No abstract

Background. Spontaneous rupture of an ovarian artery aneurysm is a rare but usually life-threatening event. It is most often associated with pregnancy or fibroids. Our case followed a normal vaginal delivery and then a delayed presentation with features similar to other less life-threatening postpartum conditions. The diagnosis could have been missed but for the meticulous and timely interventions which avoided catastrophic outcome. Case. This is a case of a multiparous woman with rupture of a left ovarian artery aneurysm, causing massive retroperitoneal hemorrhage and hematoma that required a combination of arterial embolization, percutaneous CT scan guided drainage, and surgical evacuation of the hematoma. Conclusion. Spontaneous rupture of ovarian artery should be considered as one of the differential diagnoses in the immediate postpartum period especially when the clinical symptoms do not correlate with the amount of blood loss. A high index of suspicion, prompt diagnosis, intervention, and a multidisciplinary approach in the management were the elements of a successful outcome in this case.

Background: Two strategies for same-admission cholecystectomy in mild gallstone pancreatitis (MGP) exist: early surgery (within 48-72 h from admission) and delayed surgery until resolution of symptoms and normalization of pancreatic tests.Methods: This was a single-center, open-label RCT. Patients with MGP according to revised Atlanta classification-2012 and SIRS criteria were randomly assigned to early laparoscopic cholecystectomy (E-LC) within 72 h from admission or delayed laparoscopic cholecystectomy (D-LC). Laparoscopicendoscopic rendezvous was performed when common bile duct stones were found at systematic intraoperative cholangiography. The primary outcome was length of stay (LOS), and the secondary outcomes were complications at 90 days, need for ERCP/choledocolithiasis, conversion, and readmission. One year of follow-up was carried-on.Results: At interim analysis, 52 patients were randomized (26 E-LC, 26 D-LC). E-LC versus D-LC was associated with a significantly shorter LOS (median 58 versus 167 h; P = 0.001). There were no differences in ERCP necessity for choledocolithiasis between the two approaches (E-LC 26.9% versus D-LC 23.1%, P = 1.00). No differences in postoperative complications were found.Conclusions: E-LC approach in patients with MGP significantly reduced LOS and was not associated with clinically relevant postoperative complications.Trial registration: clinicaltrials.gov (NCT02590978).

Background: Effective prognostic models are needed to manage colorectal liver metastasis (CRLM). It is unsolved problerm which is appropriate of surgery first and chemotherapy first. Thus, we developed an algorithm to facilitate treatment based on the standardized uptake value (SUV) from fluorodeoxyglucose-positron emission tomography (FDG-PET). Methods: We retrospectively evaluated 154 patients who underwent surgery for CRLM, including 112 cases that involved primary surgery and 42 cases that involved preoperative chemotherapy before conversion surgery. We evaluated the relationship between the perioperative SUV and postoperative prognosis in the primary surgery cases, as well as the relationship between the SUV change rate (post-chemotherapy SUV / pre-chemotherapy SUV) and prognosis after conversion surgery. Results: In the primary surgery group, recurrence-free survival (RFS) was independently predicted by an SUV of !6.04 (P = 0.042) and !4 liver metastases (P = 0.003). In addition, the combination of an SUV of !6.04 and !4 liver metastase was strongly associated with poor RFS (p < 0.001). In the conversion surgery group, the SUV change rate was associated with tumour size change, CA19-9 change, and pathological response. An SUV change rate of !0.293 was associated with a shorter RFS (P = 0.006) and also independently predicted RFS (P = 0.026). Conclusion:We established a therapeutic algorithm for managing CRLM based on these results (Figure). FDG-PET may be a useful modality for predicting recurrence and prognosis in cases of CRLM, and our algorithm may be useful for managing multiple CRLMs.