BACKGROUND Early identification of bowel resection risks is crucial for patients with incarcerated inguinal hernia(IIH).However,the prompt detection of these risks remains a significant challenge.Advancements in radio...BACKGROUND Early identification of bowel resection risks is crucial for patients with incarcerated inguinal hernia(IIH).However,the prompt detection of these risks remains a significant challenge.Advancements in radiomic feature extraction and machine learning algorithms have paved the way for innovative diagnostic approaches to assess IIH more effectively.AIM To devise a sophisticated radiomic-clinical model to evaluate bowel resection risks in IIH patients,thereby enhancing clinical decision-making processes.METHODS This single-center retrospective study analyzed 214 IIH patients randomized into training(n=161)and test(n=53)sets(3:1).Radiologists segmented hernia sac-trapped bowel volumes of interest(VOIs)on computed tomography images.Radiomic features extracted from VOIs generated Rad-scores,which were combined with clinical data to construct a nomogram.The nomogram’s performance was evaluated against standalone clinical and radiomic models in both cohorts.RESULTS A total of 1561 radiomic features were extracted from the VOIs.After dimensionality reduction,13 radiomic features were used with eight machine learning algorithms to develop the radiomic model.The logistic regression algorithm was ultimately selected for its effectiveness,showing an area under the curve(AUC)of 0.828[95%confidence interval(CI):0.753-0.902]in the training set and 0.791(95%CI:0.668-0.915)in the test set.The comprehensive nomogram,incorporating clinical indicators showcased strong predictive capabilities for assessing bowel resection risks in IIH patients,with AUCs of 0.864(95%CI:0.800-0.929)and 0.800(95%CI:0.669-0.931)for the training and test sets,respectively.Decision curve analysis revealed the integrated model’s superior performance over standalone clinical and radiomic approaches.CONCLUSION This innovative radiomic-clinical nomogram has proven to be effective in predicting bowel resection risks in IIH patients and has substantially aided clinical decision-making.展开更多
Amyand's hernia is a rare condition defined by the inclusion of the appendix vermiformis within the hernia sac. Its incidence among cases of groin hernia is less than 1%. The clinical manifestation of incarcerated...Amyand's hernia is a rare condition defined by the inclusion of the appendix vermiformis within the hernia sac. Its incidence among cases of groin hernia is less than 1%. The clinical manifestation of incarcerated inguinal hernia generally masks the symptoms and signs of acute appendicitis, which renders preoperative diagnosis difficult. In this study, we present two cases of Amyand's hernia that were diagnosed preoperatively. The patients were taken for operation with the prediagnosis of ?ncarcerated inguinal hernia. We evaluated these cases along with data from prior studies.展开更多
BACKGROUND Benign symmetric lipomatosis(BSL)was first described by Brodie in 1846 and defined as Madelung’s disease by Madelung in 1888.At present,about 400 cases have been reported worldwide.Across these cases,surgi...BACKGROUND Benign symmetric lipomatosis(BSL)was first described by Brodie in 1846 and defined as Madelung’s disease by Madelung in 1888.At present,about 400 cases have been reported worldwide.Across these cases,surgical resection remains the recommended treatment.Here we report a case of neck BSL with concomitant thick fatty deposit in the inguinal region,which concealed the signs of a right incarcerated femoral hernia.CASE SUMMARY A 69-year-old male patient was admitted to our hospital with“abdominal pain,abdominal distension,nausea-vomiting and difficult defecation for half a month”.Moreover,he had a mass in the right inguinal region for more than 10 years.An egg-sized neck mass also developed 15 years ago and had developed into a full neck enlargement 1 year later.In addition,the patient had a history of heavy alcohol consumption for more than 40 years.With the aid of computerized tomography scan,the patient was diagnosed with BSL and a low intestinal mechanical obstruction caused by a right inguinal incarcerated hernia.Under general anesthesia,right inguinal incarcerated femoral hernia loosening and tension-free hernia repair was performed.However,this patient did not receive BSL resection.After a 1-year follow-up,no recurrence of the right inguinal femoral hernia was found.Moreover,no increase in fat accumulation was found in the neck or other areas.CONCLUSION Secretive intraperitoneal fat increase may be difficult to detect,but a conservative treatment strategy can be adopted as long as it does not significantly affect the quality-of-life.展开更多
Surgical intervention of asymptomatic and accidentally detected pancreatic carcinoma can prolong survival. A 67-year-old man with the right incarcerated inguinal hernia was referred to our hospital, he immediately und...Surgical intervention of asymptomatic and accidentally detected pancreatic carcinoma can prolong survival. A 67-year-old man with the right incarcerated inguinal hernia was referred to our hospital, he immediately underwent manipulative treatment followed by hernioplasty on the next day. Upon the first visit, a pancreatic tumor was accidentally detected in CT images in the pancreatic tail. About approximately a month, abdominal CT revealed a slightly developed tumor;accordingly, distal pancreatectomy with lymph node dissection was performed. The patient was histopathologically diagnosed with tubular adenocarcinoma, and his final pathological stage was ypT2, pN0, cM0, Stage Ib, based on the TNM classification of malignant tumors (8th edition). For postoperative six months, he was treated with adjuvant chemotherapy using gemcitabine (1000 mg/m2). Remarkably, the patient reported no recurrence and has been alive for postoperative 7.5 years, thereby attaining excellent outcomes for accidentally detected pancreatic carcinoma at the occurrence of an incarcerated inguinal hernia.展开更多
Aim: Incarcerated stomal prolapse is a rare complication of enterostomy. Numerous procedures have been described, such as additional laparotomy to fix the intraabdominal intestine in place, enterostomy revision, or co...Aim: Incarcerated stomal prolapse is a rare complication of enterostomy. Numerous procedures have been described, such as additional laparotomy to fix the intraabdominal intestine in place, enterostomy revision, or correction of the prolapse following stoma creation. The authors report successful managements by stomal reconstruction and discuss several clinical points, including the techniques of surgical revision for incarcerated stomal prolapse in loop enterostomy. Patients: Case 1) A female infant weighing 2755 g was delivered at 34 weeks of gestation. On the first day after birth, a right supra-abdominal transverse incision of 10 cm in diameter was used for transverse loop colostomy in a cloacal malformation. Two centimeters of the stomal loop was approximated with sutures to prevent evisceration of the small intestine between the 2 limbs of the loop. Interrupted sutures of 5-0 absorbable monofilament secured the seromuscle of the colon to the peritoneum and fascia, and also to the skin. The distal limb of the colostomy prolapsed 11 months after birth. The physical findings revealed that 10 cm of the distal limb was intussuscepted. Case 2) A female infant weighing 2550 g was delivered at 39 weeks of gestation. A radiological examination by contrast enema showed no spastic rectum and colon, as in Hirschsprung’s disease. Under the laparotomy of a right supra-abdominal transverse incision of 5 cm in diameter, loop ileostomy was performed at 30cm on the proximal side of the cecum such as Case 1. Subsequently, the proximal limb of the ileostomy prolapsed 2 days after operation. The physical findings revealed that 10 cm of the proximal limb was intussuscepted. New enterostomy formation: Divided enterostomy was performed with 3-cm stitching of each limb. The stomal site was moved to the inside from the previous stomal site to oversew and fix by the rectal fascia. The children have been well without trouble since undergoing the new eneterostomy formation. Conclusions: Operation to repair the prolapse of a stoma is advised if it causes problems. We found that simple mobilization of the bowel and excision of the redundant bowel provided a satisfactory result in the present cases.展开更多
