Colo-colonic intussusception secondary to giant colonic lipoma in an adult: A case report.

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.

Xanthogranulomatous cholecystitis: Diagnostic dilemma and surgical solution in geriatric patients: A case report.

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.

Doubly complicated: A case of massive non-parasitic liver cyst presenting with dyspnea and inferior vena cava compression: A rare case report.

INTRODUCTION AND IMPORTANCE: Simple hepatic cysts, common benign liver conditions, are increasingly detected incidentally due to advancements in imaging technologies. While typically asymptomatic, complications such as compression of neighboring structures can arise, presenting unique diagnostic and management challenges. We present a doubly complicated case of a massive non-parasitic liver cyst in a 61-year-old female patient, manifesting with dyspnea and compression of the inferior vena cava. CASE PRESENTATION: A 61-year-old female with a history of treated hypertension presented with worsening dyspnea over six months. Physical examination revealed a large, painless abdominal mass, and imaging confirmed a 20 cm cystic liver mass compressing the inferior vena cava and exerting a mass effect on the diaphragm. Surgical exploration and deroofing of the cyst led to successful resolution. CLINICAL DISCUSSION: The presentation of dyspnea in non-parasitic liver cysts is rare but notable, highlighting the importance of considering hepatic etiologies in respiratory symptoms. Imaging modalities such as ultrasound and CT play crucial roles in diagnosis, while MRI aids in ruling out biliary-cystic fistulas. Surgical management, particularly subcostal laparotomy, remains a viable option for complex cases. CONCLUSION: This case underscores the need for heightened awareness of atypical presentations of non-parasitic liver cysts and the significance of imaging in diagnosis. Subcostal laparotomy, though associated with limitations, remains valuable in select cases. Further research comparing surgical approaches is warranted to optimize management strategies for symptomatic non-parasitic liver cysts.

A case report: Peritonitis secondary to perforated locally advanced gastrointestinal stromal tumor.

INTRODUCTION AND IMPORTANCE: Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms predominantly affecting the gastrointestinal tract. While they often remain asymptomatic, GISTs can lead to acute abdominal emergencies, such as peritonitis secondary to tumor perforation, a rare yet serious complication. Here, we present a unique case of a locally advanced ileal gastrointestinal stromal tumor complicated by generalized purulent peritonitis, emphasizing the diagnostic and management challenges associated with this condition. CASE PRESENTATION: A 68-year-old male presented with worsening abdominal pain, vomiting, fever, and weight loss. Imaging studies revealed a large solid-cystic mass originating from the terminal ileum, prompting emergency surgery. Intraoperative findings included a multilobulated tumor mass invading the mesocolon, necessitating hemicolectomy. Histopathological analysis confirmed a high-risk gastrointestinal stromal tumor, leading to initiation of adjuvant therapy with imatinib mesylate. CLINICAL DISCUSSION: GISTs often present with nonspecific symptoms, posing diagnostic challenges. Peritonitis secondary to tumor perforation is a rare yet critical complication requiring prompt surgical intervention. Complete resection remains the mainstay of treatment, with adjuvant imatinib therapy showing promise in high-risk cases. CONCLUSION: This case report sheds light on the complexities of diagnosing and managing locally advanced gastrointestinal stromal tumors (GISTs) complicated by peritonitis. Complete tumor resection is crucial for potential cure, with adjuvant therapy using imatinib showing promise, especially in high-risk cases. Thorough diagnostic assessment, timely intervention, and comprehensive follow-up are essential for optimizing outcomes in complex GIST presentations.

Anaphylaxis triggered by a hidden threat: A rare hydatid disease case report.

INTRODUCTION AND IMPORTANCE: Hydatid disease, caused by Echinococcus granulosus, is a zoonotic infection prevalent in specific regions, including Tunisia. Complications are rare but potentially life-threatening. This case report highlights the significance of early diagnosis and intervention in a unique case where anaphylaxis resulted from minor abdominal trauma in a 17-year-old male with an undiagnosed hydatid cyst. CASE REPORT: The patient arrived at the emergency department with syncope and hypotension after a classroom accident. Physical examination showed an urticarial rash and abdominal tenderness. Anaphylactic shock was diagnosed and promptly treated. A computed tomography scan confirmed a ruptured liver hydatid cyst. The patient received anthelmintic treatment and underwent conservative surgical management. Intraoperatively, a second anaphylactic shock occurred and was promptly treated. The post-operative course was uneventful, and histopathological analysis identified Echinococcus granulosus. CLINICAL DISCUSSION: This case emphasizes the importance of recognizing hydatid disease as a potential cause of anaphylaxis post-trauma, even in asymptomatic patients. Early diagnosis through imaging is crucial for prompt intervention. Surgical management should be considered, with conservative approaches favored in acute cases. Post-surgical albendazole treatment is essential to prevent recurrence. CONCLUSION: This report serves as a valuable reference for healthcare professionals, highlighting the need for heightened clinical suspicion in cases like this. It underscores the significance of considering hydatid cyst rupture in the differential diagnosis of anaphylaxis following blunt trauma. Awareness among pediatricians, emergency physicians, and primary care providers can lead to early diagnosis and better patient outcomes, preventing severe complications or fatalities associated with this rare condition.

Total small bowel volvulus on incomplete common mesentery, an exceptional complication in geriatric patients: A rare case report.

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.

Surgical perspective on perianal Bowen's disease: A rare case report.

INTRODUCTION AND IMPORTANCE: Bowen's Disease (BD) stands out as a dermatologic entity known for its rarity and diagnostic intricacies. While BD is recognized for its diverse clinical presentations, its occurrence in the perianal region is particularly exceptional. Our case contributes to the limited body of knowledge regarding perianal BD, shedding light on its distinctive characteristics and guiding clinicians in navigating the intricacies associated with this uncommon presentation. CASE PRESENTATION: We present the case of a 67-year-old female who sought medical attention for persistent itching in the perianal region. A thorough examination revealed a solitary BD lesion, a notable rarity in this anatomical site. Considering the distinctive characteristics and location, surgical excision was chosen as the preferred treatment strategy. The postoperative course was straightforward, yielding favorable aesthetic outcomes and no recurrence. CLINICAL DISCUSSION: The clinical discussion explores the unique challenges associated with perianal BD, emphasizing the rarity of its presentation and its potential to mimic other dermatologic conditions. Factors contributing to the diagnosis, including clinical indicators and risk factors, are scrutinized. Furthermore, the discussion delves into the evolving landscape of diagnostic tools and treatment modalities, especially relevant in the context of perianal BD. CONCLUSION: This case illuminates the rarity of BD in the perianal region, serving as a valuable addition to the limited body of knowledge on this unusual presentation. By unraveling the complexities associated with perianal BD, this report contributes to a deeper understanding of the disease and provides insights that can guide clinicians in navigating similar cases.