and methods. 124 patients with a diagnosis of acute appendicitis were examined. All patients were divided into 2 groups. The first group consisted of pregnant women of different gestational ages, the second group – comparison group consisted of non-pregnant women. The informativeness of such symptoms as Kocher-Volkovich, Rovzing, Bartomier-Michelson, Sitkovsky, Gabay, Brando, Michelson, Ivanov has been studied. Results and discussion. Pain syndrome was noted in all examined women of groups 1 and 2. The localization of pain in women of group 1 was varied and depended on the term of pregnancy. Most often the pain was observed in the epigastrium, followed by dislocation in the right iliac region. There was a significant decrease in the manifestations of such migration with each subsequent trimester. From the second half of pregnancy, pain in acute appendicitis was more often localized in the upper abdomen, namely in the right mesogastric region. There was a tendency to increase the frequency of pain in the right hypochondrium with increasing gestational age. In a small number of women, the pain was not clearly localized, was less pronounced. Pain in the lower abdomen, namely in the pubic and right groin areas was observed in isolated cases and only in early pregnancy. In women of group 2 in most cases the localization of pain was observed in the epigastrium with subsequent migration to the right iliac region. All symptoms had different qualitative characteristics. For non-pregnant women, the most informative were the symptoms of Kocher-Volkovich, Rovzing, in particular, their characteristics such as accuracy, sensitivity and efficiency, the level of which significantly exceeded the corresponding values in pregnant women. The diagnostic efficacy of symptoms such as Bartomier-Michelson and Sitkovsky was significantly higher in the group of pregnant women. The frequency of symptoms of acute appendicitis, which are characteristic of the pregnancy of Brando, Michelson and Ivanov, was maximal in the second trimester. Conclusion. Thus, the pain was accompanied by acute appendicitis in all women of both groups. The location of pain in pregnant women varied depending on the gestational age. Significant are specific clinical symptoms: Bartomier-Michelson, Sitkovsky, Brando, Michelson, Ivanov in the correct diagnosis of acute appendicitis in pregnant women. They should be considered as characteristic symptoms of acute appendicitis during pregnancy

Right portal vein thrombosis from idiopathic cause: case report

The aim of this study was to describe the case report of a 33-year-old girl with portal vein thrombosis. J.S.D.F., 33 years old, female, previously healthy, with a personal and family history negative for thromboembolic phenomena, without comorbidities, started with severe abdominal pain in the mesogastric region, radiating to HCD and back, associated with vomiting. Smoking active for about 20 years and using OC for 2 years. In view of the symptoms, she sought emergency services, where the first suspicion would be pancreatitis. Initial tests plagued leukocytosis. GUS of the total abdomen with doppler and CT of the abdomen showed the presence of thrombus in the right portal vein, with no other alterations. Rocefin® and metronidazole as an initial measure in the service began in addition to full coagulation with Clexane®. It showed clinical and laboratory improvement, with a reduction of leukocytes. The patient remained hospitalized in a hospital for 22 days to investigate the etiological cause. After of hospitalization, the patient was released with medical discharge, with guidelines for seeking the hematology service. During the investigation consultations, the results of the requested tests were negative for the diagnostic suspicions of nocturnal paroxysmal hemoglobinuria and chronic myeloproliferative disease. After 6 months of follow-up, she was discharged from the hematology service because she did not present a suspected disease and classified the cause of thrombolytic event as idiopathic associated with the combined use of OC and smoking.

Manifestation of Abdominal Lymphoma as Retroperitoneal Fibrosis in a Child: A Case Report

Non-Hodgkin’s lymphoma includes 60% of lymphoma cases in children and adolescents. Burkitt’s lymphoma and diffuse large B-cell lymphoma (DLBCL) patients usually have intra-abdominal tumors. Non-Hodgkin’s lymphoma (NHL) may present as retroperitoneal fibrosis (RF). In the present paper, a 7-year-old boy was reported who was hospitalized in our hospital because of stomachache, vomiting, and weight loss. In the patient’s history, it was found that 3 weeks ago, the patient complained of flank pain and suspected kidney stones, but urethroscopy revealed that he did not have kidney stones. After admission to our hospital, upon the examination of the abdomen, we noticed a palpable mass in the patient’s epigastric region. Diagnostic laparoscopy was performed, and a large number of hard lesions similar to fibrosis were detected in the mesogastric region, the first part of the small intestine, the head of the pancreas, and the liver. Finally, DLBCL was diagnosed in this patient.

