Intestinal obstruction due to giant liver cyst: A case report.

BACKGROUND: Congenital hepatic cysts are relatively rare but are now diagnosed earlier and more frequently with a routine prenatal ultrasound. Solitary liver cysts are divided into simple and solitary intrahepatic biliary cysts, depending on the biliary connection. While some solitary liver cysts are symptomatic in childhood, even in newborns, they are often found incidentally in adults. CASE SUMMARY: A 3-mo-old female infant was admitted to Mogadishu Somali Training and Research Hospital with recurrent vomiting, respiratory problems, and abdominal bloating complaints. On examination, the abdomen was greatly distended and extremely tight. She had repeated vomiting for 3 d, no stool output, and decreased urine. The abdominal ultrasonography detected a solitary cystic lesion measuring 10 cm × 10 cm × 14 cm, extending from the liver or right kidney to the pelvis. In the magnetic resonance imaging examination of the patient, a solitary cystic structure of 10 cm × 10 cm × 14 cm in the right abdomen was observed, extending to the pelvis and possibly originating from the liver. The patient was operated via fenestration after her fluid and electrolytes improved. Oral nutrition was initiated on the 2nd postoperative day, and the drain was removed on the 5th postoperative day. The patient visited the outpatient clinic control 1 mo later with no clinical complaints. CONCLUSION: Congenital liver cysts are usually followed without complications. They rarely reach gigantic dimensions and may cause respiratory distress, intestinal obstruction and recurrent vomiting. Surgery can provide quite successful outcomes in the treatment of giant sized simple liver cysts.

A strangulated umbilical hernia with perforated Meckel diverticulum: Case report.

INTRODUCTION AND IMPORTANCE: Meckel's diverticulum (MD) is one of the most common gastrointestinal anomalies and affects 2-3 % of the population. Strangulated umbilical hernia with a perforated Meckel diverticulum is an extremely rare event. CASE PRESENTATION: We reported here a case of one year old boy of a strangulated umbilical hernia with perforated MD that operated at the Mogadishu hospital. A wedge resection of the MD and anastomosis was performed. CLINICAL DISCUSSION: MD is one of the most common gastrointestinal anomalies and affects 2-3 % of the population. About 60 % of cases come to medical attention before the age of ten, with the remainder of patients presenting in adolescence and adulthood. It is more difficult to diagnose in males, especially in adulthood. CONCLUSION: Being aware of the likelihood that there could be a perforated Meckel's diverticulum in a sac of strangulated umbilical hernia has notable importance and may lead to innovative treatment and postoperative rehabilitation modalities.

A presentation of iatrogenic hypospadias after traditional circumcision: A case report.

Introduction and Importance: Traditional circumcisions may cause complications such as hemorrhage, infection, amputations of the penis, meatal stenosis, and urethro-cutaneous fistula. In addition to all these complications, iatrogenic hypospadias, as in our case, is a rare condition. In general, complications are mild and preventable, especially in children, but when the procedure is carried out by unskilled providers, in unsterile conditions, or with inadequate equipment and supplies, severe complications are more likely to occur. Several degrees of urethral erosion, including iatrogenic hypospadias, might result from further injury. Particularly in intensive care facilities, the ventral male urethra can undergo this kind of trauma. Case presentation: A 4-year-old child was circumcised at the age of 3 years, and after that, he bled profusely. His parents brought him to the hospital after 4 months. On physical examination of the patient, the glans was normal but there was an opening near the glans in the distal urethra at the subcoronal level. After the pre-operative check-up, the patient was prepared for elective surgery. An incision and dissection were performed to reveal the fistula tract all around by placing marker sutures from the edges of the fistula. The fistula opening was repaired with 6/0 PDS (polydioxanone) and a second layer was created over the urethral fistula repair, and then the skin was closed with 4/0 Vicryl (polyglactin). Clinical discussion: Around the world, circumcision continues to be the most common procedure done on children. Injuries to the penis may actually happen with a 1% complication incidence. A poorly placed suture at the frenulum in an effort to achieve hemostasis is the most frequent cause of the fistula. This causes strangulation and necrosis of a portion of the urethral wall, which leads to the creation of a sub glandular fistula. It is important to properly identify and treat any life-threatening injuries to the urethra as soon as possible. Conclusion: Considered a medical procedure that necessitates great care, circumcision should only be carried out by qualified surgeons under sterile hospital circumstances. Most circumcision-related injuries result from clamp circumcisions (such as Mogen or Gomco), and they can range from minor loss of penile skin to more serious glans, distal urethral, and penile shaft injuries.

