Primary Ewing sarcoma of the liver: Diagnosis, management, and prognosis: A case report and literature review.

Ewing's sarcoma tumors (ES) are a rare entity exceptionally localized on the liver. We report a case of an ES of the liver in a 26-year-old man who presented with abdominal pain. The diagnosis was confirmed with a histopathological examination of the left hepatectomy specimen and adjuvant chemotherapy was received.

Cholecystitis in a midline gallbladder: A rare ectopic location.

INTRODUCTION: The ectopic gallbladder is an uncommonly encountered anomaly that surgeons should be aware of. Its diagnosis is difficult but can be elucidated with the use of computed tomography and MRCP. PRESENTATION OF CASE: We present a case of a 64-year-old patient who presented with abdominal pain, inflammatory epigastric mass and fever. Computed tomography (CT) revealed the presence of a para-umbilical gallbladder with signs of acute cholecystitis. Laparoscopic exploration revealed that the gall bladder was not present in its usual fossa but was seen attached to the midline anterior abdominal wall with extensive adhesion between it and the omentum. Given the complexity of the cholecystectomy via the laparoscopic approach, a conversion to a midline incision was performed. The IOC confirmed the absence of anatomical variants of the biliary tree. DISCUSSION: An ectopic gallbladder is a difficult entity to diagnose as it can create clinical confusion by tampering with the common clinical presentation of cholecystitis. MRCP is currently one of the most effective preoperative examination methods as it detects the coexistence of biliary tract variation. Laparoscopic surgery is a safe procedure to be performed in the ectopic gallbladder. CONCLUSION: Ectopy of the gallbladder is a rare congenital abnormality that should be kept in mind to avoid errors or delays in management.

Acute pancreatitis secondary to ansa pancreatica: Two new cases and review of the literature.

We described two cases of acute pancreatitis secondary to ansa pancreatica. The first patient was diagnosed on MRCP and improved after standard treatment of AP. In the second case, ansa pancreatica was diagnosed on IOP. At the second episode of AP, sphincterotomy of the minor papilla was performed.

Pedunculated hepatic focal nodular hyperplasia: A case report and review of the literature.

Focal nodular hyperplasia (FNH) is a common asymptomatic benign hepatic tumor encountered in middle-aged women. However, pedunculated FNH is exceedingly rare and more frequently associated with complications. That is why surgical management is mandatory in this form.

SMARCA4-deficient thoracic sarcoma revealed by metastasis to the small intestine: a diagnostic dilemma.

SMARCA4-deficient thoracic sarcoma (SMARCA4-DTS) is a recently identified aggressive subtype of sarcoma. We present the case of a 44-year-old man who underwent a surgery for a perforated small intestine. Compued tomography scan revealed a tissular mediastino-pulmonary mass.Histopathological examination of the intestinal mass shown a malignant tumour with a typical epithelioid and rhabdoid cells, numerous mitoses and large necrosis. A large panel of immunohistochemistry revealed loss of SMARCA4 and SMARCA2 and allowed the diagnosis of SMARCA4-DTS. It is important to consider SMARCA4-deficient thoracic sarcoma in the differential diagnosis of tumours showing suggestive morphologic features in patients of all ages, especially in the case of metastasis associated with thoracic mass.

Chilaiditi's sign: A rare differential diagnosis of pneumoperitoneum.

Chilaiditi sign is a rare condition typically mistaken for pneumoperitoneum. CT scan can confirm the diagnosis. Its management is conservative that is why it should be well known by surgeons to avoid unnecessary exploratory laparotomies.

Large pedunculated colonic lipoma: a rare cause of colorectal intussusception in adults.

Colo-rectal intussusception is rare in adults and is often secondary to malignant lesions, rarely benign lesions such as colonic lipomas can also be the cause. We present the case a 60-year-old man who presented to the emergency department with acute abdominal pain. On physical examination, the abdomen was distended with diffuse tenderness. CT scan of the abdomen revealed a colo-rectal intussusception secondary to a rectal lipoma with parietal pneumatosis of the invaginated loop. An emergency laparotomy was performed. Intraoperatively the radiological findings were confirmed. A rectosigmoid resection (Hartmann's procedure) taking off the lipoma and the invaginated segment of the colon was performed and the patient had an unevent full recovery. Histopathology confirmed a 6cm sub-mucosal lipoma without evidence of malignancy. As the diagnosis of a benign disease in patients presenting with colonic intussusception can only be made on pathological examination, this entity should be managed as a malignant lesion due to the high incidence of malignancy.

[Gastric necrosis secondary to gastric volvulus complicating hiatus hernia]. / Nécrose gastrique secondaire à un volvulus gastrique compliquant une hernie hiatale.

