INTRODUCTION: Intestinal intussusception is a rare complication in adults, accounting for 1 % of intestinal obstructions. Unlike in children, it is often secondary to a malignant lesion, rarely a benign one. Colonic lipomas are asymptomatic benign tumors often discovered incidentally. Colo-colonic intussusception due to a lipoma is exceptional. Here, we report a rare case of colo-colonic intussusception secondary to a giant caecal lipoma occurring in a 65-year-old woman. CASE PRESENTATION: A 65-year-old woman, was admitted in our surgical department for intermittent crampy abdominal pain in the right iliac fossa with an alternation of diarrhea and constipation over the past 10 months. The radiological investigation revealed a colo-colonic intussusception, most likely secondary to a fatty mass in the cecum. A right hemicolectomy was performed with ileocolic anastomosis because of the risk of malignancy. Histopathological examination confirmed the lipomatous nature of the lesion. The patient remained asymptomatic three years after surgery. CLINICAL DISCUSSION: Colonic lipomas are often asymptomatic. They can cause intussusception with clinical symptoms varying based on their size and location. CT scan has increased the number of preoperative diagnoses. Treatment options include surveillance, endoscopic intervention, or surgical resection. The appropriate surgical intervention remains a major challenge for surgeons due to the risk of malignancy. CONCLUSION: A giant colonic lipoma remains a very rare cause of colonic intussusception, especially in adults. CT scan plays a crucial role in diagnosis. Surgical resection remains the treatment of choice due to the risk of malignancy.
INTRODUCTION: Xanthogranulomatous Cholecystitis (XGC) is a rare inflammatory condition characterized by the presence of xanthogranulomas within the gallbladder wall, often mimicking gallbladder carcinoma (GBC). Diagnosis is challenging and may require biopsy. Once GBC is excluded, an open cholecystectomy is recommended, although laparoscopic cholecystectomy is increasingly being performed with great caution. This case report aims to evaluate clinical and radiological features, surgical outcomes, and treatment approaches for XGC. CASE PRESENTATION: A 70-year-old patient presented with right hypochondrial pain and a palpable gallbladder. A CT scan revealed a distended lithiasic gallbladder with a thickened irregular wall and hepatic nodules. A hepatic MRI suggested xanthogranulomatous cholecystitis. A CT-guided biopsy of the liver nodule showed no signs of malignancy. An open cholecystectomy with a trans-cystic drain was performed. Histological examination confirmed chronic xanthogranulomatous cholecystitis. The patient was discharged on postoperative day 10. A clinical and radiological follow-up at 6 months postoperatively showed no abnormalities. CLINICAL DISCUSSION: XGC presents diagnostic challenges due to its resemblance to GBC. Imaging aids in diagnosis, but biopsy may be necessary. Open cholecystectomy is the recommended surgical treatment due to excessive local inflammation and the risk of concomitant malignancy. CONCLUSION: Managing XGC demands a holistic approach that integrates all clinical insights and mandates close collaboration among a multidisciplinary team of surgeons, radiologists, and pathologists. Further research is needed to refine diagnostic and therapeutic strategies for this rare condition, especially in geriatric patients.
INTRODUCTION AND IMPORTANCE: The incomplete common mesentery, resulting from a rotational anomaly, is a rare but potentially life-threatening condition. This congenital anomaly is characterized by persistent embryonic bowel arrangement and an extremely short mesentery root. Complications typically manifest during neonatal or pediatric stages, with limited occurrences in adulthood. Herein, a compelling case of an 83-year-old male with small bowel volvulus and incomplete common mesentery, underscoring the critical importance of recognizing and addressing rare but potentially life-threatening complications in the geriatric population. CASE PRESENTATION: An 83-year-old male, post-prostatectomy, presented with acute abdominal distress, indicating small bowel volvulus associated with incomplete common mesentery. Dehydration signs were evident on admission, and imaging confirmed the diagnosis. Urgent surgical intervention, including the Ladd procedure, successfully resolved the condition with a six-day recovery. CLINICAL DISCUSSION: Fetal digestive tract rotation anomalies lead to incomplete common mesentery, posing risks of volvulus. Complications, whether acute or chronic, require timely recognition. Diagnostic modalities, including the "whirlpool" sign on imaging, play a vital role. The Ladd procedure remains the standard treatment, addressing mesenteric anomalies and preventing recurrence. CONCLUSION: This case highlights the critical nature of small bowel volvulus with incomplete common mesentery, emphasizing the importance of recognizing and managing this rare condition promptly. Awareness, diagnostic accuracy, and timely surgical intervention are crucial for favorable outcomes, particularly in the geriatric population.
