Primary mantle-cell lymphoma of small intestine presenting with intussusceptions: A case report and review of the literature.

INTRODUCTION AND IMPORTANCE: Mantle cell lymphoma is a rare type of non-Hodgkin's lymphoma which accounts for 5 % of all cases. Patients present with an advanced form of the disease. We present here a case of ileocolic intussusception secondary to mantle cell lymphoma which was revealed by abdominal pain and vomiting that was treated by surgical resection followed by chemotherapy. CASE PRESENTATION: This report illustrates the case of a 34-year-old male who presented with abdominal pain and vomiting. Imageology demonstrated an ileocolic intussusception which was treated with hemicolectomy followed by chemotherapy. Histopathology confirmed the diagnosis of Mantle cell lymphoma. CLINICAL DISCUSSION: Mantel cell lymphoma is a rare type of B-cell cancer. Patients are generally diagnosed with an advanced stage of the disease. Ileocolic intussusception is an uncommon presentation. Surgery is the pillar of the treatment. Resection depends on the extent and location of the lesion. Postoperative chemotherapy is crucial and it increases survival rate. CONCLUSION: Mantle cell lymphoma is a rare subgroup of B-cell lymphomas. Ileocolic intussusception is a complicated form of the disease. Surgery combined with chemotherapy is the mainstay of the treatment. Diagnosis is confirmed by histological analysis of the surgical specimen.

Enteric fistulization of a common iliac vein aneurysm.

Iliac vein aneurysm is rare. Its complications include rupture, thromboembolism, and enteric fistulization. If a patient with surgical history presents with gastrointestinal bleeding, the veno-enteric fistula should be part of the differential diagnoses. In presence of a veno-enteric fistula, surgical treatment consists of aneurysmectomy, venorraphy, and intestinal resection.

Gastrointestinal bleeding due to jejunal metastasis of pleomorphic lung carcinoma: a case report.

Gastrointestinal metastasis of pleomorphic lung cancer presents with nonspecific manifestations, leading to delayed diagnosis. Herein, the authors report the case of a 56-year-old patient who presented with gastrointestinal bleeding due to pleomorphic lung carcinoma. Case presentation: A 56-year-old patient presented to the emergency department with melena. On examination, he was hemodynamically stable. He had a sensitive and mobile mass in the periumbilical region. A thoracoabdominal computed tomography scan showed a mass of the right apical superior lobe measuring 4 cm and a lobulated jejunal mass measuring 10 cm. A percutaneous biopsy of the lung tumor revealed primary pleomorphic lung carcinoma. The authors performed a midline laparotomy and made a bowel resection with an end-to-end anastomosis. The postoperative course was marked by severe nosocomial pneumonia, leading to septic shock and death. The histopathologic examination concluded with a metastatic lesion of pleomorphic lung carcinoma. Clinical discussion: The authors reported a rare case of jejunal metastasis of pleomorphic lung cancer. Pleomorphic carcinoma of the lung is a rare pathology that accounts for 0.1-0.4% of nonsmall-cell lung cancer. The prognosis is poor. In the presence of gastrointestinal bleeding caused by small bowel metastases of pleomorphic lung cancer, surgery is the treatment of choice. Conclusions: Small bowel metastasis of pleomorphic lung cancer is rare. Surgical treatment is the treatment of choice. The authors highlight the importance of suspecting gastrointestinal metastases in patients with pleomorphic lung cancer in the presence of nonspecific digestive symptoms.

Gallstone ileus: A case report and review of the literature.