Acute gastric volvulus is a rare condition complicating 4% of hiatus hernias. It is a more or less complete rotation of the stomach around a transverse or longitudinal axis. It can lead to perforations due to ischemic gastric wall necrosis with very poor prognosis (30% of mortality). We here report the case of an 89-year old female patient with chronic bronchopathy, presenting with epigastralgias associated with vomiting which had progressed for 03 days. Physical examination showed febrile patient at 38.5 with dyspnea (SpO2 88% at room air). Her appearence suggested infection, the abdomen was soft, tender at the level of the epigastrium. Laboratory test showed SBI (WBCs= 22000, CRP= 80). Abdominal CT scan showed hiatus hernia associated with significant gastric distension with wall defect in the anterior face of the stomach associated with pneumatosis in the gastric wall. The patient underwent surgery using a median approach, which showed voluminous hiatus hernia containing the greater curvature of the stomach. Distended stomach was restored to its normal intra-abdominal position. The anterior face of the greater tuberosity was the seat of several areas of necrosis. Total gastrectomy with manual oesojejunal anastomosis associated with Roux-en-Y gastric bypass was performed. The postoperative course was complicated by acute respiratory distress syndrome (ARDS). The patient died on day 8 after emergency hospital admission. Gastric volvulus is a rare condition, which can lead to extremely severe consequences. CT scan allows for thoracic lesion assessment and to study stomach vitality. The treatment of choice is based on surgery.

Surgical management of groove pancreatitis: a case report.

Groove pancreatitis (GP) is a rare form of chronic pancreatitis involving the groove area bound by the pancreatic head, the duodenum, and the common bile duct. The diagnosis of this entity is challenging since it can mimic pancreatic carcinoma. We herein report the case of groove pancreatitis diagnosed in a 37 year old men, with a past history of chronic alcohol consumption. The patient was admitted for several times over the past three years because of recurrent alcohol-induced pancreatitis. The diagnosis of groove pancreatitis was made on the basis of CT, MRI and EUS findings. A medical treatment was initially attempted. In the absence of improvement in clinical symptoms, a pancreatico-duodenectomy was performed with satisfying results at 24 months follow up. Pancreatico-duodenectomy is the treatment of choice in groove pancreatitis since it leads to total resolution of clinical symptoms.

Management of isolated retroperitoneal Castelman's disease: A case report.

INTRODUCTION: Castleman's disease (CD) is a rare disorder characterized by benign angio follicular lymphoid hyperplasia, with gentle behavior. Its etiology and prevalence are unclear. It is usually found in the mediastinal area and it is rare to see this tumor in the retroperitoneum. PRESENTATION OF CASE: A 53 year old male with a retroperitoneal hypervascular calcified mass densely adherent to the psoas muscle that was accidentally encountered on a CT scan. Provisional diagnosis of retroperitoneal liposarcoma was made and the patient underwent an exploratory laparotomy. The histologic examination of the surgically resected specimen disclosed « a hyaline type of Castleman's disease ¼. DISCUSSION: Castleman's disease, is a rare heterogenous group of lymphoproliferative disorders that arises mostly in the mediastinum. The retroperitoneal localization is very rare. Clinically, CD can be subdivided into a localized form (unicentric disease) and a generalized form (multicentric disease) according to the number of lymph nodes involved. A careful histological and immunohistochemical examination of the tumor tissue after surgery is the only way for tumor diagnosis. CONCLUSION: Castelman's disease is a rare entity that has often benign and non invasive behavior, but remains a diagnostic challenge. There is no reliable diagnostic method and its definitive diagnosis is based on histopathology report. For treating the unicentric variant, radical surgical resection is considered to be the gold standard.

Primary hydatic cyst of the fallopian tube.

Hydatid disease is endemic in Tunisia. The involvement of the female genital tract is uncommon, and the occurrence in the fallopian tube is exceptional. We present a case of a 42-year-old woman who had complained of a 4-month history of lower abdominal pain. The abdominal ultrasonography and CT scan showed a multiloculated cystic lesion in the left adnexa. The exploratory laparotomy found a cystic mass developing in the left fallopian tube. Left salpingectomy was performed. The pathological examination confirmed the diagnosis of hydatid cyst disease. No recurrence was detected at the 2-year follow-up. Tubal hydatid cyst is an extremely rare condition that should be considered in the differential diagnosis of any cystic lesion in patients from endemic areas.

Gallbladder agenesis in the elderly: a diagnostic challenge.

Gallbladder agenesis (GA) is a rare congenital malformation characterized by the absence of the gallbladder and cystic duct due to an anomaly in the embryonic development. It is commonly associated with other congenital abnormalities, and the isolated form is extremely rare. Its clinical presentation is variable. Actually, GA is more often incidentally diagnosed. Magnetic resonance cholangiopancreatography (MRCP) is considered to be the diagnosis method of choice since it avoids unnecessary and risky surgery in symptomatic patients. Here we report the case of a radiologically incidentally discovered gallbladder agenesis in a 68-year-old patient.