Patients with an incarcerated rectal prolapse usually present in the emergency department where manual reduction is first attempted. If reduction is unsuccessful, an emergency laparotomy and internal reduction is requ...Patients with an incarcerated rectal prolapse usually present in the emergency department where manual reduction is first attempted. If reduction is unsuccessful, an emergency laparotomy and internal reduction is required. Edema in the rectal and perineal tissues and impaired blood flow are the main factors for a high percentage of anastomotic leaks. The traditional single stage perineal rectosigmoidectomy is not a safe surgical procedure for treating incarcerated or strangulated rectal prolapses associated with severe edema. Herein we report a case of an incarcerated rectal prolapse treated with the Notaras procedure.展开更多
Incarcerated gravid uterus is a rare obstetric condition that contributes to pregnancy-related adverse outcomes,especially if the uterus remains incarcerated and the condition goes undiagnosed until delivery.An effect...Incarcerated gravid uterus is a rare obstetric condition that contributes to pregnancy-related adverse outcomes,especially if the uterus remains incarcerated and the condition goes undiagnosed until delivery.An effective diagnosis of this condition is benefited from pelvic examination combined with imaging methods and based on suspected symptoms.We present a case of ultrasound-assisted instrument reposition of an incarcerated gravid uterus at mid-gestation and discuss its clinical characteristics,diagnosis,imaging features,and treatment.We believe that once manual reduction fails,the use of instruments will undoubtedly be a better choice.展开更多
BACKGROUND The global pandemic of coronavirus disease 2019 pneumonia poses a particular challenge to the emergency surgical treatment of elderly patients with high-risk acute abdominal diseases.Elderly patients are a ...BACKGROUND The global pandemic of coronavirus disease 2019 pneumonia poses a particular challenge to the emergency surgical treatment of elderly patients with high-risk acute abdominal diseases.Elderly patients are a high-risk group for surgical treatment.If the incarceration of gallstones cannot be relieved,emergency surgery is unavoidable.CASE SUMMARY We report an 89-year-old male patient with acute gangrenous cholecystitis and septic shock induced by incarcerated cholecystolithiasis.He had several coexisting,high-risk underlying diseases,had a history of radical gastrectomy for gastric cancer,and was taking aspirin before the operation.Nevertheless,he underwent emergency laparoscopic cholecystectomy,with maintenance of postoperative heart and lung function,successfully recovered,and was discharged on day 8 after the operation.CONCLUSION Emergency surgery for elderly patients with acute abdominal disease is safe and feasible during the coronavirus disease 2019 pandemic,the key is to abide strictly by the hospital's epidemic prevention regulations,fully implement the epidemic prevention procedure for emergency surgery,fully prepare before the operation,accurately perform the operation,and carefully manage the patient postoperatively.展开更多
Meckel's diverticulum is a very common congenital anomaly of the gastrointestinal tract but many cases remain asymptomatic and are diagnosed incidentally during laparoscopic or other surgical procedures. Cases of ...Meckel's diverticulum is a very common congenital anomaly of the gastrointestinal tract but many cases remain asymptomatic and are diagnosed incidentally during laparoscopic or other surgical procedures. Cases of femoral hernia involving Meckel's diverticulum are rare, with less than 50 cases reported in the literature since Littre published the first description of this coincident condition over 300 years ago. While all true "Littre's hernias" contain a Meckel's diverticulum, the involved anatomical sites are various, the most common being the inner groin(inguinal), the outer groin(femoral), and the belly button(umbilical). Complications of Littre's hernias include incarceration, strangulation, necrosis, and perforation. Herein, we describe a case of Littre's hernia that involved an incarcerated Meckel's diverticulum in a femoral hernia that was diagnosed upon investigation of symptomology manifesting from perforation and was successfully managed by surgical resection with stapler devices.展开更多
Background: The burden of COVID-19 and human immunodeficiency virus (HIV) are some of the major and persistent global health challenges of the twenty-first century. HIV and COVID-19 are expected to overlap in high HIV...Background: The burden of COVID-19 and human immunodeficiency virus (HIV) are some of the major and persistent global health challenges of the twenty-first century. HIV and COVID-19 are expected to overlap in high HIV-burden countries, posing several public health challenges as a result. Prisons are overcrowded, have limited space for social distancing and have inadequate ventilation systems, making it difficult to contain the spread of COVID-19 in addition to the high-risk behaviours of inmates which contribute to the spread of HIV within these facilities. This study aimed to determine the prevalence of COVID-19 among inmates in a prison facility with a relatively high HIV burden in Port Harcourt, Nigeria;investigating potential risk factors and co-infection with HIV. Methodology: The study employed a descriptive cross-sectional study design sampling 200 inmates from the Port Harcourt Maximum Security Custodial Centre from July to December 2022. A well-structured questionnaire was administered via interviews in addition to screening for HIV-1/2 antibodies as well as COVID-19 antigens using rapid diagnostic test kits. Descriptive statistics and chi-square were carried out on the GraphPad Prism 9 software with statistical significance defined as a p-value of less than 0.05 at a 95% confidence interval. Result: The prevalence of HIV from the current study was 6.5%, COVID-19 prevalence was reported to be 12.5% while HIV/COVID-19 co-infection was 1.5% The duration of incarceration, face mask use, frequent visitations and vaccination against COVID-19 were found to be significantly associated with the prevalence of COVID-19 in the studied population (p Conclusion: The current study reports a relatively high prevalence of HIV and COVID-19 among the inmates in the study area. It becomes expedient for the administrators of the correctional facility to properly screen new inmates for COVID-19, quarantine and manage cases, as well as provide them with personal protective equipment such as face masks. In-person visitation should be balanced with measures to prevent the spread of the infection, and mass vaccination campaigns should be promoted. Improving access to HIV screening and therapy for all prisoners should be prioritised to identify and manage the incidence of HIV early, reducing the risk of transmission, mitigating comorbidities and improving health outcomes.展开更多
