Postoperative intussusception following surgical repair of third-grade spleen rupture in a child: A unique case report.

INTRODUCTION AND IMPORTANCE: Postoperative intussusception (POI) is a remarkably rare complication that may follow different types of operations. POI is responsible for 5-10 % of postoperative bowel obstruction. The main challenge in diagnosing this condition due to its nonspecific symptoms, which mimic post-op ileus. CASE PRESENTATION: An 8-year-old Syrian female was presented to the emergency department with multiple traumas. Laboratory tests were normal except for leukocytosis. Abdominal and pelvic ultrasound revealed a moderate amount of free fluid in Morison's pouch and splenorenal recess. Investigative laparotomy revealed third-degree splenic rupture, leading to splenorrhaphy. After a week, she suffered from sudden nausea and bilious vomiting. The patient's condition deteriorated, so a second investigative laparotomy was performed and revealed the presence of jejune-jejunal intussusception (1 m distally from the ligament of Treitz) without any predisposing lead point. The intussusception was manually solved, the patient was discharged after five days. She has been seen in follow-up with complete recovery. CLINICAL DISCUSSION: POI is one of the rare complications that may happen after various surgeries especially abdominal operations. POI is associated with some specific surgeries. The most prominent symptoms of POI are restlessness, bilious vomiting, abdominal distension, and abdominal pain, consequently, they are less specific. CONCLUSION: POI is a rare complication after surgery but it should be considered in case of the presence of bowel obstruction symptoms in the first two weeks after operation. Our case highlights this unexpected complication emphasizes the need for further studies to demonstrate the mechanism of postoperative intussusception.

Managing multiple hepatic hydatid cysts and a single cardiac hydatid cyst simultaneously through a single surgical entry via the abdomen: A case report.

INTRODUCTION AND IMPORTANCE: Hydatid Disease, primarily caused by the larval stage of the parasite Echinococcus granulosus, represents significant health challenges, particularly in endemic regions. Hepatic cysts are more common, while cardiac involvement is rare. CASE PRESENTATION: This report presents the case of a 35-year-old woman with atypical abdominal pain persisting for several months. CT scan of the thorax and abdomen revealed multiple hydatid cysts in the liver and a single cyst in the apex of the heart. The intramyocardial cyst was asymptomatic. Albendazole was administered pre- and postoperatively. The surgical approach commenced with the hepatic cysts, accessing the area via a bilateral Kocher subcostal incision in the epigastric region. The second step involved an incision of the central diaphragm, providing clear visualization of the cardiac apex. The operation was successful and the patient was discharged without any complications. CLINICAL DISCUSSION: There are many surgical techniques described in the literature. Recently, single-stage operations have been recommended to manage multiorgan hydatid cysts; however, having two surgical incisions in one operation can still be dangerous to the patient's health. CONCLUSION: To our knowledge, this is the first case that describes a surgical technique that begins in the abdominal cavity and then progresses to the thoracic cavity through the diaphragm to manage both hepatic and cardiac hydatid cysts.

A case of amoebic liver abscess and emphysematous gallbladder in a 65-year-old male with situs inversus totalis.

INTRODUCTION AND IMPORTANCE: Situs inversus totalis, a rare congenital condition, is characterized by the mirror-image reversal of the abdominal and thoracic organs. Amoebic liver abscess and emphysematous gallbladder are severe gastrointestinal infections. The coexistence of these three conditions is extremely rare. CASE PRESENTATION: We present the case of a 65-year-old male who presented with abdominal pain, fever, and jaundice. Investigations revealed situs inversus totalis, amoebic liver abscess, and emphysematous gallbladder. The patient underwent successful treatment with antibiotics and open surgery drainage of the liver abscess, and subtotal cholecystectomy. CLINICAL DISCUSSION: The co-occurrence of situs inversus totalis, amoebic liver abscess, and emphysematous gallbladder poses a diagnostic challenge and requires thorough evaluation and appropriate management. CONCLUSION: Situs inversus totalis may coincide with other conditions like amebic abscess and emphysematous gallbladder, complicating diagnosis and treatment. Early diagnosis and prompt intervention are crucial to improve outcomes.

Bilateral complete ureter duplication presenting with hydronephrosis and spontaneous stone passage in a 25-year-old male: A rare case report.

