Uncommon Presentation of a Perforated Appendicitis Leading to Duodenal Fistula: Case Report and Literature Review.

Multiple types of fistulas associated with the appendix have been reported; however, duodenal fistula resulting from perforated acute appendicitis has only been documented in one previous case. In this report, we present the case of an 18-year-old male patient who was diagnosed to have a complicated appendicitis in its normal position with abscess formation. He was started on IV antibiotics and underwent a CT-guided drainage of the abscess with drain placement. Two days later due to biliary output from the drain, CT fistulography and diagnostic laparoscopy were performed that revealed the presence of a duodenal fistula. The potential for duodenal fistula formation in patients with complicated appendicitis must always be taken into consideration. Consequently, it is crucial to establish an appropriate management plan aimed at preventing additional serious complications arising from duodenal perforation.

Two cases of intraoperative diagnosed Amyand hernia: Case report and literature review.

INTRODUCTION: Amyand hernia is the presence of an incarcerated vermiform appendix (either inflamed or not) within the hernia sac. This type of hernia is very rare with an incidence reported to be 0.5 to 1 % and even rarer in adults. CASES PRESENTATION: We present here two cases of male patients found the have an Amyand Hernia diagnosed incidentally intraoperatively, and managed with appendectomy and mesh herniorrhaphy. CLINICAL DISCUSSION: For the management of this type of hernia, in general, the surgeon should perform an appendectomy with the repair to prevent future herniation or appendicitis, but some opinions differ, and state that when there are no signs of inflammation, it is not required to perform a preventative appendectomy. CONCLUSION: The decision on how to manage depends on multiple factors including inflammation of the appendix, the possibility of abdominal sepsis, and the patient comorbidities. The status of the appendix determines whether to undergo hernia repair with or without mesh.

Primary Hepatic Neuroendocrine Tumor: A Case Report and Literature Review.

Primary hepatic neuroendocrine tumors (PHNETs) are extremely rare and account for about 0.3% of all neuroendocrine tumor cases. Resection is usually difficult because they are usually diagnosed in the late stages. We report the case of a patient diagnosed with PHNETs, initially classified as unresectable but then underwent a successful left hepatectomy. PHNETs are rare malignant tumors, and a high index of suspicion is warranted for the diagnosis after excluding the presence of a primary extrahepatic lesion. Radical hepatectomy can be curative when feasible along with a combination of multiple treatments that improve the prognosis.

CDH1 gene mutation, a challenging surgical topic: Case report and literature review.

INTRODUCTION: Gastric cancer is one of the top 5 cancers worldwide. Most gastric cancers are classified as sporadic with the exception of around 3 % that are associated with specific syndromes or genes. Hereditary diffuse gastric cancer is a very rare type of gastric cancer, associated with loss of function of a tumor suppressor gene CDH1 which has a high penetrance that can reach 90 % over a lifetime. CASE PRESENTATION: Here we present the case of a 31 years old male patient carrying the CDH1 gene who presented for prophylactic total gastrectomy and D1 lymphadenectomy followed by a roux en y esophago-jejunostomy for digestive tract reconstruction. The patient had a preoperative negative gastroscopy for gastric cancer. On final pathology, few 2 mm foci of signet ring cells involving the lamina propria (T1a) were identified. CLINICAL DISCUSSION: Randomized clinical trial data concerning HDGC is lacking. Individuals who meet the genetic testing criteria developed by the IGCLC, testing should be obtainable from the legal age of consent that range from 16 to 18 years of age. CDH1 is the main gene that is tested. The mainstay treatment of choice for HDGC is total gastrectomy and Roux-en-Y esophago-jejunostomy in asymptomatic patients but should only be undertaken after baseline endoscopy. CONCLUSION: Genetic testing for CDH1 should be carried in high-risk populations. Due to its high penetrance, any person carrying the CDH1 gene should be managed by a prophylactic gastrectomy and D1 lymphadenectomy with close follow up for any future breast neoplasm.

A rare case of ectopic adrenal gland in an adult inguinal cord lipoma: Case report and literature review.

INTRODUCTION: Ectopic adrenocortical tissue is defined as the presence of accessory adrenal cortex tissue outside the suprarenal location of the adrenal glands. It is not an infrequent finding during inguinal operations in infants, however, its incidence in adults is found to be less than 1 %. CASE: We report a case of ectopic adrenal tissue incidentally found in a cord lipoma of a 68-year-old man, presenting for elective inguinal hernia repair. CLINICAL DISCUSSION: In the literature, the majority of cases of ectopic adrenocortical tissue are reported during groin surgeries in children. After the first few years of life, it normally regresses, but in a few uncommon cases like ours, it might continue long into adulthood. The condition can have several theoretical clinical implications that need to be considered by surgeons. Adrenal insufficiency can occur if the ectopic adrenal tissue is the only adrenal tissue in the patient along with a potential for neoplastic transformation in cases of persistence of ectopia. CONCLUSION: However, studies have shown no evidence of endocrine or oncologic complications after excision or persistence of the ectopic adrenal gland. Consequently, no investigations or treatments are indicated.

A Case of Familial Appendiceal Neuroendocrine Tumor.

