A retroperitoneal pseudomyxoma of the appendix: A case report.

INTRODUCTION: Retroperitoneal pseudomyxoma (RP) is a rare condition characterized by mucinous tumor growth within the retroperitoneal space, commonly originating from the appendix or other abdominal organs. RP presents with non-specific symptoms such as abdominal pain, bloating, and weight loss, making accurate diagnosis challenging. Due to its rarity and symptom overlap with other conditions, RP requires careful management by a multidisciplinary healthcare team. CASE PRESENTATION: An 82-year-old female with a three-month history of abdominal pain and an abdominal mass underwent diagnostic imaging, revealing a retroperitoneal cystic mass. Exploratory laparotomy identified gelatinous masses originating from the retrocaecal appendix, which were resected. Histopathological examination confirmed a diagnosis of retroperitoneal pseudomyxoma with mucinous appendicular low-grade cystadenoma as the primary source. The patient had an uneventful postoperative course and remained disease-free at a 12-month follow-up. DISCUSSION: RP's exact cause is unknown but often originates from the appendix, leading to mucinous fluid accumulation in the retroperitoneal cavity. This condition presents with varied symptoms, including abdominal pain and distension, mimicking other abdominal diseases. Diagnosis involves clinical, radiological, and pathological assessments, with imaging showing characteristic features. Treatment comprises surgical resection, potentially combined with HIPEC, aiming for complete cytoreduction. Prognosis depends on factors like tumor grade, extent, and cytoreduction completeness. CONCLUSION: Retroperitoneal pseudomyxoma is a rare condition with challenging diagnosis due to its non-specific symptoms. Early recognition, surgical resection, and appropriate adjuvant therapies like HIPEC or chemotherapy can improve outcomes in patients with this uncommon disease.

Incidental pneumoperitoneum due to pneumatosis intestinalis: A rare case of benign pneumoperitoneum.

INTRODUCTION AND SIGNIFICANCE: Pneumatosis intestinalis (PI), the presence of gas within the intestinal wall, is a rare but significant gastrointestinal condition. It may be associated with underlying gastrointestinal disorders or detected incidentally, posing diagnostic challenges. This article emphasizes the importance of recognizing and managing this condition conservatively when appropriate. CASE PRESENTATION: A previously healthy 40-year-old Caucasian female patient presented with left lumbar fossa pain, initially suggestive of renal colic. Physical examination revealed stable vital signs and a soft abdomen. Laboratory tests showed no signs of inflammation or renal abnormalities. Abdominal CT scan ruled out urinary lithiasis but identified pericolonic pneumoperitoneum on the left side. Due to the absence of peritonitis signs, surgical intervention was deferred. Over 72 h of close monitoring, the patient remained stable without clinical deterioration. Subsequent CT scans confirmed pneumatosis intestinalis. The patient remained asymptomatic and underwent a confirming colonoscopy. CLINICAL DISCUSSION: Pneumatosis intestinalis can manifest with varying severity and is often linked to underlying gastrointestinal conditions. It can mimic life-threatening conditions like bowel perforation, necessitating careful differentiation. Non-surgical pneumoperitoneum, exemplified in this case, may result from benign causes like PI, warranting meticulous evaluation to prevent unnecessary surgery. CONCLUSION: This case highlights the need to recognize and manage asymptomatic PI. A multidisciplinary approach and CT imaging play pivotal roles in ensuring optimal patient outcomes. Vigilance among healthcare professionals is essential to consider PI in asymptomatic patients, mitigating the risk of undue surgical interventions, and facilitating timely diagnosis and intervention when necessary.

Dieulafoy's lesion: Is there still a place for surgery? About 2 cases.

INTRODUCTION: Dieulafoy's lesion, a rare but life-threatening condition accounting for a small percentage of acute gastrointestinal bleeding cases, has historically posed diagnostic and therapeutic challenges. CASE PRESENTATION: In this article, we present two cases that required surgical intervention due to unsuccessful attempts with endoscopy. Case 1 involved a 40-year-old patient with a history of treated duodenal ulcers, while Case 2 featured a 74-year-old woman with no notable medical history. Both patients exhibited severe bleeding, necessitating urgent surgical procedures. The surgical approach involved wide gastrotomy, careful inspection, and successful suturing of the bleeding vessel. DISCUSSION: Dieulafoy lesions, discovered by French surgeon Georges Dieulafoy in 1885, constitute 1-2 % of acute gastrointestinal bleeding cases. These anomalies involve enlarged submucosal arteries, predominantly in the stomach, but occurrences in other sites are documented. Endoscopic methods, surpassing surgical intervention, are preferred for treatment, boasting success rates over 90 %. Surgical measures become a last resort for uncontrolled bleeding, with laparoscopic surgery emerging as a minimally invasive alternative, facilitated by various intra-operative localization techniques. Laparoscopic wedge resection, in particular, exhibits lower re-bleeding rates than traditional oversewing methods, although feasibility depends on lesion location. CONCLUSION: While endoscopic methods are preferred, surgery remains a vital option when bleeding persists or endoscopic intervention fails. This report highlights the significance of surgical management in selected cases of Dieulafoy's lesion.

