Umbilical Region Research Articles

Post-intrathecal chemotherapy-related paraplegia syndrome in hematological cancer patients: A systematic review.

Intrathecal (IT) chemotherapy is essential in treating hematological malignancies, but it can lead to ascending paraplegia, a condition that currently lacks clear management guidelines. We conducted a systematic review, analyzing 1219 studies and 116 patients, adhering to PRISMA guidelines for individual patient data. The study, registered under PROSPERO (CRD42022362121), focused on the onset, diagnostic approaches, and therapeutic interventions associated with this complication, and management strategies to tackle the ascending paraplegia. Paraplegia typically manifests approximately 10 days after chemotherapy, irrespective of injection frequency. In 95% of cases, paralysis stabilizes around the umbilical region, although some patients progress to upper limb involvement and respiratory compromise. Despite various diagnostic methods, consistent inflammatory markers in blood or cerebrospinal fluid are lacking, with approximately 60% of patients showing normal magnetic resonance imaging results at presentation. Misdiagnoses often include transverse myelitis, Guillain-Barré syndrome, and autoimmune radiculitis. Common treatments such as corticosteroids and intravenous immunoglobulins show limited effectiveness. Our review delineates the clinical entity of ascending paraplegia following IT chemotherapy, aiming to increase clinician awareness and provide prognostic insight. We introduce the term post-IT paraplegia syndrome to facilitate accurate diagnosis and optimize treatment strategies for affected patients.

Reopenable clip over-the-line method in endoscopic full-thickness resection of gastric submucosal tumors: A historical control study.

Endoscopic full-thickness resection for gastric submucosal tumors is gradually gaining popularity, and secure and amenable closure is key to its success. This study aimed to compare the reopenable clip over-the-line method with the purse-string method for defect closure after endoscopic full-thickness resection for gastric submucosal tumors. This historical control trial included 37 consecutive patients with 37 gastric submucosal tumors, who underwent endoscopic full-thickness resection between January 2021 and July 2024. All lesions were resected en bloc. After excluding three patients who underwent non-full-thickness resection, 34 patients were analyzed. Post-endoscopic full-thickness resection defects were closed using the purse-string method (n=18) until 2022 and the reopenable clip over-the-line method (n=16) from 2023. The median (interquartile range) time for defect closure was longer in the reopenable clip over-the-line method group of 33 (31-57) min than in the purse-string method group of 26 (24-35) min (p=0.013). The visual analog scale pain score at the umbilical region was lower (p=0.048) after the reopenable clip over-the-line method than after the purse-string method. In the reopenable clip over-the-line method group, post-procedural abdominal pain was confined to the epigastrium, whereas it extended to the umbilical or left lateral regions in the purse-string method group. The reopenable clip over-the-line method group commenced the diet (p=0.001) and discharged (p=0.024) earlier than the purse-string method group. Reopenable clip over-the-line method facilitated secure post-endoscopic full-thickness resection defect closure, reduced post-procedural abdominal pain, and shortened the fasting and hospitalization periods after endoscopic full-thickness resection in gastric submucosal tumors.

Excretory urography can track down morphological changes in the urinary bladder associated with urachal anomalies in calves for early diagnosis.

To investigate radiographic detection by excretory urography of morphological changes in the urinary bladder associated with urachal anomalies in calves. Excretory urography was performed to detect morphological changes in the urinary bladder of 13 calves, of which 6 were nondysuric with swelling of umbilical region and 7 were dysuric without clinical umbilical swelling from November 2022 through April 2024. The urinary bladder was delineated in all 13 calves after excretory urography. The aspect ratios (length:height), which objectively evaluate the shape of the urinary bladder, ranged from 1.08 to 2.43 (1.90 in average) and 1.34 to 11.89 (4.75 in average) in nondysuric and dysuric calves, respectively. The ratios of calves with nondysuric were significantly lower than those of dysuric (P < .05). Excretory urography could play an important role in evaluating abnormal morphological changes due to urachus anomalies in the urinary bladder of calves. Among calves with dysuria, urachal anomaly should be included in the differential diagnosis. Excretory urography is proposed as an alternative option for early diagnosis among calves presenting with dysuria to improve livestock productivity.

Maximum extension and regression rate of cutaneous sensory block obtained with the external oblique intercostal block or the modified thoracoabdominal nerves block through perichondrial approach in patients undergoing laparoscopic cholecystectomy.

