Metastatic Breast Cancer Presenting as Acute Appendicitis: A Case Report and Literature Review.

Breast cancer is considered one of the most common cancers worldwide. The most common sites for breast cancer to metastasize are the lymph nodes, bones, lungs, brain, and liver. Involvement of the gastrointestinal tract is uncommon, and metastasis to the appendix is rare. We report a case involving a 43-year-old woman with no previous history of malignancy who presented with acute appendicitis and underwent laparoscopic appendectomy, with the final histopathological assessment revealing metastatic breast cancer.

Retroperitoneal Chyloma: A Case Report and Literature Review.

Retroperitoneal chyloma is a rare entity that presents with non-specific symptoms. Although benign, it can cause complications due to the mass effect. In this case report, we present the case of a 24-year-old woman who presented with a complaint of left-sided colicky abdominal pain and mild dysuria for one year. On physical examination, there was only mild abdominal tenderness. Computed tomography (CT) revealed a thick-walled cystic retroperitoneal mass with a small amount of fat in the superior part and a displaced left hydronephrotic kidney. Magnetic resonance imaging (MRI) confirmed the findings and also revealed a fat-fluid level in the cyst. A laparotomy was performed, and the cystic mass, containing milky fluid, was excised. Histopathology showed a pseudocyst with chronic inflammation and a xanthomatous reaction, with no evidence of infection or malignancy. The patient recovered without complications and has not had a recurrence so far. Retroperitoneal chyloma is difficult to diagnose preoperatively. A definitive diagnosis is usually made only after surgery and a histopathological examination. The treatment of choice is a complete excision. Other approaches, such as marsupialization or drainage, will likely result in a recurrence. However, surgery in the retroperitoneal space is associated with a risk of injury to major vessels or organs. In conclusion, retroperitoneal chyloma is a rare entity that is best treated by complete excision. For small lesions, a wait-and-watch approach may be advisable.

Transvaginal small bowel evisceration: Case report and review of literature.

INTRODUCTION: Transvaginal evisceration is a rare life-threatening condition that is usually seen in postmenopausal women with past history of gynaecological surgery. PRESENTATION OF CASE: A 54-year-old woman presented with sudden-onset abdominal pain and protrusion of a mass through the vagina after her grandson jumped on her abdomen while at play. She had undergone laparoscopic total hysterectomy and bilateral salpingo-oophorectomy 9 months earlier. Physical examination revealed an intestinal loop in the vagina. She was immediately taken to the operating room. Laparotomy was performed and the prolapsed intestine was reduced. The bowel from the duodenojejunal junction to the ileocecal valve looked healthy, with no areas of ischemia. The rupture in the vaginal vault was repaired with Vicryl. The postoperative course was uneventful, and the patient was discharged on day 5 after the surgery. DISCUSSION: Less than 100 cases of transvaginal evisceration have been reported. The condition, which is more common in postmenopausal women, usually presents with sudden-onset abdominal pain. Some patients may be asymptomatic and only complain of swelling at the introitus. Diagnosis can usually be made by visual examination. Immediate surgery is necessary to reduce the risk of intestinal ischemia and necrosis. CONCLUSION: Transvaginal evisceration must be suspected in any woman presenting with sudden-onset abdominal/pelvic pain. Awareness of this rare condition is necessary to minimize mortality.

Paracecal hernia with intestinal obstruction managed with laparoscopic surgery: A case report.

INTRODUCTION: Paracecal hernia is a rare cause of intestinal obstruction. PRESENTATION OF CASE: A 75-year-old man presented with abdominal pain for 4 days, vomiting, and obstipation. Physical examination was not conclusive. Abdominal radiograph suggested small intestinal obstruction, and computed tomography confirmed an obstructed paracecal hernia. Intraoperatively, the hernial sac was seen passing through the inferior ileocecal recess. The distal bowel was collapsed. The appendix was inflamed. The hernia was reduced and appendectomy was performed. The patient recovered without complications and was discharged on the fifth postoperative day. DISCUSSION: Internal hernia may be a cause of acute abdomen. Symptoms and signs may be nonspecific. Rapid recognition of the condition can prevent strangulation and ischemia of affected intestinal loops. Early resort to imaging examination will ensure quick diagnosis. CONCLUSION: Paracecal hernia is a rare cause of intestinal obstruction. Awareness of the imaging features will help avoid delay in diagnosis. Laparoscopic surgery appears to be a safe and feasible treatment.

