Undiagnosed Term Abdominal Pregnancy in a District-Level Hospital of a Developing Country: A Miracle Baby.

Term abdominal pregnancy is a sporadic ectopic pregnancy associated with high maternal and perinatal morbidity and mortality. As symptoms are non-specific and resemble those of other ectopic pregnancies, early diagnosis is the major challenge in poor health setups. A 24-year-old primigravida at 38 weeks gestation was planned to undergo a cesarean section for the transverse lie. Abdominal pregnancy was accidentally discovered during the cesarean section, and a healthy, normal baby boy was delivered. The placenta was attached to the greater omentum, so its removal required omentectomy without compromising the blood supply to the bowels. Both patient and her baby boy were discharged on the seventh day without complications. No congenital anomalies were detected in the baby. In a term abdominal pregnancy, the most significant challenges are the control of bleeding and the decision on placenta removal, followed by prompt delivery of the fetus. Therefore, along with the gynecologist, the availability of trained personnel, such as anesthetists, pediatricians, and general surgeons, is necessary for a successful management outcome.

A challenging case of spontaneous idiopathic omental infarction in a trisomy 21 patient.

Background: Omental infarction (OI) is a rare cause of acute abdominal pain that is often missed out. Due to its non-specific presentation can mimic other commoner conditions such as acute appendicitis, acute diverticulitis, and tuberculosis abdomen. Case presentation: We present a 42-year-old gentleman with trisomy 21 presenting right iliac fossa pain. Examination revealed tenderness in the right lower quadrant and blood parameters showed leucocytosis. With an initial impression of acute appendicitis, the patient was subjected to surgery. Intraoperatively, there were abnormalities to the omentum suggestive of OI, resulting in partial omentectomy. Symptom resolution occurred immediately and the patient was discharged early. Conclusion: OI is a rare cause of acute abdomen that can mimic other abdominal pathologies. In trisomy 21 patients who present with acute abdomen, thorough assessments including preoperative imaging are advisable. Diagnostic laparoscopy is recommended as OI can be managed via minimally invasive surgery, hence ensuring good surgical outcomes.

Torsed wandering spleen as a cause of recurrent abdominal pain in a child.

Wandering spleen is an uncommon cause of acute abdomen in children. Diagnosis of this condition is challenging due to its non-specific symptoms, varying intensity and protracted history of presentation. Radiographs and ultrasound imaging provide rapid and reliable means to diagnose this condition without exposure to excessive radiation. We present a case of a torsed wandering spleen in a child with recurrent abdominal pain. We highlight the role of imaging in identifying salient radiographic and sonographic signs for diagnosis.

A rare discovery of Spigelian-cryptorchidism syndrome in adult.

Spigelian hernia (SH) occurs due to the protrusion through a congenital or acquired defect or weakness in the Spigelian aponeurosis. SH accounts for only 0.1-0.4% of occurrence and a 17-24% risk of strangulation. We hereby report a case of a 34-year-old gentleman presented with concomitant incarceration of the omentum with small intestine and testis in Spigelian hernia sac. We have successfully operated on this patient via a transperitoneal approach with a small incision over the hernia site. This incision could be an alternative to midline laparotomy as a safe and effective method in managing incarcerated SH in an emergency setting.

Malignant ulcer: a great mimicker of gastric plasmablastic lymphoma.

Plasmablastic lymphoma (PBL) is an uncommon human immunodeficiency virus (HIV)-associated lymphoma, with a predilection to develop in the oral cavity. It usually has a plasmablastic morphology with weak or no expression of B cell-associated markers. Among non-HIV patients, it tends to occur in the gastrointestinal (GI) tract, lymph nodes, and skin. We experience a 74-year-old male who presented with abdominal discomfort, altered bowel habit, loss of weight, and loss of appetite with a palpable abdominal mass. Upper endoscopy revealed multiple dish-like and raised nodular mass with a central ulcer in the stomach and duodenum. The histology was consistent with high-grade lymphoma of the plasmablastic type. The immunohistochemistry was positive for plasma cells marker of CD38 and CD138, but negative for the lymphocytic marker of CD45, as well as mature T and B cell marker of CD3 and CD20. Unfortunately, the patient succumbed due to sepsis without completion of his investigations and treatments.