Giant pseudoaneurysms of the splenic artery, with a diameter of 5 cm or more, are rare surgical emergencies, and conventional open surgery usually involves splenectomy. The aim of this study is to report two cases from our institution and to review the world's literature on successful endovascular treatment of patients with giant splenic artery pseudoaneurysms. A retrospective review of a prospectively entered departmental computerized database was performed for the two patients from our institution. Articles were searched electronically from PubMed and Medline, using the terms ‘giant splenic artery’, ‘endovascular’ and ‘embolization’; and relevant cases were reviewed from the world's literature. We hereby report two patients with giant splenic artery pseudoaneurysms who were treated successfully with endovascular procedures. In addition to the two patients from our institution, there were five patients with giant splenic artery pseudoaneurysms in the published literature who underwent successful endovascular management. The first patient of our series had the largest pseudoaneursym size of 7.2 × 8.1 cm, which is the largest documented pseudoaneursym in the current literature. We report two cases of giant splenic artery pseudoaneurysm with one being the largest pseudoaneurysm treated with endovascular technique in the current literature. Endovascular coil embolization of main trunk of splenic artery is less invasive than open surgical treatment for giant splenic artery pseudoaneurysm, and circumvents the problem of difficult exposure, especially in those patients with significant co-morbidity.

A 42-year-old man presented with a 3-day history of epigastric pain and tarry stools. On physical examination the hemodynamics were stable, and the patient had a pallor and mild epigastric tenderness. Blood tests revealed a hemoglobin level of 7.7 g/dL, and a chest X-ray showed a rim of free gas under the diaphragm. On abdominal computed tomography, focal dilatation was noted over the greater curve of the stomach, exaggerated by the presence of organized debris with hyperdensities suspicious of blood or food particles ([Fig. 1]). In view of his stable condition, the patient was treated conservatively. However, on follow-up esophagogastroduodenoscopy (EGD) 2 weeks later, a 4-cm outpouching, containing small amounts of coffee-ground substances and food residue, was noted on the greater curvature of the stomach ([Fig. 2]). Overall, the features were suggestive of a gastric diverticulum that had previously bled and was perforated. The patient underwent laparoscopic-stapled diverticulectomy, and pathological examination revealed gastric mucosal herniations without muscular coating, compatible with a false diverticulum of the stomach. Gastric diverticulum is a rare diverticulum with around 200 cases reported in the literature [1], with a prevalence between 0.01 % and 0.11 % [2] [3]. There is no gender predilection and the presenting age ranges from 20 to 60 years. Most individuals remain asymptomatic but complications such as bleeding and perforation can occur [1] [2] [4]. Gastric diverticula can be congenital or acquired [5]. The congenital diverticula are true diverticula and account for 72 % of all cases [4]. They are usually within 2 – 3 cm of the esophagogastric junction and are believed to occur as a result of intrauterine malformation or interruption of fetal development. Acquired diverticula are false diverticula, containing only the gastric mucosa. These diverticula may be due to gastric outlet obstruction, repeated vomiting, acute cholecystitis, pancreatitis, or hepatic or splenic adhesions. Surgical resection is the recommended treatment in symptomatic patients, with laparoscopic diverticulectomy being the preferred approach. Endoscopy_UCTN_Code_CCL_1AB_2AC_3AF

To determine the factors affecting survival of patients with unresectable stage IV colon cancer with Primary tumour resection (PTR) as first treatment compared with those with conventional palliative chemotherapy. Patient with minimally or asymptomatic stage IV colon cancer at diagnosis were identified from prospectively managed database in included centers from 2015 to 2020. Patient with and without PTR performed were followed up. Primary end point was overall survival. Risk factors affecting survival will be analysis by Kaplan Meier statistics and Cox regression analysis. Secondary outcome will be stoma formation, complication rate and reoperation. 162 patients were included in analysis. 68 patients treated with systemic therapy PTR and 94 patients with tumour in-situ before systemic therapy. Baseline demographics including sex, age, functional status, tumour location, site of metastasis, RAS status were similar except there was slightly more liver metastasis on non-resection group (63.2% vs 79.8%). Cox regression analysis found PTR (HR 0.485, 0.302-0.778, p = 0.003)), bone metastasis (HR 3.163, 1.146-6.918, p = 0.004) commencement (HR 0.579, 0.345-0.971, p = 0.038) and completion of systemic therapy (HR 0.310, 0.178-0.539, p = 0.000) are independent factors predicting survival. The median overall survival after PTR vs tumour in-situ is 28 (IQR: 16-47) vs 12 (IQR:6-31) months (p<0.001). Resection of primary tumour is an independent good prognostic factor in relatively asymptomatic stage IV CA colon patients with unresectable metastasis. Resection should be considered as long as the procedure is straight forward and do not impose significant morbidities with careful patient selection.

We report the management of a case of thigh abscess with ruptured left superficial femoral artery mycotic aneurysm in a 91-year-old woman with significant comorbidity. The abscess culture grew Escherichia coli and Acinetobacter baumannii. Vascular reconstruction was not performed because the foot was viable with a heavily contaminated wound. The thigh wound healed with the help of vacuum-assisted closure. This is the first report of a ruptured mycotic aneurysm of the superficial femoral artery associated with Escherichia coli and Acinetobacter baumannii infection. This case demonstrates that resection of a mycotic aneurysm without vascular continuity is feasible, especially in frail patients.