Successful resection of a centrally located primary hepatic neuroendocrine tumor.

INTRODUCTION: Primary neuroendocrine tumors (NETs) of the liver are rare tumors that are challenging to diagnose. PRESENTATION OF CASE: A 41-year old woman presented with a four-month history of moderate abdominal pain in the right upper quadrant. A computed tomography scan of the abdomen revealed a large hypervascular liver lesion measuring 14 × 10 × 15 cm occupying segments IV and VIII and part of segment V of the liver. A liver biopsy revealed findings consistent with a well-differentiated NET. Transarterial chemoembolization was offered to the patient; however, the procedure was unsuccessful. Surgical management was therefore considered and resulted in a favorable outcome. DISCUSSION: Primary hepatic NETs are thought to originate from NET cells that may subsequently propagate to the intrahepatic biliary tree and become cancerous. These tumors are often missed during an initial evaluation due to a low clinical index of suspicion. In some cases, nonspecific symptoms such as abdominal pain and bloating may be an indication of early disease. No guidelines have been developed for the treatment of primary hepatic NETs; nevertheless, surgical resection remains the treatment of choice and plays a potentially curative role. CONCLUSION: Surgical resection may be beneficial in the management of a primary NET of the liver even when the procedure appears to be challenging, such as in the case of a centrally located liver tumor.

Retroperitoneal Ganglioneuroma (GN): Case report in 14 years old boy.

INTRODUCTION: The ganglioneuroma is a rare tumor arising from sympathetic nervous system, which is composed of gangliocytes and mature stroma. PRESENTATION OF THE CASE: A retroperitoneal ganglioneuroma was found in a 14 years old Saudi boy, presented with recurrent vomiting. CT image showing a retroperitoneal cyst near the inferior vena cava and right iliac vessels. Treated by laparoscopic cystic excision, histopathology of the cyst showing ganglioneuroma, completely excised. DISCUSSION: Ganglioneuromas arise from the sympathetic chain, The most common sites of presentation are the posterior mediastinum, retroperitoneum, head and neck region. GN are usually asymptomatic found incidentally on abdominal imaging. The treatment of retroperitoneal mass is complete surgical excision. CONCLUSION: Ganglioneuroma (GN) is a rare benign tumor, usually asymptomatic. One of the most common site of presentation is retroperitoneum, the main treatment for that is complete surgical excision.

Case report: Disseminated pulmonary mucormycosis involving spleen in diabetic patient with aggressive surgical approach.

INTRODUCTION: Mucormycosis is a life threatening fungal infection that occurs in immunocompromised patients. PRESENTATION OF CASE: A 36-year-old Saudi male with known case of Insulin-Dependent Diabetes Mellitus (IDDM), who was presented with productive cough and diarrhea. Computed tomography (CT) revealed a disseminated fungal invasion of the lungs and spleen with invading the fundus of the stomach. An aggressive surgical approach and amphotericin B treatment resolved his condition. DISCUSSION: Disseminated Mucormycosis in one organ can spread hematogenously to other organs and can cause severe morbidity and mortality in high risk individuals. The diagnosis of mucormycosis is usually delayed, Antifungal therapy alone is insufficient for mucormycosis, and surgical debridement for all infected tissue is often required. CONCLUSION: Mucormycosis is a life threating infection, and usually the diagnosis late because of non-specific clinical, radiological feature and need biopsy for confirmation of the organism. The cornerstone for the management and increase the survival rate remain on rapid diagnosis, treatment of the underlying predisposing condition, and urgent surgical debridement.