A rare case of isolated pancreatic tuberculosis in a 70-year-old patient - a case report.

We report a case of rare solitary pancreatic tuberculoma. 70 years old woman admitted to hospital in order to conduct diagnostics of a tumor located in the head of the pancreas. All symptoms pointed at pancreatic cancer, but histopathological examinations were inconclusive. Additionally, there were no clinical signs or symptoms of tuberculosis in the lungs. X-ray of the chest showed no abnormalities. The patient denied tuberculosis in the medical interview. There were no bacilli in the sputum. During exploratory laparotomy, the samples of tissue have been taken for pathomorphological examination. The microscopic image caused suspicion of Mycobacterium tuberculosis etiology, which was confirmed by Ziehl-Neelsen staining. In recent years, tuberculosis has become more and more common in Europe, which is why the described case can be a guide for doctors to help to avoid diagnostic errors and speed up the treatment process.

Chest pain caused by pneumomediastinum as the first symptom of sigmoid perforation - case report.

INTRODUCTION: Chest pain is one of the most common symptoms with which patients report to the doctor. The reason for this is the fear of the sick, who often equate this symptom with dangerous diseases such as heart attack. The primary source of pain does not always have to be located within the chest. Colon perforation is a rare but possible complication of colonoscopy, which may result in free gas entering the mediastinum which is accompanied by chest pain. CASE REPORT: We present the case of a 78-year-old woman who reported to the hospital emergency department with chest pain, shortness of breath and abdominal pain. On the basis of imaging examinations, perforation of sigmoid affected by diverticulosis, complicated by pneumomediastinum and retroperitoneal emphysema, was suspected. The aforementioned ailments were caused by iatrogenic perforation of the sigmoid during diagnostic colonoscopy performed on an outpatient basis a few hours before reporting to the hospital. The patient was urgently qualified for laparotomy. Intraoperatively, perforation was confirmed at the rectosigmoid junction, which was the cause of retroperitoneal and pneumomediastinum with rightsided emphysema of the lateral neck region. No fluid or intestinal contents were found in the abdomen. The sigmoid colon and upper rectum were resected via double-stapled anastomosis performed between the descending colon and rectum. The patient was discharged home in good condition on the 7th postoperative day. CONCLUSIONS: Colonoscopy is a diagnostic and therapeutic procedure that is considered relatively safe, but also carries complications such as bleeding or perforation of the large intestine. Diverticular disease is a common condition which most often affects the sigmoid colon. In areas of the weakest resistance, diverticulum formation occurs as a result of increased intra-abdominal pressure, which is an additional risk factor for perforation during colonoscopy. It is important to remember the possible different clinical presentation of gastrointestinal perforation, which may also manifest as chest pain. With early detection and surgical treatment, life-threatening complications associated with the development of pneumothorax can be avoided.