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Thank you for accepting our invitation to present your abstract "An Unusual Presentation of Coccidioidomycosis with Peritoneal Involvement in an Immunocompetent Individual". Your response has been recorded by the SAGES office.

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Abstract ID: 84804
Abstract Title: An Unusual Presentation of Coccidioidomycosis with Peritoneal Involvement in an Immunocompetent Individual
Session Name: iPoster Session (Non CME)
Program Number: Program Number will be assigned in January 2018
Session Date: Thursday, April 12, 2018 and Friday, April 13, 2018
Session Time: 10:00 AM - 4:00 PM
Presenter: Joseph D Krocker // jkrocker85@gmail.com // 8179394669


Please note that if you have not yet registered for the SAGES Meeting, as a Presenter you are REQUIRED to register by the early registration deadline of February 23, 2018 in order for your iPoster to be displayed.   (Registration for both the SAGES conference and military symposium will be free to military personnel currently on active duty. Active Duty Military Surgeon registrations must be made with a valid .mil email address.)

You can register online at: http://www.cvent.com/d/m5qx3y


NEW THIS YEAR: SAGES will have only digital posters at the 16th World Congress of Endoscopic Surgery, jointly hosted by SAGES & CAGS

What are iPosters?
iPosters are interactive, multimedia research presentations that will be displayed electronically on large format HD touchscreen monitors at the conference.

How do I create an iPoster?
It is all online and digital. You just log in to the online editor and create your iPoster from any Internet-connected computer. You can include high resolution images, high definition videos, sound files, and slide shows. You can add as much text and media content as you need to present your research with the detail it deserves; there are no limits.

Do you mean there’s no paper to print or carry?
Nope. You just show up at the conference and your iPoster is there, ready to be searched and explored on the iPoster directories, which are displayed on all of the HD screens.

How do attendees access the content?
Attendees will enjoy a completely different learning experience when exploring an iPoster. Content boxes scroll and expand at the tap of a finger. Tap on an image (a photo, diagram or table) and it enlarges to its full size. If you have added a video, they can watch it full screen. If you have added a narration, they can listen to your presentation (while they scroll through your iPoster) even when you are not there.

Can attendees contact me for more information?
Yep. There is a "Contact Author" button at the bottom of each iPoster. So, if you are not there when they explore your presentation, they can fill in a request for more information or, perhaps, a meeting to discuss your research while you are still at the Conference. And since the iPosters are online outside of the poster area and after the conference, they can still get in touch. Your email address is hidden, so it's up to you if you want to respond.

Can I share my iPoster with others?
Yes you can. You will find a Share button on your editing template when you log in.

What’s next?
In January 2018 more instructions will be sent to you on how to login to create your iPoster.

When you log in the first time, you will be able to choose from a number of iPoster templates and then create your iPoster on-line. You'll find links to instructions, Tutorials, FAQs, and our Support Desk. You can always log in from any internet-connected computer, anywhere, using your username and password. Check out the tutorials here:


Please note that the iPoster Session is not accredited for CME


All accepted abstracts will be published by the journal Surgical Endoscopy.


It is the responsibility of the author(s) to obtain permission from the original source to use any copyrighted materials as part of their presentation. To avoid infringements, it is recommended that copyrighted materials be avoided and that images and materials not previously published be used instead. SAGES accepts no responsibility for copyright infringements by the author(s).


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Hotel Reservations Scam

We would like to make you aware of a situation that has been affecting conferences nationwide. There are companies (Convention Housing Services, Global Housing, Global Travel, etc.) who claim to be the official housing bureau and ask to "assist" you with hotel reservations. They may disguise themselves as part of SAGES or CAGS, or may claim to represent the hotels listed above. They may note they can get better rates, the room block is filled, or use other sales pitch methods.

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As an iPoster Presenter, you are NOT REQUIRED to submit a manuscript to the SAGES journal Surgical Endoscopy however you are STRONGLY ENCOURAGED to submit a manuscript to the journal.

If you would like to submit a manuscript, it must be submitted electronically via the following website:


You may communicate with Bernie Richey at the Journal office via email at surgendosc@optonline.net or via telephone at 845-353-3106. The Journal can only answer questions about your manuscript submission to the Journal. For questions concerning your presentation at the meeting, please contact Dan Berlant at the SAGES office at abstracts@sages.org or via telephone at 310-437-0544 ext. 118.


Joseph D Krocker1, Benjamin Clapp, MD, FACS2 ; 1The Texas Tech Health Sciences Center Paul L Foster School of Medicine, 2The Texas Tech Health Sciences Center Department of Surgery

Background: Coccidioidomycosis is a fungal infection endemic to the southwestern United States, Central America and South America.  Coccidioides is ubiquitous in many of these endemic regions, with near 100% seroconversion in some communities.  Two-thirds of these mycotic infections may be asymptomatic.  The most common presentation of coccidioidomycosis consists of “flu-like” symptoms or pneumonia.  Less than five percent of symptomatic cases progress to disseminated coccidioidomycosis which may involve any organ system.  Very rarely infection may include the peritoneum.  We report a case of coccidioidomycosis with peritoneal involvement in an immunocompetent individual.

Case: A 36-year-old male presented to the Emergency Department with progressive abdominal pain.  He was seen and treated for pneumonia in the Emergency Department one week prior.  The patient worked outdoors in Arizona and was otherwise healthy with a family history of malignancy and blood disorders.  Fever, leukocytosis and ascites on computed tomography scan prompted a diagnostic laparoscopy which revealed peritoneal granulomas positive for Coccidioides.  The patient was treated outpatient with Fluconazole.

Discussion: Since 1939 this is the 38th reported case of peritoneal coccidioidomycosis to our knowledge.  The patient described in this case report was an otherwise healthy 36-year-old male; this is incongruent with many of the previously recorded cases which involved disseminated disease in immunocompromised patients.  The patient’s family history of malignancy and blood disorders suggests a potential underlying genetic predisposition that could account for this abdominal presentation.  Possible mutations include genes coding for the interleukin-12 β1 receptor and the signal transducer and activator of transcription 1 which have been implicated in increased coccidioidomycosis susceptibility.  Peritoneal infection presents a unique challenge in diagnosis.  In these cases coccidioidomycosis may not be suspected due to nonspecific symptoms and imaging, the infrequency of this extra-pulmonary manifestation and clinical characteristics that mimic the presentation of tuberculosis and malignancy.  Abdominal infections have been misdiagnosed as appendicular abscesses, iliopsoas abscesses, adnexal abscesses and pancreatic masses.  Consequently, the diagnosis of peritoneal coccidioidomycosis is often made after laparoscopic exploration of the abdomen and histopathology, as it was in this case report.

Conclusions: Coccidioidomycosis incidence is on the rise in endemic areas and it often falls on the surgeon to make the diagnosis in extra-pulmonary cases.  The peritoneal subset of coccidioidomycosis should be considered in endemic areas when a young, otherwise healthy patient presents with abdominal pain.  Failure to recognize the possibility of coccidioidomycosis may lead to unnecessary treatments and procedures.