Several studies demonstrate that both external oblique ıntercostal block (EOIB) and modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) contribute to analgesia in the anterior abdomen by targeting the thoracoabdominal nerves through distinct pathways. However, the sensory assessment and dermatomal analysis remain poorly understood. This prospective observational study aimed to determine the sensory assessment and dermatomal regression rate of EOIB and M-TAPA in patients undergoing laparoscopic cholecystectomy. The study included a total of 24 patients, with 12 patients in each group. Blocks were performed bilaterally, administering 25 mL of bupivacaine 0.25% for each side, resulting in a total volume of 50 mL. The anterior abdominal wall was vertically partitioned into the midabdomen, left-lateral abdomen, and right-lateral abdomen, and horizontally divided into the epigastric, umbilical, and hypogastric regions. Sensory block was assessed at the 45th minute with cold stimulus and pinprick. Subsequent evaluations were at intervals of 6, 10, 14, 18, 22, and 24 hours. The blocked area percentile with cold sensation in the anterior abdomen was 43.07% (36.67-55.74) with EOIB, 40.49% (34.05-43.67) with M-TAPA (P=0.3219). When the region above the intertubercular plane was examined with cold sensation, EOIB covered 55.92% (46.75-62.07), and M-TAPA covered 49.60% (40.39-54.03) of the epigastric and umbilical areas. Assessment of the midabdominal portion of the anterior abdomen revealed that the blocked area percentile was statistically significantly higher in the M-TAPA group with both cold sensation and pinprick. At 45 minutes, the percentage of blocked dermatomes was 100% between T7-T8 in the EOIB group and between T7-T10 in the M-TAPA group. Both groups exhibited lower success rates in dermatomes T5 and T12, with no sensory block within the L1 dermatome, and cutaneous dermatomal block status either absent or negligible after 24 hours. All trocar entries were located within the cutaneous sensory block for both blocks, except for trocar C, which was located most laterally. Bilateral EOIB and M-TAPA produce a comparable sensory cutaneous block in the anterior abdomen, particularly in the umbilical and epigastric regions. Additionally, the midabdominal cutaneous blocked area was greater in patients undergoing M-TAPA, suggesting a more consistent distribution along the anterior cutaneous branches of the thoracoabdominal nerves.

056. Impacted CBD Stones in Ampula Vater Evacuated by Transduodenal Approach in A 48-year-old Patient at Prof. Dr. IGNG Ngoerah Hospital in 2024

Background: Cholecystolithiasis and choledocholithiasis are common biliary disorders that can lead to significant complications if left untreated. Among these complications, the formation of impacted CBD stones, particularly at the Ampulla of Vater, poses a unique clinical challenge. The Ampulla of Vater is the anatomical site where the common bile duct (CBD) and pancreatic duct converge, and its obstruction can lead to biliary colic, cholangitis, or pancreatitis. Urgent stone removal is critical for improving the patient’s condition. Case: A 48-year-old male patient presents to the emergency department with right upper abdominal pain since 10 days ago accompanied with icteric sclera since 10 days ago. There was nausea and vomiting when eating high-fat foods. The stools were brownish in color, the urine color was similar to tea color. The patient regularly takes UDCA 3 x 250 mg IO, simvastatin 1 x 20mg IO, curcuma 3 x1 tab IO, lansoprazole 2 x 30mg IO. Physical examination showed icteric eyes, jaundice, liver enlargement 2 fingers below costae arch with positive Murphy's sign. Complete blood examination showed leukocytosis, decreased hemoglobin, hypokalemia, as well as increased direct bilirubin, total bilirubin, and indirect bilirubin. BOF result showed sentinel loop on the right umbilical region suspected inflammatory process. MRI impression of choledocholithiasis causing dilatation of EHBD and IHBD proximal aspect without signs of cholangitis, hepatomegaly, simple cyst of left kidney (Bosniak I). Abdominal ultrasound with the conclusion of cholecystitis with dilatation and thickening of the ductus cysticus wall suspicious of inflammation, dilatation of the right and left IHBD, common hepatic duct, to the proximal common biliary duct, the presence of distal obstruction cannot be evaluated because it is covered by intestinal shadows, mild prostatic hypertrophy accompanied by prostate calcification. After Cholecystectomy and Explore CBD transduodenal, the patient was placed with thoracic drain with good outcome. Conclusion: The transduodenal approach to evacuating impacted CBD stones at the Ampulla of Vater is a valuable technique that can yield excellent outcomes in select cases. This case report underscores the importance of a tailored approach based on individual patient anatomy and stone characteristics.