During the Tang Dynasty,incarcerated prisoners enjoyed various rights during their detention,including access to clothing,food,medical care,hygiene,rest,and burial arrangements.Under specific conditions,prisoners were...During the Tang Dynasty,incarcerated prisoners enjoyed various rights during their detention,including access to clothing,food,medical care,hygiene,rest,and burial arrangements.Under specific conditions,prisoners were even granted leave for family events such as funerals or weddings.The Rules for Prison Officials(Yuguanling)detailed the rights and safeguards for prisoners and set clear guidelines on the use of restraints during detention.Additionally,the Statutes on Deciding Cases(Duanyu Lü)outlined explicit penalties for judicial officials who failed to ensure prisoner rights or committed related violations.Interrogation processes adhered to strict procedural and substantive requirements,including direct questioning by judges,the avoidance of cases involving personal connections or conflicts of interest,evidence-based cross-examinations,careful investigation of circumstances,and consistent rulings across similar cases.The Tang legal code imposed comprehensive,detailed,and stringent limits on the application of coercive interrogations,specifying restrictions on tools,methods,subjects,and extent.Any breaches of these restrictions were met with severe punishments.While the concept of“human rights”did not appear in Tang legal and administrative texts,these laws and regulations embody abundant principles of people-centered governance,benevolence,and human rights concepts.Systematic examination of these ideas,values,and principles—when integrated with the Marxist perspective on human rights—can enrich China’s contemporary human rights practice,contribute to articulating China’s unique narrative on human rights,and play a role in constructing a distinctly Chinese discourse on human rights.Such efforts could provide Chinese wisdom and proposals for the advancement of human rights globally.展开更多
Following the Enlightenment,the principle of human rights protection promoted the transition of criminal justice systems from“punitiveness”to“penal humanitarianism.”However,in the second half of the 20th century,t...Following the Enlightenment,the principle of human rights protection promoted the transition of criminal justice systems from“punitiveness”to“penal humanitarianism.”However,in the second half of the 20th century,the United States and the United Kingdom witnessed the rise of“new punitiveness,”which is characterized by mass incarceration,a punitive turn in community supervision,and numerous collateral consequences of criminal offences.New punitiveness did not emerge from a unified movement or agenda but was driven by changes in crime control philosophies,adjustments in criminal laws,and the initiation of criminal justice campaigns against a backdrop of perceived severe public safety deterioration.Its deeper causes can be traced to the dominance of neoliberalism in economics,the unprecedented alignment of political elites and public attitudes under electoral and partisan politics,and traditional class control mechanisms targeting specific identity groups.Studying new punitiveness can offer valuable insights for identifying potential risks in China’s criminal justice system at both theoretical and practical levels,while providing methodological inspiration for advancing interdisciplinary research.展开更多
Development of oedema and hypoproteinaemia in a liver transplant recipient may be the first signs of graft dysfunction and should prompt a full assessment. We report the novel case of a patient who, years after liver ...Development of oedema and hypoproteinaemia in a liver transplant recipient may be the first signs of graft dysfunction and should prompt a full assessment. We report the novel case of a patient who, years after liver transplantation developed a functional blind loop in an incisional hernia, which manifested as oedema and hypoproteinaemia secondary to protein losing enteropathy. After numerous investigations, the diagnosis was made by flurodeoxyglucose positron emmision tomography (FDG-PET) imaging. Surgical repair of the incisional hernia was followed several months later by resolution of the protein loss, and confirmed at a post operative FDG-PET scan at one year.展开更多
BACKGROUND An incarcerated hernia is a common cause of acute abdominal pain.There are various types of incarcerated hernias,including incarcerated hernias of the appendix.These hernias are often complicated by appendi...BACKGROUND An incarcerated hernia is a common cause of acute abdominal pain.There are various types of incarcerated hernias,including incarcerated hernias of the appendix.These hernias are often complicated by appendiceal inflammation,necrosis,and suppuration,which affect the outcome of surgical repair.A De Garengeot hernia is a femoral hernia that contains the appendix.This type of hernia has a low incidence.When a De Garengeot hernia is clinically suspected,emergency surgical treatment should be performed as soon as possible.CASE SUMMARY A 59-year-old man was admitted to the hospital with a painful right inguinal mass that had suddenly developed 6 hours earlier.Physical examination revealed a 4 cm×2 cm palpable mass in the right groin.The mass was hard and could not be reduced due to tenderness.It did not descend into the scrotum.B-ultrasound revealed an incarcerated hernia.During surgery,the hernia was found to contain the appendix,which exhibited distal avascular necrosis.A De Garengeot hernia was diagnosed according to the classification criteria of this type of inguinal hernia.Laparoscopic reduction of the incarcerated hernia,appendectomy,and small-incision femoral hernia repair were performed in the emergency department,and cefuroxime was administered as anti-infection therapy for 2 d postoperatively.After treatment,the patient had no abdominal pain or infection and was discharged on postoperative day 4.He had no recurrence of the inguinal hernia after 16 months of follow-up.CONCLUSION De Garengeot hernias have a low incidence and are difficult to diagnose.Laparoscopy is useful for their diagnosis and treatment.展开更多
The risk factors associated with strangulated ovarian hernia (SOH)in female patients (<1 year old)were identified.A retrospective analysis was conducted regarding the data from 2006 to 2017.The patients were divide...The risk factors associated with strangulated ovarian hernia (SOH)in female patients (<1 year old)were identified.A retrospective analysis was conducted regarding the data from 2006 to 2017.The patients were divided into 2groups:SOH group (n=9)and non-SOH group (n=23). Patient demographics,clinical signs,preoperative examinations and intraoperative findings were compared between the two groups,and risk factors for SOH were tested using a binary logistic regression model.To explore whether greater ovary was more likely to be twisted,leading to SOH, all the patients were divided into ovary volume <5cm^3 and ≥5cm^3 groups and the association between ovarian volume and ovary torsion was assessed.Among a total of 32 female patients (<1year old)with incarcerated ovarian herniation,9 patients developed SOH.The single variate analysis revealed that times of manual reduction,ovarian volume,ovary with or without multiple cysts,ovary torsion or not and angle of ovary torsion were found to be significant factors associated with SOH.The multivariate analysis showed ovarian volume was evidenced as an independent risk factor for SOH.Furthermore,the incidence of ovary torsion was significantly higher in ovarian volume ≥5cm^3 group than in ovarian volume <5cm^3 group,indicating that larger ovary was more likely to result in ovary torsion,leading to SOH.Our study demonstrated that the odds of SOH increased with increasing ovarian volume in female patients (<1 year old)because the relatively greater ovary at this age was more likely to be incarcerated and twisted,leading to SOH.展开更多