Ureteric duplication is a rare anomaly in the urinary tract, with an incidence of 0.5% to 3%. Bilateral double ureters are even rarer, occurring in 1 of 500 individuals. A 25-year-old man presented with right flank pain and nausea. Physical examination revealed tenderness at the right renal angle. Urinalysis demonstrated microscopic hematuria, and Ultrasound showed enlargement in the lower pole of the right kidney, while the upper pole appeared normal. Intravenous pyelography confirmed bilateral complete ureter duplication. However, after a week of observation, a 5 mm calcium oxalate stone was passed, and this event demonstrated the underlying cause of hydronephrosis in the lower pole of the right kidney. Bilateral complete ureter duplication is a rare anomaly in the urinary tract. To our knowledge, the presence of bilateral complete ureter duplication with a single stone in the right limb of the right double ureter is a unique case that has not been reported in the existing literature.

Mesenteric cystic lymphangiomas in an 11-year-old female: A rare case report.

Mesenteric cystic lymphangiomas are a rare benign abdominal malformation of lymphatic vessels, with an estimated incidence of 1 per 250,000. Clinical presentation ranges from asymptomatic masses to acute abdominal pain. Diagnostic investigation includes ultrasound, abdominal computed tomography, or magnetic resonance imaging. Complete surgical excision is the recommended treatment. We present an 11-year-old female with abdominal cramps, and a 6-month history of gradually developing distension, constipation, and polyuria, without the occurrence of vomiting. Clinical examination revealed a soft, movable, painless abdominal mass with dullness on palpation. Ultrasound showed multi-cavity cystic masses in the abdomen, and a contrast-enhanced computed tomography scan revealed a large multi-cavity cystic mass involving most of the abdomen. A complete surgical excision was performed, and microscopic examination confirmed the diagnosis of mesenteric cystic lymphangioma. This case underscores the importance of considering mesenteric cystic lymphangiomas in the differential diagnosis of abdominal masses in pediatric patients, even in rarer age groups. Imaging aids in diagnosis and surgery planning. Complete excision curbs the risk of infection and recurrences.

Epidermoid cyst in the anus: A case report of an unusual location.

INTRODUCTION AND IMPORTANCE: Epidermoid cysts are generally seen as benign skin conditions characterized by the formation of nodules that are enclosed and located just beneath the epidermal layer. CASE PRESENTATION: This report presents the case of a 32-years-old woman with a mass that has been progressively growing for 11 years, situated at the right anal verge. The mass, which was asymptomatic throughout its development, was confirmed to be an epidermoid cyst. CLINICAL DISCUSSION: Epidermoid cysts commonly present without clinical symptoms. Ultrasound is increasingly being employed for the initial assessment. However, CT and MRI scans provide more detailed and specific imaging features. Histopathological analysis can aid in the identification of an epidermoid cyst. Treatment is often unnecessary for epidermoid cysts that are small and uncomplicated; however, if intervention is required, a complete surgical removal with an intact cyst wall is typically the straightforward solution. CONCLUSION: Epidermoid cysts are common and can manifest in various locations. When encountering a soft, well-defined mass in an atypical site for epidermoid cysts, it should be included in the differential diagnosis.

Two hydatid cysts in the psoas muscle of a 40-year-old female: A rare case report.

INTRODUCTION AND IMPORTANCE: Hydatid disease can affect any human organ. The occurrence of hydatid cysts in psoas muscle is rare, accounting for only 1-3 % of cases, and even in endemic regions. However, the presence of multiple cysts is even more rare. CASE PRESENTATION: A 40-year-old female from a rural area presented with abdominal pain. Physical examination revealed tenderness in the right hypochondrium. Her medical history pulmonary hydatid cystectomy seven years ago. Radiology investigation showed a two-hydatid cyst within the left psoas major muscle. Cystectomy of two hydatid cyst was performed. The patient was prescribed albendazole at a dose of 15 mg/kg, and at the latest month's follow-up appointment, the patient did not experience any relapse. CLINICAL DISCUSSION: This case presents a rare instance of multiple hydatid cysts in the psoas muscle, highlighting the importance of considering atypical presentations in endemic regions. CONCLUSIONS: This case highlights the rarity of psoas major muscle hydatid cysts in a middle-aged woman from a rural area. Early recognition, accurate radiological assessment, and proper surgical treatment are crucial for positive outcomes and averting complications like infection, compression of nearby structures, or anaphylactic reactions.

Carcinoma in situ within the bladder trigone with an isolated metastasis to the prostate without involvement of prostatic urethra: a unique case report.