A RARE FORM OF PRESENTATION OF A SMALL INTESTINE GIST IN THE EMERGENCY DEPARTMENT

Gastro-intestinal stromal tumors are a form of mesenchymal tumors most commonly located in the gastro-intestinal tract, as the name suggests. The symptoms that might occur can be abdominal pain or discomfort, early satiety, bloating, jaundice, fatigue, hematemesis or melena. Most of GISTs (>95%) are positive for the KIT protein. Surgery remains the only curative treatment for GIST amenable for resection. High risk tumors can receive adjuvant or neoadjuvant treatment with Imatinib Mesylate, a tyrosin-kinase inhibitor. We present the case of a 59-years old patient that presented with rectal bleeding and abdominal diffuse pain. Blood tests shows leukocytosis and moderate anemia. CT scan describes an expansive, polycyclic process projected at the limit between the mesogastric region and the left flank, in close contact with the small intestine without any clear demarcation line between them and at the superior pole of the tumor, located in an enteral loop, a band of hyperdensity with net contour. Intraoperative, an extraluminal jejunal tumor was found, located at 15 cm from the duodeno-jejunal flexure, with intraluminal active bleeding, which lead us to suspect a GIST based on the macroscopic aspect. We performed segmental enterectomy of 10 cm of the small intestine containing the tumor with entero-enteral anastomosis end to end. The histopathological and immunohistochemistry examinations correlated with the macroscopic aspect have confirmed the diagnosis of GIST.

Gastrointestinal Stromal Tumor Associated with Hypertrophic Osteopathy in a Dog

Background: Gastrointestinal stromal tumor (GIST) is a malignant mesenchymal neoplasm rarely described in the veterinary routine. The aim of this study was to report a case of GIST accompanied by a periosteal reaction, suggestive of hypertrophic osteopathy, in a dog.Case: An 11-year-old male dog had a history of progressive weight loss, difficulty in locomotion, and dyspnea. During clinical care, increased bone volume was observed. Blood samples were collected for a complete blood count and biochemical analysis. The dog also underwent thoracic radiography and abdominal ultrasonography. The test results revealed anemia, leukocytosis, hypocalcemia, hypoalbuminemia, and hypocholesterolemia. The radiographic images of the limbs showed a generalized periosteal reaction, and thoracic radiography indicated changes compatible with mild chronic lung disease. Ultrasonographic findings indicated a neoformation in the intestinal loop of the right mesogastric region and increased volume in the left testicle, both of which were indicative of neoplasia. Therefore, the dog was referred for surgery, wherein the intestinal mass and both testes were removed; the intestinal mass and left testicle were subjected to histopathological diagnosis. The results of the biopsies confirmed that the testicular neoplasm was a seminoma, whereas the intestinal nodule was compatible with GIST, and immunohistochemical analysis was necessary to confirm the diagnosis. On the basis of positive labeling for the antibodies vimentin, desmin, S100, and c-kit, the diagnosis of GIST was confirmed. Therefore, the animal underwent metronomic chemotherapy with 12 mg/m2 cyclophosphamide every 24 h for 3 months, and thereafter every 48 h for 6 months. Moreover, the dog was periodically monitored via imaging (radiography of the anterior and posterior limbs, abdominal ultrasonography, and computed tomography). A few months after the surgical resection of the intestinal nodule, radiography revealed that the periosteal reactions had disappeared, but ultrasonography revealed nonspecific alterations of mild thickening and enlargement of the intestinal loops. Computed tomography revealed two nodular areas of soft-tissue attenuation in the right mesogastric region. Although the possibility of tumor recurrence was raised, the animal’s owner chose only to perform palliative treatment. After 4 months, ultrasonography revealed a neoformation in the right mesogastric region. On July 29, 2018 the animal had a worsening of its clinical condiction, with tumor recurrence by ultrasound exam. The owners didn´t accept returning to the oncologist and made an option for a conservative treatment with tramadol (3 mg/kg/TID), dipirone(25 mg/kg/TID), and vitaminic supplement based on docosahexaenoic acid plus eicosapentaenoic acid (30 mg/kg, once daily) On August, 28, 2018 he was euthanized. The dog’s postsurgical survival time was 15 months.Discussion: The dog described in the present report was large and elderly, both of which are predisposing factors for GIST development. Although non-specific, progressive weight loss may be associated with intestinal neoplasia, owing to the impairment of digestion and nutrient absorption, because a part of the duodenal mucosa was compromised by neoplasia. The difficulty in locomotion, which did not respond to treatment, was attributed to the periosteal reaction confirmed by radiographic exam. This, in turn, was associated with hypertrophic osteopathy secondary to neoplasia, because the condition regressed after the removal of the intestinal nodule. The histopathological findings related to intestinal neoplasia were suggestive of GIST; positive immunoblotting for c-kit, vimentin, S100, and desmin confirmed the diagnosis. Although the veterinarian alerted the owner to the suspicion of recurrence and suggested continuing treatment, the owner chose not to.

