BACKGROUND Self-expandable metal stent(SEMS)as a bridge to surgery(BTS)has become a popular alternative to emergency surgery in the management of acute left-sided malignant colonic obstruction(MCO).However,it remains ...BACKGROUND Self-expandable metal stent(SEMS)as a bridge to surgery(BTS)has become a popular alternative to emergency surgery in the management of acute left-sided malignant colonic obstruction(MCO).However,it remains controversial for colonic stent as a BTS due to a lack of consensus and insufficient data.AIM To assess the clinical and oncological safety of SEMS insertion followed by elective resection for acute left-sided MCO.METHODS The data from 96 patients with acute left-sided MCO in our institution from January 2018 to May 2020 were analyzed retrospectively.They underwent colonic stenting as a bridge to elective surgery(BTS group:n=40)or emergency resection(ER group:n=56).Demographic characteristics,stoma rate,laparoscopy rate,postoperative complications,and oncological outcomes were compared between the two groups.RESULTS The two groups were comparable with regard to the demographics and tumor characteristics.The stoma rate was 7.5%in the BTS group vs 48.2%in the ER group(P<0.05).Primary anastomosis was performed in all patients in the BTS group,and only three patients underwent protective stoma in the BTS group.The BTS group had a significantly higher rate of laparoscopic surgery than the ER group(90%vs 57.1%,P<0.05),and the major postoperative complication rate was significantly higher in the ER group than in the BTS group(33.9%vs 15%,P=0.04).According to the Kaplan-Meier survival analysis and log rank test,no significant differences existed in the two groups with regard to the overall survival and disease-free survival.CONCLUSION The utilization of SEMS as a BTS is a useful alternative to emergency surgery in the treatment of acute left-sided MCO.SEMS insertion as a BTS can provide an effective and safe therapeutic option compared to emergency surgery.展开更多
BACKGROUND Gastric variceal hemorrhage is one of the primary manifestations of left-sided portal hypertension(LSPH).The hemorrhage is fatal and requires safe and effective interventions.AIM To evaluate the clinical sa...BACKGROUND Gastric variceal hemorrhage is one of the primary manifestations of left-sided portal hypertension(LSPH).The hemorrhage is fatal and requires safe and effective interventions.AIM To evaluate the clinical safety and efficacy of modified endoscopic ultrasound(EUS)-guided selective N-butyl-2-cyanoacrylate(NBC)injections for gastric variceal hemorrhage in LSPH.METHODS A retrospective observational study of patients with LSPH-induced gastric variceal hemorrhage was conducted.Preoperative EUS evaluations were performed.Enrolled patients were divided into modified and conventional groups according to the NBC injection technique.The final selection of NBC injection technique depended on the patients’preferences and clinical status.The technical and clinical success rates,operation time,NBC doses,perioperative complications,postoperative hospital stay,and recurrent bleeding rates were analyzed,respectively.RESULTS A total of 27 patients were enrolled.No statistically significant differences were observed between the two groups regarding baseline characteristics.In comparison to patients in the conventional group,patients in the modified group demonstrated significantly reduced NBC doses(2.0±0.6 mL vs 3.1±1.0 mL;P=0.004)and increased endoscopic operation time(71.9±11.9 min vs 22.5±6.7 min;P<0.001).Meanwhile,the two groups had no significant difference in the technical and clinical success rates,perioperative complications,postoperative hospital stay,and recurrent bleeding rates.CONCLUSION Modified EUS-guided selective NBC injections demonstrated safety and efficacy for LSPH-induced gastric variceal hemorrhage,with advantages of reduced injection dose and no radiation risk.Drawbacks were time consumption and technical challenge.展开更多
Left-sided portal hypertension(LSPH)followed by acute pancreatitis is a rare condition with most patients being asymptomatic.In cases where gastrointestinal(GI)bleeding is present,however,the condition is more complic...Left-sided portal hypertension(LSPH)followed by acute pancreatitis is a rare condition with most patients being asymptomatic.In cases where gastrointestinal(GI)bleeding is present,however,the condition is more complicated and the mortality is very high because of the difficulty in diagnosing and selecting optimal treatment.A successfully treated case with severe GI bleeding by transcatheter splenic artery embolization is reported in this article.The patient exhibited severe uncontrollable GI bleeding and was confirmed as gastric varices secondary to LSPH by enhanced computed tomography(CT)scan and CT-angiography.After embolization,the bleeding stopped and stabilized for the entire follow-up period without any severe complications.In conclusion,embolization of the splenic artery is a simple,safe,and effective method of controlling gastric variceal bleeding caused by LSPH in acute pancreatitis.展开更多
AIM:To give an overview of the literature on left-sided acute appendicitis (LSAA) associated with situs inversus totalis (SIT) and midgut malrotation (MM).METHODS:We present a new case of LSAA with SIT and a literatur...AIM:To give an overview of the literature on left-sided acute appendicitis (LSAA) associated with situs inversus totalis (SIT) and midgut malrotation (MM).METHODS:We present a new case of LSAA with SIT and a literature review of studies published in the English language on LSAA,accessed via PubMed and Google Scholar databases.RESULTS:Ninety-five published cases of LSAA were evaluated and a 25-year-old female,who presented to our clinic with left lower abdominal pain caused by LSAA,is reported.In the reviewed literature,fiftyseven patients were male and 38 were female with an age range of 8 to 82 years and a median age of 29.1 ± 15.9 years.Sixty-six patients had SIT,23 had MM,three had cecal malrotation,and two had a previously unnoted congenital abnormality.Fifty-nine patients had presentedto the hospital with left lower,14 with right lower and seven with bilateral lower quadrant pain,and seven subjects complained of left upper quadrant pain.The diagnosis was established preoperatively in 49 patients,intraoperatively in 19,and during the postoperative period in five;14 patients were aware of having this anomaly.The data of eight patients were not unavailable.Eleven patients underwent laparoscopic appendectomy,which was combined with cholecystectomy in two cases.Histopathological examination of the appendix specimens revealed adenocarcinoma in only two of 95 patients.CONCLUSION:The diagnosis of left lower quadrant pain is based on well-established clinical symptoms,physical examination and physician's experience.展开更多
