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  • In pediatric patients low grade astrocytoma in

    2018-10-22

    In pediatric patients, low-grade astrocytoma in all its histopathological varieties and in almost all locations within the central bethanechol chloride has a relatively favorable prognosis. This statement is especially true if surgical excision is complete. However, if this neoplasm is not completely resected, especially when dealing with children <3 years of age, it causes persistent relapses, which is an indication for chemotherapy. Chemotherapy has promising efficacy in the treatment of low-grade astrocytomas, although it is not necessarily a panacea for this type of tumor. Neoadjuvant and/or adjuvant chemotherapy may also be useful. When surgery has failed in the treatment of patients with optic gliomas, especially in the treatment of children <3 years of age, administering intravenous and intra-arterial carboplatin has produced promising results.
    Introduction Bowel perforation caused by a foreign body has various clinical manifestations, and making a preoperative diagnosis is often difficult because the ingestion is usually unintentional. Results of multiple case reports have shown that perforations are more commonly diagnosed during a laparotomy. Only a few reports have previously described treatment solely by laparoscopic methods for bowel perforation caused by a foreign body. The sites of perforation in previous reports are different, and all were detected by direct laparoscopic vision. We herein report a case in which the perforation could not be identified by laparoscopic inspection. Underwater intestinal milking was used to detect the perforation and its causative bone fragment. This case indicates that the laparoscopic approach is applicable for small perforations and can avoid unnecessary laparotomy.
    Case report A 66-year-old man was admitted to the emergency department with right lower quadrant abdominal pain. He experienced progressive right lower quadrant abdominal pain for 12 hours prior to admission. He reported the absence of melena and hematochezia and had no history of medical illness and abdominal surgeries. The patient\'s complete blood count, blood biochemistry, and blood coagulation data were all in the normal range except for an elevated leukocyte count (20,240 × 103/μL) and C-reactive protein level (2.246 mg/dL). A physical examination revealed a body temperature of 36.8°C and irritation of the peritoneum, with focal tenderness within the right lower abdominal quadrant. A computed tomography (CT) scan demonstrated extraluminal air below the right hemidiaphragm and an intraluminal calcified lesion in the small bowel (Fig. 1). Because of the persistent abdominal pain and the probability of a hollow viscus perforation, the patient underwent a diagnostic laparoscopy. Pneumoperitoneum was established using a Veress needle (Surgineedle™, Covidien, NORWALK, CT, US). An infraumbilical 12-mm trocar was inserted and two other 12-mm and 5-mm trocars were inserted in the left lower and right lower quadrants, respectively. Laparoscopic findings were turbid peritoneal fluid at the bilateral paracolic gutters and the pelvis; however, the appendix, stomach, and colon appeared normal on inspection. Swelling and congestion were noted on a long segment of dilated small bowel in the right lower quadrant of the abdomen. Nevertheless, no obvious perforation could be detected due to fibrinous peel formation. Therefore, we filled the abdominal cavity with 2000 mL of normal saline, submerged the abnormal small intestine under water, and proceeded with intestinal milking. Air bubbles were found leaking from an ulcer-like lesion on the ileum (Fig. 2). After identification of the occult perforation, further palpation of perforated bowel was performed with gentle compression, and a sharply pointed fish bone (FB) was found within the bowel lumen (Fig. 3A and B). The FB was retrieved through the perforation, which was then intracorporeally repaired with VICRYL 3-0 (Coated VICRYL™ (polyglactin 910) Suture, J338H, Ethicon, Somerville, NJ, US) interrupted sutures. Postoperatively, we questioned the patient about ingestion of the sharp material, and he recalled eating fish soup on the evening prior to the onset of his symptoms. His hospital course was uneventful, and he was discharged from hospital on postoperative Day 6.