Intestinal Ischemia Due to Methamphetamine Abuse in a Confused Elderly Patient: A Case Report.

Bowel ischemia is a critical entity that mandates an early and proper diagnosis. Causes of bowel ischemia are numerous, yet, identifying and treating the exact cause is challenging. Methamphetamine-induced bowel ischemia is rare but of clinical significance due to its high disease burden. We describe a case of a 67-year-old man who presented with colicky abdominal pain shortly after methamphetamine intake. CT angiography was done and failed to show occlusive causes, which pointed to a non-occlusive cause of bowel ischemia. The patient was hemodynamically stable on admission. Diagnostic laparoscopy was converted to laparotomy; segmental gangrene of both the small and large bowels was found. Resection of the ischemic part was done. The patient improved and was hemodynamically stable postoperatively. In conclusion, a holistic approach to patient history and physical examination can grab attention to unusual pathologies that lead to early intervention and fastened life-saving measures. Questions about stimulant drug use are crucial not only in younger patients but in older patients as well. In this case, we highlight the surgical, medical, and mental aspects of methamphetamine abuse in the elderly population.

Ciliated foregut cyst in the triangle of Calot: the first report.

Ciliated foregut cysts are rare anomalies arising from remnants of aberrant embryological development. Around 100 reports on the presence of these congenital masses in the tracheobronchial tree, mediastinum, liver, pancreas and, rarely, the gallbladder have been described. In this article, the case of a 33-year-old woman, who was operated for a laparoscopic cholecystectomy, is presented. During the dissection of the triangle of Calot, a cystic mass, attached to the common hepatic duct, was discovered incidentally. This cyst was dissected off the hepatic duct, and no communication between both structures was found. The histopathological diagnosis was consistent with a ciliated foregut cyst. The postoperative course was uneventful. After reviewing the literature on this pathological entity, we found that this is the first report of a ciliated foregut cyst that is located in the triangle of Calot and found separate from the biliary structures, the gallbladder and the liver. We present a review of the literature on this entity, discussing diagnostic measures and therapeutic options.

Small bowel volvulus with no malrotation after laparoscopic appendicectomy: Case report and literature review.

INTRODUCTION: Small bowel volvulus, as a complication of laparoscopic surgery, is a rarely reported clinical entity. We present a case of a young female who developed small intestinal volvulus after laparoscopic appendicectomy. She had this complication in the absence of malrotation or other previous abdominal operations. PRESENTATION OF CASE: A 17-year-old woman presented with acute appendicitis. After an uneventful laparoscopic appendicectomy, she developed acute small intestinal obstruction on the second post-operative day. A prompt laparotomy showed small bowel volvulus, which was reduced, with no evidence of malrotation. She had an uneventful recovery and was discharged within 3 days of the second operation, in a stable condition. DISCUSSION: This article presents a review of the literature of this rare cause of small intestinal obstruction after laparoscopic surgery, stressing on the importance of early diagnosis and treatment. A discussion of the potential factors predisposing to this entity is presented, emphasising the need of a higher-evidence study as to its aetiology and prevalence. CONCLUSION: Small bowel volvulus is a rare complication of laparoscopic surgery, but its early diagnosis and prompt treatment is essential to avoid morbid outcomes. Surgery is the therapeutic mainstay.