Müller´s Duct Persistence Syndrome Associated with Cryptorchidism, Sertoli Cell Tumor and Pyometra in a Miniature Schnauzer

Background: Sexual development disturbances (SDD) are divided in SDD with XX genotype (SDD XX) and SDD with XY genotype (SDD XY). Among SDD XY, the Müller´s duct persistence syndrome (MDPS) is characterized by XY karyotype individuals with male external genitals; however, with internal female reproductive organs such as uterine horns, uterus, and cranial vagina portion. The MDPS cases and their related complications are considered very rare in veterinary medicine. The aim of the present case report is to describe the clinical and pathological aspects of a MDPS case associated with cryptorchidism, Sertoli cell tumor, and pyometra in a Miniature Schnauzer dog.Case: A 7-year-old male Miniature Schnauzer weighting 7 kg was brought to veterinary consultation due to owner´s complain of frequent vomiting, apathy, abdominal algia and progressive scrotal enlargement in the last two months. Physical exam reveals hyperthermia (39.7°C), discrete dehydration, enlarged popliteal lymph nodes as well as scrotum enlargement with only one palpable testicle. A blood sample collected for complete blood count showed regenerative anemia, thrombocytopenia, and neutrophilia with left shift in the leukogram. Abdominal ultrasound examination indicated the presence of a tubular structure filled by anechoic content extending from the scrotum to caudal abdomen. Moreover, a 6.39 x 8.54 cm heterogeneous mass in the medial mesogastric region became evident. The patient was hospitalized and submitted to exploratory laparotomy after 24 h due to rectal temperature increase (41°C), worsened abdominal pain and intense apathy. There was free purulent liquid in abdominal cavity and two uterine horns were documented. The left uterine horn passes through inguinal ring and both horns were filled by purulent material. At the right uterine horn extremity there was the mass previously document at ultrasound. The structures were removed and sent to histopathological examination. The microscopic exam confirmed testicular and uterine tissue; furthermore, a Sertoli cell tumor and pyometra were also characterized. The dog was kept at the hospital receiving fluid, antibiotics, analgesics, and anti-inflammatory therapy. After five days the animal was discharged with clear clinical recover. A sample for karyotyping was collected from the oral mucosa which reveals a XY karyotype in the dog. By this way it was concluded that the dog suffers from a SDD XY with MDPS associated to cryptorchidism, Sertoli cell tumor and pyometra. Discussion: The MDPS cases are often associated with cryptorchidism and testicular tumors. Miniature Schnauzers is one of the most affected dog breeds with this condition, and the heritability pattern is already described. Most cases are identified in adult to old-aged dogs after vague clinical signs investigation such as apathy, anorexia and abdominal or inguinal enlargement, as observed in the present report. When Sertoli cell tumor are present, the hormone secretion pattern of this neoplasia may influence complications occurrence. Once higher estrogen levels may induce endometrial gland proliferation, hydrometra and pyometra are among these complications, as well as reduced hematopoiesis. Moreover, progesterone levels could be also increased favoring pyometra pathophysiology. By conclusion, despite very rare, MDPS should be investigated in Miniature Schnauzers with vague clinical signs, especially cryptorchidic ones. Karyotyping and histopathology were crucial to confirm the diagnosis. Moreover, no other case with MDPS, cryptorchidism, Sertoli cell tumor, and pyometra was found in the published literature consulted.