Incarceration rarely complicates the chronically progressive form of the full thickness rectal prolapse.Even more rarely,it becomes strangulated,necessitating emergency surgery.We describe an extremely rare case of in...Incarceration rarely complicates the chronically progressive form of the full thickness rectal prolapse.Even more rarely,it becomes strangulated,necessitating emergency surgery.We describe an extremely rare case of incarcerated acute rectal prolapse,without a relevant previous history or symptoms of predisposing pathology.The patient underwent emergency perineal proctosigmoidectomy,the Altemeier operation,combined with diverting loop sigmoid colostomy.The postoperative course was quite uneventful with an excellent final result after colostomy closure.The successful treatment of this patient illustrates the value of the Altemeier procedure in the difficult and unusual case scenario of bowel incarceration.展开更多
AIM To study the utility of single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection.METHODS A 2 cm transverse skin incision was made in the umbilicus, extending to the intraperit...AIM To study the utility of single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection.METHODS A 2 cm transverse skin incision was made in the umbilicus, extending to the intraperitoneal cavity. Carbon dioxide was insufflated followed by insertion of laparoscope to observe the intraperitoneal cavity. The type of hernia was diagnosed and whether there was the presence of intestinal incarceration was confirmed. When an intestinal incarceration in the hernia sac was found, the forceps were inserted through the incision site and the intestine was returned to the intraperitoneal cavity without increasing the number of trocars. Once the peritoneum was closed, totally extraperitoneal inguinal hernia repair was performed, and finally, intraperitoneal observation was performed to reconfirm the repair.RESULTS Of the 75 hernias treated, 58 were on one side, 17 were on both sides, and 10 were recurrences. The respective median operation times for these 3 groups of patients were 100 min(range, 66 to 168), 136 min(range, 114 to 165), and 125 min(range, 108 to 156), with median bleeding amounts of 5 g(range, 1 to 26), 3 g(range, 1 to 52), and 5 g(range, 1 to 26), respectively. Intraperitoneal observation showed hernia on the opposite side in 2 cases, intestinal incarceration in 3 cases, omental adhesion into the hernia sac in 2 cases, severe postoperative intraperitoneal adhesions in 2 cases, and bladder protrusion in 1 case. There was only 1 case of recurrence.CONCLUSION Single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection makes hernia repairs safer and reducing postoperative complications. The technique also has excellent cosmetic outcomes.展开更多
AIM:To investigate the feasibility of endoscopic dacryocystorhinostomy(En-DCR)with bicanalicular silicone tube intubation for treating chronic dacryocystitis secondary to nasolacrimal duct stent(NDS)incarceration.METH...AIM:To investigate the feasibility of endoscopic dacryocystorhinostomy(En-DCR)with bicanalicular silicone tube intubation for treating chronic dacryocystitis secondary to nasolacrimal duct stent(NDS)incarceration.METHODS:En-DCRs were performed on 44 chronic dacryocystitis patients(46 eyes)secondary to NDS incarceration from April 2016 to October 2022.The granuloma and scar tissues were separated,and the removal of NDS incarceration was achieved during the surgery;the flap of the lacrimal sac was trimmed and anastomosed with nasal mucosal,a bicanalicular silicone tube was implanted,and lacrimal size and condition were assessed.The tube was removed 3mo after surgery.During the final follow-up of 12mo when the surgery was completed,the complications and the rates of surgical success were assessed.RESULTS:This study covered 40 patients(42 eyes).Intraoperatively,it was found that the lacrimal sac became small,and the sac wall had granulation and scar tissue attached to the incarcerated NDS in all eyes.At 12mo after surgery completed,the rates of the functional and anatomical success reached 80.95%(34/42)and 83.33%(35/42),respectively.Under the effect of intranasal ostial closure,seven eyes failed to achieve anatomical success.No serious complications(e.g.,visual impairment,sinusitis,and orbital fat prolapse)was observed.CONCLUSION:With the success rate over 80%and no serious complications,En-DCR with bicanalicular silicone tube implantation is effective in treating chronic dacryocystitis secondary to NDS incarceration.展开更多
BACKGROUND Acute urinary retention(AUR)is rare during pregnancy.CASE SUMMARY We report on three pregnant women with AUR between the 10^(th) and 18^(th) wk of gestation.Case 1 was first diagnosed as urinary tract infec...BACKGROUND Acute urinary retention(AUR)is rare during pregnancy.CASE SUMMARY We report on three pregnant women with AUR between the 10^(th) and 18^(th) wk of gestation.Case 1 was first diagnosed as urinary tract infection and developed a urinary tract infection due to urinary retention caused by urethral obstruction.Case 2 had a history of previous abdominal surgery for pelvic tuberculosis,leading to severe adhesions and a persistent retroverted uterus.In case 3,healthcare providers focused on the patient’s gastrointestinal symptoms and did not investigate her inability to void.Case 1 required manual disimpaction of the uterus and the knee-chest position.The other cases required immediate catheterization.The condition resolved in cases 1 and 2;these patients had normal pregnancies.Case 3 had severe complications at the time of consultation,leading to an abortion.CONCLUSION Retroverted uterus is the most common cause of AUR.Prompt recognition and diagnosis are required.Clinicians should be aware of the risk factors,etiology,and clinical presentation of AUR in the first and second trimester of pregnancy.展开更多
BACKGROUND Perivascular epithelioid cell tumor(PEComa)represents a group of rare mesenchymal tumors.PEComa can occur in many organs but is rare in the colorectum,especially in children.Furthermore,PEComa is a rare cau...BACKGROUND Perivascular epithelioid cell tumor(PEComa)represents a group of rare mesenchymal tumors.PEComa can occur in many organs but is rare in the colorectum,especially in children.Furthermore,PEComa is a rare cause of intussusception,the telescoping of a segment of the gastrointestinal tract into an adjacent one.We describe a rare case of pediatric PEComa complicated with intussusception and anal incarceration,and conduct a review of the current literature.CASE SUMMARY A 12-year-old girl presented with abdominal pain and abdominal ultrasound suggested intussusception.Endoscopic direct-vision intussusception treatment and colonoscopy was performed.A spherical tumor was discovered in the transverse colon and removed by surgery.Postoperative pathologic analyses revealed that the tumor volume was 5.0 cm×4.5 cm×3.0 cm and the tumor tissue was located in the submucosa of the colon,arranged in an alveolar pattern.The cell morphology was regular,no neoplastic necrosis was observed,and nuclear fission was rare.The immunohistochemical staining results were as follows:Human melanoma black 45(HMB 45)(+),cluster of differentiation 31(CD31)(+),cytokeratin(-),melanoma-associated antigen recognized by T cells(-),smooth muscle actin(-),molleya(-),desmin(-),S-100(-),CD117(-),and Ki67(positive rate in hot spot<5%).Combined with the results of pathology and immunohistochemistry,we diagnosed the tumor as PEComa.Postoperative recovery was good at the 4 mo follow-up.CONCLUSION The diagnosis of PEComa mainly depends on pathology and immunohistochemistry.Radical resection is the preferred treatment method.展开更多
基金Supported by the National Natural Science Foundation of China,No.82000482China Postdoctoral Science Foundation funded,No.2023M741858China Crohn’s and Colitis Foundation,No.CCCF-QF-2023C18-3.
