Large pedunculated colonic lipoma: a rare cause of colorectal intussusception in adults.

Colo-rectal intussusception is rare in adults and is often secondary to malignant lesions, rarely benign lesions such as colonic lipomas can also be the cause. We present the case a 60-year-old man who presented to the emergency department with acute abdominal pain. On physical examination, the abdomen was distended with diffuse tenderness. CT scan of the abdomen revealed a colo-rectal intussusception secondary to a rectal lipoma with parietal pneumatosis of the invaginated loop. An emergency laparotomy was performed. Intraoperatively the radiological findings were confirmed. A rectosigmoid resection (Hartmann's procedure) taking off the lipoma and the invaginated segment of the colon was performed and the patient had an unevent full recovery. Histopathology confirmed a 6cm sub-mucosal lipoma without evidence of malignancy. As the diagnosis of a benign disease in patients presenting with colonic intussusception can only be made on pathological examination, this entity should be managed as a malignant lesion due to the high incidence of malignancy.

[Gastric necrosis secondary to gastric volvulus complicating hiatus hernia]. / Nécrose gastrique secondaire à un volvulus gastrique compliquant une hernie hiatale.

Acute gastric volvulus is a rare condition complicating 4% of hiatus hernias. It is a more or less complete rotation of the stomach around a transverse or longitudinal axis. It can lead to perforations due to ischemic gastric wall necrosis with very poor prognosis (30% of mortality). We here report the case of an 89-year old female patient with chronic bronchopathy, presenting with epigastralgias associated with vomiting which had progressed for 03 days. Physical examination showed febrile patient at 38.5 with dyspnea (SpO2 88% at room air). Her appearence suggested infection, the abdomen was soft, tender at the level of the epigastrium. Laboratory test showed SBI (WBCs= 22000, CRP= 80). Abdominal CT scan showed hiatus hernia associated with significant gastric distension with wall defect in the anterior face of the stomach associated with pneumatosis in the gastric wall. The patient underwent surgery using a median approach, which showed voluminous hiatus hernia containing the greater curvature of the stomach. Distended stomach was restored to its normal intra-abdominal position. The anterior face of the greater tuberosity was the seat of several areas of necrosis. Total gastrectomy with manual oesojejunal anastomosis associated with Roux-en-Y gastric bypass was performed. The postoperative course was complicated by acute respiratory distress syndrome (ARDS). The patient died on day 8 after emergency hospital admission. Gastric volvulus is a rare condition, which can lead to extremely severe consequences. CT scan allows for thoracic lesion assessment and to study stomach vitality. The treatment of choice is based on surgery.

Surgical management of groove pancreatitis: a case report.

Groove pancreatitis (GP) is a rare form of chronic pancreatitis involving the groove area bound by the pancreatic head, the duodenum, and the common bile duct. The diagnosis of this entity is challenging since it can mimic pancreatic carcinoma. We herein report the case of groove pancreatitis diagnosed in a 37 year old men, with a past history of chronic alcohol consumption. The patient was admitted for several times over the past three years because of recurrent alcohol-induced pancreatitis. The diagnosis of groove pancreatitis was made on the basis of CT, MRI and EUS findings. A medical treatment was initially attempted. In the absence of improvement in clinical symptoms, a pancreatico-duodenectomy was performed with satisfying results at 24 months follow up. Pancreatico-duodenectomy is the treatment of choice in groove pancreatitis since it leads to total resolution of clinical symptoms.

Gallbladder agenesis in the elderly: a diagnostic challenge.

Gallbladder agenesis (GA) is a rare congenital malformation characterized by the absence of the gallbladder and cystic duct due to an anomaly in the embryonic development. It is commonly associated with other congenital abnormalities, and the isolated form is extremely rare. Its clinical presentation is variable. Actually, GA is more often incidentally diagnosed. Magnetic resonance cholangiopancreatography (MRCP) is considered to be the diagnosis method of choice since it avoids unnecessary and risky surgery in symptomatic patients. Here we report the case of a radiologically incidentally discovered gallbladder agenesis in a 68-year-old patient.