This retrospective observational study aimed to evaluate whether preoperative sarcopenia, assessed by CT imaging, was associated with postoperative clinical outcomes and overall survival in patients that underwent liver resections. Patients operated on between January 2014 and February 2020 were included. The skeletal muscle index (SMI) was measured at the level of the third lumbar vertebra on preoperative CT scans. Preoperative sarcopenia was defined based on pre-established SMI cut-off values. The outcomes were postoperative morbidity, length of hospital stay (LOS), and overall survival. Among 355 patients, 212 (59.7%) had preoperative sarcopenia. Patients with sarcopenia were significantly older (63.5 years) and had significantly lower BMIs (23.9 kg/m²) than patients without sarcopenia (59.3 years, p < 0.01, and 27.7 kg/m², p < 0.01, respectively). There was no difference in LOS (8 vs. 8 days, p = 0.75), and the major complication rates were comparable between the two groups (11.2% vs. 11.3%, p = 1.00). The median overall survival times were comparable between patients with sarcopenia and those without sarcopenia (15 vs. 16 months, p = 0.87). Based on CT assessment alone, preoperative sarcopenia appeared to have no impact on postoperative clinical outcomes or overall survival in patients that underwent liver resections. Future efforts should also consider muscle strength and physical performance, in addition to imaging, for preoperative risk stratification.

Background: Median arcuate ligament syndrome (MALS) is caused by celiac trunk (CT) compression by the median arcuate ligament. Clinically, this pathology varies from postprandial pain (Dunbar syndrome) to a life-threatening hemorrhage because of a rupture of a gastroduodenal artery aneurysm (GAA). Due to the low prevalence of this disease, there is no standard management for MALS.Material and method: This was a single-center, retrospective study of 13 patients. Two groups were identified on the basis of the initial clinical presentation: those operated for a GAA rupture (bleeding group—BG) and those operated electively for Dunbar syndrome (Dunbar syndrome group—DG). The primary endpoint was 30-day postoperative complications of a systematic laparoscopic release of the median arcuate ligament and stenting during the same procedure.Results: Seven patients (54%) underwent elective surgery. Six patients (46%) underwent semiurgent repair under elective conditions post-embolization for GAA bleeding. The total operative time was longer in the BG (p = 0.06). Two patients in the BG suffered early major complications and needed reintervention, and those in the DG had a lower comprehensive complication index. No mortality was reported at 30 days. Overall median length of stay was 5 days (IQR: 3.5–15.3). Patients in the DG had a significantly shorter length of stay (p = 0.02). At 6 months, the primary and secondary CT stent patencies were 82% and 100%, respectively. There were no high-flow GAA recurrences.Conclusions: A combined approach of laparoscopic release of the median arcuate ligament and stenting during the same procedure is feasible and safe, and this approach must be systematically discussed in symptomatic patients.

Background: Patients with rectal cancer may be exposed to a loss of muscle strength and quality. This study aimed to assess the role of preoperative CT-based sarcopenia on postoperative clinical, pathological, and oncological outcomes after rectal cancer surgery. Methods: This retrospective monocentric study included patients who underwent elective oncologic resection for rectal adenocarcinoma between 01/2014 and 03/2022. The skeletal muscle index (SMI) was measured using CT at the third lumbar vertebral level, and sarcopenia was defined based on pre-established sex-specific cut-offs. Patients with sarcopenia were compared to those without sarcopenia in terms of outcomes. A Cox proportional hazard regression analysis was used to determine the independent prognostic factors of disease-free survival (DFS) and overall survival (OS). Results: A total of 208 patients were included, and 123 (59%) had preoperative sarcopenia. Patients with sarcopenia were significantly older (66 vs. 61 years, p = 0.003), had lower BMI (24 vs. 28 kg/m², p < 0.001), and were mainly men (76 vs. 48%, p < 0.001). There was no difference in overall and major complication rates between the sarcopenia and non-sarcopenia group (43 vs. 37%, p = 0.389, and 17 vs. 17%, p = 1.000, respectively). Preoperative and postoperative features related to rectal surgery were comparable. The only predictive factor impacting OS was R1/R2 resection (HR 4.915, 95% CI, 1.141–11.282, p < 0.001), while sarcopenia (HR 2.013, 95% CI 0.972–4.173, p = 0.050) and T3/T4 status (HR 2.108, 95% CI 1.058–4.203, p = 0.034) were independently associated with DFS. Conclusions: A majority of patients undergoing rectal cancer surgery had preoperative CT-based sarcopenia. In this cohort, sarcopenia had no impact on postoperative morbidity and OS but was independently associated with DFS.

