Intestinal obstruction induced by gallstone migration through unusual location of a cholecystogastric fistula: A rare case report.

INTRODUCTION: Gallstone ileus is a rare condition resulting from cholelithiasis, associated with the formation of a fistula between the gallbladder and the intestinal tract. It is responsible for less than 0.1 % of cases of mechanical bowel obstruction. PRESENTATION OF CASE: A 54-year-old male with hypertension presented with symptoms of intestinal obstruction, including inability to pass stool, anorexia, abdominal pain, vomiting, and oliguria. Physical examination revealed epigastric tenderness and a distended abdomen without jaundice. Laboratory tests indicated mild anemia. The patient initially refused any surgical interventions, so he was placed on conservative treatment for 24 h. Subsequently, an emergency exploratory open laparotomy was performed, revealing a gallstone causing small bowel obstruction. A constricted ileal loop, 15 cm in length, with stone impaction was resected, and an end-to-end anastomosis was performed. A cholecystogastric fistula was identified and repaired, and a retrograde cholecystectomy was performed. The patient recovered without complications. DISCUSSION: Gallstone ileus occurs when a fistula develops between the gallbladder and the intestinal tract. Notably, the presence of a fistula connecting the gallbladder and stomach ranges from 0 % to 13.3 %. Cholecystoenteric fistulas (CEFs) typically occur in elderly women in their seventh or eighth decade of life. Diagnosis often relies on CT scanning, and surgical intervention remains the primary treatment. Interestingly, despite improved awareness and imaging techniques, some cases are still discovered incidentally during surgery. CONCLUSION: This case highlights the diagnostic and therapeutic challenges posed by gallstone ileus, and emphasizes the importance of considering gallstone-related disorders in differential diagnoses for acute abdominal obstruction.

Unusual location of gastrointestinal stromal tumor (GIST): A case report and literature review of greater omentum location.

INTRODUCTION: Gastrointestinal stromal tumors (GISTs) represent a unique subset of neoplasms within the digestive tract. They can manifest in various organs throughout the digestive tract, ranging from the oral cavity to the anus, with a predilection for the stomach and small intestine. A distinct subtype of GISTs, known as Extra-gastrointestinal stromal tumors (EGISTs), originate outside the typical GIST organs such as the mesentery, retroperitoneum, and occasionally the omentum. EGISTs are relatively rare, accounting for <5 % of all GIST cases. PRESENTATION OF CASE: We present the case of a 30-year-old female patient who presented with an upper abdominal mass associated with anorexia, fever, and weakness. Radiographic imaging revealed a cystic mass beneath the left hypochondrium. Exploratory laparoscopy confirmed the presence of an isolated mass adherent to the gastrocolic ligament and greater omentum. Histopathological examination confirmed GIST, characterized by spindle-shaped cells with DOG1 and CD117/C-kit expression. The patient underwent successful tumor resection and was discharged home with postoperative imatinib therapy. Follow-up at 14 months showed no recurrence. DISCUSSION: The rarity of Gastrointestinal Stromal Tumors (GISTs) in the Greater Omentum highlights diagnostic challenges and underscores the need for further research. Immunohistochemical analysis aids in diagnosis, with Ki-67 staining indicating a high-risk classification. Surgery remains the primary treatment, with potential adjuvant therapy utilizing Imatinib mesylate. CONCLUSION: Our case underscores the rare occurrence of GIST in the Greater Omentum. Despite their infrequency, EGISTs should be considered in intra-abdominal masses, emphasizing accurate diagnosis for appropriate management and the need for further research.

Successful management of late stage of acute compartment syndrome after 72 h snake bite in 8-year-old female. A case report.

One of the most serious complications of snakebite is compartment syndrome (CS), Signs of CS include paresthesia in the distal part and pain that is out of proportion to the severity of the injury, Management involves improving the general condition, and fasciotomy has been found to be effective. An 8-year-old girl was referred to the internal emergency department in our hospital 72 h after a snake bite. She was unconscious, in poor general condition, and had a high fever. Edema was present throughout the right lower limb, extending to the abdomen, with signs of cellular necrosis (blackening with bubbles) on the right foot. The diagnosis of CS was made, and the patient underwent fasciotomy after improving the general condition. Although snake bites are rare, surgeons should be concerned about life-threatening and limb-threatening complications. CS can be effectively treated with fasciotomy. Additionally, it is important to emphasize the significance of daily dressing and regular follow-up for achieving the best results.