INTRODUCTION AND IMPORTANCE: Gallstone ileus (GI) is defined as the occlusion of the intestinal lumen due to the impaction of one or more gallstones. The optimal management of GI is not consensual. We report a rare case of GI with a successful surgical treatment for a 65 year-old-female. CASE PRESENTATION: A 65 year-old-woman, presented with biliary colic pain and vomiting for three days. On examination, she had a distended tympanic abdomen. A computed tomography scan revealed signs of small bowel obstruction due to a jejunal gallstone. She had pneumobilia due to a cholecysto-duodenal fistula. We performed a midline laparotomy. We found a dilated and ischemic jejunum with false membranes regarding the migrated gallstone. We performed a jejunal resection with primary anastomosis. We performed cholecystectomy and closed the cholecysto-duodenal fistula at the same operative time. The postoperative course was uneventful. CLINICAL DISCUSSION: We reported successful surgical treatment for GI. It was a one-step procedure. GI is a rare situation. Due to their restricted lumen, the terminal ileum and the ileocaecal valve are where GI occurs most commonly. GI appears usually in elderly patients with comorbidities. The clinical presentation is not specific. CT scan evokes the diagnosis with high specificity. The surgical management of GI is not consensual. In our case, we performed bowel resection due to the presence of an ischemic intestine. CONCLUSION: GI is a rare situation. It appears usually in elderly patients with comorbidities. The clinical presentation is not specific. The surgical management of GI is not consensual.

Spontaneous rupture of an infected pseudocyst of the pancreas: A case report.

INTRODUCTION AND IMPORTANCE: A pancreatic pseudocyst is a known complication of acute and chronic pancreatitis. A pseudocyst rupture into the abdomen causes peritonitis, which can be fatal if surgical treatment is delayed. Here in we report the case of a 46-year-old woman presenting with a pancreatic pseudocyst doubly complicated with infection and rupture causing sepsis shock. CASE PRESENTATION: A 46 year-old-woman, with a history of chronic pancreatitis four years prior complicated with a pancreatic pseudocyst of 3 cm, presented to our emergency department with clinical signs of generalized peritonitis. After a brief resuscitation, we performed a midline laparotomy. It showed purulent peritonitis due to a rupture of an infected pseudocyst of the pancreas. We performed an abundant peritoneal toilet with drainage. The patient was discharged after 25 days. In the one month follow-up, there were no unfavourable outcomes. CLINICAL DISCUSSION: In presence of ruptured and infected pancreatic pseudocyst, surgical treatment should be performed as soon as possible after brief resuscitation. Laparotomy is the gold standard treatment. The main objective of surgical treatment is to perform abundant peritoneal toilet with large external drainage. In our case, the pancreatic pseudocyst didn't communicate with the Wirsung duct allowing us to withdraw the drainage. Otherwise, the drainage should be retained longer to treat the pancreatic leakage. CONCLUSION: Rupture and infection of pancreatic pseudocysts is a rare situation. Diagnosis is assessed via computed tomography scan. Emergency laparotomy should be performed timely to make the peritoneal toilet and drain the pancreatic pseudocyst.

Are biopsies during endoscopic ultrasonography necessary for a suspected esophageal leiomyoma? Is laparoscopy always feasible?

The present letter to the editor is related to the work entitled "Large leiomyoma of lower esophagus diagnosed by endoscopic ultrasonography-fine needle aspiration: A case report." Although endoscopic ultrasonography seems necessary in a suspected leiomyoma of the esophagus, the performance of biopsies via fine needle aspiration is controversial as it increases the risk of complications such as bleeding, infection, and intraoperative perforations. Laparoscopy is the best treatment strategy for small tumors. Laparotomy with tumor enucleation or esophageal resection can be considered in large leiomyomas.

A pancreatic metastasis of anaplastic thyroid carcinoma: a rare case report.

Anaplastic thyroid carcinoma (ATC) is a rare malignancy with a poor prognosis. It is characterized by abrupt development with local and distant metastases. Metastases are essentially present in the lung. Pancreatic metastasis is extremely rare. The authors report that, to their knowledge, this is the first reported case of a patient who developed metachronous pancreatic metastasis related to ATC. Case Presentation: A 65-year-old woman, with a history of thyroidectomy, 2 years prior, for an anaplastic thyroid tumor presented in his regular follow-up computed tomography scan a hypodense lesion of the head of the pancreas. Definite diagnosis of neoplasm was difficult following the computed tomography-guided fine-needle aspiration biopsy. The patient had a cephalic duodenopanceatectomy with an uneventful recovery. Histopathology concluded in a pancreatic metastasis of ATC metastasis. The patient had uneventful outcomes with a follow-up of 3 months without tumor recurrence. Conclusion: Pancreatic metastases of thyroid carcinomas are extremely rare, particularly for ATC. The diagnosis of metastases is based on a regular follow-up. The prognosis is poor despite curative surgery.

