Maria Zarokosta

Congenital peritoneal encapsulation of the small intestine: A rare case report

Highlights • Be aware of the rare occasion of PE in patients with intestinal obstruction without other etiological factors.• Preoperative diagnosis of PE may be impossible.• Management of PE in case of intestinal obstruction requires urgent surgery.

Left-sided gallbladder (Sinistroposition) encountered during laparoscopic cholecystectomy: A rare case report and review of the literature

Highlights • LSG is a peculiar anatomical variation that is difficult to be identified preoperatively.• LSG is associated with anatomical anomalies that may lead to intra-operative injuries.• Safe laparoscopic cholecystectomy is feasible by placing the patient to left-side up position for better exposure of the operative field.

Leiomyomatosis peritonealis disseminata: A case report and meticulous review of the literature

Highlights • Differential diagnosis of LPD from leiomyosarcoma or benign metastasizing leiomyoma remains difficult.• Ample history of the patient, clinical evaluation, preoperative guided FNA and histopathologic analysis of the FNA tissue and of the tumor resection are essential for differential diagnosis.• Prompt diagnosis of LPD is crucial because, although benign in nature, LPD may degenerate into malignancy.

Aberrant subvesical bile ducts identified during laparoscopic cholecystectomy: A rare case report and review of the literature

Highlights • Aberrant subvesical bile ducts are a rare anatomical variation defined as a network of bile ducts located in the peri-hepatic tissue of the gallbladder fossa.• Their injury is almost inevitable and it leads to bile leakage, which is a life-threatening complication of laparoscopic cholecystectomy.• Meticulous operative technique and detailed exposure of the operative field is the cornerstone of a safe laparoscopic cholecystectomy, when surgeons encounter this rare anatomical variation.

The ligament of Parks as a key anatomical structure for safer hemorrhoidectomy: Anatomic study and a simple surgical note

Hemorrhoids are a common anal disorder which affects both men and women of all ages. One out of ten patients with hemorrhoidal disease, requires surgical treatment. Unfortunately though, hemorrhoidectomy is closely related to complications that can be present early or late postoperatively. In the present manuscript, the safe surgical technique which emphasizes to the identification of the key anatomical structure of the ligament of Parks (Trietzs muscle) is adequately described. A total of 200 patients with grades III and IV hemorrhoids, underwent Milligan-Morgan or Fergusons hemorrhoidectomy. The mucosal ligament of Parks was identified to all patients and was used as a key anatomical structure through the excision of the hemorrhoids. Its identification guides surgeons during the operation and reduces the major problem of postoperative complications. Finally, since the mucosal ligament of Parks represents a constantly identifiable landmark, it allows simple and reliable identification of the internal sphincter muscle and minimizes the probability of postoperative complications.

Abnormal distance of the extralaryngeal bifurcation point of the recurrent laryngeal nerve from the cricothyroid joint

Abstract The extralaryngeal bifurcation point of the recurrent laryngeal nerve (RLN) is typically located in a mean distance of 0–2 cm from the cricothyroid joint (CTJ). In the presented case though, the left RLN was unexpectedly identified bifurcating in a mean distance of 7 cm from the left CTJ in a young woman with multinodular goiter during total thyroidectomy. The RLN was carefully exposed throughout its course for the avoidance of iatrogenic injury of the nerval structure. The operation was uneventful. The present manuscript aims to highlight a scarce anatomic variation and its implications for thyroidectomy. Rare anatomic variations of the RLN such as the presented one encumber thyroid surgery and represent a severe risk factor of RLN injury. Meticulous operative technique combined with surgeons’ perpetual awareness concerning this peculiar anatomical aberration leads to an injury-free thyroid surgery.

Complete unilateral ureteral duplication encountered during intersphincteric resection for low rectal cancer

Abstract Complete duplication of ureters is a very rare clinical entity that may either be asymptomatic or present with a variety of clinical findings. In the presented case a 51-year-old Caucasian female underwent an intersphincteric resection for low rectal cancer. Intraoperatively, during the standard bilateral recognition and mobilization of the ureters, complete unilateral duplication of the left ureter was incidentally detected, deriving from a single renal parenchyma. Such a congenital abnormality though constitutes a major risk-factor of accidental ureteral injury during operations including pelvis. Conclusively, meticulous exposure of both ureters combined with surgeons’ unceasing awareness constitute the cornerstone of a safe operation.

Anatomic variation of the relation between the inferior mesenteric artery and the bifurcation point of abdominal aorta during lower anterior resection: A rare case report

Highlights • Anatomic variations of the origin of IMA and of its relationship with the AA are of paramount clinical importance as regards to diagnosis and surgical treatment.• Such variations might encumber high ligation of the IMA during surgery for rectal cancer, with subsequent implications or may pose a major risk factor of accidental injury and hemorrhage.• Such anatomic variations of the origin of the IMA and its relationship with AA, may be actually more common, than described in the literature.

Anomalous course of the sigmoid colon and the mesosigmoid encountered during colectomy. A case report of a redundant loop of sigmoid colon

Highlights • A redundant sigmoid colon is defined as one that is too long to fit into its owner’s body without undergoing reduplication.• It is associated with acute and chronic pathological conditions, sigmoid volvulus and serious confusions in radiological diagnosis and instrumentation of imaging procedures.• Surgeons, obstetricians and radiologists ought to be aware of this variation and to emphasize to the correlation between gross and clinical anatomy, since their awareness determines the outcomes of an operation and the accurate radiographic diagnosis.

Surgical anatomy of double pyramidal lobe on total thyroidectomy: a rare case report

Abstract Double pyramidal lobe is a scarce anatomical variation of the thyroid gland. Its presence impinges on the completeness of total and subtotal thyroidectomy and the postoperative treatment. Surgeons should be always aware of this variation in order to perform sufficient resection of the thyroid gland and minimize the possibility of recurrence of benign and malignant thyroidopathies.