BACKGROUND Handling of the inferior mesenteric artery(IMA)and maintaining anastomotic perfusion are important in radical resection of left-sided colorectal cancer.However,the branching of this artery and the drainage ...BACKGROUND Handling of the inferior mesenteric artery(IMA)and maintaining anastomotic perfusion are important in radical resection of left-sided colorectal cancer.However,the branching of this artery and the drainage patterns of this vein vary among individuals,and the characteristics and perfusion region of this artery in elderly patients remain unclear.AIM To evaluate the characteristics and perfusion region of the IMA in elderly patients using angiography.METHODS We enrolled 154 patients(>65 years old)who underwent digital subtraction angiography of the IMA.The characteristics,bifurcation,and distribution of the IMA and termination of the anastomotic perfusion of the left colon and rectum were examined using digital subtraction angiography.Collateral arterial arches and the IMA hemoperfusion region were also recorded.Perfusion regions were cross-referenced with clinical and anatomical features by the univariate analysis.RESULTS Of 154 patients,25(16.2%)had IMA lesions.The left colic artery arose independently from the IMA in 44.2%of patients,shared a trunk with the sigmoid artery in 35.1%,shared an opening with the sigmoid and superior rectal arteries in 16.9%,and was absent in 5.1%.The IMA perfusion region stopped at the splenic flexure in 50(32.5%)patients.The collateral circulation existed in the colonic perfusion region,including the marginal artery(Drummond’s artery),the ascending branch of the left colonic artery to supply the transverse colon,and the arc of Riolan with a frequency of 100%,22.7%,and 1.9%,respectively.The IMA perfusion region was independently associated with the comorbidity of atherosclerosis,IMA atherosclerotic lesion,branching pattern,collateral circulation,and marginal artery integrity.CONCLUSION The IMA and its branches are prone to arteriosclerosis,and IMA perfusion may be interrupted at the splenic flexure in elderly patients.The applicability and precision of preoperative angiography for evaluating the IMA branching and perfusion patterns could facilitate geriatric laparoscopic left-sided colorectal cancer surgery with suspicion of poor IMA perfusion.展开更多
AIM: To assess the importance of preoperative diagnosis and presentation of left-sided gallbladder using ultrasound (US),CT and angiography. METHODS: Retrospective review of 1482 patients who underwent enhanced CT sca...AIM: To assess the importance of preoperative diagnosis and presentation of left-sided gallbladder using ultrasound (US),CT and angiography. METHODS: Retrospective review of 1482 patients who underwent enhanced CT scanning was performed. Left-sided gallbladder was diagnosed if a right-sided ligamentum teres was present. The image presentations on US,CT and angiography were also reviewed. RESULTS: Left-sided gallbladder was diagnosed in nine patients. The associated abnormalities on CT imaging included portal vein anomalies,absence of umbilical portion of the portal vein in the left lobe of the liver,club-shaped portal vein in the right lobe of the liver,and difficulty in identifying segment Ⅳ. Angiography in six of nine patients demonstrated abnormal portal venous system (trifurcation type in four of six patients). The main hepatic arteries followed the portal veins in all six patients. The segment Ⅳ artery was identified in four of six patients using angiography,although segment Ⅳ was difficult to define on CT imaging. Hepatectomy was performed in three patients with concomitant liver tumor and the diagnosis of left-sided gallbladder was confirmed intraoperatively. CONCLUSION: Left-sided gallbladder is an important clinical entity in hepatectomy due to its associated portal venous and biliary anomalies. It should be considered in US,CT and angiography images that demonstrate no definite segment Ⅳ,absence of umbilical portion of the portal vein in the left lobe,and club-shaped right anterior portal vein.展开更多
AIM To explore the differences in the responses of left-sided colorectal cancer(LSCRC) and right-sided colon cancer(RSCC) to traditional Chinese medicine(TCM).METHODS Patients with postoperative stage I-III colorectal...AIM To explore the differences in the responses of left-sided colorectal cancer(LSCRC) and right-sided colon cancer(RSCC) to traditional Chinese medicine(TCM).METHODS Patients with postoperative stage I-III colorectal cancer(CRC) were enrolled and divided into the LSCRC with or without TCM and RSCC with or without TCM groups depending on the primary tumor side and TCM administration. Patients in the TCM group were given TCM for at least 6 mo. Our research adopted diseasefree survival(DFS) as the primary endpoint. We applied a Cox proportional hazards regression model for the multivariate factor analysis using Stata 12.0 and SPSS 22.0 software for data analysis.RESULTS Of the 817 patients included in our study, 617 had LSCRC(TCM group, n = 404; Non-TCM group, n = 213), and 200 had RSCC(TCM group, n = 132; NonTCM group, n = 68). The 6-year DFS for patients with LSCRC was 56.95% in the TCM group and 41.50% in the Non-TCM group(P = 0.000). For patients with RSCC, the 6-year DFS was 52.92% in the TCM group and 37.19% in the Non-TCM group(P = 0.003). Differences between LSCRC and RSCC were not statistically significant regardless of TCM ingestion.CONCLUSION Patients with either LSCRC or RSCC and who took TCM experienced longer DFS; furthermore, patients with RSCC benefited more from TCM in DFS.展开更多
There is still significant debate regarding the best surgical treatment for malignant left-sided large bowel obstruction.Primary resection and anastomosis offers the advantages of a definite procedure without need for...There is still significant debate regarding the best surgical treatment for malignant left-sided large bowel obstruction.Primary resection and anastomosis offers the advantages of a definite procedure without need for further surgery.Its main disadvantages are related to the increased technical challenge and to the potential higher risk of anastomotic leakage that occurs in the emergency setting.Primary resection with end colostomy(Hartmann's procedure) is considered the safer option.Tan et al compared in a systematic review and meta-analysis the use of self-expanding metallic stents(SEMS) as a bridge to surgery vs emergency surgery in the management of acute malignant left-sided large bowel obstruction.The authors concluded that the technical and clinical success rates for stenting were lower than expected.SEMS was associated with a high incidence of clinical and silent perforation.Stenting instead of loop colostomy can be recommended only if the appropriate expertise is available in the hospital.The goal of stenting,a decrease of the stoma rate,may be advocated only if the complication rates of stenting are lower than those of stoma creation in the emergency situation.Until now,this was not demonstrated in a prospective randomized trial.展开更多
AIM： To summarize our experience with the application of self-expanding metallic stent （SEMS） in the management of acute left-sided colorectal malignant obstruction. METHODS： A retrospective chart review of all pa...AIM： To summarize our experience with the application of self-expanding metallic stent （SEMS） in the management of acute left-sided colorectal malignant obstruction. METHODS： A retrospective chart review of all patients undergoing placement of SENS between April 2000 and January 2004 was performed. RESULTS： Insertion of SENS was attempted in 26 patients under fluoroscopic guidance with occasional endoscopic assistance. The sites of lesions were located in splenic flexure of two patients, left colon of seven patients, sigmoid colon of eight patients and rectum of nine patients. The intended uses of SENS were for palliation in 7 patients and as a bridge to elective surgery in 19 patients. In the latter group, placement of SENS allowed for preoperative systemic and bowel preparation and the following one-stage anastomosis. Successful stent placement was achieved in 22 （85%） of the 26 patients. The clinical bowel obstruction resolved 24 hours after successful stent placement in 21 （95%） patients. Three SENS-related minor complications occurred, two stents migrated and one caused anal pain. CONCLUSION： SEMS represents an effective and safe tool in the management of acute malignant colorectal obstruction. As a bridge to surgery, SEMS can provide time for systematic support and bowel preparation and obviate the need for fecal diversion or on-table lavage. As a palliative measure, SEMS can eliminate the need for emergent colostomy.展开更多