A Combination of Chemotherapy and Autogenous Vaccine for Control of Bovine Papillomatosis in Cattle

The present study was conducted during the period from July, 2023 to January, 2024. Two clinical cases of cattle were reported with cutaneous papillomas, one near right umbilical region and another over the right hind teat of cattle. Both the animals were treated with a protocol designed such that it can regulate the secondary bacterial infection, speedy recovery of integument system and enhance the immune response for complete regression of the warts. The innate immune responses of infected animals were augmented with inactivated pathogen associated molecular patterns (PAMPs) as autogenous vaccine candidate. The warts were surgically excised, triturated in sterile PBS, inactivated with 0.5% formaline and prepared the autogenous vaccine. The sterility test of vaccine revealed that the vaccine was free from bacterial and fungal contaminants. The chemotherapy includes the use of drugs Thuja ointment, Inj.Enrofloxacin, Inj.Avil and Inj.Anthiomaline. The dose of the vaccine was 1 ml 20 kg-1 b.wt. subcutaneously and given at weekly intervals for a period of 4 weeks. It was observed that the treatment protocol was successfully effective and regression of warts was noticed from 2nd week onwards. By end of 4th week a complete recovery of the wart infected area was noticed with a black scar left behind. The formalin inactivated autogenous vaccine was effective, and applied for control of bovine papillomavirus infection in cattle with combination of chemotherapeutic drugs resulted in early regression of warts.

Examination of Sarcopenia with Obesity as a Prognostic Factor in Patients with Colorectal Cancer Using the Psoas Muscle Mass Index

Background: Sarcopenia, the age-related loss of muscle mass, is a negative prognostic factor in gastrointestinal cancer. Sarcopenia combined with visceral obesity (sarcopenic obesity) is associated with poor outcomes. We explored the influence of obesity and other factors on the prognosis of patients with colorectal cancer diagnosed with sarcopenia. Methods: We enrolled 211 patients with colorectal cancer diagnosed with preoperative sarcopenic obesity who underwent radical resection at Osaka University Hospital between January 2009 and January 2012. Muscle mass was assessed using the psoas muscle mass index. Obesity was evaluated by measuring the visceral fat area in the umbilical region. Patients were categorized into two groups: sarcopenia with obesity (SO) and sarcopenia without obesity (non-SO). Overall survival, cancer-specific survival, and cancer-related relapse-free survival (CRRFS) were compared between the two groups. Patient characteristics, including age, sex, body mass index, serum albumin, C-reactive protein, tumor markers, prognostic nutritional index (PNI), modified Glasgow prognostic score (mGPS), and geriatric nutritional risk index (GNRI), were also analyzed. Results: CRRFS was significantly shorter in the SO group than in the non-SO group (p = 0.028). PNI, mGPS, and GNRI were not identified as significant prognostic factors for CRRFS. Multivariate analysis highlighted sarcopenic obesity, elevated carcinoembryonic antigen levels, and unfavorable histological types as significant predictors of poor CRRFS outcomes. Conclusions: Sarcopenic obesity is an independent predictor of poor prognosis in patients with CRC. Thus, interventions aimed at increasing muscle mass and reducing visceral fat could potentially improve the prognosis of these patients.

Evaluation of different methods for optic port entry in the umbilical region in gynecologic laparoscopic operations

