Post appendectomy young male proffer intussusception unveiled diffuse large B-cell lymphoma non-Hodgkin lymphoma

Intussusception is the telescoping of the proximal segment of the intestine within the lumen of the adjacent segment. Adult intussusception is rare and its aetiology differs from paediatrics. Surgery is highly recommended and challenging considering the possibility of carcinoma. Post-operative intussusception is a rare and bizarre complication. We report an 18-year old male who had undergone uncomplicated appendectomy outside the institute with missed histopathological examination (HPE) report, presented with abdominal pain for 1 week, vomiting 4 days, obstipation 1 day. On examination ovoid mass of size (12×7 cm) in right hypochondrium. A plain abdomen radiograph shows dilated bowel loops. Contrast-enhanced computed tomography (CECT) abdomen and pelvis showed telescoping of small bowel into the caecum. Suggestive of post-appendectomy intussusception causing intestinal obstruction, emergency laparotomy revealed telescoping of ileum into caecum, acting as the leading point of intussusception, proceeded with right hemicolectomy and ileo-transverse anastomosis. With blindsiding HPE defining high grade diffuse large B cell lymphoma, immunohistochemistry stains nuclear positivity for cluster of differentiation-20 (CD-20) >80%, and Ki-67 >90%. Surgery plus chemotherapy is warranted being a high-grade tumour. Surgery must be restricted to the primary tumour, with mesenteric lymph node involvement based on oncological principles. Laparoscopic approach is preferred nowadays.

A rare case of iliopsoas hematoma in a patient with von Willebrand disease

Iliopsoas hematoma is a serious complication that can occur in bleeding disorders, most commonly hemophillia but it can also be seen in von Willebrand disease (vWD) in less frequency. This can cause muscle pain, muscle dysfunction and sometimes even femoral nerve palsy. Iliopsoas hematomas can be diagnosed by the usage of ultrasonography, computed tomography (CT) or magnetic resonance imaging (MRI). Here we report a case of a 20-year-old boy who presented to us with complaints of pain in the right lower quadrant, flank, and inguinal region for a week. He was diagnosed with vWD type 3 when he was 10 years old. The symptoms started after he had tried to kick start his motorbike vigorously. Clinical examination revealed the patient to be in an anti-pain posture and to have tenderness at sites where he complained of pain. A subsequent CT scan showed that there was an iliopsoas hematoma of size 10×6 cm. The patient was managed conservatively with factor replacement and physiotherapy following which there was amelioration in the symptoms and the patient recovered well.