Ileocolic Intussusception Caused by a Giant Ulcerating Lipoma of Bauhin's Valve: an Unusual Cause of Intestinal Obstruction in the Adult.

We report a case of intestinal obstruction in a 73-year-old woman caused by ileocolic intussusception. The underlying cause was a giant submucosal ulcerating lipoma (6 × 3.3 × 3.8 cm) extending from the superior mucosal lip of Bauhin's valve. Abdominal ultrasonography showed a pathognomonic target-like mass appearing as multiple concentric rings. CT scan confirmed the diagnosis. Because of apparent obstruction, a laparotomy with right hemicolectomy and ileocolic anastomosis was performed. Lipomas most frequently occur in the cecum and ascending colon where they represent the most common submucosal mesenchymal tumor. They typically occur in elderly women with an incidence that varies from 0.15 to 0.56 %. Pain, rectal bleeding, and obstruction are typical symptoms. When faced with an intussusception in children, reduction with air per rectum can be performed. In adults, however, malignant cell spreading and seeding is of big concern. Since approximately 20-50 % of all underlying causes are malignant, explorative surgery is favored in adults.

Acute necrotizing emphysematous pancreatitis with air in the wirsung duct mimicking duodenal perforation: a case report

A 74-year old hemodynamically unstable woman with an acute abdomen presented at the emergency department. Laboratory findings indicated leukocytosis (21000/µl), increased CRP (300mg/l) and lipase (3792kU/l). CT abdomen without contrast showed multiple air pockets in and around the pancreas body, retroperitoneal along the duodenum as well as air in the Wirsung duct. A duodenal perforation was suspected. On explorative laparoscopy however no immediate sign of perforation was seen despite infusion of methylene blue through a nasogastric catheter. Further exploration showed a necrotizing exudative pancreatitis. Because of perioperative hemodynamic instability, further invasive actions were put off. Acute necrotizing emphysematous pancreatitis is a severe pathology with a high mortality (25-70%). Air in the Wirsung duct is rarely described in literature and so far an underlying explanation remains unclear. In this case gas-forming organisms may have entered the pancreas through haematogenous or lymphatic spread, as well as directly through the ampulla or by transmural passage from the transverse colon

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Multiple abdominal cysts in a patient with Gorlin-Goltz syndrome: a case report.

A rare case of symptomatic mesenteric cysts in a patient with Gorlin-Goltz syndrome, associated with various neoplasms, is presented. The patient, known with Gorlin-Goltz syndrome, consulted with increasingly severe abdominal pain and large abdominal cysts. At surgery, the cysts were excised and the postoperative course was uneventful. In conclusion, this case reminds clinicians to always maintain a wide differential diagnosis when dealing with patients known with Gorlin-Goltz syndrome.