Pseudoaneurysm of the Gastroduodenal Artery: A Rare Complication of Bile Duct Surgery.

Pseudoaneurysm of the gastroduodenal artery (GDA) is an exceptional complication of common bile duct (CBD) resection. We present the case of a 60-year-old woman with a history of cholecystectomy. The patient was admitted to our hospital for surgical management of the cystic dilatation of the CBD. The patient presented on postoperative day 21 with hemodynamic instability related to a pseudoaneurysm of the GDA. An urgent open surgery was performed with dissection and ligation of the GDA.

Early Small Bowel Obstruction Caused by Surgical Drain Following Rectal Cancer Surgery: A Case Report.

The abdominal drains are commonly used and could be a source of several complications, including infection and small bowel obstruction. We report the case of a 70-year-old male patient with intestinal obstruction related to abdominal drainage after rectal surgery. Acute bowel obstruction remains a rare complication of abdominal drains. Surgeons should be aware of this situation and use drains with caution. The treatment options include conservative treatment or surgery either a laparoscopic approach or laparotomy.

Peritoneal melanosis associated with serous carcinoma of the ovary: A case report and literature review.

Introduction: Melanosis peritonei is an exceptionally benign condition of uncertain origin marked by the deposition of dark pigments on the peritoneal cavity. It's usually associated with other abnormalities and must be differentiated from metastatic melanoma. Case presentation: We report this case of a 67-year-old female presented for abdominal distension for 16 months. Abdomino-pelvic CT scan showed a right pelvic ovarian mass locally developed with the presence of peritoneal ascites. We performed initially an exploratory laparotomy confirmed the radiological constatations with biopsies of the peritoneal carcinosis. Histologic analysis showed a poorly differentiated carcinomatous cell. The patient benefited from neoadjuvant chemotherapy then an abdomino-pelvic CT scan of control was performed showing the reduction in size of the ovarian mass and dispersion of the abdominal effusion. A second laparotomy was carried out and the exploration showed the appearance of dark nodules on the peritoneum. Hysterectomy associated with appendectomy and omentectomy with biopsy of the dark nodules was performed. Pathological study and immunohistochemical staining confirmed the diagnosis of benign peritoneal melanosis associated with serous carcinoma of the ovary. Discussion: Peritoneal melanosis is a rare condition with only 18 cases reported on the English literature. It is often associated with other conditions. The origin of this lesion still unclear although some hypotheses were reported. The main differential diagnosis is metastatic melanoma with very poor prognosis. Conclusion: benign peritoneal melanosis is a rare condition. Its management depends essentially on the associated disease.

Surgical management of ancient retroperitoneal schwannoma.

Schwannomas are benign and rare entities of peripheral nerve sheath origin. The clinical presentation depends the size of tumor, and they may cause symptoms of abdominal pain, urinary difficulties, anemia, hematuria, and abdominal mass as a result of the pressure of the tumor to the adjacent structures. The diagnosis can only be established by immunohistochemical study. Complete surgical clearance remains the mainstay of treatment. We report the case of a 35-year-old female patient consulted for chronic abdominal pain. Abdominal ultrasound and abdomino-pelvic CT scan identified a well-delineated, heterogenous retroperitoneal mass developed in anteraortocaval region measuring 55 × 65 × 88 mm. The lesion seemed to repress the inferior vena cava, and enhanced with contrast administration. The histopathological panel confirmed the diagnosis of retroperitoneal schwannoma.

Gastrointestinal stromal tumor in the fourth portion of the duodenum does not express the CD117: A case report.

Introduction: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the digestive tract. Presentation of case: 54-year-old woman with a history of phyllodes tumor of the left breast he patient was admitted to our hospital for management of retroperitoneal soft tissue tumor, attached to the fourth portion of the duodenum, opposite the head of the pancreas. The patient underwent a large excision of the tumor, the duodenojejunal flexure, and the third and fourth portions of the duodenum along with the head of the pancreas. The histopathological examination confirmed the presence of a spindlecell mesenchymal proliferation. These cells do not express CD117, but they express DOG1. A PDGFRA mutation was identified later. The final diagnosis was duodenal GIST. Discussion: few cases of GIST in the fourth portion of the duodenum had been reported in the literature. PDGFRA mutation is identified as GISTs tumorigenesis to 15% of cases, and the diagnosis of GISTs is not based solely on the expression of the protein Kit. Conclusion: the molecular biology examinations are very helpful in the direction of the correct diagnosis in case of negative staining for CD117.

Acute hepatitis with portal and mesenteric vein thrombosis revealing SARS-CoV-2 infection: Case report and literature review.