Left-sided periappendiceal abscesses occur in association with two types of congenital anomaly: intestinal malrotation and situs inversus. It is diffi cult to obtain an accurate preoperative diagnosis of these abscess...Left-sided periappendiceal abscesses occur in association with two types of congenital anomaly: intestinal malrotation and situs inversus. It is diffi cult to obtain an accurate preoperative diagnosis of these abscesses due to the abnormal position of the appendix. We present an unusual case of a left-sided periappendiceal abscess in an adult with intestinal malrotation, the diagnosis of which was a challenge.展开更多
AIM:To compare the outcome of the surgical management of left-sided and right-sided diverticular disease.METHODS:The medical records of 77 patients who were surgically treated for diverticular disease between 1999 and...AIM:To compare the outcome of the surgical management of left-sided and right-sided diverticular disease.METHODS:The medical records of 77 patients who were surgically treated for diverticular disease between 1999 and 2010 in a tertiary referral hospital were retrospectively reviewed.The study population was limited to cases wherein the surgical specimen was confirmed as diverticulosis by pathology.Rightsided diverticula were classified as those arising from the cecum,ascending colon,and transverse colon,and those from the descending colon,sigmoid colon,and rectum were classified as left-sided diverticulosis.To assess the changing trend of occurrence of diverticulosis,data were compared with two previous studies of 51 patients.RESULTS:The proportion of left-sided disease cases was significantly increased compared to the results of our previous studies in 1994 and 2001,(27.5%vs48.1%,P<0.05).Moreover,no differences in gender,body mass index,multiplicity of the diverticula,fever,or leukocytosis were noted between patients with rightsided and left-sided disease.However,patients with right-sided disease were significantly younger(50.9year vs 64.0 year,P<0.01).Furthermore,left-sided disease was significantly associated with a higher incidence of complicated diverticulitis(89.2%vs 57.5%,P<0.01),combined resection due to extensive inflammation(21.6%vs 5.0%,P<0.05),operative complications(51.4%vs 27.5%,P<0.05),and in-hospital mortality(10.8%vs 0%,P<0.05),along with longer post-operative hospitalization duration(21.3±10.2 d vs 10.6±8.1 d,P<0.05).CONCLUSION:Compared with right-sided diverticular disease,the incidence of left-sided disease in Korea has increased since 2001 and is associated with worse surgical outcomes.展开更多
BACKGROUND Left-sided portal hypertension(LSPH),also known as sinistral portal hypertension or regional portal hypertension,refers to extrahepatic portal hypertension caused by splenic vein obstruction or stenosis.N-b...BACKGROUND Left-sided portal hypertension(LSPH),also known as sinistral portal hypertension or regional portal hypertension,refers to extrahepatic portal hypertension caused by splenic vein obstruction or stenosis.N-butyl-2-cyanoacrylate(NBC)has been widely used in the endoscopic hemostasis of portal hypertension,but adverse events including renal or pulmonary thromboembolism,mucosal necrosis and gastrointestinal(GI)bleeding may occur after treatment.Herein,we report successfully managing gastric variceal(GV)hemorrhage secondary to LSPH using modified endoscopic ultrasound(EUS)-guided selective NBC injections.CASE SUMMARY A 35-year-old man was referred to our hospital due to an upper GI hemorrhage.Gastroscopy revealed GV hemorrhage and computed tomography venography(CTV)confirmed LSPH.The patient requested endoscopic procedures and rejected surgical therapies including splenectomy.EUS-guided selective NBC injections were performed and confluences of gastric varices were selected as the injection sites to reduce the injection dose.The“sandwich”method using undiluted NBC and hypertonic glucose was applied.No complications occurred.The patient was followed up regularly after discharge.Three months later,the follow-up gastroscopy revealed firm gastric submucosa with no sign of NBC expulsion and the follow-up CTV showed improvements in LSPH.No recurrent GI hemorrhage was reported during this follow-up period.CONCLUSION EUS-guided selective NBC injection may represent an effective and economical treatment for GV hemorrhage in patients with LSPH.展开更多
Colonic stenting has had a significant positive impact on the management of obstructive left-sided colon cancer(OLCC) in terms of both palliative treatment and bridge-to-surgery(BTS). Notably, many studies have convin...Colonic stenting has had a significant positive impact on the management of obstructive left-sided colon cancer(OLCC) in terms of both palliative treatment and bridge-to-surgery(BTS). Notably, many studies have convincingly demonstrated the effectiveness of stenting as a BTS, resulting in improvements in shortterm outcomes and quality of life, safety, and efficacy in subsequent curative surgery, and increased cost-effectiveness, whereas the safety of chemotherapy after stenting and the long-term outcomes of stenting as a BTS are controversial. Several studies have suggested an increased risk of perforation in patients receiving bevacizumab chemotherapy after colonic stenting. In addition, several pathological analyses have suggested a negative oncological impact of colonic stenting. In contrast, many recent studies have demonstrated that colonic stenting for OLCC does not negatively impact the safety of chemotherapy or long-term oncological outcomes. The updated version of the European Society of Gastrointestinal Endoscopy guidelines released in 2020 included colonic stenting as a BTS for OLCC as a recommended treatment. It should be noted that the experience of endoscopists is involved in determining technical and clinical success rates and possibly oncological outcomes. This review discusses the positive and negative impacts of colonic stenting on OLCC treatment, particularly in terms of oncology.展开更多
BACKGROUND Abnormalities of the inferior vena cava(IVC)are uncommon,and in many cases they are asymptomatic.Even so,it is vital that clinicians be aware of such anomalies prior to surgery in affected individuals.In th...BACKGROUND Abnormalities of the inferior vena cava(IVC)are uncommon,and in many cases they are asymptomatic.Even so,it is vital that clinicians be aware of such anomalies prior to surgery in affected individuals.In the present report,we describe a rare anatomical variation of the IVC.CASE SUMMARY A 66-year-old male was admitted to the hospital due to deep vein thrombosis of the right lower extremity.Upon contrast-enhanced computed tomography imaging,we found that this patient presented with a case of left-sided IVC draining into the hemiazygos vein,while his hepatic vein was directly draining into the atrium.CONCLUSION Cases of left-sided IVC can increase patient susceptibility to thromboembolism owing to the resultant changes in blood flow and/or associated vascular compression.展开更多