文摘BACKGROUND Early identification of bowel resection risks is crucial for patients with incarcerated inguinal hernia(IIH).However,the prompt detection of these risks remains a significant challenge.Advancements in radiomic feature extraction and machine learning algorithms have paved the way for innovative diagnostic approaches to assess IIH more effectively.AIM To devise a sophisticated radiomic-clinical model to evaluate bowel resection risks in IIH patients,thereby enhancing clinical decision-making processes.METHODS This single-center retrospective study analyzed 214 IIH patients randomized into training(n=161)and test(n=53)sets(3:1).Radiologists segmented hernia sac-trapped bowel volumes of interest(VOIs)on computed tomography images.Radiomic features extracted from VOIs generated Rad-scores,which were combined with clinical data to construct a nomogram.The nomogram’s performance was evaluated against standalone clinical and radiomic models in both cohorts.RESULTS A total of 1561 radiomic features were extracted from the VOIs.After dimensionality reduction,13 radiomic features were used with eight machine learning algorithms to develop the radiomic model.The logistic regression algorithm was ultimately selected for its effectiveness,showing an area under the curve(AUC)of 0.828[95%confidence interval(CI):0.753-0.902]in the training set and 0.791(95%CI:0.668-0.915)in the test set.The comprehensive nomogram,incorporating clinical indicators showcased strong predictive capabilities for assessing bowel resection risks in IIH patients,with AUCs of 0.864(95%CI:0.800-0.929)and 0.800(95%CI:0.669-0.931)for the training and test sets,respectively.Decision curve analysis revealed the integrated model’s superior performance over standalone clinical and radiomic approaches.CONCLUSION This innovative radiomic-clinical nomogram has proven to be effective in predicting bowel resection risks in IIH patients and has substantially aided clinical decision-making.
文摘Amyand's hernia is a rare condition defined by the inclusion of the appendix vermiformis within the hernia sac. Its incidence among cases of groin hernia is less than 1%. The clinical manifestation of incarcerated inguinal hernia generally masks the symptoms and signs of acute appendicitis, which renders preoperative diagnosis difficult. In this study, we present two cases of Amyand's hernia that were diagnosed preoperatively. The patients were taken for operation with the prediagnosis of ?ncarcerated inguinal hernia. We evaluated these cases along with data from prior studies.
文摘BACKGROUND Benign symmetric lipomatosis(BSL)was first described by Brodie in 1846 and defined as Madelung’s disease by Madelung in 1888.At present,about 400 cases have been reported worldwide.Across these cases,surgical resection remains the recommended treatment.Here we report a case of neck BSL with concomitant thick fatty deposit in the inguinal region,which concealed the signs of a right incarcerated femoral hernia.CASE SUMMARY A 69-year-old male patient was admitted to our hospital with“abdominal pain,abdominal distension,nausea-vomiting and difficult defecation for half a month”.Moreover,he had a mass in the right inguinal region for more than 10 years.An egg-sized neck mass also developed 15 years ago and had developed into a full neck enlargement 1 year later.In addition,the patient had a history of heavy alcohol consumption for more than 40 years.With the aid of computerized tomography scan,the patient was diagnosed with BSL and a low intestinal mechanical obstruction caused by a right inguinal incarcerated hernia.Under general anesthesia,right inguinal incarcerated femoral hernia loosening and tension-free hernia repair was performed.However,this patient did not receive BSL resection.After a 1-year follow-up,no recurrence of the right inguinal femoral hernia was found.Moreover,no increase in fat accumulation was found in the neck or other areas.CONCLUSION Secretive intraperitoneal fat increase may be difficult to detect,but a conservative treatment strategy can be adopted as long as it does not significantly affect the quality-of-life.
文摘Surgical intervention of asymptomatic and accidentally detected pancreatic carcinoma can prolong survival. A 67-year-old man with the right incarcerated inguinal hernia was referred to our hospital, he immediately underwent manipulative treatment followed by hernioplasty on the next day. Upon the first visit, a pancreatic tumor was accidentally detected in CT images in the pancreatic tail. About approximately a month, abdominal CT revealed a slightly developed tumor;accordingly, distal pancreatectomy with lymph node dissection was performed. The patient was histopathologically diagnosed with tubular adenocarcinoma, and his final pathological stage was ypT2, pN0, cM0, Stage Ib, based on the TNM classification of malignant tumors (8th edition). For postoperative six months, he was treated with adjuvant chemotherapy using gemcitabine (1000 mg/m2). Remarkably, the patient reported no recurrence and has been alive for postoperative 7.5 years, thereby attaining excellent outcomes for accidentally detected pancreatic carcinoma at the occurrence of an incarcerated inguinal hernia.