Background Scarring after surgery poses a significant concern for women, particularly for those in their youth. Aim Evaluate which method of vertical trans umbilical and tranverse supra umbilical entry approaches in laparoscopic surgeries ought to be prioritized regarding cosmetic, pain and infection. Patients and methods This prospective comparative study was performed on 50 individuals aged from 18 to 60 years old, both sexes, undergoing diagnostic or operative laparoscopy for infertility, ovarian torsion, or cystectomy, chronic pelvic pain and total laparoscopic hysterectomy. Participants divided in to two groups equally: group 1: Vertical trans umbilical incision. Group 2: Transverse supra umbilical incision. Results There were significantly lower pain scores and overall scar scores after 1 week, 1 month, and 3 months of the operation in individuals with vertical trans umbilical incision than in patients with transverse supra umbilical incision. A substantial variation existed among both groups as regard redness warmth, tenderness, and increased pain. There was significantly lower vascularity, pigmentation, pliability, thickness sub scale scores, and overall scar scores after 1 week, 1 month, and following 3 months of the operation in individuals with trans umbilical vertical incision than in patients with supra umbilical transverse incision (P&lt;0.05). Lower painful, itchy, stiff, irregular, and hyperpigmented scar in vertical trans umbilical incision than patients with transverse supra umbilical incision however, this difference was significant in itching and irregular scar formation (P&lt;0.05). Conclusion A vertical incision provides better cosmetic outcomes compared with a transverse incision one.

Cisto do canal de Nuck: Um relato de caso

Introduction: Nuck canal cyst is a rare condition that occurs due to the patency of the vaginal process in women, manifesting as indirect inguinal hernia. Clinically, it presents as a tumor in the inguinal region, which can extend to the labia majora. Case report: we present a report of a young female patient who was admitted to the emergency room with severe pain associated with tumoration in the left inguinal and umbilical region, with suspected incarcerated umbilical and/or femoral hernia, having undergone emergency surgery. Conclusion: Due to the rarity of the case, little is known about it, since there are few reports in the literature, and therefore it is often undiagnosed.

Abstract A008: The effect of body mass index on Tumor Treating Fields (TTFields) intensity distribution in the abdomen: results of a simulation model study

Abstract Introduction: Tumor Treating Fields (TTFields) are electric fields that disrupt processes critical for cancer cell viability and tumor progression. They are generated by a portable medical device and delivered noninvasively to the tumor site via skin-placed arrays. TTFields therapy is approved for the treatment of recurrent and newly diagnosed glioblastoma as well as pleural mesothelioma. Recently, the randomized, pivotal (phase 3) LUNAR study (NCT02973789) demonstrated improved overall survival for TTFields therapy (150 kHz) delivered continuously until progression or intolerable toxicity together with an immune checkpoint inhibitor (ICI) or docetaxel (DTX) vs ICI/DTX alone in patients with metastatic non-small cell lung cancer following progression on or after platinum-based therapy. PANOVA-3 (NCT03377491) is an ongoing pivotal (phase 3), randomized, open-label study evaluating the safety and efficacy of TTFields therapy (150 kHz) together with nab-paclitaxel and gemcitabine for the treatment of patients with unresectable, locally advanced pancreatic adenocarcinoma. The effects of TTFields are dependent on several factors (i.e., intensity, frequency, and distribution) which may be affected by tissue composition/conductivity and array layout. Here, we evaluate guideline TTFields array layouts for TTFields delivery to the abdominal region at therapeutic intensities (∼1 V/cm [amplitude]) using simulation models with varying body mass index (BMI). Methods: Computerized phantom models (Ella, females with BMIs of 22, 26 and 30 kg/m2) were used to simulate the distribution of TTFields. Two different arrays sizes (small [13 disks] and large [20 disks]) were applied to the abdominal region of the models based on abdominal TTFields array layout guidelines. Region of interest (ROIs) included the left and right hypochondriac, left and right lumbar, epigastric, and umbilical regions. Simulations were performed using the Sim4Life platform v6.2.1.4910 (Zurich MedTech, Zurich, Switzerland). Electric field intensity distribution maps were generated for each model, and electric field intensity values across all ROIs in the abdomen were analyzed. Results: Electric field intensities were generally lower in the higher BMI model compared with the lower BMI models (field intensities across all ROIs were 1.60–2.57 V/cm for the 22 kg/m2 BMI model, 1.36–2.13 V/cm in the 26 kg/m2 BMI model and 1.35–1.97 V/cm in the 30 kg/m2 BMI model). However, all BMI models achieved TTFields intensities at therapeutic levels (∼1 V/cm) in all ROIs. Conclusions: Results from this simulation-based study demonstrate the feasibility of delivering TTFields at therapeutic intensities to patients with abdominal tumors regardless of their BMI when using abdominal guideline layouts. Citation Format: Ariel Naveh, Nadav Shapira. The effect of body mass index on Tumor Treating Fields (TTFields) intensity distribution in the abdomen: results of a simulation model study [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Advances in Pancreatic Cancer Research; 2024 Sep 15-18; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(17 Suppl_2):Abstract nr A008.