Histoplasmosis is a fungal infection most frequently seen in immunocompromised patients. It is endemic in Central and South America and in Africa. The infection is usually asymptomatic in a healthy individual. Extrapulmonary dissemination can be seen in immunocompromised hosts. Gastrointestinal manifestations frequently involve the terminal ileum and cecum, mimicking Crohn’s disease or malignancy. We describe the case of a 36-year-old healthy man from Cameroon, living in Switzerland for 13 years and without any medical nor surgical history, who presented peritonitis not responding to antibiotics. CT-scan showed bowel obstruction and signs of peritonitis. We opted for an explorative laparoscopy, which was converted to laparotomy with extensive adhesiolysis. Diagnostic of histoplasmosis was confirmed by histology and PCR analysis on biopsy. To our knowledge, this is the first described case of peritonitis as main outcome of a disseminated histoplasmosis involving the peritoneum in an immunocompetent patient.

Background: Computed tomography (CT)-based sarcopenia is a promising predictor of postoperative complications and recovery. However, studies on the longitudinal evolution of skeletal muscle markers are lacking and findings regarding its correlation with survival are still not clear. Methods: We conducted a retrospective single-center cohort study of consecutive patients undergoing curative-intent colon cancer surgery. Skeletal muscle area (SMA), skeletal muscle index (SMI), skeletal muscle radiation attenuation (SMRA), and intermuscular adipose tissue (IMAT) area and index (IMATI) were measured on a single axial CT slice at the third lumbar vertebral level before surgery and at 6, 12, and 24 months after. Descriptive statistics were used to report the evolution over time of CT-based sarcopenia markers. Their correlation with overall survival was analyzed using Cox’s proportional hazards regression analysis. Results: The final cohort included 102 patients (65.7% males) with a mean age of 66 ± 13 years. Eighty-five (86.7%) patients were alive at 24 months, and forty-five (45.9%) underwent a CT scan at all time points. CT-based sarcopenia markers remained statistically stable over 2 years. Age (HR 1.07, 95% CI 1.00–1.14) and ASA score (HR 2.4, 95% CI 1.00–5.7) were negative independent predictive factors. Patients with larger differences ($\mathrm{\Delta }$) of IMAT area and IMATI at 12 months, HR 0.79 (95% CI 0.67–0.93) and 0.49 (95% CI 0.30–0.80), respectively, had a lower mortality. Conclusions: CT-based markers of skeletal muscle quantity (SMA, SMI) and quality (IMAT area, IMATI) remained statistically stable after curative-intent colon cancer surgery. No preoperative CT-based sarcopenia markers were predictive of overall survival. Larger cohorts are needed to generalize these initial findings.

Splenic torsion is a rare condition caused by the twisting of the splenic pedicle, potentially leading to parenchymal infarction. We report a case of splenic torsion in a young patient with situs inversus totalis, isolated polysplenia, and a wandering spleen, without other cardiothoracic or digestive anomalies. An 18year-old female, already known for situs inversus totalis, presented in the emergency department of a regional hospital with sudden right abdominal pain associated with vomiting. Laboratory tests showed leukocytosis and elevated C-reactive protein. Abdominal CT confirmed the situs inversus totalis and revealed a polysplenia with a well-delimited hypodense mass suspected of infarction of the main spleen due to the torsion of its vascular pedicle. After the emergency patient's transfer to our tertiary hospital (Lausanne University Hospital, Lausanne, CHE), hand-assisted laparoscopic splenectomy was performed. The postoperative course was uneventful, and the patient was discharged on the third postoperative day. Splenic torsion is a rare but serious condition requiring prompt diagnosis and surgical intervention. Patients with situs inversus, polysplenia, or a wandering spleen are predisposed to splenic torsion due to abnormal anatomy. Imaging by CT is crucial for diagnosis, and laparoscopic splenectomy remains a safe and effective treatment when infarction occurs.