Complications unveiled: A detailed case report on mesh migration post-incisional hernia repair.

INTRODUCTION AND IMPORTANCE: Repairing incisional abdominal wall hernia with nonabsorbable meshes is one of the most common procedures in general surgery. Mesh migration into the intestine is rare but a serious complication. It can occur months or even years after surgery and often presents with vague abdominal pain, making diagnosis tricky. CASE PRESENTATION: We report a rare case of a 52-year-old female presenting a small bowel obstruction secondary to mesh migration from the abdominal wall into the intestine, 10 years after repeated surgical repair of a ventral incisional hernia. At surgery, a mesh was migrated into a small bowl. The patient had a small bowel resection. The postoperative course was simple and the patient was discharged after 5 days. CASE DISCUSSION: Incisional hernia repair with mesh is one of the most commonly performed surgical procedures worldwide. Many complications have been linked to the use of mesh; among the most frequently reported are seromas, hematomas, and infections. Mesh migration remains an uncommon event after incisional hernia repair, and even rarer when considering complete migration within the intestinal lumen. The exact cause of this complication remains unknown. Multiple hypotheses have been proposed for mesh migration. Abdominal pain, intermittent or persistent intestinal obstruction, mass formation, and viscus perforation represent the most common clinical manifestation. Total removal of the mesh via laparoscopy or laparotomy is recommended, along with either partial or entire resection of the organ. CONCLUSION: Mesh migration is a an uncommon possible complication in case of incisional hernia mesh repair and it requires often surgical intervention.

A case report of primary pancreatic lymphoma revealed by an acute pancreatitis.

INTRODUCTION: Primary pancreatic lymphoma (PPL) is a rare malignancy. Diffuse large B-cell lymphoma is the predominant subtype, often affecting the pancreatic head in elderly males. Due to its rarity and nonspecific symptoms, PPL is frequently misdiagnosed, leading to unnecessary surgeries. This case report discusses the diagnosis and management of PPL in a 47-year-old female, emphasizing the challenges in its identification. CASE PRESENTATION: A 47-year-old female with no medical history presented with severe epigastric pain and jaundice. Diagnosed initially as acute pancreatitis. The abdominal CT scan showed a tumor in the head of the pancreas suggesting pancreatic adenocarcinoma invading the vessels, making it minimally borderline. However, due to the presence of large intra- and retroperitoneal lymph nodes casting doubt on the diagnosis, we further investigated with an MRI and Endoscopic Ultrasound with fine-needle aspiration, which ruled out adenocarcinoma and confirmed a pancreatic diffuse large B-cell lymphoma. The patient underwent chemotherapy with CHOP, showing significant improvement after six cycles. DISCUSSION: Primitive pancreatic lymphoma (PPL) is a rare form of non-Hodgkin lymphoma, often mimicking other pancreatic diseases. B-cell lymphomas, especially diffuse large B-cell lymphoma (DLBCL), are common in PPL. Diagnostic criteria include the bulk of disease in the pancreas, no splenic or hepatic involvement, and normal white blood cell count. Imaging modalities aid in diagnosis, but histopathological evaluation is essential. Treatment options include chemotherapy, radiation therapy, and surgery, with rituximab-based regimens being common for DLBCL. CONCLUSIONS: B-cell pancreatic lymphoma poses diagnostic challenges due to nonspecific symptoms. A definitive diagnosis requires histopathological evidence, often obtained through minimally invasive procedures like endosonography-guided biopsy. Treatment involves chemotherapy, immunotherapy, and radiation, with early detection correlating with improved outcomes. Surgery's role is limited due to the diffuse nature of the disease. This case underscores the importance of considering PPL in the differential diagnosis of pancreatic masses, especially in atypical clinical presentations.

Primary isolated hydatid cyst of the spleen: A case report.

INTRODUCTION AND IMPORTANCE: Primary (isolated) splenic hydatid cyst is rare and accounts for less than 2 % of hydatid patients, even in endemic regions. Diagnosis of splenic hydatid cyst can be challenging due to the rarity of the condition and its nonspecific symptoms. Surgery is the mainstay of treatment. This case report discusses management options for such a rare condition. CASE PRESENTATION: We present a 33-year-old female patient with abdominal pain for six months and splenomegaly. Ultrasonography and CT scan showed a giant splenic cyst with clear walls and multi-vesicular contents suggestive of a hydatid cyst. There was no involvement of the liver or other organs. Indirect hemagglutination was positive for Echinococcus. Through a left subcostal incision total splenectomy was performed. The patient was discharged from hospital on the sixth postoperative day. No local recurrence was detected during postoperative follow up. CASE DISCUSSION: Primary splenic hydatid disease is rare. It may be detected incidentally or present with nonspecific complaints. If untreated, a splenic hydatid cyst can lead to various potentially severe complications, including cyst rupture and secondary infection. Standard treatment is open total or partial splenectomy: preservation surgery should always be considered, to avoid post splenectomy infection, especially in young patients. CONCLUSION: Primary splenic hydatid cyst is rare even in endemic areas. Symptoms may be non-specific. Standard treatment is open total or partial splenectomy.

Arterial embolization of focal nodular hyperplasia of the liver: A case report.

