Surgical treatment of liver cancer and pancreatic cancer under the China Healthcare Security Diagnosis Related Groups payment system

BACKGROUND Data from the World Health Organization’s International Agency for Research on Cancer reported that China had the highest prevalence of cancer and cancer deaths in 2022.Liver and pancreatic cancers accounted for the highest number of new cases.Real-world data(RWD)is now widely preferred to traditional clinical trials in various fields of medicine and healthcare,as the traditional research approach often involves highly selected populations and interventions and controls that are strictly regulated.Additionally,research results from the RWD match global reality better than those from traditional clinical trials.AIM To analyze the cost disparity between surgical treatments for liver and pancreatic cancer under various factors.METHODS This study analyzed RWD 1137 cases within the HB1 group(patients who underwent pancreatectomy,hepatectomy,and/or shunt surgery)in 2023.It distinguished different expenditure categories,including medical,nursing,technical,management,drug,and consumable costs.Additionally,it assessed the contribution of each expenditure category to total hospital costs and performed cross-group comparisons using the non-parametric Kruskal–Wallis test.This study used the Steel–Dwass test for post-hoc multiple comparisons and the Spearman correlation coefficient to examine the relationships between variables.RESULTS The study found that in HB11 and HB13,the total hospitalization costs were significantly higher for pancreaticoduodenectomy than for pancreatectomy and hepatectomy.Although no significant difference was observed in the length of hospital stay between patients who underwent pancreaticoduodenectomy and pancreatectomy,both were significantly longer than those who underwent liver resection.In HB15,no significant difference was observed in the total cost of hospitalization between pancreaticoduodenectomy and pancreatectomy;however,both were significantly higher than those in hepatectomy.Additionally,the length of hospital stay was significantly longer for patients who underwent pancreaticoduodenectomy than for those who underwent pancreatectomy or liver resection.CONCLUSION China Healthcare Security Diagnosis Related Groups payment system positively impacts liver and pancreatic cancer surgeries by improving medical quality and controlling costs.Further research could refine this grouping system and ensure continuous effectiveness and sustainability.

Surgically treating a rare and asymptomatic intraductal papillary neoplasm of the bile duct:A case report

BACKGROUND Intraductal papillary neoplasms of the bile duct(IPNBs)are rare and characterized by papillary growth within the bile duct lumen.IPNB is similar to obstructive biliary pathology.In this report,we present an unexpected case of asymptomatic IPNB and consolidate our findings with the relevant literature to augment our understanding of this condition.Integrating relevant literature contributes to a more comprehensive understanding of the disease.CASE SUMMARY A 66-year-old Chinese male patient was admitted to our hospital for surgical intervention after gallstones were discovered during a routine physical examination.Preoperative imaging revealed a lesion on the left side of the liver,which raised the suspicion of IPNB.A laparoscopic left hemihepatectomy was performed,and subsequent histopathological examination confirmed the diagnosis of IPNB.At the 3-mo postoperative follow-up,the patient reported good recovery and no metastasis.IPNB can manifest both latently and asymptomatically.Radical surgical resection is the most effective treatment for IPNB.CONCLUSION Hepatic and biliary masses,should be considered to diagnose IPNB.Prompt surgery and vigilant follow-up are crucial in determining prognosis.

