Rare Case of Hepatic Endometriosis as an Incidental Finding: Difficult Diagnosis of a Diagnostic Dilemma.

Endometriosis is the abnormal existence of functional uterine mucosal tissue outside the uterus. It is a usual disorder of women in reproductive age which is mainly located in the female genital tract. Hepatic endometriosis is one of the rarest disorders characterized by the presence of ectopic endometrium in the liver. It is often described as cystic mass with or without solid component. Preoperative diagnosis is difficult via cross-sectional imaging and histopathologic evaluation remains the gold standard for diagnosis. We report an asymptomatic 40-year-old female with a large cystic mass involving the left hepatic lobe. She underwent laparoscopic removal of the cyst. The diagnosis of hepatic endometriosis was established by the histopathological analysis of the surgical specimen.

The Diagnostic Dilemma of Primary Epiploic Appendagitis and How to Establish a Diagnosis.

Primary epiploic appendagitis (PEA) is a relatively uncommon, non-surgical situation that clinically mimics other conditions requiring surgery. In PEA, torsion and inflammation of an epiploic appendix results in localized abdominal pain. This condition may be clinically misdiagnosed, resulting in unnecessary surgical intervention. We report the unusual case of a healthy 44-year-old man, who presented to the 417 NIMTS Military Veterans' Fund Hospital of Athens with non-migratory left lower quadrant abdominal pain, which had started 24 hours before admission. The patient described a constant, sharp, non-radiating pain. He had no symptoms of nausea, vomiting, constipation, diarrhea, or fever. Abdominal examination showed focal abdominal tenderness with slight rebound tenderness. The diagnosis of PEA of the sigmoid colon was made based on the findings of an abdominal contrast computed tomography (CT). The key findings of CT were an oval lesion with a maximum diameter of 2.4 cm, with fat attenuation, and a circumferential hyperdense ring located adjacent to the sigmoid colon. This case is presented to highlight the clinical characteristics of PEA, which may help clinicians to overcome this diagnostic dilemma and reach the correct diagnosis.

Human subcutaneous dirofilariasis caused by Dirofilaria immitis in a Greek adult.

Human dirofilariasis is a zoonotic infection caused by worms of the genus Dirofilaria. Most reported cases involve Dirofilaria repens, and D. immitis infection has been rarely reported. Canines act as a reservoir for the infection, while human infections are sporadic. Human dirofilariasis has been widely reported in South Europe; however, the worldwide distribution constantly changes. We herein report an extremely rare case of subcutaneous trunk dirofilariasis in a 45-year-old immunosuppressed woman, caused by D. immitis. The parasitic infection was detected using ultrasonography. The infection was confirmed by a polymerase chain reaction-based method and was attributed to D. immitis.

Sigmoid carcinoma localized in the sac of a right inguinoscrotal hernia.

The inguinoscrotal hernia with colonic malignancy in the sac presents rare but severe consequence. The most common side of this type of hernia is the left one while the most common part of the large bowel is the sigmoid colon. The clinical picture can be easily confused with simple inguinoscrotal hernia unless the clinician is alert to the presence of certain sinister symptoms and signs. We report an extremely rare case of a 91-year-old man presented with anemia who had a right inguinoscrotal hernia containing a sigmoid colon carcinoma.

Asymptomatic extraperitoneal inguinoscrotal hernia involving ureter: A case presentation and review of the literature.

An inguinoscrotal hernia is a common disorder that usually contains intraperitoneal organs (small intestine, colon, appendix, ovaries). Extraperitoneal ureteral herniation into an inguinoscrotal hernia is a rare condition and often associated with congenital abnormalities or postoperative anatomic changes. A high index of suspicion is needed in order to avoid intraoperative ureteric injuries. We herein report the case of a ureteric herniation into an inguinoscrotal hernia incidentally found during a scheduled hernia repair.

Persistent Coughing as the First Symptom of Primary Mucinous Appendiceal Adenocarcinoma.

Primary appendiceal adenocarcinomas are extremely rare entities. Preoperative diagnosis is very difficult and is mainly based on computed tomography (CT) scan findings. Furthermore, in many cases, difficulties in establishing an accurate intraoperative diagnosis have resulted in a two-stage surgical intervention. We herein report a case of a primary appendiceal mucinous adenocarcinoma in a 67-year-old Caucasian man who presented with atypical symptoms of persistent coughing and weight loss. The chest CT showed lesions with features favorable of malignancy. Further investigation with abdominal CT and colonoscopy revealed a large tumor of the cecum expanding to the ascending colon. Typical right hemicolectomy was performed and the histopathological examination confirmed mucinous adenocarcinoma of the appendix. As some cases are accidentally discovered, the presented case describes an extremely rare first presentation of this tumor and emphasizes that the preoperative diagnosis of appendiceal cancer is challenging due to the lack of specific symptoms and signs.

Rectus abdominis muscle malignant fibrous histiocytoma causing a large abdominal wall defect: reconstruction with biological mesh.