A left-sided gallbladder without a right-sided round ligament,which is called a true left-sided gallbladder,is extremely rare.A 71-year-old woman was referred to our hospital due to a gallbladder polyp.Computed tomogr...A left-sided gallbladder without a right-sided round ligament,which is called a true left-sided gallbladder,is extremely rare.A 71-year-old woman was referred to our hospital due to a gallbladder polyp.Computed tomography(CT) revealed not only a gallbladder polyp but also the gallbladder located to the left of the round ligament connected to the left umbilical portion.CT portography revealed that the main portal vein diverged into the right posterior portal vein and the common trunk of the left portal vein and right anterior portal vein.CT cholangiography revealed that the infraportal bile duct of segment 2 joined the common bile duct.Laparoscopic cholecystectomy was performed for a gallbladder polyp,and the intraoperative finding showed that the cholecystic veins joined the round ligament.A true left-sided gallbladder is closely associated with several anomalies; therefore,surgeons encountering a true left-sided gallbladder should be aware of the potential for these anomalies.展开更多
Introduction Right-sided colon cancer （RSCC） and left-sided colorectal cancer （LSCRC） differ with respect to theirbiology and genomic patterns. This study aimed to examine whether the primary tumor location is ass...Introduction Right-sided colon cancer （RSCC） and left-sided colorectal cancer （LSCRC） differ with respect to theirbiology and genomic patterns. This study aimed to examine whether the primary tumor location is associated withthe response to cetuximab in patients with metastatic colorectal cancer （mCRC）.Methods： Patients with mCRC treated with cetuximab and standard chemotherapy as first- or second-line treatmentswere compared with randomly chosen patients who were treated with chemotherapy alone between 2005 and 2013.The main outcome measures were the overall response rate （ORR）, progression-free survival （PFS）, and overall survival （OS）.The differences in the outcome were analyzed by using the chi-squared test, Student＇s t test, and Kaplan-Meier method.Results： The treatment results of 206 patients with mCRC treated with cetuximab and standard chemotherapy asfirst- or second-line treatments were compared with those of 210 patients who were treated with chemotherapyalone. As a first-line treatment, cetuximab with chemotherapy was associated with a significantly higher ORR（49.4 % vs. 28.6 %, P = 0.005） as well as longer PFS （9.1 vs. 6.2 months, P = 0.002） and OS （28.9 vs. 20.1 months,P = 0.036） than chemotherapy alone in patients with LSCRC. However, cetuximab neither improved the ORR（36.4 % vs. 26.2 %, P = 0.349） nor prolonged PFS （5.6 vs. 5.7 months, P = 0.904） or OS （25.1 vs. 19.8 months, P = 0.553） inpatients with RSCC. As a second-line treatment, cetuximab exhibited a tendency to improve the ORR （23.5 % vs. 10.2 %,P = 0.087） and prolong PFS （4.9 vs. 3.5 months, P = 0.064）, and it significantly prolonged OS （17.1 vs. 12.4 months,P = 0.047） compared with chemotherapy alone in the patients with LSCRC. In contrast, as a second-line treatment,cetuximab neither improved the ORR （7.1 % vs. 11.4 %, P = 0.698） nor prolonged PFS （3.3 vs. 4.2 months, P = 0.761） orOS （13.4 vs. 13.0 months, P=0.652） in patients with RSCC.Conclusions： The addition of cetuximab to chemotherapy in both first- and second-line treatments of mCRC may onlybenefit patients with primary LSCRC.展开更多
BACKGROUND Right-sided ligamentum teres(RSLT)is often associated with portal venous anomalies(PVA)and is regarded as a concerning feature for hepatobiliary intervention.Most studies consider RSLT to be one of the caus...BACKGROUND Right-sided ligamentum teres(RSLT)is often associated with portal venous anomalies(PVA)and is regarded as a concerning feature for hepatobiliary intervention.Most studies consider RSLT to be one of the causes of left-sided gallbladder(LGB),leading to the hypothesis that LGB must always be present with RSLT.However,some cases have shown that right-sided gallbladder(RGB)can also be present in livers with RSLT.AIM To highlight the rare variation that RSLT may not come with LGB and to determine whether ligamentum teres(LT)or gallbladder location is reliable to predict PVA.METHODS This study retrospectively assessed 8552 contrast-enhanced abdominal computed tomography examinations from 2018 to 2021[4483 men,4069 women;mean age,59.5±16.2(SD)years].We defined the surrogate outcome as major PVAs.The cases were divided into 4 subgroups according to gallbladder and LT locations.On one hand,we analyzed PVA prevalence by LT locations using gallbladder location as a controlled variable(n=36).On the other hand,we controlled LT location and computed PVA prevalence by gallbladder locations(n=34).Finally,we investigated LT location as an independent factor of PVA by using propensity score matching(PSM)and inverse probability of treatment weighting(IPTW).RESULTS We found 9 cases of RSLT present with RGB.Among the LGB cases,RSLT is associated with significantly higher PVA prevalence than typical LT[80.0%vs 18.2%,P=0.001;OR=18,95%confidence interval(CI):2.92-110.96].When RSLT is present,we found no statistically significant difference in PVA prevalence for RGB and LGB cases(88.9%vs 80.0%,P>0.99).Both PSM and IPTW yielded balanced cohorts in demographics and gallbladder locations.The RSLT group had a significantly higher PVA prevalence after adjusted by PSM(77.3%vs 4.5%,P<0.001;OR=16.27,95%CI:2.25-117.53)and IPTW(82.5%vs 4.7%,P<0.001).CONCLUSION RSLT doesn't consistently coexist with LGB.RSLT can predict PVA independently while the gallbladder location does not serve as a sufficient predictor.展开更多
BACKGROUND Left-sided accessory pathways(APs)can be accessed with either a transaortic(TA)or transseptal approach(TS).For children with Marfan syndrome(MFS)who have aortic disease,the use of TA can aggravate the disea...BACKGROUND Left-sided accessory pathways(APs)can be accessed with either a transaortic(TA)or transseptal approach(TS).For children with Marfan syndrome(MFS)who have aortic disease,the use of TA can aggravate the disease,making TS the best choice for these patients.CASE SUMMARY A 10-year-old girl was hospitalized because of intermittent heart palpitations and chest tightness.She was diagnosed with MFS,supraventricular tachycardia,Wolff-Parkinson-White syndrome,and left-sided AP was detected by cardiac electrophysiological.Catheter ablation was successfully performed via TS under the guidance of the Ensite system.During the follow-up,no recurrence or complications occurred.CONCLUSION The TS for catheter ablation of left-sided APs can be considered in children with MFS.Adequate evaluation and selection of the appropriate puncture site are particularly important.展开更多
<b>Introduction:</b> Left-sided acute appendicitis (LSAA) develops in association with two types of congenital anomalies: situs inversus totalis (SIT) and midgut malrotation (MM). A Left sided appendicitis...<b>Introduction:</b> Left-sided acute appendicitis (LSAA) develops in association with two types of congenital anomalies: situs inversus totalis (SIT) and midgut malrotation (MM). A Left sided appendicitis is an ambiguous and difficult diagnosis to make. <b>Aim: </b>To present a proven case of left-sided acute appendicitis (LSAA) associated with situs inversus totalis (SIT). <b>Case</b> <b>Report:</b> A case of Left appendicitis was evaluated in a 28-year-old Asian male, who presented to our hospital in Feb. 2016, with lower abdominal pain more on left side and suspected diverticulitis or acute appendicitis with unusual appendix location. The patient doesn’t recall any history of abdominal surgery or about situs inversus totalis, abdominal and pelvic ultrasound was done, left iliac fossa appendicitis was diagnosed, Erect chest X-ray including upper abdomen revealed dextrocardia and stomach air on right side (situs inversus totalis), the patient underwent diagnostic Laproscop and Endoscopic resection of the appendix, with no incidents, and then discharged without complications, follow visits went unremarkable. <b>Conclusion: </b>The diagnosis of left lower quadrant pain is based on well-established clinical symptoms, physical examination and physician’s experience.展开更多
