ERCP in a patient with Billroth II gastrectomy: a rare case report.

Introduction: Gangrenous cholecystitis is a serious complication of untreated gallbladder inflammation, necessitating immediate intervention. The primary resolution involves cholecystectomy, the surgical removal of the gallbladder.The Billroth II gastrectomy, named after Theodor Billroth, addresses gastric conditions by removing a portion of the stomach and reconnecting the remaining section to the small intestine.Endoscopic retrograde cholangiopancreatography (ERCP) is a minimally invasive procedure that diagnoses and treats bile duct and pancreatic duct disorders, using an endoscope to access the ducts, administer contrast dye, and perform interventions like stone removal and stent placement. It aids in managing conditions such as bile duct stones, strictures, pancreatic tumors, and pancreatitis. Case report: A 25-year-old male with a history of gastric ulcer and Billroth II anastomosis presented with right hypochondrium pain, fever, and vomiting. Examination and imaging indicated gallbladder edema, abscess, and fluid collection. Laparotomy revealed severe adhesions around the gallbladder, which were released, and an abscess was drained. Postsurgery, a biliary fistula was suspected, leading to the proposal of an ERCP procedure. During ERCP, a plastic stent was inserted to aid bile drainage. Discussion: Therapeutic ERCP effectively treats biliary exudate, including in patients with Billroth II gastrectomy. Using a side-viewing duodenoscope simplifies accessing Vater's papilla. This successful procedure had no complications, such as pancreatitis or bleeding, and the patient remained stable. Conclusion: ERCP in patients with a prior Billroth II gastrectomy is a risky procedure with potential complications. However, it can be considered as an alternative to avoid additional surgery if performed by experienced specialists with the necessary equipment.

Early pyeloplasty and excision of a multicystic kidney in a neonate with a complicated nephrostomy: A case report.

The association of multicystic renal dysplasia with ureteropelvic junction obstruction is noteworthy in newborn. However, the possibility of conservative management is still a primary requirement, unless there are complications that suggest surgery. The authors are studying a case of a newborn in which an incorrect nephrostomy led to complications that required emergency surgery. Case Presentation: A newborn girl with left-side ureteropelvic junction obstruction and an enlarged and multicystic right kidney was operated on at an early age by unexpert hands, leading to complications. Was monitored daily, and an emergency procedure was done. Following up shows the success of the emergency operation. Clinical Discussion: The age and the precise timing of intervention are controversial. In this case, several postnatal diagnostic tests were made due to the severity of the hydronephrosis in the antenatal period, which resulted in the implementation of percutaneous nephrostomy. Conclusion: Authors suggest that it is better to not operate as long as the patient's condition is stable.

Unusual cause of chronic abdominal pain in a 17-year-old female: a case report of an epithelial adrenal cyst.

Adrenal cysts are rare lesions that make up 4% of all adrenal masses. They are often found incidentally during imaging or surgery and can vary in symptoms depending on their size and location; with cysts < 10 cm often being asymptomatic. These cysts are more common in adults in their 30s or 60s and can be divided into four histological subtypes, with epithelial cysts being less common. We present a case of a 17-year-old female who experienced recurrent right flank pain for a year. Ultrasonography revealed a cystic mass on the right kidney, and computerized tomography showed a well-defined suprarenal cyst measuring ~8 cm misdiagnosed as mesenteric cyst. However, during laparoscopy, an adrenal cyst was discovered, which was excised along with the right adrenal gland. Histopathology confirmed the diagnosis of an epithelial adrenal cyst. This case highlights the occurrence of adrenal cysts in younger individuals and the uncertainty of preoperative diagnosis.

A rare cause of small bowel diaphragm disease presenting with palpated abdominal mass.

Small bowel diaphragm disease is a rare complication related to non-steroidal anti-inflammatory drug (NSAID) use. It presents with non-specific symptoms such as vomiting, abdominal pain, subacute bowel obstruction and occasionally as an acute abdominal condition. We report a case of diaphragm disease in a 33-year-old female who presented with vomiting, constipation and abdominal pain started 5 days earlier. Physical examination revealed palpated abdominal mass. The patient's past medical history was remarkable for NSAID use. The patient was managed by surgical resection of involved intestine and diagnosis was confirmed by histological examination. Although there are few published cases of diaphragm disease in the medical literature, we recommend that this disease should be considered as one of the differential diagnoses when assessing patients presenting with non-specific abdominal symptoms with remarkable past medical history of NSAID use.