A rare case of bilateral synchronous renal cancer, characterized by distinct histologies; leiomyosarcoma and clear cell renal cancer.

INTRODUCTION: Renal cancer is a significant global cause of death and clear cell being the most common subtype. Bilateral synchronous renal cancers with different histologies are extremely rare and less reported. Managing bilateral renal cancer is challenging. CLINICAL PRESENTATION: A 51-year-old woman with a history of hypertension and hypothyroidism presented with right loin pain, leading to the discovery of a 7 cm right renal mass and a 2.3 × 2.6 cm mass on the upper pole of the left kidney, associated with reactive right para-aortic lymph nodes. The right kidney mass was identified as leiomyosarcoma with liver metastasis while the left kidney mass was diagnosed as clear cell renal carcinoma. Patient was managed with right side nephrectomy, left side microwave ablation and follow-up chemotherapy. DISCUSSION: Primary leiomyosarcoma of kidney is extremely rare and aggressive, leading to poor outcome. Synchronous bilateral renal cancer pose surgical challenges due to potential loss of renal function. In this case of differing histologies in synchronous bilateral renal masses, a nephron-sparing approach was taken, but despite aggressive treatment, the patient developed metastases in the liver and peritoneum. CONCLUSION: Bilateral synchronous renal cancer, particularly with differing histologies in each kidney, are exceptionally uncommon, making their management challenging. Despite the limited guidance available due to their rarity, addressing these cases aggressively and promptly is crucial, as their prognosis is generally unfavorable, necessitating further research to advance management strategies.

Minimal invasive management of generalized peritonitis as a result of spontaneous ureteral rupture.

INTRODUCTION AND IMPORTANCE: Generalized peritonitis following proximal ureteral rupture is a very rare complication. This is about a successfully managed case without open surgical intervention. CASE PRESENTATION: A lady in her 70s presented with generalized abdominal pain, high spiking fever and low urine output for 3 days. She was haemodynamically unstable on admission and was resuscitated and managed at intensive care unit. CECT abdomen revealed partial anterior ureteral rupture with pyonephrosis. She was managed with percutaneous nephrostomy and subsequent anterograde stenting. Her recovery was uneventful and follow up imaging revealed no features of malignancy. CLINICAL DISCUSSION: Generalized peritonitis due to renal pathology is very rare and it can be due to urolithiasis or neoplasm. Retroperitoneal infections may lead to irritation of peritoneum or fistulation into the peritoneum leading to generalized peritonitis. This can be managed by various surgical and non-surgical management modalities. CONCLUSION: There are various pathological causes for acute abdomen. One of the rare causes is spontaneous rupture of ureter in pyonephrotic kidney which can also be managed successfully with minimal intervention.

Hemorrhagic Cholecystitis: A Rare Cause of Melena.

Hemorrhagic cholecystitis -- a rare cause of hemobilia and melena -- is an atypical presentation of calculous cholecystitis, associated with significant morbidity and mortality. A 75-year-old woman with multiple comorbidities, who was undergoing dual antiplatelet therapy, presented with symptoms of acute cholecystitis. Two days later, she developed melena and symptoms of obstructive jaundice. Following radiological evaluation, a diagnosis of hemorrhagic cholecystitis was made. The patient was managed conservatively with IV antibiotics and blood transfusion in the initial period (clopidogrel was withheld); an interval cholecystectomy was performed six weeks later. Hemorrhagic cholecystitis is a rare complication of acute cholecystitis, and its diagnosis is challenging as it mimics various other hepatopancreaticobiliary diseases. Management options include early surgery or conservative management at the initial stage, followed by interval cholecystectomy.