Stump appendicitis after laparoscopic appendectomy; laparoscopic management and literature review.

INTRODUCTION: Appendectomy is one of the most common surgical procedures performed worldwide There are different etiologies for acute appendicitis such as obstruction of the appendiceal lumen by fecalith, lymphoid hyperplasia, or neoplasm. Laparoscopic appendectomy has become the treatment of choice for both complicated and uncomplicated appendicitis; common postoperative complications include wound infection, bleeding, intraabdominal abscess. Stump appendicitis is defined as the interval repeated inflammation of remaining residual appendiceal tissue after an appendectomy. PRESENTATION OF CASE: 38-Year-old female patient with a history of laparoscopic appendectomy performed in 2016 for acute uncomplicated appendicitis. She arrived to the emergency room due to abdominal pain 7 out of 10, located in the periumbilical region, later with migration to the right lower quadrant, abdominal CT scan evidenced the presence of a cecal and pericecal inflammatory process as well as the base and residual proximal portion of the cecal appendix laparoscopic stump appendectomy was performed. DISCUSSION: Stump appendicitis (SA) is defined as the inflammation of the remnant of the cecal appendix after an appendectomy, whether due to impaction of a fecalith or secondary to an ischemic process, the probability of developing SA is estimated to be about 1/50,000 cases throughout life. The most frequently used treatment is exploratory laparotomy to complete the previous appendectomy; however, there are 5 reported cases of stump appendicitis, where surgical resolution was performed through laparoscopic surgery. CONCLUSIONS: It is important to keep this entity in mind when evaluating a patient with acute abdomen with previous history of appendectomy, since the delay in diagnosis and treatment increases morbidity and mortality; laparoscopic stump appendectomy has been shown to be a safe treatment (Agha et al., 2020 [14]).1.

Foreign modeling agent reaction; managed with two staged surgical reconstruction. Case report and review of literature.

INTRODUCTION: In Mexico, body modeling with injectable biomaterials such as liquid silicone is a common practice in non-certified clinics by non-medical personnel; These materials produces a series of complications described as Foreign modeling agent reaction (FMAR) with variable spectrum of severity. CASE PRESENTATION: 38-year-old female with history of biomaterial injection in a non-certified cosmetic clinic 10 years prior to evaluation. Presents with intermittent symptoms characterized by fever, erythema, induration and pain in the gluteal region. An exhaustive debridement and resection with primary closure was performed. Thereafter, reconstruction was done using a combined technique with gluteal implants and autologous fat graft, evolving without complications. DISCUSSION: The use of biomaterials has been widely documented throughout history; liquid silicone being one of the protagonists. Used for aesthetic purposes and modeling areas such as buttocks and breasts. They have been associated with an assortment of early or late onset complications, sometimes resulting in fatal outcomes. Various treatment modalities have been described depending on the severity of presentation, from conservative to surgical management. CONCLUSION: There is a shortage of treatment guidelines regarding FMAR due to its wide variety of presentation, treatment must be individualized to obtain adequate results. Although conservative treatment has shown good results, the anatomical alterations usually condition dissatisfaction that should be addressed with reconstructive techniques [10].

Gallbladder osteoma in a 66-year-old female; Case report and review of literature.

INTRODUCTION: Gallbladder mesenchymal tumours are rare. The more common include fibroma, lipoma or haemangioma. A gallbladder osteoma is very rare indeed there is only one other case reported in medical literature). We report a new case. PRESENTATION OF CASE: A 66-year-old female presented to the emergency department complaining of colicky epigastric pain and generalised abdominal discomfort for 1 month. The pain was scored 5/10 but there were no associated symptoms of fever, nausea or vomiting. Vital signs were normal as were all laboratory parameters. An abdominal ultrasound revealed a thin walled gallbladder with a solitary 3 mm polyp. Motility studies confirmed gallbladder dyskinesia. Laboratory studies were ordered reporting normal findings. Abdominal ultrasound was ordered reporting an image suggesting a gallbladder polyp and gallbladder dyskinesia. Cholecystectomy was done without any incidents and the gallbladder was sent to pathology. Pathology reported mature bone tissue in the stromal gallbladder tissue. Due to the rareness of the presence of mature bone tissue in the gallbladder we decided to report the case for the medical community. DISCUSSION: Osteomas are mesenchymal cell tumors derived from the mesoderm; the gallbladder may be the primary site of numerous types of mesenchymal tumors, although these tumors are common the location is not. CONCLUSIONS: We report only the second case of gallbladder osteoma. These mesenchymal tumours are common but this location is not. This case report will serve to remind readers of both benign osteomas and unusual conditions causing gallbladder disease.