文摘Aim: Incarcerated stomal prolapse is a rare complication of enterostomy. Numerous procedures have been described, such as additional laparotomy to fix the intraabdominal intestine in place, enterostomy revision, or correction of the prolapse following stoma creation. The authors report successful managements by stomal reconstruction and discuss several clinical points, including the techniques of surgical revision for incarcerated stomal prolapse in loop enterostomy. Patients: Case 1) A female infant weighing 2755 g was delivered at 34 weeks of gestation. On the first day after birth, a right supra-abdominal transverse incision of 10 cm in diameter was used for transverse loop colostomy in a cloacal malformation. Two centimeters of the stomal loop was approximated with sutures to prevent evisceration of the small intestine between the 2 limbs of the loop. Interrupted sutures of 5-0 absorbable monofilament secured the seromuscle of the colon to the peritoneum and fascia, and also to the skin. The distal limb of the colostomy prolapsed 11 months after birth. The physical findings revealed that 10 cm of the distal limb was intussuscepted. Case 2) A female infant weighing 2550 g was delivered at 39 weeks of gestation. A radiological examination by contrast enema showed no spastic rectum and colon, as in Hirschsprung’s disease. Under the laparotomy of a right supra-abdominal transverse incision of 5 cm in diameter, loop ileostomy was performed at 30cm on the proximal side of the cecum such as Case 1. Subsequently, the proximal limb of the ileostomy prolapsed 2 days after operation. The physical findings revealed that 10 cm of the proximal limb was intussuscepted. New enterostomy formation: Divided enterostomy was performed with 3-cm stitching of each limb. The stomal site was moved to the inside from the previous stomal site to oversew and fix by the rectal fascia. The children have been well without trouble since undergoing the new eneterostomy formation. Conclusions: Operation to repair the prolapse of a stoma is advised if it causes problems. We found that simple mobilization of the bowel and excision of the redundant bowel provided a satisfactory result in the present cases.
文摘Patients with an incarcerated rectal prolapse usually present in the emergency department where manual reduction is first attempted. If reduction is unsuccessful, an emergency laparotomy and internal reduction is required. Edema in the rectal and perineal tissues and impaired blood flow are the main factors for a high percentage of anastomotic leaks. The traditional single stage perineal rectosigmoidectomy is not a safe surgical procedure for treating incarcerated or strangulated rectal prolapses associated with severe edema. Herein we report a case of an incarcerated rectal prolapse treated with the Notaras procedure.
文摘Incarcerated gravid uterus is a rare obstetric condition that contributes to pregnancy-related adverse outcomes,especially if the uterus remains incarcerated and the condition goes undiagnosed until delivery.An effective diagnosis of this condition is benefited from pelvic examination combined with imaging methods and based on suspected symptoms.We present a case of ultrasound-assisted instrument reposition of an incarcerated gravid uterus at mid-gestation and discuss its clinical characteristics,diagnosis,imaging features,and treatment.We believe that once manual reduction fails,the use of instruments will undoubtedly be a better choice.
基金Beijing Municipal Science and Technology Commission,No.Z171100000417056。
文摘BACKGROUND The global pandemic of coronavirus disease 2019 pneumonia poses a particular challenge to the emergency surgical treatment of elderly patients with high-risk acute abdominal diseases.Elderly patients are a high-risk group for surgical treatment.If the incarceration of gallstones cannot be relieved,emergency surgery is unavoidable.CASE SUMMARY We report an 89-year-old male patient with acute gangrenous cholecystitis and septic shock induced by incarcerated cholecystolithiasis.He had several coexisting,high-risk underlying diseases,had a history of radical gastrectomy for gastric cancer,and was taking aspirin before the operation.Nevertheless,he underwent emergency laparoscopic cholecystectomy,with maintenance of postoperative heart and lung function,successfully recovered,and was discharged on day 8 after the operation.CONCLUSION Emergency surgery for elderly patients with acute abdominal disease is safe and feasible during the coronavirus disease 2019 pandemic,the key is to abide strictly by the hospital's epidemic prevention regulations,fully implement the epidemic prevention procedure for emergency surgery,fully prepare before the operation,accurately perform the operation,and carefully manage the patient postoperatively.
文摘Meckel's diverticulum is a very common congenital anomaly of the gastrointestinal tract but many cases remain asymptomatic and are diagnosed incidentally during laparoscopic or other surgical procedures. Cases of femoral hernia involving Meckel's diverticulum are rare, with less than 50 cases reported in the literature since Littre published the first description of this coincident condition over 300 years ago. While all true "Littre's hernias" contain a Meckel's diverticulum, the involved anatomical sites are various, the most common being the inner groin(inguinal), the outer groin(femoral), and the belly button(umbilical). Complications of Littre's hernias include incarceration, strangulation, necrosis, and perforation. Herein, we describe a case of Littre's hernia that involved an incarcerated Meckel's diverticulum in a femoral hernia that was diagnosed upon investigation of symptomology manifesting from perforation and was successfully managed by surgical resection with stapler devices.
文摘Background: The burden of COVID-19 and human immunodeficiency virus (HIV) are some of the major and persistent global health challenges of the twenty-first century. HIV and COVID-19 are expected to overlap in high HIV-burden countries, posing several public health challenges as a result. Prisons are overcrowded, have limited space for social distancing and have inadequate ventilation systems, making it difficult to contain the spread of COVID-19 in addition to the high-risk behaviours of inmates which contribute to the spread of HIV within these facilities. This study aimed to determine the prevalence of COVID-19 among inmates in a prison facility with a relatively high HIV burden in Port Harcourt, Nigeria;investigating potential risk factors and co-infection with HIV. Methodology: The study employed a descriptive cross-sectional study design sampling 200 inmates from the Port Harcourt Maximum Security Custodial Centre from July to December 2022. A well-structured questionnaire was administered via interviews in addition to screening for HIV-1/2 antibodies as well as COVID-19 antigens using rapid diagnostic test kits. Descriptive statistics and chi-square were carried out on the GraphPad Prism 9 software with statistical significance defined as a p-value of less than 0.05 at a 95% confidence interval. Result: The prevalence of HIV from the current study was 6.5%, COVID-19 prevalence was reported to be 12.5% while HIV/COVID-19 co-infection was 1.5% The duration of incarceration, face mask use, frequent visitations and vaccination against COVID-19 were found to be significantly associated with the prevalence of COVID-19 in the studied population (p Conclusion: The current study reports a relatively high prevalence of HIV and COVID-19 among the inmates in the study area. It becomes expedient for the administrators of the correctional facility to properly screen new inmates for COVID-19, quarantine and manage cases, as well as provide them with personal protective equipment such as face masks. In-person visitation should be balanced with measures to prevent the spread of the infection, and mass vaccination campaigns should be promoted. Improving access to HIV screening and therapy for all prisoners should be prioritised to identify and manage the incidence of HIV early, reducing the risk of transmission, mitigating comorbidities and improving health outcomes.
