Parastomal herniation (PSH) is a common complication after establishing an enterotomy. The hernia typically contains omentum, small bowel, colon, and rarely other viscera. We present the case of an 83-year-old woman with PSH of the entire gallbladder containing gallstones with acute cholecystitis and necrosis due to torsion of the gallbladder neck. Surgery was complicated by fascial dehiscence with reactive small bowel obstruction caused by bile leakage from a subvesical bile duct. The case illustrates the high level of complexity related to the surgical treatment of organ herniation and raises awareness that such surgery poses significant risks of postoperative complications.

Background: Routine use of the chorioallantoic membrane (CAM) tumor model in nuclear imaging studies is hampered by small tumors, embryonic movements and laborious volume-restricted intravenous tracer/drug administration. We sought a workaround by using fast-growing tumors, high-resolution autoradiography and non-intravenous tracer administration. Methods: Dekalb White chicken eggs were grafted with C3H mammary carcinoma fragments or MOC2 oral squamous cell carcinoma fragments from donor mice. The tumor uptake of ¹⁸F-fluorodeoxyglucose (FDG) following in-yolk-sac injection, dripping after CAM scoring or allantoic cavity injection was evaluated using positron emission tomography (PET) and autoradiography. Using in-yolk-sac injection, eggs were administered different tracer mixtures, namely (1) pimonidazole (hypoxia-marker), FDG and ¹⁴C-2-deoxyglucose (¹⁴C-2DG), (2) pimonidazole, FDG and ¹⁴C-acetate or (3) pimonidazole, the hypoxia-selective tracer ¹⁸F-fluoroazomycin-arabinoside (FAZA) and ¹⁴C-2DG. For comparison, tumor-bearing mice were administered FDG/¹⁴C-acetate/pimonidazole. Gross tumor uptake was evaluated using PET. Tumor cryosections were analyzed using dual-tracer autoradiography. Complementary autoradiograms were co-registered, covered by a square grid (0.5 × 0.5 mm). Pearson correlation coefficients (PCC) were calculated from scatterplots. Results: C3H tumors reached a mean weight (with 95% confidence interval) of 0.32 g (0.28–0.37 g), while for MOC2, it was 0.19 g (0.09–0.29 g). In-yolk-sac tracer injection was simple and effective, producing high tracer uptake and contrast 3 h post-administration. Spatial tracer overlap (PCC) was: FDG vs. ¹⁴C-2DG, 0.95–0.97; FAZA vs. ¹⁴C-2DG, 0.71–0.79 and FDG vs. ¹⁴C-acetate, 0.26–0.84 (0.15–0.76 in mice). Pimonidazole revealed tumor hypoxia. Conclusions: Direct-grafting from donor mice generated larger tumors than previously reported. In-yolk-sac tracer administration was practical and allowed larger injected volumes. Autoradiography revealed that: (1) FDG and ¹⁴C-2DG can be used interchangeably, (2) ¹⁴C-2DG was elevated in FAZA-positive areas, suggesting that in some tumors FDG-PET may provide information on the intratumoral distribution of hypoxic areas, and (3) FDG and ¹⁴C-acetate showed variable overlap. We conclude that in-yolk-sac tracer injection and autoradiography simplify and optimize CAM-based nuclear imaging research.