DIFFICULTIES IN DIAGNOSING A FOREIGN BODY IN THE GASTROINTESTINAL TRACT (HYDROGEL) OF A 10-MONTH-OLD CHILD

Abstract. Purpose: informing the doctors who provide aid to children of the peculiarity of the pathology. Methods: a 10-month-old boy who developed recurrent vomiting, cough, nasal discharge and fatigue was admitted to the hospital in his place of residence and diagnosed ARVI with abdominal pain syndrome. In spite of the treatment, the patient’s condition worsened, cerebral edema aggravated, and he received artificial pulmonary ventilation with a diagnosis of acute meningoencephalitis of unclear etiology, cerebral edema, and stage 3 coma. The patient was transferred to the republican hospital where his condition was stabilized using intensive care and correction of water-electrolyte and metabolic disorders. At day 9 after the disease onset, a mobile tumor-like lesion was found on palpation in the right mesogastric region. An abdominal ultrasound showed a round anechogenic lesion with distinct regular outlines (40x40 mm). A surgery was performed to eliminate jejunal obstruction with hydrogel balls. Relaparotomy was done in 6 days. Discussion: this clinical observation shows there are diagnostic difficulties that are unavoidable when a history of peroral intake of hydrogel is lacking. Being in the intestine, hydrogel granules absorbed fluid and their size increased leading to obturation intestinal obstruction. Recurrent vomiting resulted in extrarenal loss of fluid and electrolytes. The patient developed cytotoxic cerebral edema due to hypotonic dehydration. A tumour-like lesion was found on palpation at day 9 after the disease onset. Conclusions: hydrogel balls result in obturation intestinal obstruction with severe water-electrolytic disorders. This pathology requires a surgery with full revision and complete evacuation of foreign bodies from the intestine.

LARAPOSCOPIC LIVER RESECTION IN SURGERY FOR COLORECTAL CANCER METASTASES

BACKGROUND: nowadays laparoscopic liver resection (LapLR) in contrast to traditional open approach is more preferable because of reduction of intraoperative blood loss and postop morbidity, decrease of postop hospital stay. Unfortunately, the place of LapLR in surgery for colorectal liver metastases is still controversial because of small number of comparative studies. PATIENTS AND METHODS: between November 2017 and December 2018 fifty two patients with resectable colorectal liver metastases were included in our pilot study - 35 in the prospective group for laparoscopic liver resection and 17 patients in retrospective group of open-approach liver resections (selected group of historical control) (OLR). RESULTS: one patient was excluded from LapLR group because of absence of intraoperative evidence for metastatic disease (in spite of preop MRI). Two patients had lap-to-open conversion (in one case because of technical difficulties due to the location of the permanent ileostomy in the right mesogastric region; in the other case due to intraoperative bleeding). These patients were included into open group. Atypical liver resections were the most often procedures in both groups - 79% (23/32) and 76% (13/19), p=0.3 (LapLR and OLR, respectively). Duration of the procedure was shorter in the OLR group: 218+71 min vs. 237+101min in LapLR, p=0.6. The mediana for blood loss in LapLR was 100 ml (quartile 100; 200) vs. 320 ml (quartile 200;600) in OLR, p=0.0001. The rate of R0 resections was comparable in both groups (p=1.0). The patients of OLR group more often had >1 complication (16 vs. 13, p=0.01) and had higher frequency of bile fistulas, abscesses in the liver resection area and clostridial colitis. Postoperative hospital stay was shorter in the LapLR group: 11+3 vs. 14+5 days, p=0.008. CONCLUSION: laparoscopic liver resections for metastases of colorectal cancer were associated with less intraoperative blood loss, morbidity, and shorter postoperative hospital stay, with comparable rate of R0 resections.