INTRODUCTION AND IMPORTANCE: Focal nodular hyperplasia (FNH) is a benign liver lesion that can pose diagnostic and management dilemmas, especially when distinguishing it from other hypervascular hepatic lesions. The benign nature of FNH often makes conservative management a priority; however, intervention may be necessary in symptomatic cases or when diagnostic uncertainty exists. CASE PRESENTATION: A 19-year-old male presenting with abdominal pain, found to have a large 25 cm FNH lesion in the right lobe of the liver. Initial diagnosis was achieved through ultrasonography and contrast-enhanced computed tomography (CECT), with histopathological confirmation via core needle biopsy. Given the lesion's size and the patient's symptomatic presentation, we opted for arterial embolization, a less invasive surgical approach, over traditional resection methods. This technique not only led to symptom resolution but also resulted in a significant reduction in lesion size. CLINICAL DISCUSSION: Our approach to managing this FNH case involved a multidisciplinary team. The decision to employ arterial embolization over more invasive surgical options was based on the lesion's characteristics, the patient's age, and the potential for significant morbidity associated with traditional surgery. Arterial embolization of the FNH lesion resulted in complete resolution of symptoms and a significant reduction in lesion size, from 25 cm to 12 cm, demonstrating the effectiveness of this technique in managing large FNH lesions. CONCLUSION: Our findings contribute to the scientific literature by showcasing the potential of less invasive surgical techniques in the management of FNH, offering valuable insights for clinicians faced with similar diagnostic and therapeutic challenges.

A case report of idiopathic sclerosing encapsulating peritonitis causing an acute bowel occlusion in adult.

INTRODUCTION: Sclerosing peritonitis (SP), also known as abdominal cocoon, is a and potentially serious condition characterised by the fibrous encapsulation of the small intestine within the peritoneal cavity. CASE PRESENTATION: In this report, we detail the case of a 67-year-old male with SP who initially presented with symptoms of constipation, vomiting, and abdominal pain. Despite a previous computed tomography (CT) scan revealing ileal thickening, the accurate diagnosis remained elusive until exploratory laparotomy. The patient underwent successful excision of the thick fibro-collagenous membrane, and histopathological examination revealed fibro-collagenous tissue with mild chronic inflammation. DISCUSSION: SP can be classified into primary (idiopathic) and secondary forms. Primary SP, also referred to as cocoon abdomen, is more common in young females from tropical regions, while secondary SP is associated with peritoneal dialysis and other causative factors. Diagnosing SP presents challenges, as clinical symptoms may mimic those of other conditions. Imaging studies, especially CT scans, play a crucial role in the diagnostic process, yet the rarity of SP often leads to misdiagnosis. Although there is no consensus on treatment options, surgical intervention is generally recommended for symptomatic cases, involving excision of the cocoon and adhesiolysis. Conservative management may be considered for asymptomatic cases. The mortality rate for SP is high, emphasizing the importance of early diagnosis and intervention. CONCLUSION: Primary sclerosing encapsulating peritonitis is a and complex, primarily affecting young individuals. Maintaining a high index of suspicion is crucial for an accurate diagnosis, and surgical intervention remains the primary treatment for symptomatic cases. The prognosis is generally favourable with timely and appropriate management.

Retrorectal Schwannomas: Atypical Presentation and Controversial Surgical Management.

Schwannomas also known as neurilemomas are benign tumors. Retrorectal schwannomas are extremely rare, accounting for 1 to 5% of all schwannomas. They are mostly asymptomatic but may present with symptoms such as pelvic pain, back pain, lower extremities pain, or constipation. Physical examination is often poor. Imaging (CT, MRI) and fine needle biopsy can often help orient the diagnosis. The treatment of choice is monoblock resection of the mass. The prognosis is good. Recurrence has been reported especially after intralesional enucleation. We report a case of a 41-year-old male patient consulting for chronic low back pain eventually diagnosed with retrorectal schwannoma. We performed a surgical resection and the histological examination was consistent with the diagnosis of benign (ancient) schwannoma.

Hydatid disease of the liver with portal vein invasion and cavernous transformation: A case report and literature review.

INTRODUCTION: Hydatid cyst disease is a zoonosis caused by the parasite Echinococcus Granulosus. It may infest any organ of the body, but it most frequently involves the liver and lungs. Portal vein involvement by hydatid cyst disease is extremely rare with only six cases published to our knowledge. CASE PRESENTATION: We present a 47-year-old male with abdominal pain. His laboratory tests were in normal ranges. Upper gastrointestinal endoscopy demonstrated esophageal and gastric fundal varices. The ultrasonography (US) and computed tomography (CT) findings hydatid disease of the liver with portal venous thrombosis and cavernous transformation. It had been treated with albendazole. DISCUSSION: Hydatid cyst disease is a zoonosis caused by Echinococcus granulosus. It can infest various organs of the body with a particular predilection of the liver and lungs. It still continues to be a health problem in a significant part of the world. The symptoms are frequently non-specific and patients may even be asymptomatic. The portal vein thrombosis is usually accompanied with portal cavernous transformation. Patients with hydatid liver cysts and portal cavernous transformation require treatments for both hydatid cysts and portal hypertension. CONCLUSION: invasion of the portal vein and cavernous thrombosis by the echinococcus cysts is a very rare complication. Treatment should consist of both hydatid liver cyst and portal hypertension.