BACKGROUND: Carcinoma in situ of the bladder is a high-grade cancer that originates in the superficial layer of the bladder. It has the potential to invade nearby organs, and it can spread through blood and lymphatic circulation to distant parts of the body. CASE PRESENTATION: A 58-year-old non-smoker male presented with gross and microscopic hematuria. His family history included his father's recent bladder cancer. Initial investigations showed hematuria, inflammation, negative urine culture, digital rectal examination revealed an enlarged right lobe of the prostate, and an elevated Prostate-Specific Antigen level. Histopathological examination of samples taken from the bladder mucosa and the prostate confirmed urothelial carcinoma in situ in the bladder and prostate. Further evaluation revealed no other metastasis. The tumor was classified as T4aN0M0. The patient underwent radical cystoprostatectomy and histopathological examination showed that the tumor invading the muscularis propria of the bladder as well as the prostatic glands, but no malignancy was found in prostatic urethra and other areas. The patient was discharged three weeks post-operation and completed on adjuvant chemotherapy consisting of Gemcitabine, and Cisplatin to prevent of relapse. The patient is currently in a good healthy. CONCLUSION: The occurrence of bladder cancer metastasizing to the prostate without involving the prostatic urethra is uncommon and requires precise diagnostic techniques for accurate tumor classification. Early management is advised to enhance the prognosis for the patient.

A 7-year-old with extravaginal torsion of an undescended testicle in the left inguinal region: The first case report from Syria.

The incidence of undescended testicles torsion in a 7-year-old is rare, making it a clinically unusual occurrence. Emphasizing the importance of thorough urogenital assessments in children, particularly in underserved communities, is critical to prevent serious complications like testicular gangrene.

Bilateral hearing impairment as an early symptom in a patient with Charcot-Marie-Tooth Type 1: the first case report from Syria.

Introduction: Charcot-Marie-Tooth (CMT) is a group of inherited neuromuscular disorders that vary clinically and genetically. It is characterized by peripheral nerve damage, leading to muscle weakness and sensory loss. Case presentation: A 13-year-old male presented to the rheumatology department with bilateral hearing impairment since the age of 3 years, pes cavus, and difficulties walking. Some family members had Achilles tendon lengthening surgery. During physical examination, the patient had a shortened Achilles tendon, there are high arches in the feet, curled toes, loss of touch sensation in the feet, ankles, and legs, atrophy in the foot muscles. An eye examination revealed a discrepancy that needed glasses. Neurological findings included horizontal and vertical nystagmus, proprioception disorder, and demyelinating sensorimotor disorder diagnosed as CMT type 1. The audiogram showed bilateral sensorineural hearing impairment. MRI revealed spinal disc bulges. The treatment plan includes Achilles tendon lengthening surgery and physical therapy. Clinical discussion: CMT patients need to receive supportive treatment including physical therapy, hearing aids, and glasses, to help improve their quality of life. Conclusion: CMT disease is a genetic disorder that causes difficulties in movement, coordination, and daily activities due to muscle weakness and sensory impairments. In a few cases, patients have been documented to have bilateral hearing impairment as their first symptoms. It affects individuals in Syria and around the world, and requires proper diagnosis and treatment.

Successful surgical reconstruction of atypical variant mirror hand anomaly in a 2-year-old female child: a unique case report.

Introduction: Mirror hand is an extremely rare congenital abnormality characterized by polydactyly and duplication of the ulna, with the absence of the radius and thumb. Atypical presentations of mirror hand were described, including the presence of the radius in a few cases; here the authors report one of the atypical cases of mirror hand that underwent successful management. Case presentation: A 2-year-old and 7-month-old female child presented with 7 well-developed digits, with an absent thumb; the X-ray imaging of the forearm showed a well-formed ulna and radius with proximal fusion. The patient has good shoulder movement, minor limitations in supination and pronation, and elbow flexion restriction. The patient underwent multiple surgical interventions for pollicization. Follow-up revealed a significant improvement of hand function and appearance. Clinical discussion: In the literature review, mirror hand is a rare congenital malformation and has many varieties. The management of this deformity is a challenge and differs from case to case; here the authors described a novel variant of this deformity and its successful management. Conclusion: Mirror hand is a rare congenital abnormality and has a wide spectrum of variants. The management challenge, but with early pollicization with appropriate functional considerations, the outcome is promising.