The rare finding of the vermiform appendix within an inguinal hernia sac is known as Amyand’s hernia. It was first described by Claudius Amyand in 1735, in a right inguinal hernia. A much rarer find is a left-sided A...The rare finding of the vermiform appendix within an inguinal hernia sac is known as Amyand’s hernia. It was first described by Claudius Amyand in 1735, in a right inguinal hernia. A much rarer find is a left-sided Amyand’s hernia. This is a report of a case of complicated left-sided Amyand’s hernia in an eighteen month old male child. He presented as an emergency with an obstructed inguino-scrotal hernia and the diagnosis of Amyand’s hernia was made intra-operatively. He made uneventful recovery after surgery. Treatment options depend on findings during operation and clinical status of the patient.展开更多
文摘BACKGROUND Self-expandable metal stent(SEMS)as a bridge to surgery(BTS)has become a popular alternative to emergency surgery in the management of acute left-sided malignant colonic obstruction(MCO).However,it remains controversial for colonic stent as a BTS due to a lack of consensus and insufficient data.AIM To assess the clinical and oncological safety of SEMS insertion followed by elective resection for acute left-sided MCO.METHODS The data from 96 patients with acute left-sided MCO in our institution from January 2018 to May 2020 were analyzed retrospectively.They underwent colonic stenting as a bridge to elective surgery(BTS group:n=40)or emergency resection(ER group:n=56).Demographic characteristics,stoma rate,laparoscopy rate,postoperative complications,and oncological outcomes were compared between the two groups.RESULTS The two groups were comparable with regard to the demographics and tumor characteristics.The stoma rate was 7.5%in the BTS group vs 48.2%in the ER group(P<0.05).Primary anastomosis was performed in all patients in the BTS group,and only three patients underwent protective stoma in the BTS group.The BTS group had a significantly higher rate of laparoscopic surgery than the ER group(90%vs 57.1%,P<0.05),and the major postoperative complication rate was significantly higher in the ER group than in the BTS group(33.9%vs 15%,P=0.04).According to the Kaplan-Meier survival analysis and log rank test,no significant differences existed in the two groups with regard to the overall survival and disease-free survival.CONCLUSION The utilization of SEMS as a BTS is a useful alternative to emergency surgery in the treatment of acute left-sided MCO.SEMS insertion as a BTS can provide an effective and safe therapeutic option compared to emergency surgery.
基金Program for Youth Innovation in Future Medicine,Chongqing Medical University,China,No.W0138.
文摘BACKGROUND Gastric variceal hemorrhage is one of the primary manifestations of left-sided portal hypertension(LSPH).The hemorrhage is fatal and requires safe and effective interventions.AIM To evaluate the clinical safety and efficacy of modified endoscopic ultrasound(EUS)-guided selective N-butyl-2-cyanoacrylate(NBC)injections for gastric variceal hemorrhage in LSPH.METHODS A retrospective observational study of patients with LSPH-induced gastric variceal hemorrhage was conducted.Preoperative EUS evaluations were performed.Enrolled patients were divided into modified and conventional groups according to the NBC injection technique.The final selection of NBC injection technique depended on the patients’preferences and clinical status.The technical and clinical success rates,operation time,NBC doses,perioperative complications,postoperative hospital stay,and recurrent bleeding rates were analyzed,respectively.RESULTS A total of 27 patients were enrolled.No statistically significant differences were observed between the two groups regarding baseline characteristics.In comparison to patients in the conventional group,patients in the modified group demonstrated significantly reduced NBC doses(2.0±0.6 mL vs 3.1±1.0 mL;P=0.004)and increased endoscopic operation time(71.9±11.9 min vs 22.5±6.7 min;P<0.001).Meanwhile,the two groups had no significant difference in the technical and clinical success rates,perioperative complications,postoperative hospital stay,and recurrent bleeding rates.CONCLUSION Modified EUS-guided selective NBC injections demonstrated safety and efficacy for LSPH-induced gastric variceal hemorrhage,with advantages of reduced injection dose and no radiation risk.Drawbacks were time consumption and technical challenge.
基金Project supported by the National Natural Science Foundation of China (No. 30901445)the Zhejiang Provincial Natural Science Foundation (No. Y2100285)the Specialized Research Fund for the Doctoral Program of Higher Education (No. 20090101120122),China
文摘Left-sided portal hypertension(LSPH)followed by acute pancreatitis is a rare condition with most patients being asymptomatic.In cases where gastrointestinal(GI)bleeding is present,however,the condition is more complicated and the mortality is very high because of the difficulty in diagnosing and selecting optimal treatment.A successfully treated case with severe GI bleeding by transcatheter splenic artery embolization is reported in this article.The patient exhibited severe uncontrollable GI bleeding and was confirmed as gastric varices secondary to LSPH by enhanced computed tomography(CT)scan and CT-angiography.After embolization,the bleeding stopped and stabilized for the entire follow-up period without any severe complications.In conclusion,embolization of the splenic artery is a simple,safe,and effective method of controlling gastric variceal bleeding caused by LSPH in acute pancreatitis.
文摘AIM:To give an overview of the literature on left-sided acute appendicitis (LSAA) associated with situs inversus totalis (SIT) and midgut malrotation (MM).METHODS:We present a new case of LSAA with SIT and a literature review of studies published in the English language on LSAA,accessed via PubMed and Google Scholar databases.RESULTS:Ninety-five published cases of LSAA were evaluated and a 25-year-old female,who presented to our clinic with left lower abdominal pain caused by LSAA,is reported.In the reviewed literature,fiftyseven patients were male and 38 were female with an age range of 8 to 82 years and a median age of 29.1 ± 15.9 years.Sixty-six patients had SIT,23 had MM,three had cecal malrotation,and two had a previously unnoted congenital abnormality.Fifty-nine patients had presentedto the hospital with left lower,14 with right lower and seven with bilateral lower quadrant pain,and seven subjects complained of left upper quadrant pain.The diagnosis was established preoperatively in 49 patients,intraoperatively in 19,and during the postoperative period in five;14 patients were aware of having this anomaly.The data of eight patients were not unavailable.Eleven patients underwent laparoscopic appendectomy,which was combined with cholecystectomy in two cases.Histopathological examination of the appendix specimens revealed adenocarcinoma in only two of 95 patients.CONCLUSION:The diagnosis of left lower quadrant pain is based on well-established clinical symptoms,physical examination and physician's experience.