Abdominal pseudohernia as an exceptional complication of herpes-zoster.

INTRODUCTION: Herpes zoster (HZ), caused by the reactivation of the Varicella-Zoster virus, is typically characterized by sensory complications. However, motor complications, such as abdominal pseudohernia, are rare and exceptional. This report presents a case of post-herpes zoster pseudo-hernia in a previously healthy 54-year-old man. CASE PRESENTATION: A 54-year-old Caucasian patient developed an abdominal wall protrusion over two weeks, following a resolved herpes zoster infection. Physical examination revealed healed skin lesions and a painless protrusion on the right flank, triggered by coughing, suggesting an abdominal wall hernia. Abdominal CT scan ruled out parietal but noted asymmetry in the abdominal wall muscles, particularly thinning on the right side. The diagnosis of post-herpes zoster pseudo-hernia was established, with spontaneous resolution occurring after four months. DISCUSSION: Herpes zoster typically manifests as a sensory condition. However, motor complications can lead to muscle weakness or paralysis. Pseudo-herniation is a rare motor complication, affecting less than 1 % of cases. It must be differentiated from true abdominal wall hernias, which require surgical intervention. Pseudo-hernia typically presents as painless abdominal bulging, often asymptomatic, but can lead to gastrointestinal issues if visceral nerves are affected. Imaging studies and EMG may be employed for diagnosis. Treatment for pseudo-hernia is conservative, addressing the underlying HZ, and the prognosis is favorable, with most cases resolving within 3 to 12 months. CONCLUSION: Abdominal post-herpes zoster pseudo-hernia is a rare HZ complication. Recognizing this entity is crucial, as it typically resolves spontaneously without surgical intervention. This case aims to enhance awareness of this exceptional clinical manifestation.

Jejunogastric intussusception associated with jejunojejunal intussusception (double telescoping) occurring 20 years after gastrojejunostomy.

INTRODUCTION: Jejunogastric intussusception (JGI) is a rare but potentially lethal complication following gastrectomy or gastrojejunostomy surgeries. Diagnosis of this condition can be challenging due to its rarity and non-specific symptoms. This article presents a case report of a 60-year-old male with a history of trans mesocolic gastrojejunostomy who developed acute symptoms of JGI. CASE REPORT: The patient presented with acute epigastric pain, vomiting, and hematemesis. Physical examination and laboratory tests indicated dehydration, tachycardia, and leukocytosis. Computed tomography (CT) revealed intussuscepted loops within the stomach. Emergency laparotomy was performed, and the intussusception was manually reduced without the need for resection. The patient recovered well and was discharged five days post-surgery. DISCUSSION: Retrograde jejunogastric intussusception is a rare complication, often occurring years after gastric surgery. It can be classified into acute and chronic forms, with the former presenting with intense pain and potential hematemesis. The condition can arise in different surgical contexts and even spontaneously. The cause of JGI remains unclear, but factors such as hyperacidity, abnormal motility, and increased intra-abdominal pressure have been implicated. Diagnosis can be made through endoscopy or alternative imaging modalities such as CT. Surgical intervention is the treatment of choice, with various options available based on intraoperative findings. CONCLUSION: Retrograde jejunogastric intussusception is challenging to diagnose and treat due to its rarity and lack of understanding of its causes. Imaging techniques and endoscopy play important roles in diagnosis, while surgery remains the primary treatment option. Vigilance is necessary among medical professionals to consider JGI in cases of acute abdominal pain and vomiting following gastric surgery, allowing for prompt diagnosis and intervention to prevent bowel necrosis. Further research is needed to establish optimal surgical strategies and evaluate recurrence rates.

