Cubital tunnel syndrome of the ulnar nerve caused by an epineural ganglion cyst: a case report and review of the literature.

BACKGROUND: The ulnar nerve has a long and complex anatomical course, originating from the brachial neural plexus in the neck with nerve trunk formation at the posterior neck triangle, and on to the axilla. This intricate anatomical pathway renders the nerve susceptible to compression, direct injury, and traction throughout its course. Compression of the ulnar nerve is the second most common compression neuropathy of the median nerve adjacent to the wrist joint, after carpal tunnel syndrome. CASE PRESENTATION: A 45-year-old Sudanese housewife complained of progressive right forearm and hand muscle wasting, pain, and neuropathic symptoms. She was diagnosed with right-sided cubital tunnel syndrome. The diagnosis was derived intraoperatively from a nerve conduction study suggesting the level of conduction block and recommending decompression. Magnetic resonance imaging was not done preoperatively due to financial limitations. An epineural ganglion (15 × 20 mm2) compressing and flattening the ulnar nerve was diagnosed intraoperatively. Surgical decompression of the ulnar nerve and removal of the epineural ganglion achieved a remarkable postoperative result and pleasing outcome. CONCLUSION: Surgical management is the cornerstone of treatment for compressive neuropathy and ranges from simple nerve decompression to complex neurolysis procedures and nerve transposition to adjust the anatomical course of the nerve.

Cecal perforations due to descending colon obstruction (closed loop): a case report and review of the literature.

BACKGROUND: Cases of large bowel closed-loop phenomenon with cecal perforation are extremely rare, especially when extracolonic epiploic appendage and peritoneal bands are the cause. However, sporadic cases exist in the literature with various presentations, but very few occur in patients in the abdomen without a previous scar. CASE PRESENTATION: An 89-year-old Sudanese farmer was admitted to the emergency department with 9-day history of generalized colicky abdominal pain, abdominal distension, anorexia, persistent vomiting, and constipation. Given his clinical presentation and assessment, he was diagnosed with peritonitis due to a perforated viscus in a virgin abdomen. Operative exploration revealed an extraluminal left-sided omento-epiploic band that resulted in closed-loop colonic obstruction with secondary multiple cecal perforations. Standard right hemicolectomy with adhesiolysis was done. Postoperative wound infection and hypoalbuminemia were treated, and the patient was discharged on postoperative day 9 on a regular oral diet. CONCLUSIONS: Although this condition is rare, it can be extremely dangerous, requiring prompt investigation and surgical intervention. It usually occurs secondary to raised intraluminal pressure with subsequent ischemia of the cecal wall. Through this case report, we aim to reflect on this rare experience, shedding light on the benign, extracolonic pathologies that can be life threatening or even fatal.

Infected urachal sinus with de novo stone and peritonism in a young athlete adult: A case report.

INTRODUCTION AND IMPORTANCE: Urachal cyst (UC) sinus occur secondary failed regression of allantois's embryonal canal during fetal development. Several types depending on the arrest level and connection to the urogenital tract. Umbilical urachal sinus is characterized in less than 15 % of cases. An infected urachal sinus patient can present with umbilical sinus and purulent discharge with various emergency presentations and scenarios. CASE PRESENTATION: A 26-year-old Sudanese male, a healthy athlete, presented two weeks before the last presentation with periumbilical discomfort, and umbilical discharge increased with physical activity. He was first seen in the outpatient clinic and diagnosed with an uncomplicated umbilical cyst. One week later, periumbilical pain became throbbing, severe with a dragging sensation, and skin erythema. His swelling produced purulent discharge with concomitant low-grade fever. He denied any past medical, surgical, or family history. An ultrasound scan revealed a periumbilical cyst confirmed by CECT consistent with an infected urachal sinus. Surgical excision of the cyst and umbilicoplasty was achieved with an uneventful postoperative course. CLINICAL DISCUSSION: Urachal sinuses may vary in their presentation according to the anomaly and clinical effect. It can be daunting to diagnose, even with the availability of CECT modalities. Conservative management can be of benefit in case of incidental findings, but surgical management is the preferred approach for complicated patients. A laparoscopic approach is the recommended treatment. CONCLUSION: Our case report shows that serious complications can be prevented with early diagnosis, management, and prompt surgical intervention if this rare diagnosis is kept in mind.

