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INTRODUCTION: Neuroendocrine carcinoma (NEC) of the gallbladder is a rare entity with much of the surgical strategy and management mirroring that of adenocarcinoma of the gallbladder. In contrast to gallbladder adenocarcinoma, however, it tends to be a more aggressive and lethal malignancy associated with a short survival after the time of diagnosis. Furthermore, due to its rarity, there are no consensus guidelines for its management. PRESENTATION OF CASE: We present the case of a 73-year-old female who presented with acute cholecystitis and was found to have a poorly differentiated large cell NEC of the gallbladder after laparoscopic cholecystectomy. She was treated with adjuvant chemotherapy and has shown no evidence of cancer recurrence on three-year follow up. DISCUSSION: Surgical resection is the cornerstone of curative treatment for gallbladder NEC. Management may include simple cholecystectomy, extended cholecystectomy, radical cholecystectomy, or palliative cholecystectomy. It is unclear whether lymphadenectomy confers a survival benefit. Adjuvant chemotherapy with platinum-based regimens, on the other hand, has been associated with increased survival rates. Radiation, immunotherapy, somatostatin analogs and targeted therapy have also been used for treatment. CONCLUSION: NEC of the gallbladder is extremely rare, aggressive, and carries a dismal prognosis. Further studies are needed to develop the optimal treatment approach to increase survival rates and establish best practices to manage these patients.
RESUMEN
Buried bumper syndrome (BBS) is a rare but severe complication of percutaneous endoscopic gastrostomy (PEG) tube feeding. Patients with BBS lose PEG tube patency and may experience peristomal pain, content leaks, or peritonitis. An early diagnosis can avert further complications. BBS is a clinical diagnosis, but an abdominal computerized tomography scan or upper endoscopy is needed to confirm the diagnosis. BBS is a long-term complication of PEG tube feeding, and cases of acute onset are scant in the literature. We report a unique case of a 65-year-old female with a history of stroke who developed BBS five weeks after PEG tube placement.
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INTRODUCTION AND IMPORTANCE: Traumatic bladder rupture is a rare occurrence. It is more likely to occur following blunt injury and is associated with pelvic fractures in patients presenting with hematuria. We present a unique case of an extraperitoneal bladder rupture in a female after sustaining a minor fall in the absence of a pelvic fracture. PRESENTATION OF CASE: The patient is a morbidly obese female with a history of vaginal vault prolapse who reported profuse vaginal bleeding and lower abdominal and suprapubic pain shortly after falling off of her bed. The patient showed no signs of hemodynamic instability and genital bleeding was ruled out in the emergency department. A Computed Tomography (CT) cystogram confirmed bladder rupture confined to the extraperitoneal space without any evidence of pelvic fractures. DISCUSSION: Blunt traumatic extraperitoneal bladder rupture is typically associated with concomitant pelvic fracture. These injuries tend to occur as a result of high-impact motor vehicle or motorcycle collisions and are associated with an increased morbidity and mortality. CONCLUSION: Dedicated bladder imaging should be considered in blunt abdominopelvic trauma patients presenting with hematuria in the absence of pelvic fracture when the patient's underlying medical conditions or comorbidities increase the risk of bladder rupture. Our patient's history of pelvic organ prolapse placed her at an increased risk of traumatic injury to the bladder.