Appendicitis mimicry of dolichocolon.

Dolichocolon is an under-reported, under-diagnosed etiology of chronic constipation that is often overlooked as being a primary diagnosis. We present a case of an undiagnosed dolichocolon in a young adult female whose initial presentation was concerning of appendicitis. Eventually, the patient underwent a subtotal colectomy as a definitive treatment for chronic constipation. Dolichocolon is an anatomical variant that can have severe lifelong consequences, such as chronic constipation, which greatly affects a patient's quality of life and overall health if undiagnosed. The purpose of this case report is to raise awareness among the surgical community regarding the significance of early dolichocolon diagnosis, prevent misdiagnosis, and ultimately improve patient outcomes, including reducing complications associated with chronic constipation.

A Rare Case of Cholecystoduodenal Fistula with Rapid Distal Gallstone Migration.

BACKGROUND Abnormal communicating channels or fistulas between the gallbladder or common bile duct and the intestine are rare, but have potential to result in serious complications. Further complications can arise with migration of gallstones from the gallbladder to the intestines, causing distal obstruction in the ileum, intestinal hemorrhage, or intestinal perforation. High clinical suspicion is warranted for the diagnosis of Bouveret's syndrome, with anticipation of surgery to prevent distal gallstone migration that would otherwise result in unfavorable patient outcomes. CASE REPORT A 51-year-old woman presented with biliary colic and a computed tomography scan showed that a gallstone measuring approximately 3 cm was lodged in the first portion of the duodenum. The patient was diagnosed with cholecystoduodenal fistula with Bouveret's syndrome. Because of the acute presentation of symptoms, she underwent an exploratory laparotomy with disconnection of the cholecystoduodenal fistula, cholecystectomy with debridement of the duodenum, transduodenal gallstone removal, and primary duodenoplasty closure of D1. CONCLUSIONS As the present case illustrates, distal migration of a gallstone through a cholecystoduodenal fistula can occur rapidly and without obvious symptoms. It also can occur spontaneously and not just secondary to fragmentation by laser lithotripsy. To prevent morbidity and mortality, a high degree of clinical suspicion is warranted when diagnosing patients in whom a gallstone ileus is seen on imaging.

A unique case of mid-tendonpalmaris longus muscle - dissection presentation and literature review

The palmaris longus (PL) muscle is one of five muscles that originates from the common flexor tendon, which attaches at the medial epicondyle of the humerus, and has its own insertion distally into the palmar aponeurosis. Although the PL contributes minimal biomechanical function, its wide anatomic variation can produce pathologies in the forearm and wrist such as median nerve entrapment. The present work describes a unique case of a PL distally migrated muscle belly with wide tendon both proximal and distal not noted in other anatomical or surgical reference materials. Here-in, the current case is compared to previously re-ported PL variations and their documented frequencies by region and ethnicity. Key findings include several studies showing Caucasian populations with greater than 25% frequencies of absent PL, compared to 4-6% in African regions. Potential explanations for this finding include evolutionary adaptations associated with manual labor and need for increased grip strength. In addition, the considerations of abnormal PL in surgical procedures inclusive of challenges in graft procedures that might present with such anatomic variations of the PL are examined

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