A huge retroperitoneal ganglioneuroma in a middle-aged patient: Report of a diagnostically challenging case with review of the literature.

Ganglioneuromas (GNs) are benign, slow-growing tumors of neural crest cell origin. On rare occasions, adipose cells have been detected in these tumors. The present study reported a case of a huge retroperitoneal GN misdiagnosed and mismanaged as a liposarcoma. A 54-year-old male patient presented with gradually progressing dull back pain with abdominal discomfort for the past 6 months. The patient had abdominal distention and mild right abdominal tenderness. Ultrasound of the abdomen and pelvis revealed a large right-sided retroperitoneal mass. Contrast-enhanced computed tomography findings were consistent with sarcoma. Cytologic examination was suggestive of liposarcoma. A decision was made to start neoadjuvant radiochemotherapy, which proved ineffective. Complete surgical excision of the mass was performed via a midline laparotomy. Histopathology of the mass confirmed the diagnosis of GN. At two years post-operation, the patient developed a recurrence in the subhepatic area with the same diagnosis and the recurrent mass was surgically removed. Initially, the imaging findings were not sufficiently specific to establish the diagnosis. Rarely, cytologic techniques have detected adipose cells in these tumors, resulting in misdiagnosis. Hence, histopathology is the gold standard for definitive diagnosis. Preoperative diagnosis of GN is difficult due to the lack of specific clinical manifestations, radiological confusion with other tumors and the presence of adipocytes in rare cases, leading to misdiagnosis and mismanagement.

Conservative management of delayed presentation of intraperitoneal bladder rupture following caesarean delivery: A case report.

INTRODUCTION: Bladder injury is an uncommon complication of cesarean delivery (CD) with an incidence ranging from 0.0016% to 0.94%. The risk factors are emergency CDs, subsequent CDs, trial of normal delivery after CD and whether adhesions are present or not. The presentation is either immediate intraoperative event or delayed bladder rupture and urinary ascites. CASE PRESENTATION: A 35-year-old female presented with considerable abdominal distension, shortness of breath, oliguria, straining to void and elevated levels of blood urea and serum creatinine 11 days after an uneventful Caesarean delivery. Abdominal ultrasound showed marked ascites. Immediate resuscitation was done, a urethral catheter and percutaneous intraperitoneal pigtail catheter were inserted confirming urinary ascites. Next day cystoscopy was performed and revealed a perforation at the posterior wall of the bladder. She was kept on conservative treatment with adequate urine diversion through both urethral and intraperitoneal catheter. Her condition improved and responded well. DISCUSSION: To the best of our knowledge this presentation of delayed intraperitoneal bladder rupture post CD is the second case reported in literature. Although surgical repair is regarded as the treatment of choice for intraperitoneal bladder injury, conservative treatment may succeed in properly selected cases. Non-operative managements include indwelling transurethral Foley catheter alone, percutaneous peritoneal drain alone or combined Foley catheter and percutaneous peritoneal drain for complete urinary drainage. CONCLUSION: Delayed urinary bladder rupture is a very rare complication of cesarean delivery. Non-operative treatment can be a viable alternative to surgical repair in carefully selected patients.

Intermammary pilonidal sinus: The first case series.

INTRODUCTION: Pilonidal sinus (PNS) is an inflammatory condition caused by hair penetration into the epidermis. It occurs usually in sacro-coccygeal area. Intermammary pilonidal sinus is a very rare variant with a few case reports in literature. The aim of this study is to highlight the presentation and management of intermammary pilonidal sinus. METHOD: A retrospective multicenter case series. Including all cases of intermammary PNS admitted to either of 5 major tertiary hospitals in Kurdistan region of Iraq. Inclusion criteria were any case of intermammary PNS diagnosed by histopathological examination. The data were taken from the medical records and direct interview with the patients. RESULTS: The case series included 12 patients, all case were female. The age range was from 13 to 29. All of cases were obese with body mass index (BMI) ranged between 30.1-32.2kg/m2. All of them presented with discharge for a long time ranging between four weeks to two years. Nine cases (75) were diagnosed preoperatively as cases of infected sebaceous cysts. Resection and direct closure without flap were done for nine (75%) of them and in other three cases (25%), the PNS were resected and left for secondary healing. Three of the patients (25%) developed recurrence. CONCLUSION: Intermammary PNS occurs in young, obese ladies with large breasts which are kept in tight brassieres. Resection and primary closure is the main method of management.