Intrabiliary Rupture of a Hepatic Hydatid Cyst: A Case Report.

BACKGROUND Hydatid disease is a common parasitic infection in many areas of Asia, South America, and Africa. It can affect any organ, most commonly the liver. The hydatid is often asymptomatic and the diagnosis is made when complications arise. The most common complication of this disease is opening in the bile ducts, which is a life-threatening condition causing serious acute cholangitis. We report a case of acute cholangitis caused by hydatid cyst rupture into the right bile duct. CASE REPORT A 33-year-old woman, with no medical or surgical history, presented to our Emergency Department with abdominal pain, jaundice, and fever for 3 days prior to admission. The patient was hemodynamically stable. In the examination, we noticed right upper-quadrant tenderness with guarding, icterus sclera, and negative Murphy sign. A CT scan showed a liver hydatid cyst of the 4th and 8th of segments, with intrahepatic and extrahepatic biliary duct dilation. The cyst communicated with the right hepatic bile duct via a large fistula. A diagnosis of acute cholangitis was made and she underwent conservative treatment with external drainage of the pericystic cavity through the biliary duct. The postoperative course was uncomplicated and she was discharged 15 days later. CONCLUSIONS The surgical approach to hepatic hydatid must be customized based on the specific characteristics of the cyst and associated complications. Acute hydatid cholangitis is a rare but serious complication of a hydatid cyst, which requires early diagnosis and adequate surgical management.

Ileocecal colonic intussusception with adenocarcinoma: A rare case report and management strategy.

INTRODUCTION AND IMPORTANCE: Intussusception, a condition primarily seen in pediatric populations, involves the telescoping of one segment of the bowel into an adjacent section. In adults, intussusception is rare and presents unique diagnostic and management challenges. This case report highlights a 73-year-old female with ileocecal colonic intussusception complicated by an underlying adenocarcinoma, emphasizing the need for early diagnosis and a multidisciplinary approach. CASE PRESENTATION: A 73-year-old female with a history of hypertension and type 2 diabetes presented with right-sided abdominal pain, nausea, and vomiting. Physical examination revealed tenderness in the right upper quadrant, and no palpable mass or rectal bleeding. Lab results, including tumour markers, were normal. Multi-detector computed tomography (MDCT) identified ileocecal colonic intussusception with the "target sign" and low colonic wall enhancement. An emergency laparoscopic right colectomy was performed due to compromised blood supply. Postoperatively, an anastomotic leak was managed with antibiotics, bowel rest, and wound care. Pathological examination revealed cecal adenocarcinoma with one positive lymph node, staged as T3N1aM0, necessitating adjuvant chemotherapy. CLINICAL DISCUSSION: Adult intussusception, a rare condition, often has an identifiable organic cause, with clinical symptoms ranging from acute to chronic or asymptomatic. Diagnostic imaging, such as MDCT, plays a crucial role in diagnosis and evaluation. Surgical management varies based on the nature and location of the lead point. In this case, the chronic symptoms, lymph node as the lead point, and low colonic wall enhancement warranted an urgent laparoscopic right colectomy with complete mesocolic excision. CONCLUSION: This case underscores the complexity of adult ileocecal colonic intussusception, especially when associated with adenocarcinoma. Timely diagnosis, multidisciplinary collaboration, and meticulous surgical intervention are essential. Effective management of postoperative complications, like the anastomotic leak, is crucial.

Hydatid peritonitis caused by liver hydatid cyst rupture into the peritoneal cavity: A case report.

INTRODUCTION AND IMPORTANCE: Hydatid disease predominantly affects the liver and poses a global health concern in regions with significant livestock presence. Hydatid peritonitis, a rare complication, arises when a liver hydatid cyst ruptures into the peritoneal cavity, posing a potential threat to the patient's life. CASE PRESENTATION: We present a case of a 45-year-old female with abdominal distension, tenderness, and altered general status following an abdominal contusion. Imaging revealed ruptured hydatid cysts in the liver, causing complicated hydatid peritonitis. Emergency laparotomy and various surgical procedures, including cyst evacuation, cholecystectomy, and drainage placement, were performed. The patient's postoperative recovery was uneventful with albendazole therapy. CLINICAL DISCUSSION: Rupture of liver hydatid cysts into the peritoneal cavity is a rare but serious complication, affecting 1 % to 16 % of cases. Factors contributing to rupture include young age, cyst diameter exceeding 10 cm, and superficial lesion location. Clinical presentation varies, and prompt diagnosis through imaging, such as CT scans, is crucial. Surgical intervention is the primary management, focusing on cyst removal, prevention of anaphylactic shock, and peritoneal lavage with scolicidal solutions. CONCLUSION: The rupture of liver hydatid cysts into the peritoneal cavity is a rare but potentially life-threatening complication. Early diagnosis and emergent surgical intervention are critical for improved outcomes. Postoperative albendazole treatment and close follow-up contribute to reducing recurrence risk. Public health measures, including hygiene practices and canine vaccination, play a crucial role in preventing the spread of hydatid disease. Early detection and intervention can mitigate complications and enhance outcomes in hydatid disease cases.