基金Supported by the National Natural Science Foundation of China,No.81800483.
文摘BACKGROUND Handling of the inferior mesenteric artery(IMA)and maintaining anastomotic perfusion are important in radical resection of left-sided colorectal cancer.However,the branching of this artery and the drainage patterns of this vein vary among individuals,and the characteristics and perfusion region of this artery in elderly patients remain unclear.AIM To evaluate the characteristics and perfusion region of the IMA in elderly patients using angiography.METHODS We enrolled 154 patients(>65 years old)who underwent digital subtraction angiography of the IMA.The characteristics,bifurcation,and distribution of the IMA and termination of the anastomotic perfusion of the left colon and rectum were examined using digital subtraction angiography.Collateral arterial arches and the IMA hemoperfusion region were also recorded.Perfusion regions were cross-referenced with clinical and anatomical features by the univariate analysis.RESULTS Of 154 patients,25(16.2%)had IMA lesions.The left colic artery arose independently from the IMA in 44.2%of patients,shared a trunk with the sigmoid artery in 35.1%,shared an opening with the sigmoid and superior rectal arteries in 16.9%,and was absent in 5.1%.The IMA perfusion region stopped at the splenic flexure in 50(32.5%)patients.The collateral circulation existed in the colonic perfusion region,including the marginal artery(Drummond’s artery),the ascending branch of the left colonic artery to supply the transverse colon,and the arc of Riolan with a frequency of 100%,22.7%,and 1.9%,respectively.The IMA perfusion region was independently associated with the comorbidity of atherosclerosis,IMA atherosclerotic lesion,branching pattern,collateral circulation,and marginal artery integrity.CONCLUSION The IMA and its branches are prone to arteriosclerosis,and IMA perfusion may be interrupted at the splenic flexure in elderly patients.The applicability and precision of preoperative angiography for evaluating the IMA branching and perfusion patterns could facilitate geriatric laparoscopic left-sided colorectal cancer surgery with suspicion of poor IMA perfusion.
基金Supported by Project Grant NHRI-GT-EX92-9228SP from the National Health Research Institutes and NSC 93-2314-B-182A-084 from the National Science Council, Taiwan, China
文摘AIM: To assess the importance of preoperative diagnosis and presentation of left-sided gallbladder using ultrasound (US),CT and angiography. METHODS: Retrospective review of 1482 patients who underwent enhanced CT scanning was performed. Left-sided gallbladder was diagnosed if a right-sided ligamentum teres was present. The image presentations on US,CT and angiography were also reviewed. RESULTS: Left-sided gallbladder was diagnosed in nine patients. The associated abnormalities on CT imaging included portal vein anomalies,absence of umbilical portion of the portal vein in the left lobe of the liver,club-shaped portal vein in the right lobe of the liver,and difficulty in identifying segment Ⅳ. Angiography in six of nine patients demonstrated abnormal portal venous system (trifurcation type in four of six patients). The main hepatic arteries followed the portal veins in all six patients. The segment Ⅳ artery was identified in four of six patients using angiography,although segment Ⅳ was difficult to define on CT imaging. Hepatectomy was performed in three patients with concomitant liver tumor and the diagnosis of left-sided gallbladder was confirmed intraoperatively. CONCLUSION: Left-sided gallbladder is an important clinical entity in hepatectomy due to its associated portal venous and biliary anomalies. It should be considered in US,CT and angiography images that demonstrate no definite segment Ⅳ,absence of umbilical portion of the portal vein in the left lobe,and club-shaped right anterior portal vein.
基金Supported by the Scientific Research Foundation of Traditional Chinese Medicine of the Shanghai Health Bureau,No.2014LZ079Athe Scientific Research Plan Project of the Shanghai Science and Technology Committee,No.14401930800the Program of Shanghai Municipal Technology and Education Commission,No.16401970500
文摘AIM To explore the differences in the responses of left-sided colorectal cancer(LSCRC) and right-sided colon cancer(RSCC) to traditional Chinese medicine(TCM).METHODS Patients with postoperative stage I-III colorectal cancer(CRC) were enrolled and divided into the LSCRC with or without TCM and RSCC with or without TCM groups depending on the primary tumor side and TCM administration. Patients in the TCM group were given TCM for at least 6 mo. Our research adopted diseasefree survival(DFS) as the primary endpoint. We applied a Cox proportional hazards regression model for the multivariate factor analysis using Stata 12.0 and SPSS 22.0 software for data analysis.RESULTS Of the 817 patients included in our study, 617 had LSCRC(TCM group, n = 404; Non-TCM group, n = 213), and 200 had RSCC(TCM group, n = 132; NonTCM group, n = 68). The 6-year DFS for patients with LSCRC was 56.95% in the TCM group and 41.50% in the Non-TCM group(P = 0.000). For patients with RSCC, the 6-year DFS was 52.92% in the TCM group and 37.19% in the Non-TCM group(P = 0.003). Differences between LSCRC and RSCC were not statistically significant regardless of TCM ingestion.CONCLUSION Patients with either LSCRC or RSCC and who took TCM experienced longer DFS; furthermore, patients with RSCC benefited more from TCM in DFS.
文摘There is still significant debate regarding the best surgical treatment for malignant left-sided large bowel obstruction.Primary resection and anastomosis offers the advantages of a definite procedure without need for further surgery.Its main disadvantages are related to the increased technical challenge and to the potential higher risk of anastomotic leakage that occurs in the emergency setting.Primary resection with end colostomy(Hartmann's procedure) is considered the safer option.Tan et al compared in a systematic review and meta-analysis the use of self-expanding metallic stents(SEMS) as a bridge to surgery vs emergency surgery in the management of acute malignant left-sided large bowel obstruction.The authors concluded that the technical and clinical success rates for stenting were lower than expected.SEMS was associated with a high incidence of clinical and silent perforation.Stenting instead of loop colostomy can be recommended only if the appropriate expertise is available in the hospital.The goal of stenting,a decrease of the stoma rate,may be advocated only if the complication rates of stenting are lower than those of stoma creation in the emergency situation.Until now,this was not demonstrated in a prospective randomized trial.
文摘AIM： To summarize our experience with the application of self-expanding metallic stent （SEMS） in the management of acute left-sided colorectal malignant obstruction. METHODS： A retrospective chart review of all patients undergoing placement of SENS between April 2000 and January 2004 was performed. RESULTS： Insertion of SENS was attempted in 26 patients under fluoroscopic guidance with occasional endoscopic assistance. The sites of lesions were located in splenic flexure of two patients, left colon of seven patients, sigmoid colon of eight patients and rectum of nine patients. The intended uses of SENS were for palliation in 7 patients and as a bridge to elective surgery in 19 patients. In the latter group, placement of SENS allowed for preoperative systemic and bowel preparation and the following one-stage anastomosis. Successful stent placement was achieved in 22 （85%） of the 26 patients. The clinical bowel obstruction resolved 24 hours after successful stent placement in 21 （95%） patients. Three SENS-related minor complications occurred, two stents migrated and one caused anal pain. CONCLUSION： SEMS represents an effective and safe tool in the management of acute malignant colorectal obstruction. As a bridge to surgery, SEMS can provide time for systematic support and bowel preparation and obviate the need for fecal diversion or on-table lavage. As a palliative measure, SEMS can eliminate the need for emergent colostomy.