Lemierre's syndrome with cranial epidural abscess complication: A case report.

Introduction: Lemierre's syndrome is a rare disease typically manifested by thrombophlebitis of the jugular vein and septic embolism following a history of oropharyngeal infection. Fusobacterium necrophorum is the causative agent of Lemierre syndrome, commonly known as post-anginal sepsis. Case presentation: We reported a 24-year-old male who came to the emergency department complaining of a history of a sore throat, fever, malaise, fever, and neck swelling with a normal consciousness level. A laboratory examination showed leukocytosis and high C-reactive protein serum. Radiological diagnosis reveals an anterior neck abscess with left jugular vein thrombosis and left epidural abscess. The blood culture was positive for Fusobacterium necrophorum. The patient underwent surgical drainage and, at the same time, was treated with antibiotics and anticoagulant drugs. After 45 days, the patient improved clinically and was discharged. There were no other symptoms after a one-month follow-up clinically and neck ultrasonography. Clinical discussion: Lemierre's syndrome has historically had a high mortality rate, approximately up to 90% before antibiotics. The disease's incidence has declined gradually, leading it to become recognized as the "forgotten disease." Nevertheless, the incidence of Lemierre syndrome has been increasing over the last twenty to thirty years. Primary oropharyngeal infection, bacteremia, radiographic or clinical evidence of internal jugular vein thrombosis, and septic metastatic foci are the main clinical hallmarks of Lemierre's syndrome. Surgical debridement, antibiotics, and anticoagulants are the treatments of choice. Conclusion: Lemierre's syndrome with cranial epidural abscess is very rare. It is a forgotten disease. Nowadays, the prevalence is increasing. Awareness of clinical and radiological features will aid the prompt management of patients.

A case of empyema necessitans in an adolescent with mycobacterium tuberculosis.

Introduction and importance: An empyema is a buildup of pus in the pleural space and is most commonly associated with pneumonia. Streptococcus pneumonia is the most common cause of pneumonia, although staphylococcus aureus is common in developing countries. empyema necsitans is An extravasation of purulent material outside the pleural space involving the chest wall. Case presentation: Here we present a 15-year-old girl presented with swelling on the right thorax wall. I was told that the swelling had been there for 1 year with moderate discomfort upon lifting objects, with no other complaints. Her medical history was unremarkable until the mass appeared. There was no history of fever, cough, or weight loss, and there was no family history of tuberculosis. Clinical discussion: Empyema necessitatis can be quite harmful. It has the potential to cause bone and soft tissue erosion. This may be asymptomatic at first and proceed at a slow and steady pace. Tuberculous EN can be treated with both surgical and medical treatments. This case applies to both surgical intervention and medical treatment with antituberculosis. Conclusion: Empyema necessitans is uncommon consequence of pleural space infection. pulmonary mycobacterium tuberculosis, Actinomyces, and nontuberculous organisms such Staphylococcus aureus are the most prevalent causes.

Rare case cystic scrotal lymphangioma presented as a hydrocele.