Unicornual Uterine Twist in Non-Pregnant Bitch

Background: Uterine twisting in bitches is an uncommon disease in which the difficulty of diagnosis is due to nonspecific clinical signs. This condition is more commonly observed in pluriparous females and is usually associated with a pregnant uterus close to birth, or associated with hemometra, pyometra and neoplasms in non-pregnant bitches. This study reports a case of an 11-year-old Poodle bitch with a rare case of uterine twisting in a non-pregnant womb.Case: A 11-year-old Poodle dog, weighing 3.2 kg, was admitted at the institution with a history of anorexia, oligodipsia and apathy during one day. There was no information on the last phase of estrus or previous pregnancies. The patient arrived at the emergency room of the veterinary hospital with cardiorespiratory arrest and was resuscitated with mechanical ventilation, cardiac massage and administration of adrenaline (0.1 mg/kg IV, 1 mg/ml concentration), tramadol hydrochloride (2 mg/kg via IV) and oxygen therapy. Clinical examination revealed a distended and tense abdomen with a palpable mass in the mesogastric region. Ultrasound examination showed a heterogeneous structure (> 10cm. in diameter), with cavitary areas filled with heterogeneous anechoic content and septations, located between the liver and urinary bladder. It was not possible to identify in which organ or structure the mass originated, and the possibility of gestation and fetal death was discarded. The female died six hours after admission. The patient was submitted to necropsy and histopathological analysis revealed a dark red and enlarged segment of the uterine horn with a 360º twist, occupying most of the abdominal cavity. The left uterine horn was about 10 cm in diameter and firm, and cystic areas were observed on a reddish-black surface containing a large amount of bloody fluid. The right uterine horn was normal in appearance, but with a small amount of fluid, slightly viscous and translucent. The histopathological examination of the structure found in the left uterine horn showed areas of partially organized hematomas with red blood cells inside the vessels, without neoplastic or inflammatory cells. The definitive diagnosis was unilateral uterine twist, unrelated to the gestational or neoplastic process. Discussion: Uterine twist is an uncommon problem in most domestic species. The occurrence of this condition is higher in the gravid uterus, usually in pluriparous females at the end of gestation or delivery, or in non-pregnant bitches secondary to hemometra or pyometra. During uterine twist, occlusion of blood vessels occurs, with subsequent engorgement and vascular rupture, leading to intraluminal hemorrhage and tissue ischemia, which may lead to extravasation of blood into uterine lumen. Thus, the main suspect for the occurrence of unicornual twisting was hemometra in the left uterine horn, associated with relaxation of the uterine ligaments due to the advanced age of the patient. These factors may have favored abnormal mobility and the twist of the organ within the abdominal cavity, even in the absence of the most common predisposing factors, such as gestation and delivery. The rarity of the case is highlighted by the absence of a gestational process associated with the condition. In addition, due to the non-specific clinical signs, the difficulty in the accurate and immediate diagnosis was demonstrated, as well as the potential to cause a rapid clinical deterioration of the patient.

A Rare Case Of Graves’ Disease With Splenomegaly And Pancytopenia

Introduction: Splenomegaly and pancytopenia are rare complications of Graves' disease with few reports in the literature about this association. The pathogenesis is unknown and immunological mechanisms seem to be involved. The possibility of hyperthyroidsm should always considered in patients with pancytopenia.
 Objective: Describe clinical case of association between Grave's disease, splenomegaly and pancytopenia.
 Method: This is a case report, obtained through data from medical records of a reference hospital located in the city of Juazeiro do Norte, Ceara, Brazil. Case report: Patient, 46 years old, female, sought treatment at a reference hospital with abdominal pain that started two days earlier, prevalent in mesogastric region and left hypochondrium very intense and recurrent, associated with significant consuptive syndrome ( loss of 10 Kg in 4 months), asthenia, dyspnea on minimum exertion, irritability and fine tremor in extremitie. SHe denied fever, palpitations, heat intolerance, skin ou eye changes. A diffuse thyroid enlargement with the presence of thrill and murmur, digital clubbing, fixed and bright look, light exophthalmos and splenomegaly about 6 cm below the left costal margin were abserved after physical examination. Ultrasound examination (USG) of the abdomen and CT scan showed moderate splenomegaly. Laboratory tests showed normocytic and normochromic anemia, leukocytosis and mild thrombocytopenia. Thyroid USG showed characteristic features of Graves' disease, a bone marrow biopsy revealed maturation preserved in all strains and lack of fibrosis and megakaryocytes present in normal number without atypia. treatment was set with propylthiouracil 300 mg a day and after the first revaluation after hospital discharge three weeks later a regression of splenomegaly has been observed.
 Conclusion: This case ilustrates the rare association between hyperthyroidism and splenomegaly with pancytopenia.