文摘Left-sided periappendiceal abscesses occur in association with two types of congenital anomaly: intestinal malrotation and situs inversus. It is diffi cult to obtain an accurate preoperative diagnosis of these abscesses due to the abnormal position of the appendix. We present an unusual case of a left-sided periappendiceal abscess in an adult with intestinal malrotation, the diagnosis of which was a challenge.
文摘AIM:To compare the outcome of the surgical management of left-sided and right-sided diverticular disease.METHODS:The medical records of 77 patients who were surgically treated for diverticular disease between 1999 and 2010 in a tertiary referral hospital were retrospectively reviewed.The study population was limited to cases wherein the surgical specimen was confirmed as diverticulosis by pathology.Rightsided diverticula were classified as those arising from the cecum,ascending colon,and transverse colon,and those from the descending colon,sigmoid colon,and rectum were classified as left-sided diverticulosis.To assess the changing trend of occurrence of diverticulosis,data were compared with two previous studies of 51 patients.RESULTS:The proportion of left-sided disease cases was significantly increased compared to the results of our previous studies in 1994 and 2001,(27.5%vs48.1%,P<0.05).Moreover,no differences in gender,body mass index,multiplicity of the diverticula,fever,or leukocytosis were noted between patients with rightsided and left-sided disease.However,patients with right-sided disease were significantly younger(50.9year vs 64.0 year,P<0.01).Furthermore,left-sided disease was significantly associated with a higher incidence of complicated diverticulitis(89.2%vs 57.5%,P<0.01),combined resection due to extensive inflammation(21.6%vs 5.0%,P<0.05),operative complications(51.4%vs 27.5%,P<0.05),and in-hospital mortality(10.8%vs 0%,P<0.05),along with longer post-operative hospitalization duration(21.3±10.2 d vs 10.6±8.1 d,P<0.05).CONCLUSION:Compared with right-sided diverticular disease,the incidence of left-sided disease in Korea has increased since 2001 and is associated with worse surgical outcomes.
文摘BACKGROUND Left-sided portal hypertension(LSPH),also known as sinistral portal hypertension or regional portal hypertension,refers to extrahepatic portal hypertension caused by splenic vein obstruction or stenosis.N-butyl-2-cyanoacrylate(NBC)has been widely used in the endoscopic hemostasis of portal hypertension,but adverse events including renal or pulmonary thromboembolism,mucosal necrosis and gastrointestinal(GI)bleeding may occur after treatment.Herein,we report successfully managing gastric variceal(GV)hemorrhage secondary to LSPH using modified endoscopic ultrasound(EUS)-guided selective NBC injections.CASE SUMMARY A 35-year-old man was referred to our hospital due to an upper GI hemorrhage.Gastroscopy revealed GV hemorrhage and computed tomography venography(CTV)confirmed LSPH.The patient requested endoscopic procedures and rejected surgical therapies including splenectomy.EUS-guided selective NBC injections were performed and confluences of gastric varices were selected as the injection sites to reduce the injection dose.The“sandwich”method using undiluted NBC and hypertonic glucose was applied.No complications occurred.The patient was followed up regularly after discharge.Three months later,the follow-up gastroscopy revealed firm gastric submucosa with no sign of NBC expulsion and the follow-up CTV showed improvements in LSPH.No recurrent GI hemorrhage was reported during this follow-up period.CONCLUSION EUS-guided selective NBC injection may represent an effective and economical treatment for GV hemorrhage in patients with LSPH.
文摘Colonic stenting has had a significant positive impact on the management of obstructive left-sided colon cancer(OLCC) in terms of both palliative treatment and bridge-to-surgery(BTS). Notably, many studies have convincingly demonstrated the effectiveness of stenting as a BTS, resulting in improvements in shortterm outcomes and quality of life, safety, and efficacy in subsequent curative surgery, and increased cost-effectiveness, whereas the safety of chemotherapy after stenting and the long-term outcomes of stenting as a BTS are controversial. Several studies have suggested an increased risk of perforation in patients receiving bevacizumab chemotherapy after colonic stenting. In addition, several pathological analyses have suggested a negative oncological impact of colonic stenting. In contrast, many recent studies have demonstrated that colonic stenting for OLCC does not negatively impact the safety of chemotherapy or long-term oncological outcomes. The updated version of the European Society of Gastrointestinal Endoscopy guidelines released in 2020 included colonic stenting as a BTS for OLCC as a recommended treatment. It should be noted that the experience of endoscopists is involved in determining technical and clinical success rates and possibly oncological outcomes. This review discusses the positive and negative impacts of colonic stenting on OLCC treatment, particularly in terms of oncology.
文摘BACKGROUND Abnormalities of the inferior vena cava(IVC)are uncommon,and in many cases they are asymptomatic.Even so,it is vital that clinicians be aware of such anomalies prior to surgery in affected individuals.In the present report,we describe a rare anatomical variation of the IVC.CASE SUMMARY A 66-year-old male was admitted to the hospital due to deep vein thrombosis of the right lower extremity.Upon contrast-enhanced computed tomography imaging,we found that this patient presented with a case of left-sided IVC draining into the hemiazygos vein,while his hepatic vein was directly draining into the atrium.CONCLUSION Cases of left-sided IVC can increase patient susceptibility to thromboembolism owing to the resultant changes in blood flow and/or associated vascular compression.
文摘A left-sided gallbladder without a right-sided round ligament,which is called a true left-sided gallbladder,is extremely rare.A 71-year-old woman was referred to our hospital due to a gallbladder polyp.Computed tomography(CT) revealed not only a gallbladder polyp but also the gallbladder located to the left of the round ligament connected to the left umbilical portion.CT portography revealed that the main portal vein diverged into the right posterior portal vein and the common trunk of the left portal vein and right anterior portal vein.CT cholangiography revealed that the infraportal bile duct of segment 2 joined the common bile duct.Laparoscopic cholecystectomy was performed for a gallbladder polyp,and the intraoperative finding showed that the cholecystic veins joined the round ligament.A true left-sided gallbladder is closely associated with several anomalies; therefore,surgeons encountering a true left-sided gallbladder should be aware of the potential for these anomalies.
