Small bowel mucormycosis: An unexpected case in a penetrating trauma survivor.

INTRODUCTION: Small bowel mucormycosis is a rare entity with few reports in the literature. Mortality rates secondary to necrosis and perforation remain above 85 %, with an increase in populations at risk noted. PRESENTATION OF CASE: This is a case report of a survivor of penetrating trauma who sustained small bowel injuries and was managed with damage control surgery. He required relook laparotomies due to extensive contamination and subsequently developed progressive ischaemia and necrosis of areas of his small bowel - histology confirming mucormycosis. There were no apparent risk factors noted in this case. Early addition of Amphotericin B and prompt surgical management resulted in a positive outcome. The patient was discharged from the hospital successfully. No further complications were noted post-discharge. DISCUSSION: Small bowel mucormycosis can be a challenging diagnosis and requires a high index of suspicion. The lack of traditional risk factors should not deter a surgeon from considering this diagnosis in trauma patients as the micro-invasive properties of this organism can result in unexpected gastrointestinal ischaemia. Favourable outcomes are associated with prompt surgical debridement, histopathological diagnosis, and appropriate antifungal therapy. CONCLUSION: Gastrointestinal Mucormycosis is a diagnosis that should be considered in trauma patients with unusual patterns of ischaemia. Prompt therapy can result in positive outcomes.

A case report of colonic Ameboma mimicking colon cancer in an immunocompromised patient.

INTRODUCTION AND IMPORTANCE: Entamoeba histolytica is an anaerobic protozoan. It infects humans causing Amoebiasis. Most infections are asymptomatic; however, clinical manifestations include intestinal or extraintestinal. In rare instances, patients can present with Ameboma: a mass of granulation tissue consisting of a core of inflammation with peripheral fibrosis related to chronic amoebic infection usually found in the cecum/ascending colon. PRESENTATION OF CASE: A 50-year-old patient presented with signs and symptoms of bowel obstruction. He had raised inflammatory markers and was HIV positive on treatment and virally suppressed. At laparotomy a hepatic flexure stricture with desmoid reaction, and wall thickening with induration at the mesenteric border of mid-transverse colon was found, with disseminated nodular disease. Histology confirmed entamoeba histolytica infection. DISCUSSION: The parasite exists in two forms: a cyst stage and a trophozoite stage: the form causing invasive disease. The presentation of intestinal amoebiasis ranges from an asymptomatic carrier state, colitis, to abscess formation and bowel perforation The management principles: to eliminate the invading trophozoites and eradicate the organism's intestinal carriage and manage complications such as obstruction, fulminant colitis, or toxic megacolon with surgery. CONCLUSION: This case identifies a rare cause of bowel obstruction in a patient without a travel history. Even with the lack of significant risk factors other than HIV, clinicians should be aware of the infective causes of colonic mass/stricture outside of malignant causes. Entamoeba histolytica is an infection of impoverished communities in developing countries, it should remain high on our differential for tumour-like granulation tissue in the colon.

Leiomyo-adenomatoid Tumor of the Uterus: Finding the Rare in the Routine.

Leiomyo-adenomatoid tumour (LMAT) is a rare benign neoplasm and very few cases of LMAT of the uterus are documented in the literature. Uterine LMATs are usually detected incidentally during the histopathologic evaluation of routine myomectomy or hysterectomy specimens for leiomyomata. Thorough evaluation of the morphological features and a concise immunohistochemical panel allows for accurate classification of this benign neoplasm.