Ciliated hepatic foregut cyst: A case report and review of literature.

INTRODUCTION: Ciliated hepatic foregut cyst (CHFC) is a rare cystic lesion that arises from the embryonic foregut with approximately 100 cases reported. Most commonly identified in segment IV of the liver, CHFC is typically asymptomatic and incidentally found on abdominal imaging. It is important to consider this entity in the differential diagnosis of atypical liver lesions since CHFC carries a risk of transformation into squamous cell carcinoma. A suspicion of CHFC is therefore an indication for surgical resection. CASE PRESENTATION: A 62-year-old male presented to surgery consultation for further evaluation of a hepatic cyst incidentally found on abdominal ultrasound. The patient was completely asymptomatic. Both abdominal computerized tomography and magnetic resonance imaging scan confirmed a 4 cm subcapsular cyst in segment IVa. Additional workup was unremarkable. Considering the diagnostic doubt the patient underwent laparoscopic cyst enucleation. Histology revealed a ciliated pseudostratified epithelium consistent with a CHFC. CLINICAL DISCUSSION: CHFC is a rare diagnostic entity that should be considered in the differential diagnosis of cystic hepatic lesions, particularly those located in segment IV of the liver. Since it is frequently asymptomatic, CHFC is usually found incidentally during surgery or imaging studies. Diagnosis of CHFC preoperatively is difficult due to the lack of specific radiographic findings. Moreover, metaplasia and squamous carcinoma can occur. Therefore complete surgical excision is the recommended treatment. CONCLUSION: Despite its rarity, CHFC carries a risk of malignant transformation. Accurate diagnosis is mandatory and surgical excision is recommended even in asymptomatic CHFC.

Intussusception in a pregnant woman.

Abdominal pain in a pregnant woman with a history of laparoscopic Roux-en-Y gastric bypass (LRYGB) in the emergency department is challenging. Intussusception is a rare cause of small bowel obstruction after LRYGB and can lead to intestinal necrosis, perforation, sepsis and death. The authors report a case of a 34-week pregnant patient, previously submitted to LRYGB, presenting to the emergency department with abdominal pain and vomiting. A computed tomography scan suggested the presence of ileoileal intussusception. So, an emergent laparotomy was performed with invagination reduction. The postoperative period was uneventful, as well as pregnancy and caesarian performed 4 weeks after surgery. At the 45-month follow-up, there was no recurrence of intussusception.

Perforation of Meckel's diverticulum by a swallowed fish bone: case report and literature review.

Meckel's diverticulum is the commonest congenital abnormality of the gastrointestinal tract. Most cases are asymptomatic and only incidentally found. Its perforation by a foreign body is an extremely rare event. A 53-year-old female presented to Emergency Department with abdominal pain on the right iliac fossa and vomiting. CT scan was performed and showed an intestinal perforation by a foreign body. Diagnostic laparoscopy identified a perforation of a Meckel's diverticulum by a fish bone and a laparoscopic stapled diverticulectomy was performed. Meckel's diverticulum complications are more common in childhood, usually as bleeding. In adults, intestinal obstruction and inflammation are the usual manifestations. Although most swallowed foreign bodies are harmless, in a small number of cases perforation may occur. Preoperative diagnosis of complicated Meckel´s diverticulum is challenging and can often mimic other more common conditions. Laparoscopy is a valuable tool for the diagnosis and treatment of complicated Meckel's diverticulum.

Perforated duodenal diverticulum: Surgical treatment and literature review.

INTRODUCTION: Duodenum is the second most frequent location for a diverticulum in the digestive tract. Complications are rare and perforation was only reported in less than 200 cases. PRESENTATION OF CASE: A 79-year-old female was admitted to Emergency Department with abdominal pain and vomiting for the last 24h. A CT scan was performed and moderated extra-luminal air was identified. During surgery a fourth portion perforated duodenal diverticulum was diagnosed and duodenal resection was performed. DISCUSSION: First reported in 1710, the incidence of duodenal diverticula can be as high as 22%. Nevertheless complications are extremely rare and include haemorrhage, inflammation, compression of surrounding organs, neoplastic progression, cholestasis and perforation. As perforations are often retroperitoneal, symptoms are nonspecific and rarely include peritoneal irritation, making clinical diagnose a challenge. CT scan will usually present extra-luminal retroperitoneal air and mesenteric fat stranding, providing clues for the diagnosis. Although non-operative treatment has been reported in selected patients, standard treatment is surgery and alternatives are diverse including diverticulectomy or duodenopancreatectomy. CONCLUSION: Perforated diverticula of the fourth portion of the duodenum are extremely rare and current evidence still supports surgery as the primary treatment modality.

Cateter ventriculoperitoneal migrado para o escroto através de hérnia inguinal ? Relato de caso / Ventriculoperitoneal shunt migrated to scrotum through inguinal hernia ? Case report

A derivação ventriculoperitoneal é atualmente o método mais utilizado no tratamento da hidrocefalia comunicante. As complicações mais comuns são a disfunção do shunt e infecções. Este relato de caso tem como objetivo apresentar um doente com idas recorrentes ao serviço de urgência por agitação psicomotora e dor abdominal, e cujo cateter distal previamente desconectado encontrava-se alojado no interior do saco escrotal através de hérnia inguinoescrotal. A formação de hérnia inguinal com migração de cateter é um evento raro no adulto, sendo mais comum na criança, possivelmente pela maior taxa de patência do processo vaginal e aumento da pressão intra-abdominal. No momento em que este artigo foi redigido, não foi encontrado caso semelhante na literatura...

Ventriculoperitoneal shunt is the most used method for the treatment of communicating hydrocephalus. Common complications include shunt dysfunction and infection. This case report aims to present a patient, with recurrent visits to the emergency department for abdominal pain and agitation, and whose distal catheter previously disconnected, was housed inside the scrotum through a scrotal inguinal hernia. The association of inguinal hernia and catheter migration is uncommon in adults, being more frequent in infants possibly because of the higher rate of patent processus vaginalis and increased abdominal pressure. No similar case was found in the literature by the time this article has been written...