Results of Open Surgical Treatment of Humeral Paddle Fractures about 63 Cases

Fractures of the humeral paddle, common to young adults, are most often complex, linked to violence and an increase in road accidents. The objective of our work is to evaluate our functional results, in the medium term, correlated with a review of the literature. This is a retrospective study of 63 patients, carried out in the traumatology-orthopedics department 1 of the IBN EL JAZZAR hospital in KAIROUAN, over a period of 7 years from January 2015 to December 2021. The average age of patients was 39 years (17 - 68 years). Predominantly male. The etiologies are dominated by falls and accidents on public roads. Fractures are classified according to the Müller and Allgöwer classification where type C is found in 51% of cases. All our patients undergo an olecranon osteotomy in 71% of cases. Osteosynthesis using a Lecestre plate combined with screwing or plugging is used in 84% of cases. The evolution is marked by complications observed in eight patients (16%), including two cases of sepsis, four cases of elbow stiffness (8%), one case of joint callus and one case of pseudarthrosis. Our results are evaluated according to the Mayo Elbow Performance Score, they are excellent and good in 71% of cases, average in 18% of cases and poor in 11% of cases. Fractures of the humeral paddle are fractures with a satisfactory functional prognosis, requiring ad integrum anatomical restoration and solid osteosynthesis allowing early rehabilitation of the elbow. One case of joint callus and one case of pseudarthrosis.

Surgical Treatment of Upper Urinary Tract Lithiasis in Conakry

Introduction: The management of urinary lithiasis in our settings has long been conventional surgery. The recent introduction of endoscopy of the upper urinary tract represents a major advance in our department. The aim was to contribute to the study of the treatment of lithiasis of the upper urinary tract in Conakry and to report on our initial experience of ureteroscopy in Conakry. Methodology: This is a prospective descriptive study lasting one year, from January 1 to December 31, 2022, carried out at the Urology Department of the Ignace Deen National Hospital and at the PERCHIN Urological Clinic. The study included all patients treated surgically for lithiasis of the upper urinary tract who met the selection criteria. Results: The study included 57 patients. The mean age was 30 years, with extremes of 20 and 73 years;the most represented age group was 31 to 40 years, followed by 20 to 30 years with 29.9% and 26.3% respectively. Males predominated in 36 cases (63.15%), with a M/F sex ratio of 1.71. Left-sided renal colic was the most common, at 75.43% (n=43), and right-sided renal colic at 40.35%, associated with digestive signs at 43.85%. 77.19% had normal creatinine levels before surgery, versus 22.81% with elevated creatinine levels, i.e. 15.78% improvement in renal function after surgery. Urinary tract infection was found in 47.36%, and Escherichia coli in 31.57%, followed by staphylococcus aureus in 8.77%. Overall, 82.45% of patients had organic damage to the kidneys or ureters. Right ureterohydronephrosis was noted in 56.14%, followed by left hydronephrosis in 26.32%. Open surgery was predominant in 52.63% of cases, with endoscopic surgery (URS) accounting for a significant 47.36% during the study period. The endoscopic treatment used was laser ureteroscopy. In our study, 73.68% underwent drainage of the upper excretory tract, including 64.91% with a JJ catheter. The average length of stay was 07 days, with extremes of 02 and 28 days, and 81.4% of patients who underwent URS had a length of stay of less than 4 days. Conventional surgery had the highest complication rate (14.28%). The stone free rate for the two surgical treatment methods (open and endoscopic surgery) was 73% and 92.59%.

Assessing the Impact of General Anesthesia and Bronchial Intubation in Conjunction with Thoracic Paravertebral Nerve Block on Cellular Immunity and Surgical Management in Tuberculous Pyothorax Patients

Objective:This study aims to investigate the impact of combining general anesthesia with bronchial intubation and thoracic paravertebral nerve block during surgery for patients with tuberculous pyothorax.Methods:Eighty patients diagnosed with tuberculous pyothorax,admitted to the hospital between January 2023 and September 2023,were randomly selected for this study.The patients were divided into control and study groups using a numerical table method.The control group underwent general anesthesia with bronchial intubation,while the study group received general anesthesia with bronchial intubation in conjunction with thoracic paravertebral nerve block.Subsequently,the patients were monitored to assess mean arterial pressure,heart rate variations,and adverse reactions to anesthesia.Results:The study group exhibited significantly lower mean arterial pressure and heart rate levels during the post-surgical incision,immediate end of surgery,and immediate extubation periods compared to the control group(P<0.05).Furthermore,the Ricker and Ramsay scores in the study group were significantly lower than those in the control group(P<0.05).Conclusion:The combined use of general anesthesia via bronchial intubation and thoracic paravertebral nerve block has been found to stabilize mean arterial pressure and heart rate while providing effective sedation for surgical treatment in patients with tuberculous septic thorax.

