Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

To unsubscribe from our mailing list, please click on the following link: unsubscribe

I am looking forward to hearing from you.

Kind regards,

David Rain
Email:join@sciepub.com
Science and Education Publishing (http://www.sciepub.com)

Label_Title

Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

To unsubscribe from our mailing list, please click on the following link: unsubscribe

I am looking forward to hearing from you.

Kind regards,

David Rain
Email:join@sciepub.com
Science and Education Publishing (http://www.sciepub.com)

Label_Title

Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

To unsubscribe from our mailing list, please click on the following link: unsubscribe

I am looking forward to hearing from you.

Kind regards,

David Rain
Email:join@sciepub.com
Science and Education Publishing (http://www.sciepub.com)

Label_Title

Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

To unsubscribe from our mailing list, please click on the following link: unsubscribe

I am looking forward to hearing from you.

Kind regards,

David Rain
Email:join@sciepub.com
Science and Education Publishing (http://www.sciepub.com)

Unexpected Anatomopathological Diagnosis of a Right Adrenal Mass

Youssef Jakhlal*, Abdelmounim El Khamri, Ahmed Jahid, Abdellatif Settaf

Department of Digestive surgery B, Ibn Sina Teaching Hospital, Mohammed V University, Rabat, Morocco

Abstract: We report a case of a 43-year-old male who had a right partial nephrectomy for renal trauma. He was asymptomatic for 28 years before presenting with intermittent right flank pain. Imaging showed a tumor-like mass of the right adrenal gland. The anatomopathological of the resected specimen confirmed the diagnosis of textiloma.

Keywords: textiloma, gossypiboma, surgery

Received June 22, 2020; Revised July 23, 2020; Accepted August 03, 2020

Citation: Youssef Jakhlal, Abdelmounim El Khamri, Ahmed Jahid, Abdellatif Settaf, Unexpected Anatomopathological Diagnosis of a Right Adrenal Mass. Global Journal of Surgery, 8 (1). 21-23. January 2020. doi:10.12691/js-8-1-5

1. Introduction

Textiloma and gossypiboma are referred to as a surgical gauze or towel retained inadvertently in the human body during surgery and the resulting reactions [1]. It may present serious diagnostic, therapeutic, and medico-legal problems. Such a foreign body can mimic a tumor during clinical and radiological examinations. [2]

We describe a case of textiloma in a patient presenting with tumor-like mass of the right adrenal 28 years after a right partial nephrectomy. We also review the literature on the diagnosis and management of similar cases.

2. Case Report

A 43-year-old male with a medical history of a right partial nephrectomy for a renal trauma in 1992, surgery for head trauma in 2002 and lymph node tuberculosis treated 5 years ago, who reported biliary colic type pain 5 years ago without jaundice, vomiting or pruritus. All evolving in the context of preservation of the general state and apyrexia.

Physical examination did not show major issues except for mild tenderness over the right hypochondrium.

Abdominal ultrasound objectifies a large solid formation, heterogeneous, +/- rounded and well limited, avascular, centered on the right liver, measuring 16 × 13mm. Abdominal CT shows a voluminous right retroperitoneal mass, inter hepato-renal, fairly well limited, of tissue density, containing peripheral and central calcifications in places with heterogeneous zones, increasing heterogeneously measuring 16 × 17 × 14 cm. This suggests an adrenal tumor. (Figure 1).

Biological examinations were normal with no inflammatory and infectious signs or anemia. An endocrine workup, including urine catecholamine and cortisol levels, was normal.