基金This article is an interim achievement of the National Social Science Fund Major Project“Classification,System Construction,and Database Building of Legislative Language of Qin-Han to Tang Dynasty”(Project Approval Number 21&ZD197).
文摘During the Tang Dynasty,incarcerated prisoners enjoyed various rights during their detention,including access to clothing,food,medical care,hygiene,rest,and burial arrangements.Under specific conditions,prisoners were even granted leave for family events such as funerals or weddings.The Rules for Prison Officials(Yuguanling)detailed the rights and safeguards for prisoners and set clear guidelines on the use of restraints during detention.Additionally,the Statutes on Deciding Cases(Duanyu Lü)outlined explicit penalties for judicial officials who failed to ensure prisoner rights or committed related violations.Interrogation processes adhered to strict procedural and substantive requirements,including direct questioning by judges,the avoidance of cases involving personal connections or conflicts of interest,evidence-based cross-examinations,careful investigation of circumstances,and consistent rulings across similar cases.The Tang legal code imposed comprehensive,detailed,and stringent limits on the application of coercive interrogations,specifying restrictions on tools,methods,subjects,and extent.Any breaches of these restrictions were met with severe punishments.While the concept of“human rights”did not appear in Tang legal and administrative texts,these laws and regulations embody abundant principles of people-centered governance,benevolence,and human rights concepts.Systematic examination of these ideas,values,and principles—when integrated with the Marxist perspective on human rights—can enrich China’s contemporary human rights practice,contribute to articulating China’s unique narrative on human rights,and play a role in constructing a distinctly Chinese discourse on human rights.Such efforts could provide Chinese wisdom and proposals for the advancement of human rights globally.
基金a phased result of the“National Funded Postdoctoral Researchers Program”(GZC20230818).
文摘Following the Enlightenment,the principle of human rights protection promoted the transition of criminal justice systems from“punitiveness”to“penal humanitarianism.”However,in the second half of the 20th century,the United States and the United Kingdom witnessed the rise of“new punitiveness,”which is characterized by mass incarceration,a punitive turn in community supervision,and numerous collateral consequences of criminal offences.New punitiveness did not emerge from a unified movement or agenda but was driven by changes in crime control philosophies,adjustments in criminal laws,and the initiation of criminal justice campaigns against a backdrop of perceived severe public safety deterioration.Its deeper causes can be traced to the dominance of neoliberalism in economics,the unprecedented alignment of political elites and public attitudes under electoral and partisan politics,and traditional class control mechanisms targeting specific identity groups.Studying new punitiveness can offer valuable insights for identifying potential risks in China’s criminal justice system at both theoretical and practical levels,while providing methodological inspiration for advancing interdisciplinary research.
文摘Development of oedema and hypoproteinaemia in a liver transplant recipient may be the first signs of graft dysfunction and should prompt a full assessment. We report the novel case of a patient who, years after liver transplantation developed a functional blind loop in an incisional hernia, which manifested as oedema and hypoproteinaemia secondary to protein losing enteropathy. After numerous investigations, the diagnosis was made by flurodeoxyglucose positron emmision tomography (FDG-PET) imaging. Surgical repair of the incisional hernia was followed several months later by resolution of the protein loss, and confirmed at a post operative FDG-PET scan at one year.
基金Zhejiang Provincial Medical Science Research Foundation,No.2020ZH053 and No.2021KY1133.
文摘BACKGROUND An incarcerated hernia is a common cause of acute abdominal pain.There are various types of incarcerated hernias,including incarcerated hernias of the appendix.These hernias are often complicated by appendiceal inflammation,necrosis,and suppuration,which affect the outcome of surgical repair.A De Garengeot hernia is a femoral hernia that contains the appendix.This type of hernia has a low incidence.When a De Garengeot hernia is clinically suspected,emergency surgical treatment should be performed as soon as possible.CASE SUMMARY A 59-year-old man was admitted to the hospital with a painful right inguinal mass that had suddenly developed 6 hours earlier.Physical examination revealed a 4 cm×2 cm palpable mass in the right groin.The mass was hard and could not be reduced due to tenderness.It did not descend into the scrotum.B-ultrasound revealed an incarcerated hernia.During surgery,the hernia was found to contain the appendix,which exhibited distal avascular necrosis.A De Garengeot hernia was diagnosed according to the classification criteria of this type of inguinal hernia.Laparoscopic reduction of the incarcerated hernia,appendectomy,and small-incision femoral hernia repair were performed in the emergency department,and cefuroxime was administered as anti-infection therapy for 2 d postoperatively.After treatment,the patient had no abdominal pain or infection and was discharged on postoperative day 4.He had no recurrence of the inguinal hernia after 16 months of follow-up.CONCLUSION De Garengeot hernias have a low incidence and are difficult to diagnose.Laparoscopy is useful for their diagnosis and treatment.
文摘The risk factors associated with strangulated ovarian hernia (SOH)in female patients (<1 year old)were identified.A retrospective analysis was conducted regarding the data from 2006 to 2017.The patients were divided into 2groups:SOH group (n=9)and non-SOH group (n=23). Patient demographics,clinical signs,preoperative examinations and intraoperative findings were compared between the two groups,and risk factors for SOH were tested using a binary logistic regression model.To explore whether greater ovary was more likely to be twisted,leading to SOH, all the patients were divided into ovary volume <5cm^3 and ≥5cm^3 groups and the association between ovarian volume and ovary torsion was assessed.Among a total of 32 female patients (<1year old)with incarcerated ovarian herniation,9 patients developed SOH.The single variate analysis revealed that times of manual reduction,ovarian volume,ovary with or without multiple cysts,ovary torsion or not and angle of ovary torsion were found to be significant factors associated with SOH.The multivariate analysis showed ovarian volume was evidenced as an independent risk factor for SOH.Furthermore,the incidence of ovary torsion was significantly higher in ovarian volume ≥5cm^3 group than in ovarian volume <5cm^3 group,indicating that larger ovary was more likely to result in ovary torsion,leading to SOH.Our study demonstrated that the odds of SOH increased with increasing ovarian volume in female patients (<1 year old)because the relatively greater ovary at this age was more likely to be incarcerated and twisted,leading to SOH.