INTRODUCTION AND IMPORTANCE: Cystic scrotal lymphangiomas are very uncommon lesions caused by congenital lymphatic malformation. These tumors are usually located in the neck and axilla, occasionally in the mediastinum, retroperitoneum, and thigh. The scrotum and perineum are the least frequented sites. They present as painless scrotal swelling and are easily misdiagnosed as hydrocele. We present here a case of cystic scrotal lymphangioma in a school-aged child who presented to us with a massive scrotal swelling. CASE PRESENTATION: We present here a case of a 6-year-old child who presented with scrotal swelling, which was sonographically identified as chronic hydrocele. The right testis could be felt separately from the mass, and the left scrotum was normal. Scrotal ultrasound reveals multiple cystic lesions with septa in the right hemiscrotum extending to the proximal inguinal canal. Median raphe incision and excision of the lobulated mass Cyst testicular lymphangioma was confirmed histopathologically. CLINICAL DISCUSSION: Cystic lymphangiomas are benign congenital tumors with no identifiable cause. The majority of lymphangiomas (90%) appear during the first two years of life, and half of them are present at birth. Lymphangiomas are categorized into three types: capillary, cavernous lymphangiomas, and cystic hygromas. A scrotal lymphangioma is frequently misdiagnosed as a hydrocele, inguinal hernia, hematocele, varicocele, or even testis torsion. In our case, the diagnosis was made by ultrasonography with Doppler and confirmed by a biopsy of an excised mass lesion. The scrotum is a very uncommon site for cystic lymphangioma. CONCLUSION: A cystic or septate cystic mass discovered intra-operatively should not be dismissed as a complex hydrocele, since cystic lymphangiomas predictably recur if incompletely resected. A proper diagnosis of the scrotal lymphangioma and its extent using the US is essential for planning an appropriate surgical approach.

Waardenburg-Shah syndrome rare and challenging case report from Somalia.

INTRODUCTION AND IMPORTANCE: Waardenburg-Shah disorder could be an uncommon autosomal recessive inherited ailment characterized by aganglionic megacolon with a high mortality rate. Babies born with Waardenburg syndrome may have typical features of hair, skin and eye pigmentary abnormalities, and hearing loss. Here we present a case with typical presentation of Waardenburg Shah syndrome. CASE PRESENTATION: This is a case of neonatal intestinal obstruction caused by a rare syndrome known as Waardenburg-Shah syndrome, with clinical manifestations of abdominal distension, bilious vomiting, and a history of delayed meconium passage with a family history of variant forms of this syndrome. The patients underwent first laparotomy, which found no atresia.post op colongarphy revealed a narrowed colon. Then reoperated, and a biopsy was taken and opened ileostomy. The pathology result showed gangilion negative. The patient was lost due to uncontrollable sepsis at the age of 2 months. CLINICAL DISCUSSION: Waardenurg syndrome is a congenital audito-pigmentary syndrome first described in 1951.Waardenurg syndrome is classified into four types, WS1 to WS4, and they share the common presence of congenital sensoneural hearing loss and pigmentary defects. The diagnosis of WS has major and minor criteria. The definitive management of this disorder involves surgical removal of aganglionic segment of the bowel and connecting functioning gangilioic bowel to the anus. CONCLUSION: Shah-Waardenburg syndrome TYPE-4 is a relatively unusual syndrome characterized by a higher prevalence of whole colonic aganglionosis with or without small bowel involvement, resulting in substantial morbidity and mortality in the neonatal age range.

Infrequent cause of small bowel obstruction in a child: A lemon.

Introduction: Small bowel obstruction in children induced by phytobezoar impaction is reported here. Bezoars are classified into four types: phytobezoars, trichobezoars, pharmacobezoars, and lactobezoars. We present here the first case of lemon shelves induced by small intestinal obstruction without previous gastrointestinal surgery and diagnosis was made erect abdominal x-ray. Case presentation: We present a case of a three-year-old boy who presented with a history of abdominal pain, distension, and bilious vomiting, for the preceding one week. The child had no previous history of gastric or intra-abdominal surgery. The definitive diagnosis was not known before the operation. The case was diagnosed at laparotomy and removed through a distal enterotomy. Clinical discusion: In surgical practice, small bowel obstruction is a prevalent problem. Phytobezoar is a rarely mentioned cause of mechanical small intestine obstruction, accounting for only 0.4-4% of all cases. The lemon shelves measuring 35 cm and 75 cm had impacted the terminal ileum of our patient, causing an obstruction that could only be discovered after an enterotomy as it was not feasible to be fragmented and milked into the cecum and an open appendectomy was performed because of the socio-economic reason. Conclusion: The total bowel obstruction is treated with both laparotomies and milking through the ileocecal junction or enterotomy and direct extraction.