Figure 1. CT showing a voluminous right adrenal mass of tissue density, containing peripheral and central calcifications in places with heterogeneous zones. (A: before injection, B: after injection)

Figure 2. The macroscopic aspect of the resected specimen confirming the diagnosis of textiloma

Surgical exploration by subcostal incision revealed a large bulging retro-peritoneal adrenal mass pushing back the underside of segments 6 and 7 (leading to atrophy of the right liver) with right postero-lateral parietal adhesions. Laborious and meticulous extraction of the mass of its reports. The anatomopathological result returned in favor of a diffuse necrotico-hemorrhagic reorganization with reaction to foreign body confirming the diagnosis of textiloma of a textiloma. (Figure 2)

3. Discussion

Textiloma is a rare incident caused by retained postoperative foreign bodies. The reported incidence varies between 1 in 1000 and 1500 of all intraperitoneal operations. Probably, the condition is underestimated owing to diagnostic difficulties and medico-legal implications associated with it [3,4].

Textilomas represent complications regarding all forms of surgery: general (52%), gynecologic (22%), urologic/vascular (10%), and orthopedic/spinal surgery (6%). It is interesting to note that emergency operations are implicated in only 30% of the reported cases of textilomas, whereas 70% appear after elective operations. [5] To date, the case reported by Taylor et al [6] features the longest period from surgery to the manifestation of symptoms. They detected an intrapulmonary foreign body 43 years after thoracotomy. The present case was diagnosed 28 years after renal surgery.

There are two types of foreign body reactions: (1) the exudative-type tissue reaction, which leads to acute abscess formation, and (2) aseptic fibrous tissue reaction, which involves slow adhesion formation, such as encapsulation and granuloma formation. [7]

The clinical presentations of textilomas are highly variable, ranging from incidental observation to severe postoperative complications. In the early period after surgery, these forgotten materials can lead to infections, abscess formation, chronic fistulae, and septic conditions [8]. However, 20% remain clinically asymptomatic for many years before causing a foreign body reaction in the surrounding tissue, with new clinical signs indicating significant mass effect [9].

Imaging is the key to diagnosis and includes plain radiograph, ultrasonography, computed tomography, magnetic resonance imaging, and specific radiological examinations (if and when indicated). 2010.

On plan X-ray, the radiopaque marker attached to the sponge may be easily detected; however, due to the possibility of folding, twisting, or disintegrating over a while, the surgical material and marker may be difficult to be identified on a radiograph. 2017.

The typical ultrasonic performance usually presents as a well-defined mass including internal wavy hyperechoic focus, encompassing a hypoechoic rim, and having a strong posterior shadow. However, owing to the clinical rarity, this performance is often misinterpreted. [10,11].

On CT scan, which is the preferred modality, gossypiboma containing gas bubbles and a whorl-like appearance is characteristic. The lesion may appear as a cystic lump with internal spongy appearance mimicking teratoma or dermoid cyst. Occasionally, it may manifest as a hypodense mass, which has a thick peripheral rim and usually misinterpreted as a new-onset tumor or a recurrent tumor [12,13,14]. It can be difficult in the diagnosis of a gossypiboma if no radiopaque marker is embedded on the sponge itself.

Magnetic resonance imaging usually shows a well-defined mass with a fibrous capsule that exhibits a low signal intensity (hypo-intense lesion) on T1-weighted image sequences and high signal intensity (hyperintense lesion) on T2-weighted images [15,16]. A wavy, striped, or spotted appearance may also be seen.

To prevent severe gastrointestinal complications or to overcome the accompanied medico-legal problems, appropriate surgical treatment should be performed as early as possible when gossypiboma is detected or suspected. The most commonly adopted approach is surgical removal through the previous operative site, but treatments like percutaneous, endoscopic, or laparoscopic approaches were also be attempted and reported [17].

The prevention of textiloma is the best approach. The primary preventive measure is counting the pieces of surgical gauze [18]. Small sponges should not be used during laparotomy and any sponges used should have radiopaque filaments. A plain X-ray film should be taken before ending the laparotomy procedure. The surgeon should completely explore the cavity for foreign materials before closing the patient after any operation [18].