Intraperitoneal migration of hydatid cyst of the liver with intact proligerous membrane: Hydatid delivery.

•Intra-peritoneal migration of hydatid cysts is a rare complication.•Intact proligerous membrane is a protective factor.•Surgery is the best treatment and should be performed timely.

Hydatid cyst of the ilium: A case report.

INTRODUCTION AND IMPORTANCE: Hydatid cyst is a common parasitic disease in endemic countries. It frequently occurs in the liver and lungs. Ilium involvement is extremely rare. We report the case of a 47-year-old man presenting with a hydatid cyst of the left ilium. CASE PRESENTATION: A rural 47-year-old patient, presented with pelvic pain and limping on walking for six months. He had a pericystectomy 10 years prior for a hydatid cyst of the left liver. A pelvic computed tomography scan showed an osteolytic remodeling of the left iliac wing associated with a large multiloculated cystic mass fusing along the left ilium. The patient had partial cystectomy and curettage of the ilium. The postoperative course was uneventful. CLINICAL DISCUSSION: Hydatid cysts of the bone are exceptional but aggressive due to the absence of a pericyst limiting the extension of the lesions. We report a rare case of a patient presenting with a hydatid cyst of the ilium. The prognosis is poor even in patients who undergo extensive surgical treatment. CONCLUSION: Early and adequate management can improve the prognosis. We highlight the importance of conservative treatment consisting of partial cystectomy with curettage of the bone to avoid morbidity related to radical surgery.

Spontaneous rupture of a left omental artery aneurysm treated by transcatheter arterial embolization: A case report.

Background: Omental artery aneurysms are extremely rare. Their rupture is related to high mortality and often treated by open surgery. We describe a case of a spontaneous rupture of a left omental artery aneurysm (OAA) that was successfully treated by transcatheter arterial embolization (TAE). Case presentation: A 68-year-old man presented with acute abdominal pain. On examination, he was hypotensive and tachycardic with a blood pressure of 90/50 mm Hg. He had diffuse abdominal distension and tenderness.An abdominal enhanced computed tomography scan (CT) showed a rupture of the left OAA responsible for moderate hemoperitoneum. We performed a successful TAE. Conclusion: Ruptured OAA causes high mortality. OAA represents the rarest form of splanchnic artery aneurysms. Interventional radiology permits to avoid unnecessary surgery.TAE is a safe procedure to control ruptured OAA. We highlight the importance of a rapid embolization if the patient is hemodynamically stable.

Primary small bowel volvulus: A case report and literature review.

Background: Small bowel volvulus (SBV) is an aberrant rotation of the small bowel segment along the axis of its mesentery.Secondary SBV is the most frequent situation. Postoperative adhesions represent the main cause. On the other hand, primary SBV is an extremely rare situation. There are no predisposing anatomical abnormalities.Herein, we present a case of a 73-year-old-patient, with no surgical history, presenting primary SBV. Case presentation: A 73-year-old-patient presented to the emergency department with a one-day history of acute abdominal pain and vomiting. He had no medical comorbidities and no previous abdominal surgery.On examination, he was agitated and afebrile.Urgent computed tomography (CT) scan showed dilated small bowel loops with a "whirl sign".A laparotomy was performed. It revealed a 320° SBV of the distal jejunum and the proximal ileum. The small bowel was ischemic. There were no congenital malformations, no adhesions, and no internal hernia.We performed a detorsion of the small bowel. It regained good vitality. To avoid recurrence, we performed enteropexy of the terminal ileum, and the caecum to widen the mesenteric base.We noted no recurrence of the pathology after three months of follow-up. Conclusion: Primary SBV is an extremely rare situation. Physiopathology is still misunderstood. The clinical presentation is not specific. Diagnosis can be evoked by CT scan but can only be confirmed intraoperatively. The surgical treatment should be performed timely. Different techniques have been described to avoid recurrence. None of those techniques is consensual.

Extra-gastrointestinal stromal tumor of the pancreas: A case report.