The risk of developing appendiceal neuroendocrine tumor (aNET) may be attributed to multiple factors. A familial clustering is found in less than 1% of the cases. We report the case of a 25-year-old woman who initially presented with a clinical presentation of acute appendicitis and was subsequently diagnosed with aNET by histopathological examination after an emergency appendectomy. While revealing the result to the patient, she was found to have a positive family history of appendiceal carcinoid tumor. Although rare and only found in 1% of the cases, aNET found in family history should raise the suspicion of neuroendocrine tumors in other family members.

Meckel's Diverticulum Causing a Small Bowel Obstruction in an 80-Year-Old Male: Report of a Rare Case and Review of the Literature.

Meckel's diverticulum (MD) is the most common congenital malformation occurring in the gastrointestinal tract and results from the persistence of the vitelline duct during embryology. MD is typically asymptomatic in adults with most of its symptoms manifesting in early childhood. Small bowel obstruction (SBO) due to MD in the elderly population is an entity that has not been widely described in the literature. We present a very rare case of SBO in an 80-year-old patient with no previous abdominal surgeries (virgin abdomen). The cause of obstruction was determined to be an adhesive band formed on top of an MD. The obstruction was relieved and the small bowel segment that contained the diverticulum was resected, and anastomosis was made.

Gastric Volvulus: A Delayed Surgical Complication After Debulking and Hyperthermic Intraperitoneal Chemotherapy for Advanced Ovarian Cancer.

Gastric volvulus in conjunction with diaphragmatic hernia is an uncommon but life-threatening presentation that is generally in association with hiatal hernia or diaphragmatic injuries. Diaphragmatic hernia with gastric volvulus can occur many years after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy despite initial diaphragm intactness, and should be suspected in this patient population when they present with upper gastrointestinal obstruction. An acute episode of gastric volvulus can have a mortality of 30% to 50%, hence the importance of early diagnosis and treatment. Surgical management remains the treatment of choice and can be an emergency in obstructive cases. We report the case of a 68-year-old woman presenting with signs and symptoms of acute upper gastrointestinal obstruction. Three years ago, the patient had undergone debulking surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis secondary to advanced ovarian cancer. A diagnosis of gastric volvulus was established. The pylorus was seen near the cardia on gastroscopy, and barium swallow showed stomach upside down and with a mirror image of normal anatomy suggestive of gastric volvulus. We opted for urgent laparotomy that revealed the presence of a rotated stomach adherent to the spleen and left diaphragm. After reduction, a diaphragmatic defect that was missed on the computed tomography scan was discovered and repaired, and the patient recovered uneventfully.

Surgical management of 10 years delayed recurrent acute pancreatitis post Whipple procedure for chronic pancreatitis: A case report.

INTRODUCTION: In patients who underwent pancreatoduodenectomy for management of Chronic pancreatitis, early and late anastomotic failure can occur [1]. Nevertheless, taking into consideration that most pancreatic head resections are performed for malignant disease with poor prognosis, long term pancreatico-jejunal anastomotic durability has not been well examined; similarly, the management of its stenosis has not been well assessed [1]. CASE: Here we present a case of a 69 years old male patient with history of chronic alcoholic pancreatitis and ampullary fibrosis managed by pancreatico-duodenectomy presenting for 10 years delayed onset of recurrent acute pancreatitis with signs of pancreatico-jejunal anastomotic stenosis, managed surgically with revision of pancreatico-jejunal anastomosis. CONCLUSION: Our case report might hold strongly for bringing up a purposeful approach, and be an insight to take into consideration in approaching pancreatic anastomosis, especially when pancreatic resections are utilized for treating benign pathologies.

Urodynamics in patients with multiple sclerosis: is it necessary? A randomized-controlled trial.

BACKGROUND: The need for complete urodynamic evaluation in Multiple Sclerosis (MS) patients with Lower Urinary Tract Symptoms (LUTS) is not fully established in the literature. The objective was to evaluate the effect of urodynamics in MS patients with LUTS on treatment outcomes. METHODS: MS patients with LUTS were recruited. On their first visit, urinary symptoms, symptom bother and urologic quality-of-life were evaluated using standardized questionnaires. On their second visit, patients were randomized into two groups: Group A underwent uroflowmetry, and Group B underwent a urodynamic study. Patients received treatment based on the whole evaluation and then were evaluated at 1, 3 and 6 months. RESULTS: Fifty MS patients with LUTS were randomized to 25 patients in each group. All scores decreased significantly after 6 months of treatment in both groups (p < 0.05). However, no differences were found between the two groups at baseline and at 1, 3 and 6 months of treatment (p > 0.05) concerning treatment outcomes. CONCLUSION: A detailed clinical and non-invasive evaluation of MS patients with LUTS seems to be sufficient for prescribing an effective treatment. A urodynamic study does not influence the response to the prescribed treatment in terms of LUTS severity, bother or urologic quality-of-life.

Isolated Breast Relapse after Metastatic Alveolar Rhabdomyosarcoma in a Young Premenarcheal Girl: What Could Have Been Done?

Alveolar rhabdomyosarcoma (RMS) is one of the most common pediatric soft-tissue neoplasms. Breast involvement either as primary tumor or metastasis is extremely rare. Herein, we report a case of primary limb alveolar RMS with breast metastases in a young premenarcheal girl that relapsed only to the metastatic breast site after achieving complete response. Accordingly, we believe that investigations of the mammary glands should be part of the routine diagnostic workup in adolescent females with RMS. Local therapeutic measures to control breast disease, including surgery or radiotherapy has to be considered for better prognosis. Newer radiation modalities aiming at reducing side effects should be developed.