Malignant fibrous histiocytoma (MFH) is a common soft tissue sarcoma usually involving limbs and retroperitoneum. MFH of the rectus abdominis muscle is extremely rare. Surgery in similar cases leads to large abdominal wall defects needing reconstruction. Biological and synthetic laminar absorbable prostheses are available for the repair of hernia defects in the abdominal wall. They share the important feature of being gradually degraded in the host, resulting the formation of a neotissue. We herein report the case of an 84-year-old man with MFH of the rectus abdominis muscle which was resected and the large abdominal wall defect was successfully repaired with a biological mesh.

Multicystic hepatocarcinoma mimicking liver abscess.

The diagnosis of hepatocellular carcinoma (HCC) became easier in relation to the improved radiological examinations; however, the neoplasm may occur under atypical presentations mimicking other benign or malignant processes. Multicystic HCC mimicking a liver abscess associated with septic-type fever and leukocytosis is rare, has a poor prognosis, and poses diagnostic and therapeutic dilemmas. We present the case of an 80-year-old patient, who presented with fever, leukocytosis, and large cystic masses involving right and left lobes of the liver initially considered abscesses and finally diagnosed as HCC after open drainage and liver biopsy. Although the patient died on the tenth postoperative day due to pulmonary oedema, the authors emphasize the high index of suspicion needed in the diagnosis of this unusual presentation of HCC.

Pneumoperitoneum, Retropneumoperitoneum, Pneumomediastinum, and Diffuse Subcutaneous Emphysema following Diagnostic Colonoscopy.

Colonoscopy is a widely used diagnostic and curative procedure. Extraperitoneal perforation with pneumoretroperitoneum, pneumomediastinum and subcutaneous emphysema combined with intraperitoneal perforation is an extremely rare complication. We report a case of a 78-year-old woman presented to the emergency department with abdominal pain and diffuse abdominal, chest, neck, and facial swelling appeared after a diagnostic colonoscopy. Diagnostic and therapeutic modalities are discussed.

Recurrent Urinary Tract Infections due to Asymptomatic Colonic Diverticulitis.

Colovesical fistula is a common complication of diverticulitis. Pneumaturia, fecaluria, urinary tract infections, abdominal pain, and dysuria are commonly reported. The authors report a case of colovesical fistula due to asymptomatic diverticulitis, and they emphasize the importance of deeply investigate recurrent urinary tract infection without any bowel symptoms. They also briefly review the literature.

Strangulated intestinal hernia through a drain site.

INTRODUCTION: Intra-abdominal drains have been widely used in order to prevent intra-abdominal fluid accumulation and detection of anastomotic leakage. PRESENTATION OF CASE: We herein report a case of small bowel herniation followed by strangulation in an 82 year old woman who had undergone sigmoidectomy for colorectal cancer. DISCUSSION: Although several complications related to drain usage such as drainsite infection, hemorrhage and intestinal perforation may occur, intestinal incarceration through drain site is rarely reported. CONCLUSION: Drains must be used with caution and only if indicated. Careful insertion, regular post-operative or post-removal inspection is strongly recommended.

Traumatic mesenteric cyst after blunt abdominal trauma.

Mesenteric cysts are rare abdominal tumors of unclear histologic origin, usually asymptomatic. Post-traumatic mesenteric cyst usually results as a consequence of a mesenteric lymphangitic rupture or a hematoma followed by absorption and cystic degeneration. The preoperative histological and radiological diagnosis is difficult. We present the case of a 45-year-old male patient with sizable, palpable abdominal tumor, the gradual swelling of which the patient himself combined with the blunt abdominal trauma he acquired from an opponent's knee in a football game 5 months ago.

Primary retroperitoneal mucinous cystadenoma of borderline malignancy in a male patient. Case report and review of the literature.

BACKGROUND: Primary retroperitoneal mucinous cystadenoma of borderline malignancy represents a rare tumor, with unclear histogenesis, concerning almost exclusively women. Only two cases concerning male patients have been reported. CASE REPORT: We herein report a case of a 37 year old man undergone laparotomy for a sizable retroperitoneal tumor resulting after the histological examination to a primary retroperitoneal mucinous cystadenoma of borderline malignancy. CONCLUSION: This is the third case of primary retroperitoneal mucinous cystadenoma of borderline malignancy in a male patient reported in the literature. The preoperative diagnosis is impossible. Laparotomy constitutes the only diagnostic and curative approach.

Multiarticular chronic tophaceous gout with severe and multiple ulcerations: a case report.

INTRODUCTION: Gout is a common inflammatory arthritis caused by articular precipitation of monosodium urate crystals. It usually affects the first metatarsophalangeal joint of the foot and less commonly other joints, such as wrists, elbows, knees and ankles. CASE PRESENTATION: We report the case of a 75-year-old Caucasian man with tophaceous multiarticular gout, soft-tissue involvement and ulcerated tophi on the first metatarsophalangeal joint of the left foot, on the first interphalangeal joint of the right foot and on the left thumb. CONCLUSION: Ulcers due to tophaceous gout are currently uncommon considering the positive effect of pharmaceutical treatment in controlling hyperuricemia. Surgical treatment is seldom required for gout and is usually reserved for cases of recurrent attacks with deformities, severe pain, infection and joint destruction.