Acute adomen in a transplant patient with tuberculous colitis: a case report.

INTRODUCTION: Tuberculous colitis is a rare form of tuberculosis and is found in immunosuppressed patients, usually with the clinical appearance of Crohn's disease. The purpose of this article is to report a rare case of tuberculous colitis in a transplant patient, presenting in the form of bowel obstruction and acute abdomen. METHODS: A male patient, 51 years old, with a history of kidney transplant in a foreign country 19 months before, presented at the emergency department, after being referred by a primary care center, with obstipation during the previous week and acute abdominal pain. The patient had the clinical appearance of acute abdomen. Five days before the patient underwent colonoscopy, which revealed an intraluminal mass that partially occluded the lumen of the ascending colon. Blood tests revealed a mildly elevated WBC count and anaemia. Imaging studies revealed air in the peritoneal cavity and free fluid in the pelvis. The patient was diagnosed with perforation of a hollow viscus and was admitted for surgery RESULTS: During laparotomy the findings were a perforation of the cecum, a fragile mass (pseudopolyp), which occluded the lumen approximately in the middle of the ascending colon, diffuse erosions of the mucosa and pseudomembranes. A bezoar was found impacted at the level of the occlusion. There was also marked lymph node enlargement in the mesentery and ischaemia of the cecum. A typical right hemicolectomy was performed and special care was taken so, as not to damage the renal transplant. The pathological and microbiological (from free peritoneal fluid) investigation suggested the diagnosis of tuberculous colitis. Further blood tests and respiratory investigation confirmed the diagnosis of active tuberculosis, with the colon as a primary site. The patient received the appropriate antituberculous treatment. CONCLUSIONS: Tuberculous colitis is a rare form of tuberculosis and is found in immunosuppressed patients. Deferential diagnosis from other forms of colitis is usually problematic. Tuberculous colitis rarely manifests itself in the form of acute surgical abdomen. The possible diagnosis of tuberculous colitis must be always in mind when treating transplant patients.

Mucinous adenocarcinoma of the appendix presenting with atypical symptomatology and presence of pseudomyxoma peritonei: a case report.

INTRODUCTION: Primary tumors of the appendix are unusual and most of them are carcinoids. Their main presentation is that of an acute appendicitis or as a palpable mass, mainly in the right lower quadrant. CASE PRESENTATION: A female patient with mucous adenocarcinoma of the appendix, which primarily presented as atypical abdominal pain. Diagnosis of the disease was made after appendicectomy and histopathological analysis of the specimen. The patient finally underwent a complementary right hemicolectomy. CONCLUSION: Mucin producing adenocarcinomas of the appendix are a category of rare cancers of the gastrointestinal tract. Although at present they are a well studied pathologic entity, the crucial issue of their preoperative diagnosis remains unsolved.