A Rare Cause of Duodenal Obstruction: Spontaneous Intramural Duodenal Hematoma Caused by a Hemangioma

Small bowel hemangioma is a rare benign lesion, and it usually presents with bleeding or as a leading point of an intussusception. However, obstruction due to intramural hematoma by this lesion is unusual. Intramural hematoma of the duodenum is also an uncommon lesion, and it is usually a complication of blunt abdominal trauma in children and young adults. We present here a case of an intramural hematoma that was caused by spontaneous bleeding of a hemangioma, and this caused duodenal obstruction.

Hydrocele of the Canal of Nuck

In females, a small evagination of parietal peritoneum accompanies the round ligament through the inguinal ring into the inguinal canal and is called the canal of Nuck; it is homologous to the process vaginalis in males. If it fails to undergo complete obliteration, an indirect inguinal hernia or a hydrocele of the canal of Nuck can occur. We report three cases of this rare developmental disorder, discuss the CT findings and its use in the diagnosis of a hydrocele of the canal of Nuck.

Clinical Findings of Appendiceal Mucocele

PURPOSE: A mucocele of the appendix is an uncommon pathology, representing 0.2% to 0.3% of all appendix specimens. It is often diagnosed clinically as a result of its ability to cause signs and symptoms similar to those of acute appendicitis. If it is asymptomatic, it is often detected as an incidental finding during ultrasonography, computed tomography, radiographic examination of the gastrointestinal tract, or laparotomy. The purpose of this study was to identify the clinical features of mucocele of the appendix. METHODS: We describe 35 cases of mucocele of the appendix diagnosed at Uijeongbu St. Mary's hospital between January 1993 and December 2006. We analyzed demographic, clinical, and pathologic data of all the cases. RESULTS: A total of 12 males and 13 females with mean age of 54.7+/-14.9 years are described. The peak incidence occurred in the seventh decade (34.3%). Sixteen patients presented with symptoms and signs similar to those found in acute appendicitis. Ten patients complained of a palpable mass, 2 patients complained of non-specific abdominal pain, and 7 patients were asymptomatic. Fourteen cases were diagnosed preoperatively, and 3 cases were discovered incidentally. Pathologic examination revealed mucosal hyperplasia in 20% of the cases, cystadenoma in 71%, and cystadenocarcinoma in 9%. The mean age of cystadenocarcinoma patients was older than the mean age of mucosal hyperplasia patients, and the diameter of the appendix was larger in cystadenoma patients than in mucosal hyperplasia patients. CONCLUSION: The preoperative diagnosis of appendiceal mucocele is very important to make in order to facilitate treatment planning and avoid inadvertent rupture of the mucocele during operation. We recommend more diagnostic studies in cases of suspected mucocele. Mucocele of the appendix must be included in the differential diagnosis of patients with pain in the right iliac fossa, patients older than 40 years of age, patients suffering from long-term symptoms, and patient with a palpable mass in the right iliac fossa.

Primary Retroperitoneal Mucinous Cystadenoma

Primary retroperitoneal mucinous cystadenomas are rare tumors that are almost always found in women. They are similar to ovarian originated mucinous cystadenoma, but there is no any other evidence of an ovarian origin for primary retroperitoneal mucinous cystadenomas. A 33-year-old woman with complaints of RLQ pain was found to have a cystic mass in the right retroperitoneal space on her abdominal CT scan. The histological diagnosis was confirmed as primary mucinous cystadenoma. We report here on a case of retroperitoneal mucinous cystadenoma, and we also talk about this tumor, including its histogenesis, through a review of the available literature.