Analysis of the Clinical Value of Surgical Treatment and Postoperative Anti-Infection Treatment of Acute Suppurative Appendicitis

Objective: To explore the clinical value of surgical treatment and postoperative anti-infection treatment for acute suppurative appendicitis. Methods: A total of 116 patients with acute suppurative appendicitis were enrolled in this study. The collection period was from December 2021 to December 2023. The patients were randomly grouped into a control group (surgical treatment) and an observation group (surgical treatment and postoperative anti-infection treatment), of 58 patients each. At the end of the treatment, the results of each index of the two groups were compared. Results: The length of hospitalization time, exhaust time, and incidence of complications in the observation group were shorter than those of the control group (P < 0.05). The total effective rate of the observation group was higher than that of the control group (P < 0.05). Conclusion: It is crucial to perform anti-infective treatment promptly after surgical treatment in patients with acute suppurative appendicitis. It can effectively prevent the occurrence of complications and improve the clinical efficacy. Hence, it is worthy of research and promotion.

A meta-analysis of the long-term effects of chronic pancreatitis surgical treatments： duodenum-preserving pancreatic head resection versus pancreatoduodenectomy

Background Surgery is regarded as the most effective treatment to relieve pain and reduce complications in chronic pancreatitis （CP）. Two major strategies exist： duodenum-preserving pancreatic head resection （DPPHR） and pancreatoduodenectomy （PD）. Many studies suggest that DPPHR offers advantages during surgery and in the short-term; however, the long-term effects have not been thoroughly investigated. We analyzed the long-term outcomes of DPPHR and PD, over follow-up times of at least 1 year, to determine the optimal surgical treatment for CP. Methods We systemically reviewed all CP surgical treatment reports, and only included randomized controlled trials （RCT） comparing DPPHR and PD, excluding unqualified studies using several pre-specified criteria. When multiple publications of a single trial were found, the most comprehensive current data were selected. Characteristics of the study populations and long-term postoperative outcome parameters were collected. The quality of the studies and data was analyzed using RevMan 4.2 software. Results Five trials were qualified for meta-analysis, with 261 participants in total （114 in the DPPHR group and 147 in the PD group）. There were no significant differences in the age, gender, or indications for surgery of each group. At the mean of 5.7-year （1-14 years） follow-up examination, DPPHR and PD resulted in equally effective pain relief, exocrine and endocrine function, and similar mortality rates （P 〉0.05）; however, DPPHR patients had improved global quality of life and weight gain, and reduced diarrhea and fatigue （P 〈0.05）. Conclusion DPPHR and PD result in equal pain relief, mortality, and pancreatic function; however, DPPHR provides superior long-term outcomes.

Examining the impact of early enteral nutritional support on postoperative recovery in patients undergoing surgical treatment for gastrointestinal neoplasms

