Acute necrotizing pancreatitis caused by ampullary cancer: a case report.

Ampullary malignancies are extremely rare tumors that are usually diagnosed when they cause biliary obstruction. Rarely, any tumor or mass near or within the pancreas can cause acute pancreatitis and on even rarer occasions, these tumors can cause severe complications such as acute peripancreatic fluid collections, necrotizing pancreatitis, and infections. As a medical team, we must embrace these difficulties and these dreadful scenarios, as they are opportunities for growth for the medical team and opportunities to save even more patients. We present the case of a 59-year-old male who suddenly presented acute severe pancreatitis with necrosis and infection due to an ampullary mass. After recovery, he was referred to a tertiary center, where his cancer was successfully treated.

Duodenal perforation after percutaneous fluid drainage, a rare event: a case report.

Duodenal perforations can be caused by surgical instruments during operations. These injuries can go initially unnoticed and lead to problematic complications. While uncommon, bowel perforation after percutaneous fluid drainage can severely impact the patient's outcome. These can occur from equipment used for image-guided percutaneous drainage, a technique that has changed the way surgeons handle postoperative fluid collections and has become daily practice. Prompt recognition and timely treatment of these types of complications can minimize the consequences of this dreaded scenario. We present the case of a 29-year-old male, for whom an intra-abdominal collection was detected after laparoscopic cholecystectomy. CT-guided percutaneous drainage was performed, during which the catheter inadvertently punctured the duodenum. Surgical consultation was required and, since the patient remained asymptomatic, conservative management of the duodenal perforation was accomplished without complications. On follow-ups, the patient is doing well.

Subcapsular liver hematoma after extracorporeal shock wave lithotripsy, a rare complication.

Extracorporeal shock wave lithotripsy (ESLW) is a common and relatively safe procedure, with a high success rate and low adverse effects. Complications of this procedure are usually limited to the kidneys and almost always resolve spontaneously. However, on rare occasions, a frightening complication, as a hematoma of a parenchymatous organ, such as the liver can appear. Abdominal pain is usually the only manifestation when a liver hematoma develops, and should always be investigated, as this dreaded complication can put the patient's life at risk. Conservative treatment is usually the treatment of choice, nevertheless, on severe cases that do not respond to conservative measures, surgery or embolization is necessary. We report the case of a 38-year-old male who underwent ESWL, 12 h after the procedure he presented to the emergency room with severe abdominal pain, after complementary exams a liver hematoma was detected. Following conservative management, the patient fully recovered.

Colonic perforation due to amebiasis, a rare and lethal complication.

Amebiasis is still a major healthcare concern, especially in developing countries like Ecuador. The lack of sanitary control and hygiene measures make parasites infections still a burden for patients and physicians. Despite infections due to this parasites are usually mild, severe infections and fatal outcomes although rare still occur. Bowel perforation is a rare complication of amebiasis, and unfortunately, it continues to be almost fatal. We present a case of an Ecuadorian patient who presented to the emergency room with an acute abdomen, despite adequate surgery and critical care, the patient regrettably died. Bowel perforation due to Entamoeba histolytica was the final diagnosis.

Massive retroperitoneal dedifferentiated liposarcoma in a young patient.

Liposarcomas are rare malignant tumors that mostly develop in the retroperitoneum. They have a broad behavioral spectrum, from small masses of tissue to highly aggressive tumors. The dedifferentiation process occurs in up to 10% and it's most likely to occur in the retroperitoneum, a process that not only changes its components but also its prognosis. These tumors can grow to a massive size since most of them do not give any symptoms until they invade the adjacent structures. Timely detection and surgery could avoid all these potentially lethal scenarios. We present a case of a 34-year-old patient, who reported a growing mass in her abdomen that reached massive proportions but remained untreated due to lack of sufficient access to healthcare facilities in her geographic location. After complete removal of the mass the patient underwent complete recovery, dedifferentiated liposarcoma was the final diagnosis.

Abdominal hernia and the unexpected final diagnosis.

Mucinous neoplasm of the appendix are rare entities, among these, mucinous cystadenomas contribute to 31-34%. Cystadenomas often produce extensive dilatation of the appendix with epithelial atypia. Spontaneous perforation often occurs in 20%, leading to mucin distribution throughout the peritoneal cavity. Half of the patients are completely asymptomatic and are detected as an incidental diagnosis, others symptoms include a palpable mass, hernias, weight loss, peritonism or even intestinal obstruction. We present a case of a 71-year-old female, she presented with a palpable mass in the upper abdomen. A ventral hernia was the most likely diagnosis and hernioplasty was planned. At surgery, a mucinous mass was discovered and mucous material was found free en the peritoneal cavity. Also, a perforated appendix and a mass in the cecum was found. Patient underwent full recovery. Pathology reported pseudomyxoma peritonei as the final diagnosis.

Laparoscopic approach to non-communicating intestinal duplication cyst in adult.

Intestinal duplication is rare congenital pathology generally diagnosed in infancy or early childhood. Presentation in adults is extremely rare. We present a case of a 36-year-old otherwise healthy female patient without any past medical history. She presented with a month of lower abdominal pain, clinical examination revealed pain and a palpable mass in the lower abdomen. CT scan confirmed a cystic mass dependent of the cecum wall and colonoscopy showed an extrinsic compression of the lateral wall of the ascending colon. However, the mucosa and the rest of the colon appeared normal. Since pain became more intense laparoscopy was performed and a cystic mass dependent on the cecum was discovered. Laparoscopic hemicolectomy was performed. Patient underwent full recovery. On follow up controls, pathology described intestinal cystic duplication of the colonic wall.