PurposeHead and neck unicentric Castleman disease (HN-UCD) often lacks specific clinical and laboratory markers, leading to frequent preoperative misdiagnoses. While surgical resection typically offers a favorable prognosis, the management of atypical postoperative outcomes, such as new regional lymphadenopathy or persistent systemic symptoms, remains poorly defined. This study aimed to identify the characteristic imaging features of HN-UCD and explore effective management strategies for these atypical postoperative scenarios.MethodsA retrospective analysis was conducted on 24 patients diagnosed with HN-UCD at the Peking Union Medical College Hospital over the past 20 years. The preoperative imaging characteristics and postoperative clinical outcomes were systematically evaluated.ResultsImaging confirmed significant hypervascularity as a hallmark of HN-UCD: 94.4% (17/18) of lesions exhibited abundant and disordered blood flow signals on ultrasound, and 71.4% (10/14) of lesions presented with prominent feeding vessels on CT. Postoperatively, 87.5% (21/24) of the patients achieved complete remission within the surgical field. For the two patients exhibiting atypical outcomes (new regional lymphadenopathy and persistent fever), a strategy of rigorous follow-up was adopted after multidisciplinary exclusion of malignancy and infection; both patients remained clinically stable.ConclusionProminent feeding vessels and marked hypervascularity are characteristic preoperative imaging markers for HN-UCD. For patients with atypical postoperative outcomes, a management protocol based on multidisciplinary evaluation and close clinical observation is recommended.

Ureteroscopy, which is now one of the primary treatments for kidney and ureteral stones, can suffer from unstable vision due to debris and fluid retention, fragment and dust migration, and temporary increases in intrarenal pressure resulting in infectious complications in vulnerable patients. Negative-pressure suction sheaths were introduced as an aid to ureteroscopy to assist in evacuating debris and turbid irrigant while providing more consistent flow dynamics. These devices are intended to improve both the efficiency of the procedure and the physiological safety of the patients. This review will combine the current research on ureteroscopy using suction sheaths with the integration of device design, irrigation-suction coupling, technical standardization, and clinical outcome data. Stone characteristics, device specifications, irrigation/suction variables, and primary endpoint data including stone-free rates, operative time, residual fragment burden, postoperative pain, ureteral injuries, and infectious complications (fever, SIRS, sepsis) were extracted from all eligible studies. The evidence is presented within a mechanistic to outcome model, where suction-assisted flow improves optical clarity, facilitates fragment evacuation, and reduces pressure surges during high energy lithotripsy. The model also addresses tradeoffs related to mucosal collapse risks, ureteral wall stresses, and the requirement for parameter standardization. Suction-assisted ureteroscopy provides a systems-based approach to improving the safety and efficacy of endoscopic lithotripsy, potentially most beneficially applied to high-dusting cases, contaminated or obstructed collecting systems, and anatomically challenging situations. To facilitate the widespread acceptance of this technology, there should be standardized reporting of intrarenal pressure surrogates, suction variable ranges, and comparison techniques used in conjunction with large-scale multicenter clinical trials, and cost-effectiveness analyses.

Cesarean section is among the most frequently performed surgical procedures worldwide. In recent years, the increasing rate of cesarean deliveries has led to an increased incidence of post-operative complications. The present case report describes a rare case of a post-operative pelvic abscess located at the uterine scar following a cesarean section, managed successfully via laparotomy. The patient, a 17-year-old woman, was admitted 1 week after undergoing a cesarean delivery. She presented with abdominal pain, fever and chills. Blood tests revealed elevated inflammatory markers and a mild coagulation disorder, consistent with an ongoing infectious process. The results of urinalysis did not reveal any notable findings. A transvaginal ultrasound and an abdominal computed tomography scan revealed a large, mixed echogenic mass with irregular borders and the presence of intralesional air bubbles, localized at the uterine scar anterior to the bladder. Given the persistence of clinical symptoms, supportive imaging and laboratory findings, and the failure of conservative management of the post-operative intra-abdominal infection, surgical intervention was deemed necessary. A laparotomy was performed through the previous cesarean incision. Intraoperatively, an abscess was identified at the site of the uterine scar and was surgically drained. Samples were collected for aerobic and anaerobic cultures, and the cavity was irrigated thoroughly to remove purulent and hemorrhagic material. A drainage tube was placed before closure. The postoperative course of the patient was uneventful, with complete clinical resolution. Following the case presentation, a brief review of the current diagnostic and therapeutic strategies for this uncommon post-operative complication is also provided. On the whole, the present case report underscores the importance of timely surgical intervention via laparotomy when image-guided drainage or laparoscopy is not feasible.

BACKGROUND Stasis within the biliary limb of the Roux loop is rarely reported after successful Kasai portoenterostomy (KPE) for biliary atresia (BA). CASE REPORT This retrospective report describes 2 children (cases 1 and 2, aged 47 and 42 months) who underwent KPE for type 3 BA at 33 and 54 days of life, respectively, with postoperative jaundice clearance at 3 months (total bilirubin levels of 15 and 6 μmol/L, respectively). Both children experienced frequent episodes of cholangitis (5 episodes each within 3 months and 1 month post-KPE, respectively); they presented with fever and elevated liver enzymes. Hepatobiliary scintigraphy demonstrated prompt hepatic uptake and excretion, with extrahepatic stasis in the Roux loop. Laparotomy (at 4 and 19 months of age, respectively) confirmed dense adhesions and bowel dilatation in the biliary limb in case 1, and at the T-junction of the enteroenterostomy of the Roux loop in case 2. Adhesiolysis, resection of the dilated bowel, and restoration of bowel continuity resulted in improved liver function, with cholangitis resolution during 33 months of follow-up in case 1 and 3 episodes of cholangitis over 23 months in case 2. CONCLUSIONS Evaluation of recurrent cholangitis after successful KPE for BA may reveal bile stasis in the Roux limb. However, further studies are required to clarify any association or causal relationship before general recommendations can be made regarding surgical exploration to relieve biliary stasis and reduce the risk of cholangitis.