Detection of Urachal Anomaly during Prenatal: A Newborn Case Report

The urachus is the remnant of the cloaca and allantois that has remained since the embryological period. If this remnant does not close in the early period, congenital urachal anomalies, such as patent urachus, urachal cyst, urachal sinus and urachal diverticulum occur. Congenital urachal fistula is a rare type of these anomalies. This case report presents a newborn born at 38 weeks and four days of age, weighing 2820 grams. A healthy-term baby, whose urachus anomaly was detected during the antenatal period, was admitted to the neonatal unit for follow-up and treatment. The patient, who had urine discharge from the umbilical region, was diagnosed with a urachal fistula. The patient was operated on by pediatric surgeons on the 7th day of his life.

Anthelmintic activity of crude and separated extract of Aloe vera (Xanthorrhoeaceae) against bovine adults parasites of Onchocerca ochengi and infected larvae of drug resistant strains of the free-living nematode Caenorhabditis elegans.

Human onchocerciasis is caused by the filarial worm. Onchocerca volvulus is a parasite that forms nodules under the skin. The aim of this work was to assess the nematicidal activities of Aloe vera on Onchocerca ochengi and Caenorahbditis elegans and to determine the phytochemical compounds. Nodules were collected from the umbilical region of infected cattle, dissected and male worms were cultured in RPMI-1640. Worms were incubated with different concentrations of A. vera extracts in RPMI-1640 and M9-buffer. Polyphenol, tannin and flavonoid contents of extract were determined by using gallic acid and rutin as standards. The anthelmintic effect of A. vera extract against O. ochengi was concentration dependent with LC50 of 20.71µg/mL and 11.75µg/mL after 48 and 72h respectively. A. vera extract exerted concentration dependent lethal effects (LC50 = 2747 and LC50 = 31,937µg/mL) against C. elegans (Wild Type). Methanolic-methylene chloride (MeOH-CH2Cl2) of A. vera extract exhibited high DPPH activity with an IC50 value of 15µg/mL and 9µg/mL for ascorbic acid. The highest activity in adult worms was observed with the MeOH (100: 0) and AcOEtMeOH fractions with LC50 values of 12.82 and 15.50µg/mL respectively. EcOEtMeOH (8:2 v/v) was more effective (LC50 = 250µg/mL) on WT of C. elegans. A. vera contains polyphenols (1015.05 and AcOEtMeOH = 893.60), flavonoids (25.35 and MeOH = 225.76) and tannins (401.37 and Hex = 788.89). A. vera showed in vitro nematicidal activity against O. ochengi and C. elegans. A. vera could be used as an alternative anthelmintic for onchocerciasis treatment.

Effectiveness of Pilates-based exercises on the diastasis recti abdominis in climacteric women: a randomized controlled trial

Introduction: Recent studies have related the climacteric period with changes in connective tissue elasticity that may be related to diastasis recti abdominis. Mat Pilates is a method of exercise without impact that currently has more practitioners, due to its satisfactory results. However, there are no studies that evaluate the effectiveness of mat Pilates for women with diastasis recti abdominis. Objective: To evaluate the effectiveness of the mat Pilates program in climacteric women with diastasis recti abdominis. Methods: This randomized single-blinded clinical trial evaluated climacteric women with diastasis recti abdominis. The participants were randomized into the experimental group, which participated in 3 weekly sessions of mat Pilates for 12 weeks for a total of 36 sessions, and the control group (without exercises). The inter-rectus distance was measured with a digital caliper. The G*Power Version 3.1.9.2. software was used for the sample calculation, and the SPSS 20.0 program was used for statistical analysis. Results: The study comprised 21 women, including 10 in the control group and 11 in the experimental group, with mean ages of 54.3 ± 7.1 and 55.3 ± 6.0 years and body mass index values of 28.8 ± 5.5 kg/m2 and 29.9 ± 4.48 kg/m2, respectively. In the experimental group, reductions were observed in all the measures related to diastasis recti abdominis (p&lt;0.05) in the supraumbilical, umbilical, and infra-umbilical regions. Conclusion: The mat Pilates method is effective for reducing diastasis recti abdominis in the climacteric period.