Total colonic aganglionosis with ileum extension Hirschsprung's disease in an adult: A case report.

INTRODUCTION: Hirschsprung's disease is a gastrointestinal anomaly affecting neuronal development and function. The primary abnormality is the absent ganglionic cells in the submucosal and myenteric neural plexuses. Disease presentation can vary, and patients may present with delayed meconium passage or late in adulthood. Total colonic aganglionosis is considered a rare subtype and even rarer to extend proximally into the small bowel. Therefore, adult Hirschsprung disease is frequently misdiagnosed as chronic constipation until comorbid events such as volvulus or perforation occur. CASE PRESENTATION: A 34 years South-Sudanese male presented with chronic constipation since early childhood, abdominal discomfort, pain, and distension. His bowel habits were infrequent, requiring occasional enemas. A strong family history of Hirschsprung disease was identified. He underwent total abdominal colectomy and end ileostomy. Postoperative diagnosis of TCA and small bowel extension of more than 50 cm was confirmed. The patient was discharged home after ileostomy education and possible future reconstruction. CLINICAL DISCUSSION: Hirschsprung's ileal extension resembles a risk of morbidities and mortality. It increases as the segment extends proximally. No international consensus on surgical management. It should be tailored to patient condition, diseased segment length, and the possible definitive primary reconstruction. Our patient's surgical diversion considered the patient's long-standing constipation history and dilated fecal-loaded ileum. CONCLUSION: TCA requires a high index suspension during the workup of chronic constipation patients. There is no reported superior surgical approach, and it depends on the institution's experience and surgeon's expertise. Primary reconstruction can be achieved, but we recommend an ileostomy for such cases.

Small bowel obstruction and ileocolic fistula caused by post-myomectomy Gossypiboma transmural migration: A case report and review of the literature.

INTRODUCTION: Post-myomectomy Gossypiboma causing Ileo-colic fistula is tremendously rare; it may present as a tumor and stand a diagnostic challenge. The duration between the primary procedure and the presentation is unpredictable. CASE PRESENTATION: A 37-year-old Sudanese/African woman presented with a 4-month history of left iliac fossa mass, pain, anorexia, and persistent, recurrent vomiting with episodes of diarrhea during the last month PTP. She had two gynecological surgeries. Abdominal X-ray & abdominopelvic CECT showed a left iliac fossa pelvic-abdominal collection, distal small bowel partial obstruction, and contrast passage from the small bowel to the sigmoid colon. Diagnosis retained foreign body with abscess causing distal ileal subacute obstruction and an ileo-sigmoid fistula. Surgical exploration, extraction of Gossypiboma with small bowel resection, primary sigmoid colon repair, and a protective transverse colon stoma were done. Six weeks later, colostomy closed after distal loopogram and flexible-sigmoidoscopy. CLINICAL DISCUSSION: A missed intraperitoneal gauze is the top differential diagnosis in patients presenting with acute abdomen after recent abdominal surgery. Transmural migration is slow but leads to difficult clinical situations, peritonitis, or fistulas. Our case reflects the light on the importance of the golden rule of perioperative gauze count and documentation. Thus, minimizing the surgical complications and preventing severe postoperative morbidities. CONCLUSION: Entero-colic fistula due to trans mural migration is not frequently encountered, and its complications can lead to morbidities and even mortality if not promptly diagnosed and treated. Strict adherence to the golden rule of counting and prevent such life-threatening complications and improves patients' safety.

Isolated pancreatic injury in an adolescent treated with Roux-en-Y pancreatojejunostomy: a case report and review of the literature.

BACKGROUND: Pancreatic injury presented as isolated injury in the pediatric population is exceptionally rare, with a conveyed incidence of less than 2% of all abdominal trauma injuries cases and a very controversial management approach for grade III injuries. CASE PRESENTATION: A 16-year-old adolescent Sudanese boy was referred to our emergency department with a 5-day history of upper and left hypochondrial pain after blunt abdominal trauma to the epigastric region with a solid object. Grade III pancreatic body trauma with major duct involvement can be successfully treated operatively. The boy was discharged home on day 10 with regular oral intake and diet. A follow-up for 6 months continued by phone, and it was uneventful with no further complications. CONCLUSIONS: Roux-en-Y pancreatojejunostomy reconstruction can be a safe and valuable surgical option when the surgical approach is considered for grade III pancreatic injury.