The coral genus Caulastraea Dana, 1846 (Scleractinia, Merulinidae) as a new host for gall crabs (Decapoda, Cryptochiridae), with the description of Lithoscaptus tuerkayi sp. nov.

A new gall crab species is described from the stony coral genus Caulastraea, a new host coral genus for Cryptochiridae crabs. Specimens were collected during fieldwork off Kudat (Malaysian Borneo) and Okinawa (Japan). Further material was retrieved from the collections of the Institute of Oceanography in Nha Trang (Vietnam). The new species, here named Lithoscaptus tuerkayi sp. nov., is the tenth assigned to the genus in which it is tentatively placed. It can be separated from its congeners by the strongly demarcated, inverted V-shaped protuberance flanking the mesogastric region, with denuded spots on the anterolateral sides of this inverted V-shape, as well as the denuded area just below the frontal margin. Based on morphology and COI sequence data, the closest species to L. tuerkayi sp. nov. is determined to be Lithoscaptus helleri (Fize & Serène, 1957).

Ureterocolonic Anastomosis in a Dog with Transitional Cell Carcinoma in the Vesical Trigone

Background: Primary bladder tumors are rare in dogs, in spite of that, the transitional cell carcinoma (TCC) is the malignant tumor that most affects dogs. The TCC usually begins in the vesical trigone and extends into the bladder, and may cause partial or complete obstruction of the urinary flow. The treatment with cystectomy and urinary diversion in veterinary medicine is not usual probably because the partial cystectomy has low success and ureterocolonic anastomosis can cause pyelonephritis and/ or urinary incontinence. This paper describes the cystectomy surgery and ureterocolonic anastomosis in a dog with TCC in the bladder and bilateral hydronephrosis. Case: A 8-year-old, male, not castrated, Pitbull was referred to the Veterinary Clinic Hospital - UFRGS. The patient had progressive weight loss, low appetite, dysuria, and hematuria. Abdominal ultrasound showed bilaterally hydronephrosis, kidney pelvis and ureter dilatation. The mesogastric region presented a mass measuring about 14 cm. An exploratory laparotomy was request by the responsible veterinarian. A mass, measuring about 20 cm was observed in the spleen and a splenectomy was requested. An increased of the kidney’s volume and an expansion of the renal pelvis and ureter were observed. The bladder wall had thickened and presented a firm consistency, an ureterocolonic anastomosis was requested by the responsible veterinarian. Total cystectomy was performed in a second surgical procedure. Six days after the second surgery the patient condition got worse. The dog presented abdominal pain signals and pale mucous membranes. The hematological and biochemistry analysis findings were, severe anemia, and elevated serum creatinine (6.12 mg/dL) and urea (263 mg/dL) levels. Based on severity of clinical signs and unfavorable prognosis the owners elected for euthanasia. Necropsy revealed a viscous material into the left ureter and in left renal pelvis, and papillary necrosis in the right kidney. The histologic assessment revealed tumor cells in regional lymph nodes and lungs. Discussion: The urinary diversion when consist of total cystectomy and ureteral transplantation to the gastrointestinal tract can be considered a therapeutic option in cases where the trigone is affected. In this study an ureterocolonic anastomosis was requested due to bilateral ureteral obstruction caused by TCC involving the trigone. Neurological and gastrointestinal signs, elevated serum creatinine levels and pyelonephritis may occur after surgery. Neurological signs were not observed. The dog, in the present case report, had already azotemia in pre-surgical examinations, probably caused by bilateral ureteral obstruction. One of the reasons for the increase in postoperative serum creatinine levels is chronic renal failure caused by ascending infection or post-renal obstruction. Another reason could also be reabsorption of the metabolite through the colon. Necropsy findings were ascending infection and pyelonephritis. Dilation of ureter at the time of surgery may have predisposed to the ascending infection. In previous studies aggressive surgical therapy did not result in a significant increase in survival time in dogs when compared to chemotherapy. Most dogs presented metastases, observed most frequently in lymph nodes and lungs. In this report the surgery was performed in an attempt to improve kidney function and life quality of the patient during hospitalization. The prognosis was considered unfavorable because of the advanced stage of the disease and kidney failure. The absence of an early diagnosis and inability to start early chemotherapy may result in a reduced in the survival time of these patients. Keywords: vesical neoplasm, hydronephrosis, urinary diversion, dogs.