4. Conclusion

Textiloma is a rare and preventable challenging medical situation. Its diagnosis should always be suspected in front of an abdominal mass in a patient with previous surgical intervention. Radiological diagnostic methods are of great value, both in preventing the problem and in diagnosing its presence. The conclusive diagnosis is made during surgery. Prevention remains better than the cure.

References

[1]   | Biswas RS, Ganguly S, Saha ML, Saha S, Mukherjee S, Ayaz A. Gossypiboma and surgeon- current medicolegal aspect—a review. Indian J Surg. 2012; 74: 318-22.
[2]   | Sataa Sallami, Sami Ben Rhouma, Karim Cherif, Mohamed Hmidi, Ali Horchani. A Case of Textiloma Mimicking a Retroperitoneal Tumor. UroToday Int J. 2009 Dec; 2(6).
[3]   | Gawande AA, Studdert DM, Orav EJ, Brennan TA, Zinner MJ. Risk factors for retained instruments and sponges after surgery. N Engl J Med. 2003; 348: 229-35.
[4]   | Silva SM, Sousa JB. Gossypiboma after abdominal surgery is a challenging clinical problem and a serious medicolegal issue. Arq Bras Cir Dig. 2013; 26: 140-3.
[5]   | Mouhsine E, Halkic N, Garofalo R, Taylor S, Theumann N, Guillou L, et al. Soft-tissue textiloma: a potential diagnostic pitfall. Can J Surg 2005; 48(6): 495-6.
[6]   | Taylor FH, Zollinger RW 2nd, Edgerton TA, Harr CD, Shenoy VB. Intrapulmonary foreign body: sponge retained for 43 years. J Thorac Imaging. 1994; 9(1): 56-59.
[7]   | Sahin-Akyar G, Yagci C, Aytac S. Pseudotumour due to surgical sponge: gossypiboma. Australas Radiol 1997;41(3): 288-91.
[8]   | Bani-Hani KE, Gharaibeh KA, Yaghan RJ. Retained surgical sponges (gossypiboma). Asian J Surg. 2005 ; 28(2): 109-115.
[9]   | Zerati Filho M, Furtado PS, De Andrade LA. Textiloma nine years after nephrectomy. Int Braz J Urol. 2002; 28(6): 537-8.
[10]   | Yildirim S, TarimA, Nursal TZ et al (2006) Retained surgical sponge (gossypiboma) after intraabdominal or retroperitoneal surgery: 14 cases treated at a single center. Langenbecks Arch Surg 391: 390-395.
[11]   | Sugano S, Suzuki T, Linuma M et al (1993) Gossypiboma: diagnosis with ultrasonography. J Clin Ultrasound 21: 289-292.
[12]   | Cheng TC, Chou AS, Jeng CM, Chang PY, Lee CC. Computed tomography findings of gossypiboma. J Chin Med Assoc. 2007; 70: 565-9.
[13]   | Manzella A, Filho PB, Albuquerque E, Farias F, Kaercher J. Imaging of gossypibomas: pictorial review. AJR Am J Roentgenol. 2009; 193: S94-101.
[14]   | O'Connor AR, Coakley FV, Meng MV, Eberhardt SC. Imaging of retained surgical sponges in the abdomen and pelvis. AJR Am J Roentgenol. 2003; 180: 481-9.
[15]   | Sugimura H, Tamura S, Kakitsubata Y et al (1992) Magnetic resonance imaging of retained surgical sponge. Clin Imaging 16: 259-262.
[16]   | Kim CK, Park BK, Ha H (2007) Gossypiboma in abdomen and pelvis: MRI findings in four patients. AJR Am J Roentgenol 189: 814-817.
[17]   | Ozsoy Z, Okan I, Daldal E, Dasiran MF, Angin YS, Sahin M. Laparoscopic removal of gossypiboma. Case Rep Surg. 2015; 2015: 317240.
[18]   | Lauwers PR, Van Hee RH. Intraperitoneal gossypibomas: the need to count sponges. World J Surg. 2000; 24(5): 521-527.