Hidradenitis suppurativa: definition, epidemiology, etiology, diagnosis (part 1)

Hidradenitis suppurativa (HS) is a chronic recurrent skin disease characterized by development of autoimmune inflammation in the infundibulum of the hair follicle and apocrine sweat glands located in the axillary, inguinal, anogenital regions, submammary folds, near the areola of mammary glands and the umbilical region. HS is difficult to treat and has an extremely negative impact on the quality of life. HS is separated into a distinct clinical entity fundamentally different in etiopathogenesis from acute bacterial hidradenitis. The exact prevalence of HS is unknown, it varies greatly in different studies ranging from 0.03 to 4% in general population. The detection of IL-1β, IL-23, and IL-17 in the lesions indicates the key role of autoimmune inflammation involving Th17-lymphocytes in the pathogenesis of HS. Risk factors include smoking, obesity, mechanical friction, genetic predisposition. The diagnosis of HS relies on three obligatory criteria: characteristic distribution, typical morphology of the lesions and relapsing, chronic disease course. There is no “gold standard” in assessing the severity of the disease, since all available scoring systems have many limitations, therefore many questions regarding this disease remain unsolved at present — from terminology and clear and most objective assessment criteria for the severity of the process to the development of native clinical guidelines.

Persistence of the omphalomesenteric duct in adults: Case report and literature review

Introduction: Multiple pathologies can affect the umbilical cord, either due to infectious causes or malformation causes (acquired or congenital). However, the persistence of the omphalomesenteric duct and the urachus are the most frequent congenital malformations, especially in the pediatric setting, but not in the case of adults. Case report: The case of a 68-year-old male patient from a rural area, a farmer, with an enterocutaneous fistula, who received surgical treatment, is presented. He went to the consultation due to yellowish fluid leaking from the umbilical region, pain, and erythema, with a history of prostatectomy, osteoarthritis, and arterial hypertension. He was admitted with a diagnostic impression of cellulitis vs wall abscess. According to the assessment by the surgical team, a clear discharge of intestinal fluid was observed through the navel, for which reason emergency surgical resolution was decided for exploratory laparotomy. The patient reports discharge of yellowish fluid from the navel since childhood; there is a high suspicion of a picture compatible with the persistence of the omphalomesenteric duct in the adult. The patient underwent surgery with the following finding: A fully patent omphalomesenteric duct (enteroumbilical fistula) was found 70 cm from the ileocecal valve, plus incidental appendectomy. He was discharged on the eighth day of hospitalization, with a favorable evolution, outpatient treatment, and outpatient control. In addition, a bibliographical review in scientific databases such as Pubmed, Scopus, Proquest, Lilacs, Scielo, and Google Academic. Conclusions: surgical treatment with a favorable evolution, outpatient treatment, and outpatient control

SIMPLIFIED MATHEMATICAL MODEL OF THERMAL RESPONSE IN ABDOMEN AFTER ABDOMINOPLASTY

The search for beauty and perfection brings with it an increase in the number of plastic surgeries. Thus, there is a need for effective postoperative approaches and immediate observation of possible complications, which can lead to more efficient procedures. Among the plastic surgeries, the aforementioned study selected the abdominoplasty surgery as a reference and a certain area 12 x 12 cm, assuming a size in the infra umbilical region, which will supposedly be in the process of tissue repair and with possible temperature changes on the skin surface. The creation of a simplified 2D mathematical modeling to predict the thermal response of the abdomen is presented here. The model considers the local metabolic activities of a healthy skin before the surgical intervention and after it, considering an obstruction of blood flow at a certain point. The model considers such changes by applying mass and energy conservation equations where the amount of O2 supplied regulates the local temperature. Therefore, the reduction of oxygen supplied to the tissues causes a drop in the local temperature representing poor circulation. Decreased local temperature can cause tissue death. Determining the period of low metabolism can be crucial for choosing a treatment and avoiding complications, financial expenses and suffering.