Новые данные по хирургической анатомии межреберных нервов в чревной области передней брюшной стенки

The purposeof our research is to study the topographic features of intercostal nerves in the mesogastric region of the anterior abdominal wall. We studied 88 nonfixed corpses of both sexes with no pathology of the anterior abdominal wall. Intercostal nerves in the mesogastric region of the anterior abdominal wall were dissected to determine the degree of their penetration into the rectus abdominis relative to the the low end of the costal arch and the outer edge of the rectus. The study revealed from 1 to 4 pairs of intercostal nerves in the mesogastric region of the anterior abdominal wall. Intercostal nerves penetrated into the rectus abdominis through its outer edges (52%), rather through its posterior surface (39%). To reduce the risk of intraoperative traumas of intercostal nerves we determined the degree of their penetration into the depth of the rectus abdominal muscle. The obtained data can be used to predict the topography of intercostal nerves in prosthetic hernia repair of umbilical hernias.

Rupture of Meckel’s diverticulum after a blunt abdominal trauma: a case report

Background : Meckel’s diverticulum is relatively rare in the general population. Generally, symptoms are extremely varied and prior diagnosis is difficult because of the abnormality being an occasional finding in laparotomies. This report describes the unusual possibility of diverticulum rupture, even after low-impact abdominal trauma. The case is unusual because of the low frequency of small bowel injury in abdominal contusions, except in trauma with high kinetic energy, such as high-speed car crashes, and the unexpected finding of a ruptured diverticulum. Usually, the lesions occur at relatively fixed structures, specifically in the angle of Treitz or ileocecal region, after undergoing stretching. Case presentation : A 32-year-old male patient presented at another service after incurring a trauma in a car crash about 5 hours earlier. He complained of abdominal pain of moderate intensity and intense thirst. Bruises were found on the mesogastric region. Ultrasonography and computed tomography suggested the presence of a small amount of free fluid in the cavity and pneumoperitoneum. Emergency exploratory laparotomy was performed because of the blood and faecal content in the peritoneal cavity. A single lesion, the contusion in Meckel’s diverticulum, was observed. Excision of the segment was performed with thorough washing of the cavity. Conclusion : Patients with Meckel’s diverticulum may be more susceptible to hollow viscus rupture and can be a finding in exploratory laparotomy.

Carcinoma de células de transição da pelve renal em uma cadela – relato de caso

Primary renal tumors in dogs are rare; among these, renal carcinomas are the most frequent. Renal tumors may be classified according to their origin as renal tubular, nephroblastic, non-epithelial and transitional cell carcinomas. The latter can originate either in the ureter or in the renal pélvis. This work reports the case of a non-neutered nine-year-old female mongrel assisted by the Surgery Sector of a Veterinary Hospital. Ultrasound examination of the abdomen disclosed a mass in the right mesogastric region. The ovary and right kidney could not be visualized. The patient underwent exploratory laparotomy, followed by nephrectomy and hysterectomy with salpingo-oophorectomy. Histopathology confirmed the diagnosis of transitional cell carcinoma of renal pélvis.