BACKGROUND Patients with gastrointestinal tumors often suffer from poor nutritional status during treatment.Surgery is the main treatment for these patients,but the long postoperative recovery period is often accompanied by digestive and absorption dysfunction,leading to further deterioration of the nutritional status.Early enteral nutrition support is hypothesized to be helpful in improving this situation,but the exact effects have yet to be studied in depth.AIM To observe the effect of early enteral nutritional support on postoperative recovery in patients with surgically treated gastrointestinal tract tumors,with the expectation that by improving the nutritional status of patients,the recovery process would be accelerated and the incidence of complications would be reduced,thus improving the quality of life.METHODS A retrospective analysis of 121 patients with gastrointestinal tract tumors treated in our hospital from January 2020 to January 2023 was performed.Fifty-three of these patients received complete parenteral nutrition support as the control group for this study.The other 68 patients received early enteral nutritional support as the observation group of this study.The clinical indicators comparing the two groups included time to fever,time to recovery of postoperative bowel function,time to postoperative exhaustion,and length of hospital stay.The changes in immune function and nutritional indexes in the two groups were compared.Furthermore,we utilized the SF-36 scale to compare the changes in the quality of life between the two groups of patients.Finally,the occurrence of postoperative complications between the two patient groups was also compared.RESULTS The postoperative fever time,postoperative bowel function recovery time,postoperative exhaustion time,and hospitalization time were all higher in the control group than in the observation group(P<0.05).The levels of CD3+,CD4+,immunoglobulin(Ig)A,IgM,and IgG in the observation group were significantly higher than those in the control group at 1 d and 7 d postoperatively,while CD8+was lower than in the control group(P<0.05).Total protein,albumin,prealbumin,and transferrin levels were significantly higher in the observation group than in the control group at 7 d postoperatively(P<0.05).The SF-36 scores of patients in the observation group were significantly higher than those in the control group(P<0.0001).The overall incidence of adverse reactions after the intervention was significantly lower in the control group than in the observation group(P=0.021).CONCLUSION We found that patients with gastrointestinal tumors are nutritionally vulnerable,and early enteral nutrition support programs can improve the nutritional status of patients and speed up postoperative recovery.This program can not only improve the immune function of the patient and protect the intestinal function,but it can also help to improve the quality of life of the patient.However,this program will increase the incidence of complications in patients.Caution should be taken when adopting early enteral nutrition support measures for patients with gastric cancer.The patient's condition and physical condition should be comprehensively evaluated and closely monitored to prevent possible complications.

Surgical treatment of mixed cervical spondylosis with spontaneous cerebrospinal fluid leakage: A case report

BACKGROUND Spontaneous cerebrospinal fluid(CSF)leaks associated with cervical spondylosis are rare.To our knowledge,only a few cases have been reported in which treatment is challenging and varies from case to case.Here,we review the literature and describe the surgical treatment of a 70-year-old woman who presented with a CSF leak due to a cervical spine spur.CASE SUMMARY A 70-year-old female patient who was treated for a cerebral infarction,presented with complains of weakness in the right lower extremity and a feeling of stepping on cotton.The patient underwent regular neck massage and presented with neck and right shoulder pain radiating to the right upper extremity one-month ago.Magnetic resonance imaging showed a strip of leaking cerebrospinal fluid posterior to the C1-4 vertebrae,and computed tomography showed a“sickleshaped”disc prolapse with calcification in C4/5.We chose to perform an anterior cervical discectomy.When the prolapsed C4/5 disc was scraped,clear fluid leakage was observed,and exploration revealed a 1 mm diameter rupture in the anterior aspect of the dura mater,which was compressed continuously with cotton patties,with no significant cerebrospinal fluid leakage after 1 h.CONCLUSION Three months after surgery,the patient was asymptomatic and follow-up imaging demonstrated complete resolution.

Surgical treatment of atlantoaxial dysplasia and scoliosis in spondyloepiphyseal dysplasia congenita:A case report

BACKGROUND Spondyloepiphyseal dysplasia congenita(SEDC)is a rare autosomal dominant hereditary disease caused by COL2A1 mutations.SEDC primarily involves the skeletal system,with typical clinical manifestations,including short stature,hip dysplasia,and spinal deformity.Due to the low incidence of SEDC,there are only a few case reports regarding the surgical treatment of SEDC complicated with spinal deformities.CASE SUMMARY We report a case of a 16-year-old male patient with SEDC.He presented with typical short stature,atlantoaxial dysplasia,scoliosis,and hip dysplasia.Cervical magnetic resonance imaging showed spinal canal stenosis at the atlas level and cervical spinal cord compression with myelopathy.The scoliosis was a right thoracic curve with a Cobb angle of 65°.He underwent atlantoaxial reduction,decompression,and internal fixation from C1–C2 to relieve cervical myelopathy.Three months after cervical surgery,posterior correction surgery for scoliosis was performed from T3 to L4.Scoliosis was corrected from 66°to 8°and remained stable at 2-year follow-up.CONCLUSION This is the first case report of a patient with SEDC who successfully underwent surgery for atlantoaxial dysplasia and scoliosis.The study provides an important reference for the surgical treatment of SEDC complicated with spinal deformities.

