Inguinal Squamous Cell Carcinoma Presenting as a Marjolin Ulcer in the Absence of Mesh Infection: A Case Report.

Inguinal hernias are the most common type of hernias, and most are repaired surgically with mesh placement to prevent future reoccurrence. Mesh infection and hernia recurrence are some of the rare complications of mesh placement, and chronic mesh infections increase the risk of squamous cell carcinoma at the site. Squamous cell carcinoma (SCC) in the setting of a mesh infection presents in a similar manner to a Marjolin ulcer and is treated with the removal of the tumor and degraded infected mesh. However, in this case, the patient presented atypically with an absence of mesh involvement. This report aims to explore the etiology of SCC due to mesh infections as well as describe the perplexing case of inguinal SCC in the absence of mesh involvement.

Severe Paraesophageal Hiatal Hernia Repair During a Sleeve Gastrectomy Surgery in a Morbidly Obese Patient.

Morbid obesity increases the average risk of a patient developing a paraesophageal or hiatal hernia. Paraesophageal hernias (PEH) include several types, and their treatment is indubitably one of the most contentious topics in minimally invasive surgery. Though it is rare for PEH to manifest as a strangulated, volatilized intrathoracic stomach with infection, the increased risk of mortality is an indication for many to pursue surgical repair. Moreover, morbidly obese individuals represent a substantial rate of failure of PEH repairs. The modes of confirmation diagnostics are barium swallow or upper endoscopy. This case study focuses on a 64-year-old female who presented with several comorbidities, was appropriately evaluated for laparoscopic sleeve gastrectomy, and was previously identified to have a severe type III PEH with grade IV configuration. Additionally, the pathological finding from the extracted specimen was significant for helicobacter pylori gastritis.

A Rare Case of Hepatocellular Carcinoma Presenting as a Massive Abdominal Hematoma and Shock: A Case Report.

Hepatocellular carcinoma (HCC) has an affluent blood supply stemming from the hepatic artery. Subsequent spontaneous tumor rupture can lead to massive abdominal hematoma and shock, a rare fatal gastrointestinal incident. The diagnosis of rupture is complicated, with most patients presenting with abdominal pain and shock. Prompt correction of hypovolemic shock is the primary goal of treatment. This rare case presents a 75-year-old male who presented to the emergency department because of abrupt and increasing abdominal pain after a meal. Laboratory data revealed elevated alanine aminotransferase, aspartate aminotransferase, and alpha-fetoprotein levels. Immediate computed tomography demonstrated a defect in the right ventral abdominal wall. The patient underwent an emergency exploratory laparotomy. Despite massive intra-abdominal adhesions, the identified source of bleeding was from the left lobe of the liver at the base of the lesser sac above the pancreas. There was a maximum effort to cease bleeding and minimize blood loss. An ensuing biopsy of the liver revealed HCC. After improving, the patient received instructions to follow up on an outpatient basis. Two months after surgery, the patient endorses no complications. The success outlined in this case highlights the essence of prompt action in an emergency, which delineates the significance of surgical experience in handling unorthodox patient presentations.

A Case Report of Perforated Appendix Vermiform Attached to the Left Ovary.

Acute appendicitis, a typical abdominal emergency, presents in nonperforated and perforated forms. While nonperforated cases often respond well to antibiotics or appendectomy, perforated cases pose more significant challenges. We report a unique case of appendicitis in a 34-year-old female with an unusual anatomical adherence to the left ovary. The patient successfully underwent laparoscopic surgery, during which precise incisions were made to accommodate the unique location of the appendix. This tailored approach contributed to a positive surgical outcome. This case underscores the importance of tailored surgical approaches in managing complex appendiceal variations.

Rare Metallic Allergy Reaction Presentation to Cholecystectomy Surgical Clip.

Metal allergies have been a growing concern in the general population over the past several decades. Laparoscopic cholecystectomy is the standard treatment for gallbladder diseases such as cholelithiasis and cholecystitis, during which surgical clips composed of metals such as nickel or titanium are often used to clamp the arteries and ducts. These metals are documented to produce hypersensitivity reactions. Here, we present the case of a 53-year-old male patient who successfully underwent laparoscopic cholecystectomy and two weeks later reported constant right upper quadrant pain accompanied by nausea that was exacerbated by exercise and food. After several months of severe interference with the patient's lifestyle, we removed the surgical clips after ruling out all possible organic causes of the pain. A total of six surgical clips were removed during surgery, and the patient reported a substantial resolution of symptoms post-operation. Post-cholecystectomy syndrome (PCS), allergy to the metallic surgical clips, and migration or improper clip placement during surgery were all considered possible causes for the pain. Still, the clinical presentation and laboratory studies pulled focus toward metallic surgical clip allergy as the most plausible cause for the presenting symptoms. The metallic haptens released by the surgical clips activate the innate and adaptive immune response cascades and pre-sensitize the CD8 and B cells to the metallic allergens. With reexposure, these pre-sensitized CD8 and B cells trigger a hypersensitivity reaction. Standardizing allergy tests as part of the pre-operation checklist can prove to be an inexpensive way to eliminate such post-surgical complications. Furthermore, alternatives like absorbable sutures or even different hypoallergenic metal or plastic clips can be considered viable options to replace nickel or titanium-made surgical clips during surgery.