A uterine fibroid presenting as an incarcerated epigastric hernia: a case report and review of the literature.

BACKGROUND: Uterine fibroids incarcerated in abdominal wall hernias during pregnancy are rare, with only six cases reported in umbilical hernias. This case report presents the first reported case of an incarcerated uterine fibroid in an epigastric hernia. CASE PRESENTATION: A 31-year-old primigravid Caucasian woman at 28 weeks gestational age presented with sudden onset abdominal pain and vomiting. Physical examination revealed an incarcerated epigastric hernia containing a non-reducible firm mass. Ultrasound showed a healthy fetus, and during surgery, a subserosal and sessile fibroid originating from the anterior uterine wall was found in the hernia sac. It was easily reduced, and the hernia was repaired with no complications. The patient proceeded to deliver a healthy baby boy by cesarean section at full term. CONCLUSION: Uterine fibroids incarcerated in abdominal wall hernias during pregnancy are rare and affect mostly primigravid women in the third trimester. Abdominal ultrasound may facilitate the diagnosis, and pedunculated fibroids may be resected while sessile fibroids should be simply reduced. Clinicians should consider incarcerated fibroid as a differential diagnosis in pregnant women with irreducible ventral abdominal wall hernias. This case report aims to contribute to the literature and optimize the management of abdominal wall hernias in pregnant women.

Dropped gallstone-related perihepatic abscess 20 years after open cholecystectomy.

INTRODUCTION: Gallstone spillage during cholecystectomy is a recognized complication that can lead to various postoperative complications. CASE PRESENTATION: We present a rare case of a gallstone abscess that developed 20 years after an open cholecystectomy. An 80-year-old woman with a history of high blood pressure and previous gallbladder removal presented with severe abdominal pain. Imaging revealed a large abscess with a suspicious calcification, indicating a lost gallstone. Surgical intervention was performed, resulting in the removal of multiple gallstone fragments from the abscess cavity. CLINICAL DISCUSSION: Gallbladder perforations and the spillage of gallstones are common complications during cholecystectomies, with laparoscopic procedures being more prone to stone spillage. Studies show a significant difference between open and laparoscopic cholecystectomies, with laparoscopy having a higher risk of spilled stones. Complications from spilled gallstones are rare but can vary in presentation and location. They may lead to long-term issues such as abscesses and even erosion into other organs. These complications can manifest years after surgery. Treatment involves evacuating the abscess and addressing the gallstone. Surgical intervention, like laparotomy or laparoscopy, is required for retrieval. Ensuring proper traction during surgery is crucial to prevent gallbladder perforation and stone spillage. Consideration of alternative, gentler instruments for traction may be beneficial. CONCLUSION: Surgeons should be vigilant, proactive, and employ prophylactic measures to minimize complications related to gallstone spillage, ensuring the best possible patient outcomes.

Amoeboma of the gallbladder mimicking a cholangiocarcinoma: A case report.

INTRODUCTION AND IMPORTANCE: Amoeboma is a pseudotumoral presentation of amebiasis which is a parasitic infection caused by entamoeba histolytica. Its location in the gallbladder is extremely rare. Indeed, only one other case was found in the literature. Therefore, we present this case report on managing a gallbladder amoeboma mimicking a cholangiocarcinoma. CASE PRESENTATION: A 62-year-old presenting for consultation for biliary colic that has been developing for 4 months without associated signs. MRI and thoraco-abdominal CT concluded to a cholangiocarcinoma of the gallbladder extended to the liver with probable localized peritoneal carcinosis. We, therefore, performed extended cholecystectomy with lymphadenectomy for the diagnosis of cholangiocarcinoma. Pathology concluded to an amoeboma of the gallbladder extended to the liver and duodenum. CLINICAL DISCUSSION: To our knowledge, there is only one case of gallbladder amoeboma in the literature making this case report valuable. It is important to draw lessons of this observation. Indeed, in front of the discrepancy between the clinic, biology (good general condition and negative tumor markers) and the imaging, we prefer this therapeutic strategy: make a biopsy of the hepatic parenchyma, realize amoebic serology to confirm the diagnosis. Then subject the patient to a therapeutic test based on metronidazole and confirm the disappearance of suspicious lesions by CT scan. CONCLUSION: Gallbladder amoeboma is an exceptional entity, but it needs to be kept in mind in case of an atypical presentation of a cholangiocarcinoma. Evoking and confirming the diagnosis preoperatively makes it possible to avoid excessive surgery.