文摘Incarceration rarely complicates the chronically progressive form of the full thickness rectal prolapse.Even more rarely,it becomes strangulated,necessitating emergency surgery.We describe an extremely rare case of incarcerated acute rectal prolapse,without a relevant previous history or symptoms of predisposing pathology.The patient underwent emergency perineal proctosigmoidectomy,the Altemeier operation,combined with diverting loop sigmoid colostomy.The postoperative course was quite uneventful with an excellent final result after colostomy closure.The successful treatment of this patient illustrates the value of the Altemeier procedure in the difficult and unusual case scenario of bowel incarceration.
文摘AIM To study the utility of single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection.METHODS A 2 cm transverse skin incision was made in the umbilicus, extending to the intraperitoneal cavity. Carbon dioxide was insufflated followed by insertion of laparoscope to observe the intraperitoneal cavity. The type of hernia was diagnosed and whether there was the presence of intestinal incarceration was confirmed. When an intestinal incarceration in the hernia sac was found, the forceps were inserted through the incision site and the intestine was returned to the intraperitoneal cavity without increasing the number of trocars. Once the peritoneum was closed, totally extraperitoneal inguinal hernia repair was performed, and finally, intraperitoneal observation was performed to reconfirm the repair.RESULTS Of the 75 hernias treated, 58 were on one side, 17 were on both sides, and 10 were recurrences. The respective median operation times for these 3 groups of patients were 100 min(range, 66 to 168), 136 min(range, 114 to 165), and 125 min(range, 108 to 156), with median bleeding amounts of 5 g(range, 1 to 26), 3 g(range, 1 to 52), and 5 g(range, 1 to 26), respectively. Intraperitoneal observation showed hernia on the opposite side in 2 cases, intestinal incarceration in 3 cases, omental adhesion into the hernia sac in 2 cases, severe postoperative intraperitoneal adhesions in 2 cases, and bladder protrusion in 1 case. There was only 1 case of recurrence.CONCLUSION Single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection makes hernia repairs safer and reducing postoperative complications. The technique also has excellent cosmetic outcomes.
文摘AIM:To investigate the feasibility of endoscopic dacryocystorhinostomy(En-DCR)with bicanalicular silicone tube intubation for treating chronic dacryocystitis secondary to nasolacrimal duct stent(NDS)incarceration.METHODS:En-DCRs were performed on 44 chronic dacryocystitis patients(46 eyes)secondary to NDS incarceration from April 2016 to October 2022.The granuloma and scar tissues were separated,and the removal of NDS incarceration was achieved during the surgery;the flap of the lacrimal sac was trimmed and anastomosed with nasal mucosal,a bicanalicular silicone tube was implanted,and lacrimal size and condition were assessed.The tube was removed 3mo after surgery.During the final follow-up of 12mo when the surgery was completed,the complications and the rates of surgical success were assessed.RESULTS:This study covered 40 patients(42 eyes).Intraoperatively,it was found that the lacrimal sac became small,and the sac wall had granulation and scar tissue attached to the incarcerated NDS in all eyes.At 12mo after surgery completed,the rates of the functional and anatomical success reached 80.95%(34/42)and 83.33%(35/42),respectively.Under the effect of intranasal ostial closure,seven eyes failed to achieve anatomical success.No serious complications(e.g.,visual impairment,sinusitis,and orbital fat prolapse)was observed.CONCLUSION:With the success rate over 80%and no serious complications,En-DCR with bicanalicular silicone tube implantation is effective in treating chronic dacryocystitis secondary to NDS incarceration.
文摘BACKGROUND Acute urinary retention(AUR)is rare during pregnancy.CASE SUMMARY We report on three pregnant women with AUR between the 10^(th) and 18^(th) wk of gestation.Case 1 was first diagnosed as urinary tract infection and developed a urinary tract infection due to urinary retention caused by urethral obstruction.Case 2 had a history of previous abdominal surgery for pelvic tuberculosis,leading to severe adhesions and a persistent retroverted uterus.In case 3,healthcare providers focused on the patient’s gastrointestinal symptoms and did not investigate her inability to void.Case 1 required manual disimpaction of the uterus and the knee-chest position.The other cases required immediate catheterization.The condition resolved in cases 1 and 2;these patients had normal pregnancies.Case 3 had severe complications at the time of consultation,leading to an abortion.CONCLUSION Retroverted uterus is the most common cause of AUR.Prompt recognition and diagnosis are required.Clinicians should be aware of the risk factors,etiology,and clinical presentation of AUR in the first and second trimester of pregnancy.
文摘BACKGROUND Perivascular epithelioid cell tumor(PEComa)represents a group of rare mesenchymal tumors.PEComa can occur in many organs but is rare in the colorectum,especially in children.Furthermore,PEComa is a rare cause of intussusception,the telescoping of a segment of the gastrointestinal tract into an adjacent one.We describe a rare case of pediatric PEComa complicated with intussusception and anal incarceration,and conduct a review of the current literature.CASE SUMMARY A 12-year-old girl presented with abdominal pain and abdominal ultrasound suggested intussusception.Endoscopic direct-vision intussusception treatment and colonoscopy was performed.A spherical tumor was discovered in the transverse colon and removed by surgery.Postoperative pathologic analyses revealed that the tumor volume was 5.0 cm×4.5 cm×3.0 cm and the tumor tissue was located in the submucosa of the colon,arranged in an alveolar pattern.The cell morphology was regular,no neoplastic necrosis was observed,and nuclear fission was rare.The immunohistochemical staining results were as follows:Human melanoma black 45(HMB 45)(+),cluster of differentiation 31(CD31)(+),cytokeratin(-),melanoma-associated antigen recognized by T cells(-),smooth muscle actin(-),molleya(-),desmin(-),S-100(-),CD117(-),and Ki67(positive rate in hot spot<5%).Combined with the results of pathology and immunohistochemistry,we diagnosed the tumor as PEComa.Postoperative recovery was good at the 4 mo follow-up.CONCLUSION The diagnosis of PEComa mainly depends on pathology and immunohistochemistry.Radical resection is the preferred treatment method.
