Biliary tree traumatic neuroma following laparoscopic cholecystectomy: A case report and literature review.

Laparoscopic cholecystectomy has been found to be associated with the development of traumatic neuromas on rare occasions. The present study reports a rare case of post-cholecystectomy biliary tree traumatic neuroma. Herein, a 47-year-old female with a history of laparoscopic cholecystectomy presented with upper abdominal pain and anorexia. Upon an examination, a yellow discoloration of the sclera was observed. Magnetic resonance cholangiopancreatography revealed a dilated proximal bile duct and mild dilatation of the intrahepatic biliary tree due to a stricture. Intraoperatively, a hard bile duct mass was observed with multiple enlarged lymph nodes in the peri-hepatic region. The patient was initially suspected to have bile duct cancer; however, a histopathological analysis of the resected mass revealed a bile duct traumatic neuroma. Biliary traumatic neuromas may be underestimated since they often remain asymptomatic. It is unfortunate that, as traumatic neuromas often lack distinguishing characteristics, no particular radiological findings for traumatic neuromas of the bile duct have been described to date, at least to the best of our knowledge. The rarity of this condition, combined with the absence of a standardized diagnostic modality, renders its diagnosis difficult and can even lead to misdiagnosis as biliary cancer.

Aurora rings may not always indicate an inverted colonic diverticulum: Report of a rare case of colonic lipoma.

Aurora rings are prominent endoscopic features of the inverted colonic diverticulum (ICD), and their appearance alongside a colonic lipoma is an unprecedented phenomenon. The present study reports a case of colonic lipoma with Aurora rings, contradicting the assumption that Aurora rings are indicative of ICD. A 52-year-old male patient presented with left-sided abdominal pain for >1 year, associated with constipation in the form of the decreased frequency of bowel motions every 4 to 5 days. A physical examination revealed an obese, protuberant abdomen and a mildly tender left iliac fossa region without other notable findings. A transabdominal ultrasonography revealed a thickening of the large bowel wall (<7 mm) with a suspected inflammatory lesion on the left side of the colon. During an ileocolonoscopy, multiple diffuse diverticula of various sizes were observed, affecting the entire colonic mucosa. Furthermore, a large (1.5 cm) pedunculated polyp with a thick stalk was found in the sigmoid colon, exhibiting positive Aurora rings. A polypectomy was conducted with the deployment of two hemoclips at the polyp base to prevent perforation. The histopathological examination of the specimen, a 1.3 cm polyp, revealed the presence of a colonic lipoma, rather than an ICD. The identification of Aurora rings has emerged as a significant endoscopic feature in the diagnosis of ICD; nevertheless, the underlying etiology of these rings remains elusive. Based on an extensive search of the literature, no study was found mentioning the appearance of Aurora rings in an endoscopic screening of other colonic conditions other than ICD. The appearance of Aurora rings alongside a colonic lipoma has not previously been mentioned, at least to the best of our knowledge, which renders the differentiation of ICD from lipomas and polyps more challenging.

Ectopic papilla of Vater in the pylorus presenting with cholangitis: A case report with literature review.

INTRODUCTION: The papilla of Vater is situated in the second part of the duodenum. The current study aims to report a rare occurrence of an ectopic papilla of Vater in the pyloric region presenting with cholangitis. CASE REPORT: A 59-year-old male patient presented with right upper quadrant pain, anorexia, nausea, and jaundice. He was feverish and exhibited tenderness in the right upper quadrant. Endoscopic retrograde cholangiopancreatography revealed an ectopic papilla of Vater on the pyloric canal. A gastroscope was used instead of a duodenoscope for better visibility of the opening, easier cannulation, and a less risky sphincterotomy. He returned one year after his last procedure with no symptoms and no recurrence of acute cholangitis. DISCUSSION: It has been suggested that developmental defects are acquired during embryogenesis. If subdivision happens early in embryogenesis, leaving the pars hepatica above the zone of proliferation that divides the stomach from the duodenum, the pars hepatica will develop into a duct that empties into the pylorus area. CONCLUSION: It is preferable to use a gastroscope rather than a duodenoscope to visualize and manipulate the common bile duct in the case of an ectopic papilla of Vater in the pylorus.