Surgical strategy of the treatment of atypical femoral fractures

The atypical femoral fracture(AFF)has been attracting significant attention because of its increasing incidence;additionally,its treatment is challenging from biological and mechanical aspects.Although surgery is often required to manage complete AFFs,clear guidelines for the surgical treatment of AFFs are currently sparse.We reviewed and described the surgical treatment of AFFs and the surveillance of the contralateral femur.For complete AFFs,cephalomedullary intramedullary nailing spanning the entire length of the femur can be used.Various surgical techniques to overcome the femoral bowing common in AFFs include a lateral entry point,external rotation of the nail,and the use of a nail with a small radius of curvature,or a contralateral nail.In the case of a narrow medullary canal,severe femoral bowing,or pre-existing implants,plate fixation may be considered as an alternative.For incomplete AFFs,prophylactic fixation depends on several risk factors,such as a subtrochanteric location,presence of a radiolucent line,functional pain,and condition of the contralateral femur;the same surgical principles as those in complete AFFs can be applied.Finally,once AFF is diagnosed,clinicians should recognize the increased risk of contralateral AFFs,and close surveillance of the contralateral femur is recommended.

Impact of tumour rupture risk on the oncological rationale for the surgical treatment choice of gastrointestinal stromal tumours

Tumour rupture of gastrointestinal stromal tumours(GISTs)has been considered to be a remarkable risk factor because of its unfavourable impact on the oncological outcome.Although tumour rupture has not yet been included in the current tumor-node-metastasis classification of GISTs as a prognostic factor,it may change the natural history of a low-risk GIST to a high-risk GIST.Originally,tumour rupture was defined as the spillage or fracture of a tumour into a body cavity,but recently,new definitions have been proposed.These definitions distinguished from the prognostic point of view between the major defects of tumour integrity,which are considered tumour rupture,and the minor defects of tumour integrity,which are not considered tumour rupture.Moreover,it has been demonstrated that the risk of disease recurrence in R1 patients is largely modulated by the presence of tumour rupture.Therefore,after excluding tumour rupture,R1 may not be an unfavourable prognostic factor for GISTs.Additionally,after the standard adjuvant treatment of imatinib for GIST with rupture,a high recurrence rate persists.This review highlights the prognostic value of tumour rupture in GISTs and emphasizes the need to carefully take into account and minimize the risk of tumour rupture when choosing surgical strategies for GISTs.

Surgical management of duodenal Crohn's disease

BACKGROUND The case of Crohn's disease involving the duodenum is rare,and its surgical management requires a thorough understanding.AIM To investigate the surgical management of duodenal Crohn’s disease.METHODS We systematically reviewed patients diagnosed with duodenal Crohn's disease who underwent surgery in the Department of Geriatrics Surgery of the Second Xiangya Hospital of Central South University from January 1,2004,to August 31,2022.The general information,surgical procedures,prognosis,and other information of these patients were collected and summarized.RESULTS A total of 16 patients were diagnosed with duodenal Crohn’s disease,where 6 cases had primary duodenal Crohn’s disease,and 10 had secondary duodenal Crohn’s disease.Among patients with primary disease,5 underwent duodenal bypass and gastrojejunostomy,and 1 received pancreaticoduodenectomy.Among those with a secondary disease,6 underwent closure of duodenal defect and colectomy,3 received duodenal lesion exclusion and right hemicolectomy,and 1 underwent duodenal lesion exclusion and double-lumen ileostomy.CONCLUSION Crohn's disease involving the duodenum is a rare condition.Different surgical management should be applied for patients with Crohn's disease presenting with different clinical manifestations.