INTRODUCTION: Gastrointestinal stromal tumors (GIST) represent the most common mesenchymal tumors of the gastrointestinal tract. In rare cases, these tumors do not develop in the gastrointestinal tract and are defined as extra-gastro-intestinal stromal tumors (EGISTs). Pancreatic EGIST is extremely rare. We reported a case of EGIST of the pancreas in a 53-year-old patient. PRESENTATION OF CASE: A 53-year-old man presented with chronic epigastralgia. An enhanced CT scan showed a solido-cystic tumor of the pancreatic body-tail. The patient underwent a laparotomy. Cytology fine needle aspiration did not find any tumor cells. Enucleation was performed. Histopathology and immunohistochemical examination confirmed the diagnosis of EGIST (CD117 +, Dog-1 +) with a high risk of malignancy. The patient received adjuvant therapy. There was no evidence of disease recurrence after 8 months of follow-up. CLINICAL DISCUSSION: We reported a rare case of a pancreatic EGIST. Enucleation was performed permitting to avoid distal pancreatectomy and thus decreasing morbidity rates. The clinical presentation is not specific and it depends on the location and the size of the tumor. CT scan shows hypervascular tumors with no regional lymph nodes metastasis but is not accurate in assessing diagnosis. Whenever possible, enucleation should be performed. This tumor should be considered in the differential diagnoses of pancreatic neoplasms. CONCLUSION: Pancreatic stromal tumor is extremely rare. There are no specific clinical and radiologic findings. A careful decision should be made after a discussion in a multidisciplinary coordination meeting. Surgical resection is the cornerstone of the treatment. Whenever possible, enucleation is sufficient.

5-mFI is more accurate than ASA score in predicting postoperative mortality in rectal cancer: A case series of 109 patients.

Introduction: The aim of this study was to compare the accuracy of 5-mFI (modified frailty index) to ASA score (American Society of Anesthesiologists score) in predicting postoperative mortality in patients with rectal cancer. Materials and methods: The ability of each parameter to predict postoperative mortality was attested in 2 ways: Area under the curve (AUC) was determined using ROC curves analysis. A comparison of AUC was performed using Delong test and Henley-McNeil test.-Multivariate analysis to determine the weight of each variable in predicting postoperative mortality. Results: The records of 109 patients undergoing surgical resection, for curative intent, for rectal cancer, were analyzed. Nine patients died during the 30-day postoperative period (8.25%). The optimum cutoff for 5-mFI to predict mortality using the ROC analysis was 1.5. The AUC at the cut-off point was 0.93. The optimum cutoff for ASA score to predict mortality was 1.5 and the AUC at the cut-off point was 0.81. The AUC of 5-mFI was significantly higher than the AUC of ASA score (p < 0.0001 using Delong test and p = 0.0024 using Hanley and McNeil test).On univariate analysis, predictive factors of mortality were: age (p = 0.002), ASA score≥2 (p = 0.0001) and 5-mFI≥2 (p = 0.0001). On multivariate analysis, 5-mFI≥2 was the only factor significantly associated with increased odds of postoperative mortality (OR = 1.73; 95% CI 1.05-2.01). Conclusion: 5-mFI was more accurate than ASA score in predicting postoperative mortality in patients with rectal cancer.

Intra-abdominal cystic lymphangioma in adults: A case series of 32 patients and literature review.

Introduction: Cystic lymphangioma (CL) is a benign tumor originating from the lymph vessels. Lymphangiomas in the abdominal cavity are extremely rare, particularly in adults.This article was designed to study the epidemiological, diagnostic difficulties, and therapeutic principles of intra-abdominal cystic lymphangioma (ACL) in adults. Material and methods: We conducted a single-center, retrospective study of 32 adult patients with ACL admitted to surgical department "A" in "La Rabta Hospital" in Tunis, from January 1998 through December 2020. The demographic, clinical, biological, radiological characteristics, histopathologic, and therapeutic data were collected, as well as the surgical intervention used and the postoperative immediate and late complications. Results: Thirty-two adult patients with ACL were recruited, including 20 females and 12 males. The median age at treatment was 47 (range 14-80) years. The most prevalent sites were the retroperitoneum (25%), the mesentery (21.9%), and the paracolic gutters (n = 18. 7%). Twenty patients underwent open surgery (62.5%), whereas 12 cases (37.5%) had laparoscopic surgery. Twenty-eight patients received total cystectomy (87%). Three recurrences were observed during follow-up (9.4%). Conclusion: The clinical features of CL in adults remain unclear. The diagnosis is only confirmed by histopathological examination after complete surgical resection. The laparoscopic approach is considered safe and feasible.

