ABSTRACT
Diffuse intestinal ganglioneuromtosis is a benign tumor of the enteric nervous system, that almost always occurs in children with systemic syndromes. Whereas isolated cases in adults are exceedingly rare. Case Presentation: A 38-year-old man presented with refractory chronic constipation. An abdominal computed tomography scan revealed a redundant sigmoid colon, then he underwent a sigmoid colectomy. Histopathologic examination showed diffuse ganglioneuromatosis. However, the patient was in good health 18 months after surgery. Clinical Discussion: Intestinal ganglioneuromas commonly occur in children with systemic syndromes such as multiple endocrine neoplasia type 2B and neurofibromatosis type 1. The most frequent symptoms are abdominal discomfort, constipation, ileus, weight loss, appendicitis, and obstruction in more severe cases. surgical resection is the standard management in diffuse ganglioneuromatosis. Conclusion: Although diffuse ganglioneuromatosis is uncommon, it should be considered in patients with refractory constipation.
ABSTRACT
Hydatidosis or Echinococcosis is a parasitic disease caused by infection with the larval stage of Echinococcus granulosus. Primary isolated pancreatic hydatidosis is very rare even in countries where echinococcosis disease is highly endemic. The objective of this case report is to highlight this unusual and rare hydatid cyst presentation to avoid incorrect diagnosis and management. In our case, preoperative evaluation guided the diagnosis toward cystic pancreatic neoplasms, leading us to contemplate a radical surgical approach (Pancreaticoduodenectomy). Pancreatic hydatid cysts can be confused with cystic pancreatic neoplasms, it should always be considered as a differential diagnosis in endemic areas, to prevent misdiagnosis and inappropriate management.
ABSTRACT
BACHGROUND: Since the first laparoscopic cholecystectomy report in situs inversus totalis in 1991, the safety of this procedure has still been questionable. A few surgeons were preferred to perform an open cholecystectomy due to technical difficulties as well as various anatomical varieties that can be faced during surgery. CASE PRESENTATION: We report a case report of a 50 years old patient came with epigastric pain that radiated to her left shoulder, intermittent nausea, vomiting and bloating after some meals. She did not associate her symptoms with fatty food. She was a known case of situs inversus totalis and had a previous laparoscopic Nissen fundoplication that we performed 5 years ago. A laparoscopic cholecystectomy was performed by a left-handed surgeon, illustrating challenges, technique, and the advantages of left-handed surgeon over right-handed ones. DISCUSSION: After the first discovery of situs inversus totalis by Fabricus in the 1600 the standard procedure for cholelithiasis was open surgery. The introduction of the first laparoscopic cholecystectomy in patients with situs inversus put surgeons in challenge for performing laparoscopic rather than open surgery for patients with situs inversus diagnosed with gallbladder disease. Only 67 cases used laparoscopic cholecystectomy in treating situs inversus patients with cholelithiasis. Although technical difficulties and expected anatomical variation are the main challenges in those patients, the current literature confirms the safety of laparoscopy in such cases. CONCLUSION: Despite having all these difficulties, handling this type of operations can be safe and uneventful especially with experienced surgeon.