Progress and Prospects of Surgical Treatment of Portal Hypertension

Portal hypertension is a group of syndrome characterized by splenic hyperfunction, esophageal and gastric varices and ascites caused by abnormal portal vein hemodynamics. Among them, upper gastrointestinal bleeding caused by esophageal and gastric varices is the most dangerous complication, which often threatens the lives of patients. After half a century of development, the treatment of portal hypertension is divided into two categories: medical drug therapy, endoscopic therapy and surgical treatment. With the understanding of portal hypertension and the continuous development of medical technology, the surgical operation of portal hypertension has also been greatly improved, reducing postoperative complications and improving the quality of life of patients after operation. However, at present, there is no surgical method that can completely cure portal hypertension. This article reviews the progress of surgical treatment of portal hypertension in recent years, in order to provide reference for the surgical treatment of portal hypertension.

Review of surgical strategies in gastric cancer

Successful and effective management of gastric cancer involves a multidisciplinary approach.Accurate and appropriate staging of gastric cancer is mandatory to define the optimum treatment strategy.Safe surgery achieving R0 resection is considered potentially curative.Surgery remains the cornerstone of multimodal therapy.There is a well-defined role for neoadjuvant and adjuvant chemotherapy regimens.Newermedications and chemotherapy combinations have improved tumor response rates,which have translated into more effective surgery and reduced local recurrences and improved long-term survivals.

Risk Prediction Model for Surgical Treatment of Ruptured Corpus Luteum in the Ovary

Objective: To explore the related factors of surgical treatment of patients with corpus luteum rupture and establish a risk prediction model of surgical treatment of corpus luteum rupture. Methods: 222 patients with corpus luteum rupture treated in Jingzhou First People’s Hospital from January 2015 to March 2022 were analyzed retrospectively, including 45 cases of surgery and 177 cases of conservative treatment. The training set and validation set were randomly assigned according to 7:3. We collected the basic information, laboratory and ultrasonic examination data of 222 patients. Logistic regression analysis was used to determine the independent risk factors and combined predictors of surgical treatment of corpus luteum rupture. The risk prediction model was established and the nomogram was drawn. The discrimination and calibration of the prediction model were verified and evaluated by receiver operating characteristic (ROC) curve, calibration curve and Hosmer-Lemeshow goodness of fit test;Decision curve analysis (DCA) was used to evaluate the clinical effectiveness of the prediction model. Results: Univariate logistic regression showed that whole abdominal pain (OR: 2.314, 95% CI: 1.090 - 4.912), abdominal muscle tension (OR: 2.379, 95% CI: 1.112 - 5.089), adnexal mass ≥ 4 cm (OR: 3.926, 95% CI: 1.771 - 8.266), hemoglobin Conclusion: The nomogram prediction model containing three predictive variables (hemoglobin, depth of pelvic effusion under ultrasound and cervical lifting pain) can be used to predict the risk of surgical treatment in patients with corpus luteum rupture.

Mirizzi syndrome:Problems and strategies

Mirizzi syndrome is a serious complication of gallstone disease.It is caused by the impacted stones in the gallbladder neck or cystic duct.One of the features of Mirizzi syndrome is severe inflammation or dense fibrosis at the Calot’s triangle.In our clinical practice,bile duct,branches of right hepatic artery and right portal vein clinging to gallbladder infundibulum are often observed due to gallbladder infundibulum adhered to right hepatic hilum.The intraoperative damage of branches of right hepatic artery occurs more easily than that of bile duct,all of which are hidden pitfalls for surgeons.Magnetic resonance cholangiopancreatography(MRCP)and endoscopic retrograde cholangiopancreatography(ERCP)are the preferable tools for the diagnosis of Mirizzi syndrome.Anterograde cholecystectomy in Mirizzi syndrome is easy to damage branches of right hepatic artery and bile duct due to gallbladder infundibulum adhered to right hepatic hilum.Subtotal cholecystectomy is an easy,safe and definitive approach to Mirizzi syndrome.When combined with the application of ERCP,a laparoscopic management of Mirizzi syndrome by well-trained surgeons is feasible and safe.The objective of this review was to highlight its existing problems:(1)low preoperative diagnostic rate,(2)easy to damage bile duct and branches of right hepatic artery,and(3)high concomitant gallbladder carcinoma.Meanwhile,the review aimed to discuss the possible therapeutic strategies:(1)to enhance its preoperative recognition by imaging findings,and(2)to avoid potential pitfalls during surgery.