基金supported by grants from National Natural Science Foundation of China (No. 81302194 and 81372570)the Specialized Research Fund for the Doctoral Program of Higher Education (No. 20130171120047)+1 种基金the Fundamental Research Funds for the Central Universities (No.14ykpy40)the Young Talent Fund of Sun Yat-sen University Cancer Center
文摘Introduction Right-sided colon cancer （RSCC） and left-sided colorectal cancer （LSCRC） differ with respect to theirbiology and genomic patterns. This study aimed to examine whether the primary tumor location is associated withthe response to cetuximab in patients with metastatic colorectal cancer （mCRC）.Methods： Patients with mCRC treated with cetuximab and standard chemotherapy as first- or second-line treatmentswere compared with randomly chosen patients who were treated with chemotherapy alone between 2005 and 2013.The main outcome measures were the overall response rate （ORR）, progression-free survival （PFS）, and overall survival （OS）.The differences in the outcome were analyzed by using the chi-squared test, Student＇s t test, and Kaplan-Meier method.Results： The treatment results of 206 patients with mCRC treated with cetuximab and standard chemotherapy asfirst- or second-line treatments were compared with those of 210 patients who were treated with chemotherapyalone. As a first-line treatment, cetuximab with chemotherapy was associated with a significantly higher ORR（49.4 % vs. 28.6 %, P = 0.005） as well as longer PFS （9.1 vs. 6.2 months, P = 0.002） and OS （28.9 vs. 20.1 months,P = 0.036） than chemotherapy alone in patients with LSCRC. However, cetuximab neither improved the ORR（36.4 % vs. 26.2 %, P = 0.349） nor prolonged PFS （5.6 vs. 5.7 months, P = 0.904） or OS （25.1 vs. 19.8 months, P = 0.553） inpatients with RSCC. As a second-line treatment, cetuximab exhibited a tendency to improve the ORR （23.5 % vs. 10.2 %,P = 0.087） and prolong PFS （4.9 vs. 3.5 months, P = 0.064）, and it significantly prolonged OS （17.1 vs. 12.4 months,P = 0.047） compared with chemotherapy alone in the patients with LSCRC. In contrast, as a second-line treatment,cetuximab neither improved the ORR （7.1 % vs. 11.4 %, P = 0.698） nor prolonged PFS （3.3 vs. 4.2 months, P = 0.761） orOS （13.4 vs. 13.0 months, P=0.652） in patients with RSCC.Conclusions： The addition of cetuximab to chemotherapy in both first- and second-line treatments of mCRC may onlybenefit patients with primary LSCRC.
基金reviewed and approved by the Institutional Review Board I&II of Taichung Veterans General Hospital(Approval No.TCVGH-IRB No.CE22408B).
文摘BACKGROUND Right-sided ligamentum teres(RSLT)is often associated with portal venous anomalies(PVA)and is regarded as a concerning feature for hepatobiliary intervention.Most studies consider RSLT to be one of the causes of left-sided gallbladder(LGB),leading to the hypothesis that LGB must always be present with RSLT.However,some cases have shown that right-sided gallbladder(RGB)can also be present in livers with RSLT.AIM To highlight the rare variation that RSLT may not come with LGB and to determine whether ligamentum teres(LT)or gallbladder location is reliable to predict PVA.METHODS This study retrospectively assessed 8552 contrast-enhanced abdominal computed tomography examinations from 2018 to 2021[4483 men,4069 women;mean age,59.5±16.2(SD)years].We defined the surrogate outcome as major PVAs.The cases were divided into 4 subgroups according to gallbladder and LT locations.On one hand,we analyzed PVA prevalence by LT locations using gallbladder location as a controlled variable(n=36).On the other hand,we controlled LT location and computed PVA prevalence by gallbladder locations(n=34).Finally,we investigated LT location as an independent factor of PVA by using propensity score matching(PSM)and inverse probability of treatment weighting(IPTW).RESULTS We found 9 cases of RSLT present with RGB.Among the LGB cases,RSLT is associated with significantly higher PVA prevalence than typical LT[80.0%vs 18.2%,P=0.001;OR=18,95%confidence interval(CI):2.92-110.96].When RSLT is present,we found no statistically significant difference in PVA prevalence for RGB and LGB cases(88.9%vs 80.0%,P>0.99).Both PSM and IPTW yielded balanced cohorts in demographics and gallbladder locations.The RSLT group had a significantly higher PVA prevalence after adjusted by PSM(77.3%vs 4.5%,P<0.001;OR=16.27,95%CI:2.25-117.53)and IPTW(82.5%vs 4.7%,P<0.001).CONCLUSION RSLT doesn't consistently coexist with LGB.RSLT can predict PVA independently while the gallbladder location does not serve as a sufficient predictor.
文摘BACKGROUND Left-sided accessory pathways(APs)can be accessed with either a transaortic(TA)or transseptal approach(TS).For children with Marfan syndrome(MFS)who have aortic disease,the use of TA can aggravate the disease,making TS the best choice for these patients.CASE SUMMARY A 10-year-old girl was hospitalized because of intermittent heart palpitations and chest tightness.She was diagnosed with MFS,supraventricular tachycardia,Wolff-Parkinson-White syndrome,and left-sided AP was detected by cardiac electrophysiological.Catheter ablation was successfully performed via TS under the guidance of the Ensite system.During the follow-up,no recurrence or complications occurred.CONCLUSION The TS for catheter ablation of left-sided APs can be considered in children with MFS.Adequate evaluation and selection of the appropriate puncture site are particularly important.
文摘<b>Introduction:</b> Left-sided acute appendicitis (LSAA) develops in association with two types of congenital anomalies: situs inversus totalis (SIT) and midgut malrotation (MM). A Left sided appendicitis is an ambiguous and difficult diagnosis to make. <b>Aim: </b>To present a proven case of left-sided acute appendicitis (LSAA) associated with situs inversus totalis (SIT). <b>Case</b> <b>Report:</b> A case of Left appendicitis was evaluated in a 28-year-old Asian male, who presented to our hospital in Feb. 2016, with lower abdominal pain more on left side and suspected diverticulitis or acute appendicitis with unusual appendix location. The patient doesn’t recall any history of abdominal surgery or about situs inversus totalis, abdominal and pelvic ultrasound was done, left iliac fossa appendicitis was diagnosed, Erect chest X-ray including upper abdomen revealed dextrocardia and stomach air on right side (situs inversus totalis), the patient underwent diagnostic Laproscop and Endoscopic resection of the appendix, with no incidents, and then discharged without complications, follow visits went unremarkable. <b>Conclusion: </b>The diagnosis of left lower quadrant pain is based on well-established clinical symptoms, physical examination and physician’s experience.
文摘The rare finding of the vermiform appendix within an inguinal hernia sac is known as Amyand’s hernia. It was first described by Claudius Amyand in 1735, in a right inguinal hernia. A much rarer find is a left-sided Amyand’s hernia. This is a report of a case of complicated left-sided Amyand’s hernia in an eighteen month old male child. He presented as an emergency with an obstructed inguino-scrotal hernia and the diagnosis of Amyand’s hernia was made intra-operatively. He made uneventful recovery after surgery. Treatment options depend on findings during operation and clinical status of the patient.