Imaging Gigantic Small Bowel Gastrointestinal Stromal Tumours Through Different Radiological Lenses: A Case Report

Gastrointestinal stromal tumours (GIST) account for 1–3% of all the gastrointestinal (GI) neoplasms. It is the most common mesenchymal tumour in the Gl tract. The majority of GISTs are KIT gene positive; however, it is necessary to diagnose them pre-operatively. Here, the authors report the case of a 65-year-old male who presented with pain and a lump in the umbilical region for the last 2 years. On abdominal ultrasound, there was a heterogeneously hypoechoic mass in the umbilical region, with lobulated margins and central necrotic areas. On small bowel series, the core of the mass showed faint contrast opacification. Contrast-enhanced CT of the abdomen showed a heterogeneously enhancing, lobulated exophytic lesion arising from the small bowel loops, the central core of the lesion demonstrating an air-contrast level. Under ultrasound guidance, the lesion was biopsied. Histopathological findings were suggestive of a spindle cell tumour. The sample was c-KIT positive. Hence, the diagnosis of GIST was confirmed. The patient was given imatinib after resection of the mass. Usually, a GIST of larger size has higher malignant and metastatic potential; however, this article shows a gigantic small bowel GIST with cavitation and heterogeneity in different imaging modality, and still has no metastasis on imaging or high mitotic activity, and nuclear atypia on histopathology. A radiologist should also know the imaging pattern on conventional imaging and ultrasound, apart from usual cross-sectional imaging.

Unusual presentation of cutaneous angiomyolipoma in the umbilical region: A case report

Background: Cutaneous angiomyolipoma (CAML) is a rare benign tumour originating from the perivascular cells of the smooth muscle and fat. Owing to its rarity, clinical presentation, size, and location, we report a case of interest. Case report: A 59-years-old male patient from the Etawah district presented with a lump in the anterior abdominal wall of the umbilical region for the past 5 months. The patient was asymptomatic, but was concerned about the nature of the lump and agreed to undergo excision of the lump, which revealed angiomyolipoma of the anterior abdominal wall on histopathological examination. The patient experienced no complications from the excision and was discharged from the hospital. This particular subsite is rare and lacks association with tuberous sclerosis, a clinical entity commonly associated with renal angiomyolipoma Conclusion: The final diagnosis was confirmed by histopathology based on the traditional criteria of the presence of blood vessels, fat tissue, and smooth muscles. Surgery is the preferred course of treatment, and complete resection is important because incomplete resection may cause recurrence. Keywords: benign; smooth muscle; tumor; blood vessel; adipose tissue

The first robotic-assisted hysterectomy below the bikini line with the Dexter robotic system™.

Robotic-assisted hysterectomy (RAH) is a widely accepted minimally invasive approach for uterus removal. However, as RAH is typically performed in the umbilical region, it usually results in scars in cosmetically suboptimal locations. This is the first case of RAH with cervicosacropexy performed below the bikini line, using the new Dexter robotic system™. The aim of this article is to show the surgical steps of the first RAH with cervicosacropexy performed below the bikini line with the new Dexter robotic system™ (Distalmotion), and furthermore assess the feasibility of this approach using this robotic platform. A 43-year-old woman with uterine adenomyosis and recurrent uterine prolapse underwent a robotic-assisted subtotal hysterectomy with cervicosacropexy, performed below the bikini line, using the Dexter robotic system™, at the Clinic of Gynecology and Obstetrics at Universitätsklinikum Schleswig-Holstein (UKHS) in Kiel, Germany. Perioperative data, surgical approach specifics, objective, and subjective outcomes of this new approach. The procedure was performed without intra-operative complications; estimated blood loss was 10 ml. Operative time was 150 minutes, console time 120 minutes, total docking time 6 minutes. Dexter performed as expected; no device-related issues or robotic arm collisions occurred. The patient did not require pain medication and was released on the second postoperative day. RAH performed below the bikini line using the Dexter robotic system™ is a feasible, safe, and adequate procedure. These initial results should be confirmed and further extensively refurbished with larger patient cohorts, and functional and psychological outcomes need further investigation.

Lumpy Bumpy Cyst that Still Persists: A Rare Case of Cysticercosis of Abdominal Wall

Cysticercosis of the anterior abdominal wall without parasitosis of central nervous system is extremely rare and mimics as a tumor which leads to diagnostic and therapeutic challenge. In such cases histopathological examination plays an important role in diagnosis. We present here a unique case of isolated cysticercosis in a 21-year-old female presenting with a painless lump in the infra umbilical region. This report contributes to the limited literature on cysticercosis of the anterior abdominal wall, aiming to increase awareness and knowledge about this in frequency clinical entity. Keywords Cysticercosis, Taenia solium, Anterior abdominal wall