Abdelmounaim Aitali

Giant inguinoscrotal hernia containing intestinal segments and urinary bladder successfully repaired by simple hernioplasty technique: a case report

IntroductionGiant inguinoscrotal hernias are extremely rare nowadays, but they may still be encountered after years or even decades of neglect. Such hernias containing both bowel loops and urinary bladder have not been reported in the medical literature to date, to the best of our knowledge.Case presentationWe report a case of a 65-year-old Moroccan man who presented with giant right-sided and long-standing inguinoscrotal hernia with compromised quality of life due to walking difficulties and sexual discomfort. Computed tomography revealed a voluminous hernia sac containing small and large bowel loops, greater omentum, and urinary bladder. Surgical repair was done through the classical inguinal incision using the Lichtenstein tension-free hernioplasty technique. No debulking or abdominal enlargement procedure had to be performed, apart from a partial omentectomy.ConclusionsGiant inguinoscrotal hernia containing intestinal segments and urinary bladder is a challenging surgical disease. A Lichtenstein tension-free technique seems to be the best surgical procedure for both the patient and the operating surgeon. It should be used whenever possible in such cases.

Medial Pancreatectomy for a Neuroendocrine Tumor Invading the Splenic Artery and Vein

CONTEXT Pancreatic tumors in the midportion have traditionally been treated by an extended right or left pancreatectomy. A medial or central pancreatectomy is an alternative technique for benign or low-grade malignant neoplasms located to the left of the gastroduodenal artery and close to the splenomesenteric confluence. CASE REPORT A 38-year-old woman with no previous surgical history presented with epigastric abdominal pain. A computed tomography scan showed a 4 cm heterogeneous lesion within the pancreatic body. This tumor invaded the splenic artery and vein. There was no postoperative diabetes mellitus or exocrine insufficiency. The patient continues to be well after a 10-month follow-up without pancreatic insufficiency or local recurrence, and CT has demonstrated splenic perfusion by the collateral vessels. CONCLUSION We believe that a medial or central pancreatectomy may be a safe procedure where there is involvement of the large splenic vessels by a low grade malignant pancreatic tumor and that a systematic splenectomy is not justified.

Giant Gastric Liposarcoma: A Fatal Exceptional Location

Gastric liposarcoma is extremely rare and only few cases have been reported in the literature. Esophagogastroduodenoscopy (EGD) is generally inconclusive, with frequent negative biopsy results. Imaging tests can guide the diagnosis toward a fatty tissue tumor; however definitive diagnosis is obtained only by histopathological studies. Treatment is not well-standardized; the mainstay is surgical resection for curative treatment and certain patients may be candidates for a multimodality treatment with chemotherapy and radiation. The prognosis is difficult to determine given the rare nature of the disease [1]. Our study is a case report of a patient who was diagnosed with a gastric liposarcoma, and our work intends to put emphasis on the diagnostic and therapeutic challenges that the disease poses.