Colocutaneous fistula due to an infected sigmoid adenocarcinoma: A case report of an unusual revelation.

INTRODUCTION AND IMPORTANCE: As revealed as a colocutaneous fistula with an abscess in the abdominal wall, colon cancer is rare. It should be suspected in case of a painful abdominal wall mass in elderly patients. This case presentation of an infected sigmoid adenocarcinoma aims to highlight this uncommon presentation presenting some therapeutic issues. CASE PRESENTATION: A 90-year-old woman with a past medical history of hypertension and major depressive disorder consulted the Emergency Department for lower left quadrant abdominal pain. The physical examination objectified a mild fever; lower left abdominal quadrant guarding, and abdominal mass of 10 cm with inflammatory signs. The abdominal CT scan showed a concentric thickness of the sigmoid colon with an abdominal wall abscess. She underwent an emergent laparotomy. Intraoperatively, we found an infected sigmoid tumour that invades the abdominal wall and is associated with a peritumoral abscess. This tumour was at the origin of the abdominal wall fistula. She underwent surgical drainage of the abscess, sigmoid colectomy, and colostomy. The postoperative follow-up was uneventful. The pathological examination of the operative specimen concluded with a colonic adenocarcinoma with lymph node invasion classified as pT4N2M0. CASE DISCUSSION: Despite initial medical and radiological interventions, emergent surgery became necessary to address the infected sigmoid tumour invading the abdominal wall. Pathological examination revealed advanced cancer, but timely intervention and adjuvant therapy resulted in a positive outcome with no recurrence after two years. This case emphasizes the importance of recognizing unusual colon cancer presentations and the need for swift diagnosis and intervention. CONCLUSIONS: The diagnosis of colon cancer complicated with a colocutaneous fistula remains based on pathological examination after surgical management. These tumours presented an advanced stage and correlated to a poor prognosis. This highlights the interest in screening colonoscopy in front of any digestive symptoms in elderly patients.

A case report of abdominal wall hydatidosis: An uncommon location.

Liver hydatid cyst fistulized in the abdominal wall is rare. The clinical symptoms were often misleading. It often poses a problem of seat diagnosis rather than a problem of its hydatid nature despite the great contribution of modern imagery. We reported this uncommon case to highlight the difficulties of preoperative diagnosis and a better operative approach. 46-year-old men consulted for right flank pain. The clinical exam revealed a right flank subcutaneous mass. An abdominal CT scan showed multicystic lesions on the right flank. The MRI showed multiple cystic lesions on the right flank with several endophytic and exophytic daughter cysts. The patient was operated on. A wide excision was adopted to remove all the cystic lesions. The postoperative follow-up was uneventful. Abdominal subcutaneous hydatid cysts cause a diagnostic problem and the treatment is controversial. Surgery remains the only curative treatment. It avoids the risk of complications such the fistula, infection, and rupture.

Upper gastrointestinal haemorrhage caused by duodenal metastasis from primary lung cancer: A case report.

Duodenal metastases from primary lung carcinoma are uncommon. They usually occur in terminal-stage disease. Bleeding, as the first presentation of duodenal metastases, is rare. This case reports a rare mechanism of upper gastrointestinal bleeding due to a metastatic involvement of the duodenum and gastroduodenal artery. A 58-year-old man with a past medical history of pulmonary carcinoma presented an episode of hematemesis of great abundance with melena. On physical examination, he was afebrile and pale. The biological data found an anaemia with haemoglobin at 6 g/dL. The upper gastrointestinal endoscopy revealed a congestive duodenal lesion with signs of recent bleeding. An angio CT scan localized the bleeding from the gastroduodenal artery. A few hours later, the patient presented a recurrent episode of hematemesis with deglobalization. So we performed a radiologic embolization of the gastroduodenal artery. Haemorrhage as the first presentation of small bowel metastases is rare, especially when these are located in the duodenum, with a poor prognosis. Radiological embolisation could be the best choice for treatment.