Rare giant intradural epidural hemolymphangioma:A case report

BACKGROUND Hemolymphangioma is a rare,noninvasive benign tumor that originates from vascular and lymphatic malformations.It is usually congenital and can present with varying symptoms depending on its location and size.There are very few reports of hemolymphangiomas within the spinal canal,and giant lesions are exceptionally rare.CASE SUMMARY In July 2023,a 64-year-old male with a giant intravertebral epidural hemolymphangioma from thoracic 11 to lumbar 2(T11-L2)was admitted to the Department of Spine Surgery at the People's Hospital of Binzhou City,China.The patient experienced progressive lumbar and left lower limb pain,numbness,weakness in both lower limbs,and difficulty with urination and defecation.Imaging studies revealed a large cystic mass in the spinal canal at T11-L2.Surgical decompression was performed,and the pathology confirmed hemolymphangioma.CONCLUSION Complete resection of hemolymphangiomas has the best prognosis,and final diagnosis relies on pathologic diagnosis.In this case,the mass was removed intact with a pedicle nail rod system,leading to adequate spinal decompression and restoration of spinal stability.

Goblet cell carcinoid of the appendix:Six case reports

BACKGROUND Goblet cell carcinoid(GCC)of the appendix is a rare tumor characterized by neuroendocrine and adenocarcinoma features.Accurate preoperative diagnosis is very difficult,with most patients complaining mainly of abdominal pain.Computed tomography shows swelling of the appendix,so diagnosis is usually made incidentally after appendectomy based on a preoperative diagnosis of appendicitis.Even if a patient undergoes preoperative colonoscopy,accurate endoscopic diagnosis is very difficult because GCC shows a submucosal growth pattern with invasion of the appendiceal wall.CASE SUMMARY Between 2017 and 2022,6 patients with GCC were treated in our hospital.The presenting complaint for 5 of these 6 patients was abdominal pain.All 5 patients underwent appendectomy,including 4 for a preoperative diagnosis of appendicitis and the other for diagnosis and treatment of an appendiceal tumor.The sixth patient presented with vomiting and underwent ileocecal resection for GCC diagnosed from preoperative biopsy.Although 2 patients with GCC underwent colonoscopy,no neoplastic changes were identified.Two of the six patients showed lymph node metastasis on pathological examination.As of the last followup(median:15 mo),all cases remained alive without recurrence.CONCLUSION As preoperative diagnosis of GCC is difficult,this possibility must be considered during surgical treatments for presumptive appendicitis.

Tuberculous peritonitis complicated by an intraperitoneal tuberculous abscess: A case report

BACKGROUND Tuberculous peritonitis(TBP)is a chronic,diffuse inflammation of the peritoneum caused by Mycobacterium tuberculosis.The route of infection can be by direct spread of intraperitoneal tuberculosis(TB)or by hematogenous dissemination.The former is more common,such as intestinal TB,mesenteric lymphatic TB,fa-llopian tube TB,etc.,and can be the direct primary lesion of the disease.CASE SUMMARY We present an older male patient with TBP complicated by an abdominal mass.The patient's preoperative symptoms,signs and imaging data suggested a poss-ible abdominal tumor.After surgical treatment,the patient's primary diagnosis of TBP complicating an intraperitoneal tuberculous abscess was established by com-bining past medical history,postoperative pathology,and positive results of TB-related laboratory tests.The patient's symptoms were significantly reduced after surgical treatment,and he was discharged from the hospital with instructions to continue treatment at a TB specialist hospital and to undergo anti-TB treatment if necessary.CONCLUSION This case report analyses the management of TBP complicated by intraperitoneal tuberculous abscess and highlights the importance of early definitive diagnosis in the hope of improving the clinical management of this type of disease.