Novel coronavirus disease 2019 (COVID-19) is a single-stranded RNA virus identified for the first time in Wuhan, China, and it unfurls quickly worldwide. The corona virus 2019 is a systemic disease which develops a prothrombotic environment, and has an extensive spectrum of clinical presentations in the gastrointestinal and hepatobiliary systems. Ischemic hepatitis (hypoxic hepatitis) is one potential mechanism behind lessened perfusion of the liver. The portal and mesenteric vein thrombosis are extremely rare complications and unusual main manifestations of COVID-19. We report the case of a patient presented acute hepatitis with portal and mesenteric vein thrombosis revealing a SARS-CoV-2 infection. In addition, we discuss the most characteristic elements of the Impact of COVID-19 on liver Injury, and the mechanisms of this damage and the formation of thrombus in portal and mesenteric vein.

A rare association of Vagus Nerve Schwannoma and Pheochromocytoma: A case report.

Vagus nerve schwannoma is a very rare benign nerve tumor. Pheochromocytoma is a rare, mostly benign tumor of the adrenal medulla with a large clinical spectrum. Their association is uncommon. The management of both tumors depends solely on surgery. The surgery of vagal schwannomas is particularly challenging considering the anatomical compositions of the area. Here, we report a case of a 76 year-old patient with cervical vagal schwannoma and benign pheochromocytoma association. We discuss the diagnosis and the surgical management of these tumors.

Extra gastrointestinal stromal tumor EGIST in the recto-vesical pouch: A case report and literature review.

INTRODUCTION: Extra-gastrointestinal stromal tumors (EGISTs) are rare mesenchymal tumors located outside the gastrointestinal tract, and exhibit the same phenotypic and morphological profile of gastrointestinal stromal tumors (GISTs). CASE REPORT: We report the case of a 20-year-old male patient consulted for chronic discomfort in the hypogastric region. Abdominal ultrasound and abdomino-pelvic CT scan identified a retro-vesical mass measuring 16 × 9 cm. He underwent an exploratory laparotomy and a total resection of the mass R0. The histopathological panel of the surgical specimen confirmed the diagnosis of EGIST. CLINICAL DISCUSSION: The primary localization in the recto-vesical pouch of EGIST is a very rare entity. Their clinical and radiological presentations are unusual, and their definitive diagnosis is largely based on immunohistochemistry staining. CONCLUSION: the origin of extra gastrointestinal stromal tumors EGIST can remain unclear.

Intraductal papillary mucinous neoplasm of the pancreas presenting as a giant abdominal mass: A case report.

INTRODUCTION: Intraductal papillary mucinous neoplasms (IPMNs) constitute a group of rare conditions with a potential for malignant degeneration. The appearance of symptoms should suggest degeneration. This case demonstrates an unusual case of a patient presenting an intestinal type IPMN that was revealed by a large abdominal mass. CASE REPORT: 47-year-old woman with a history of hydatid cyst of the liver. The patient was admitted to our hospital for management of large abdominal mass measuring 185 × 128*190 mm. Intra-operative findings showed a voluminous tumor, of approximately 20 cm in all its dimensions, with double solido-cystic component at the expense of the neck and the body of the pancreas. The patient underwent splenopancreatectomy. The histopathological examination confirmed the presence of intestinal type of IPMN of pancreas. DISCUSSION: Acute pancreatitis is revealed in the majority of cases of IPMNs, related to duct obstruction by secreting mucus plug. IPMNs are rarely the cause of a large abdominal mass. They are cystic lesions of slow evolution, macroscopically visible and rarely macrocystic, unlike serous cystadenoma. The tumor size is a powerful indicator of the malignancy of IPMNs. The current definitive and ideal treatment for main duct and mixed type IMPNs is a surgical resection. CONCLUSION: IPMNs are a cystic lesion, rarely revealed by a large mass.

Desmoid tumor of trapezius muscle: A case report.

INTRODUCTION: Desmoid tumors are benign fibrous entities developed from connective tissue, and they result from muscle fascia or aponeurosis. Surgical excision is the main pillar of treatment. CASE REPORT: A 29-year-old female patient presented with a left postero-lateral cervical swelling that had been evolving for 11 months. Cervical MRI showed a mass at the expense of the trapezium muscle measuring 41 × 68 × 81 mm. A biopsy of the mass was performed, concluding a desmoid tumor. The patient underwent a large resection of the tumor involving the left trapezius muscle. An immunohistochemistry staining was performed, demonstrating cytoplasmic labeling with anti AML antibody, and nuclear labeling of tumor cells with anti-beta-catenin antibody. The case was analyzed by a multidisciplinary committee, and it was decided to follow the patient for surveillance. DISCUSSION: The localization of desmoid tumors in the trapezius muscle is extremely rare. The main risk of these benign lesions is infiltration of surrounding tissue leading to morbidity and mortality. Recurrence is a main feature of these tumors, even if complete excision has been performed. Unresectable desmoid tumors require medical and non-surgical treatment such as hormone therapy (tamoxifen), and chemotherapy with vinblastine and methotrexate. CONCLUSION: Desmoid tumor of trapezius muscle is classified as benign without metastatic power, and the main risk is infiltration of surrounding tissue.