Perforated appendicitis with endosalpingiosis.

Endosalpingiosis a condition of ectopic glandular epithelium diagnosed histologically, most commonly on pelvic and abdominal peritoneum, that can be associated with abdominal pain mimicking appendicitis. There is evidence emerging that endosalpingiosis may be associated with serous ovarian malignancies. Here we describe a case of perforated appendicitis with concurrent endosalpingiosis. Further research is required to better elucidate the association between endosalpingiosis and malignancy, and the implications of a concurrent presentation with a hollow viscus perforation.

Rare dual surgical pathology at emergency laparotomy: a case report of concurrent small bowel obstruction and appendicitis.

Dual surgical pathology at emergency laparotomy is an uncommon finding outside of trauma scenarios. There is a scarcity of case reports of concomitant small bowel obstruction and appendicitis at laparotomy, likely in part because of advancements in investigative tools, diagnostic processes and the ready availability of medical care, which is demonstrated by harrowing statistics from developing nations where these factors are lacking. However, despite these advancements, initial diagnosis of dual pathology can be difficult. We report a case of concurrent small bowel obstruction and occult appendicitis discovered at emergency laparotomy in a previously well female with a virgin abdomen.

Scoliosis and spina bifida contributing to strangulation of a hiatus hernia: a case report.

Hiatus hernia is defined as a trans-diaphragmatic protrusion of the intra-abdominal contents through the oesophageal hiatus into the mediastinum. Surgical repair is indicated in symptomatic patients, with some patients presenting emergently with strangulation and ischaemia of hernial contents. In this situation, emergent decompression and surgical repair is indicated. Although it has been suggested previously that kyphoscoliosis may contribute to development and progression of hiatus hernia, there are no published reports of obstruction being caused by severe spinal deformity. A 67-year-old male patient with spina bifida and severe scoliosis who presented with an obstructed hiatus hernia is discussed here. Because of his obstruction, laparoscopic hiatus hernia repair and fundoplication was undertaken. The patient had an uncomplicated recovery following this. This case highlights the importance of providing definitive management to patients with difficult anatomy, which has caused their obstruction, as conservative management is unlikely to lead to an optimal outcome.

Rapidly developed heterotopic ossification: a rare complication after trauma.

Heterotopic ossification (HO) is a condition where aberrant bone grows in tissues. This case study presents a rare complication of trauma and laparotomies, where the rapid and extensive occurrence of HO has delayed abdominal incision closure resulting in multiple surgeries and prolonged recovery. A 44-year-old man was retrieved after a truck accident resulting in multi-organ injuries. He required damage control trauma laparotomy followed by several relooks and multiple orthopaedic procedures. Despite several attempts, approximation of the laparostomy wound was not possible due to abdominal rigidity. Computed tomography scans done 20 days after injury demonstrated advanced HO over the wound edge. Early development of HO may explain why the abdominal incision was difficult to close and highlights the importance of being aware of HO as an early complication after trauma and midline laparotomy.

A case of liver injury and pneumo-haemoperitoneum during pericardiocentesis.

Pericardiocentesis is a generally safe procedure that provides effective resolution of cardiac tamponade. Emergency pericardiocentesis may be a life-saving intervention. Encountering an intra-abdominal organ in the path of the needle is predicted to be a potential complication in emergency subxiphoid approaches. Despite predictions of intraabdominal injuries, only few instances are recorded. In this case study, a patient recovering from percutaneous cardiac intervention required an emergency pericardiocentesis that was complicated by a liver injury, diaphragmatic penetration and pneumo-haemoperitoneum requiring surgical intervention to remove the drain. The case discusses options for performing the procedure, patient factors that can complicate the procedure and radiological and surgical diagnosis and treatment of this rare event.

Low-grade appendiceal mucinous neoplasm (LAMN) as a mimicker of perforated diverticulitis: a case report.

The differential diagnosis of abdominal pain is wide as both benign and malignant pathologies must be considered. There are currently no published case reports of low-grade appendiceal mucinous neoplasms (LAMNs) mimicking perforated diverticulitis. LAMNs are a heterogenous group of tumours, with no consensus treatment algorithm based on stage and histology. In this case report, we discuss a patient who presented emergently with generalized peritonism, with a diagnosis of perforated diverticulitis made on computed tomography scan. At laparotomy, a perforated appendix was identified, with histopathology identifying a perforated LAMN. This case highlights the importance of considering this rare but increasing incidence tumour when operative management is being planned.

A case of metastatic neuroendocrine disease and cholecystitis: surgical remedy and management of carcinoid crisis.

The report presents a case of a 70-year-old male with a known mesenteric neuroendocrine tumour and metastases to the liver diagnosed with acute cholecystitis. During surgery, the patient developed a carcinoid crisis with mixed distributive and cardiogenic shock involving systemic vasodilation and arrhythmia. During surgical procedures, carcinoid crisis can be precipitated by tumours that secrete a pathological shower of vasoactive mediators. Somatostatin analogues are utilized to control carcinoid syndrome and are routinely used peri-operatively. However, no standard infusion regimen exists. The case raises the suggestion that metastatic liver neuroendocrine disease may confound the diagnosis of cholecystitis, complicates the management of acute surgical presentations and highlights the need for agreement on octreotide therapy for surgical patients with carcinoid tumours.

A Rare Case of Gallstone Ileus: Bouveret Syndrome Presenting with Concurrent Gallstone Coleus.

BACKGROUND: Bouveret syndrome and gallstone coleus are two rare subsets of gallstone ileus. Bouveret syndrome involves a gastric outlet obstruction, whereas gallstone coleus involves an obstruction of the large intestine. Both of the conditions are caused by gallstones, which migrated from the gallbladder via the fistulae. Due to its rarity, only few cases were reported for each condition. The current case describes an even rarer case of Bouveret syndrome and gallstone coleus presenting together. The case report will hopefully provide better understanding of the disease presentation and hence, lead to early diagnosis and management. CASE: Ms. B is an 86-year-old woman of Italian background who presented to our emergency department with worsening symptoms of bowel obstruction. Her past clinical history included Kaposi sarcoma, hypertension, osteoarthritis, and vitamin D deficiency with surgical history including caesarean section and tonsillectomy. On her imaging, she had two large gallstones, one in the proximal duodenum and one in the distal colon. It also showed gastric dilatation and gas in the gall bladder. She was subsequently diagnosed with Bouveret syndrome with concurrent gallstone coleus. The laparotomy revealed two points of gallstone obstruction at the first part of the duodenum and at the distal sigmoid colon. Her postoperative recovery was uncomplicated. She was discharged to the care of her family and followed up in the general surgery clinic. CONCLUSION: The current case report describes a unique presentation of Bouveret syndrome where an additional gallstone was found simultaneously in the sigmoid colon causing the obstruction. By introducing this novel case of having two different subsets of gallstone ileus simultaneously, there will be a better understanding of both conditions and hopefully improve our scope of practice.