Leiomyosarcoma of the small bowel: A case report and literature review.

INTRODUCTION: Malignant tumors of the small bowel are rare. The jejunum, ileum, and duodenum represent the most common sites of intestinal leiomyosarcoma (LMS). Herein, we present a case of a 65-year-old patient having ileal LMS successfully treated with surgical resection. PRESENTATION OF CASE: A 65-year-old patient, with no comorbidities, presented with chronic and paroxysmal abdominal pain. Upper endoscopy and colonoscopy showed no abnormalities. Thoracoabdominal computed tomography (CT) revealed an ileal lobulated, heterogeneously enhancing solid mass measuring 6 cm. Laparotomy was performed. Findings showed a lobulated ileal mass. We made an enlarged ileal resection with end-to-end anastomosis. The postoperative course was uneventful. Histology and IHC stains concluded into ileal LMS. No relapse of the disease was noted during the 4-month follow-up. CLINICAL DISCUSSION: Ileal LMS is a rare tumor originating from the smooth muscle cells within the muscularis mucosa or muscularis propria. CT colonography (CTC) and magnetic resonance enterography (MRE) represent good options to aid the diagnosis. Histologically, LMS often has a comparable morphological appearance to GISTs. IHC is essential to differentiate those tumors. Surgery is the only curative treatment. The prognosis is poor knowing that those tumors are discovered at advanced stages. CONCLUSION: Ileal LMS is a rare tumor originating from the smooth muscle cells. It has a comparable morphological appearance to GISTs. Immunohistochemistry is essential to confirm the diagnosis. Surgery is the only curative treatment. The prognosis is poor.

Primary splenic lymphoma discovered on massive splenomegaly: A case report.

INTRODUCTION AND IMPORTANCE: Malignant lymphoma occurs in all the systemic organs. Rarely, large B-cell lymphoma is located in the spleen, making the diagnosis difficult. Herein, we report a patient presenting with massive splenomegaly due to LBCL. Splenectomy was essential to assess the diagnosis and to guide postoperative therapeutics. PRESENTATION OF A CASE: A 47-year-old woman, with no comorbidities, complained of weight loss and abdominal pain. She had a palpable spleen that extended below the navel. CT scan revealed massive splenomegaly and lymph nodes in the spleen hilum. Splenectomy was performed. Histopathological examination confirmed the diagnosis of large B-cell lymphoma. The postoperative course was uneventful. Three courses of chemotherapy were given. The patient was in remission after a follow-up of 8 months. DISCUSSION: Massive splenomegaly can be one of the circumstances of the discovery of large B-cell lymphoma. Splenectomy was then essential to confirm the diagnosis and to guide postoperative therapeutics. It also permits reducing hypersplenism and preventing spleen rupture. In patients with high operative risk, splenic needle biopsy should be taken into consideration. Splenic artery embolization before surgery can also be performed in patients having massive splenomegaly to reduce the spleen volume. We highlight the importance of splenectomy to confirm the diagnosis and to relieve the symptoms. Postoperative chemotherapy is essential to prevent relapses. CONCLUSION: Splenectomy is essential in spleen localized large B-cell lymphoma. It permits to confirm the diagnosis, relieve symptoms, and treatment of underlying hematologic malignancies. Postoperative chemotherapy is essential to prevent relapses.

Acute cholangitis due to haemobilia complicating percutaneous cholecystostomy: First literature case report.

BACKGROUND: Laparoscopic cholecystectomy is the standard treatment for acute cholecystitis. Cholecystostomy is a good option in patients with significant comorbidities. We report a case of a patient having had a percutaneous cholecystostomy for acute cholecystitis complicated with haemobilia and acute cholangitis. PRESENTATION OF A CASE: A woman aged 64 years old, with a history of diabetes, arterial hypertension, and chronic obstructive pulmonary disease was admitted to our institution with acute cholecystitis. We opted for transhepatic percutaneous cholecystostomy (PC) and antibiotics. On the fourth day, the patient had acute cholangitis due to haemobilia. We injected physiologic saline serum through the drain of cholecystostomy to dissolve the blood clot. There was a clinical improvement. We performed laparoscopic cholecystectomy two months later. The patient had an uneventful recovery with a follow-up of five months. DISCUSSION: We report the first literature report of acute cholangitis due to haemobilia complicating percutaneous cholecystostomy in a patient admitted for cholecystitis. We highlight the importance of the injection of saline physiologic serum from the catheter. Medical treatment with antibiotics may be enough knowing that blood clots can disappear spontaneously. In case of failure, ERCP with sphincterotomy should be performed. CONCLUSION: Haemobilia causing acute cholangitis is a rare complication of percutaneous cholecystostomy. Conservative treatment with antibiotics and injection of saline physiologic serum from the catheter is a good treatment option. In case of failure, ERCP should not be delayed.

Idiopathic megabowel causing acute bowel obstruction: A case report.

Background: Idiopathic megabowel is a rare condition. Its physiopathology is still unclear. We report a case of a patient presenting with acute bowel obstruction due to idiopathic megacolon and megarectum that was successfully treated with proctocolectomy. Case presentation: A 65-year-old man, with a history of chronic constipation, presented to the emergency with acute bowel obstruction symptoms.His CT scan on admission showed a very dilated rectum and sigmoid colon filled with faeces. The patient was managed conservatively.Due to the deterioration of his condition. We opted for an emergency laparotomy and it revealed the important dilation of the descending colon, the sigmoid colon, and the rectum leading to a Hartmann procedure.degenerative lesions of the smooth muscle layers were seen on the histopthological report and the diagnosis of rectosigmoid idiopathic megacolon was made.Postoperatively, we performed a rectoscopy that showed a distended rectum full of faeces.We performed a proctectomy with colo-anal anastomosis. He had an uneventful recovery. Conclusion: Idiopathic megacolon is a rare condition. The pathogenesis is still unclear. Surgical treatment is the best option to prevent complications and to improve the quality of life of the patient.

Risk stratifying patients with non-varicosic upper gastrointestinal hemorrhage using the Glasgow-Blatchford score: A case series of 91 patients.

Introduction: Non-variceal upper gastrointestinal hemorrhage (NVUGIH) often leads to systematic hospitalization and emergency endoscopy. However, in most cases, it does not constitute an immediate life threat. This study aimed to evaluate the Glasgow-Blatchford Score (GBS) in predicting the need for transfusions, and/or endoscopic or surgical treatments. Materials and methods: We conducted a retrospective monocentric study including 91 patients admitted in the general surgery department of the Hospital La Rabta Tunis for a NVUGIH.Univariate analysis was performed with the Student t-test for continuous variables and with the Chi-square test for categorical variables. For a cut-off point of 9, we calculated the sensibility and the sensitivity of the GBS to predict the need for transfusions and/or hemostatic procedure. Results: During the study period, 91 patients were admitted for NVUGIH. Sixty-one patients (67%) were transfused. Seven patients (7.7%) underwent emergency surgery and two patients had endoscopic hemostasis.The predictive factors for the use of transfusion and/or hemostasic treatments were: Age >50 years, ASA score, HR ≥ 90 bpm, pallor, Hb ≤ 9,5 g/dl, Urea ≥9,7 mmol/L.For a cut-off of 9 points of the GBS, sensitivity was 85.71% and specificity 92.86%. The positive predictive value was 96%. The negative predictive value was 74%. Conclusion: The main interest of the GBS lies in dispatching the patients between intensive care units for therapeutic intervention (if GBS> = 9) and ordinary hospitalization for surveillance (if GBS <9). It then makes it possible to rationalize the management of patients with digestive hemorrhage to identify those requiring hospital treatments (transfusion, endoscopic treatment, or surgery).