A "fruitful" cause of acute appendicitis.

INTRODUCTION: Acute appendicitis is a common health problem mainly due to a lumen obstruction. The obstruction is mainly due to fecal material, lymphoid hyperplasia or parasites. Foreign bodies and especially seeds have been rarely reported as causes of acute appendicitis and account for less than 1% of the different causes. CASE REPORT: The authors described a rare case of acute appendicitis caused by seed and causing diagnostic challenge with the most frequent parasites observed in the appendix lumen. Different arguments were gathered to rule out enterobius vermicularis, taenia species, ascaris infection or schistosomiasis. CONCLUSION: Seed-caused-appendicitis has to be known and identified by pathologists in order to avoid the diagnosis of parasites infection which may induce an overuse of antibiotics after the appendectomy.

Primary Ewing sarcoma of the liver: Diagnosis, management, and prognosis: A case report and literature review.

Ewing's sarcoma tumors (ES) are a rare entity exceptionally localized on the liver. We report a case of an ES of the liver in a 26-year-old man who presented with abdominal pain. The diagnosis was confirmed with a histopathological examination of the left hepatectomy specimen and adjuvant chemotherapy was received.

Cholecystitis in a midline gallbladder: A rare ectopic location.

INTRODUCTION: The ectopic gallbladder is an uncommonly encountered anomaly that surgeons should be aware of. Its diagnosis is difficult but can be elucidated with the use of computed tomography and MRCP. PRESENTATION OF CASE: We present a case of a 64-year-old patient who presented with abdominal pain, inflammatory epigastric mass and fever. Computed tomography (CT) revealed the presence of a para-umbilical gallbladder with signs of acute cholecystitis. Laparoscopic exploration revealed that the gall bladder was not present in its usual fossa but was seen attached to the midline anterior abdominal wall with extensive adhesion between it and the omentum. Given the complexity of the cholecystectomy via the laparoscopic approach, a conversion to a midline incision was performed. The IOC confirmed the absence of anatomical variants of the biliary tree. DISCUSSION: An ectopic gallbladder is a difficult entity to diagnose as it can create clinical confusion by tampering with the common clinical presentation of cholecystitis. MRCP is currently one of the most effective preoperative examination methods as it detects the coexistence of biliary tract variation. Laparoscopic surgery is a safe procedure to be performed in the ectopic gallbladder. CONCLUSION: Ectopy of the gallbladder is a rare congenital abnormality that should be kept in mind to avoid errors or delays in management.

Hydatid cyst of the liver fistulized into the inferior vena cava.

INTRODUCTION: Fistulization or rupture of hydatid liver cysts to the inferior vena cava (IVC) is an extremely rare and life-threatening condition. PRESENTATION OF CASE: We report the case of a 70-year-old patient who presented with right-upper-quadrant pain and fullness evolving for 03 months. Physical examination showed dilated veins over the anterior abdominal wall and the flanks associated with lower-extremity swelling. Computed tomograph of the abdomen showed a hydatid cyst invading segments VI and VII of the liver fistulized into the inferior vena cava. The IVC was partially trombosed. The diagnosis of a possibly ruptured hydatid cyst in the inferior vena cava was then made. The patient underwent surgical management. Per-operatively the cystic cavity had bloody content but the cysto-vascular communication was not identified. Partial cystectomy was performed leaving a fairly extensive contact between the calcified pericyst and the IVC. The postoperative course was uneventful. DISCUSSION: Rupture of the hepatic hydatid cyst into the IVC is very rare and may lead to fatal pulmonary embolism secondary to the migration of vesicles in the pulmonary artery or haemorrhagic shock. CT scan remains the best investigation method to assess the vascular links of the hepatic hydatid cyst especially with the IVC. Surgical treatment of the hepatic hydatid cyst ruptured into the IVC mandates vascular control before the hydatid cyst is punctured or removed. CONCLUSION: Fistulized hydatid cysts into the IVC should be operated on in centres equipped for extracorporeal bypass techniques, and experienced in the surgery of hepatic echinococcosis.

Acute pancreatitis secondary to ansa pancreatica: Two new cases and review of the literature.

We described two cases of acute pancreatitis secondary to ansa pancreatica. The first patient was diagnosed on MRCP and improved after standard treatment of AP. In the second case, ansa pancreatica was diagnosed on IOP. At the second episode of AP, sphincterotomy of the minor papilla was performed.

Perforated Jejunal Diverticulitis: a rare cause of acute abdominal pain.

It is imperative for surgeons to have a heightened awareness of complications of jejunal diverticular disease so that they can act quickly and contribute to a successful clinical outcome for their patients.

Pedunculated hepatic focal nodular hyperplasia: A case report and review of the literature.

Focal nodular hyperplasia (FNH) is a common asymptomatic benign hepatic tumor encountered in middle-aged women. However, pedunculated FNH is exceedingly rare and more frequently associated with complications. That is why surgical management is mandatory in this form.

Ileocecal and hepatic tuberculosis mimicking a metastatic cecal malignancy: Case report.

We wish to highlight that on encountering a suspicious hepatic and a colonic lesion, the possibility of TB should also be kept in mind apart from the obvious possibility of metastasis of a colonic cancer especially in an endemic country like Tunisia.

Thoracoscopic retrieval of an intrapulmonary sewing needle: A case report.

The intrathoracic sewing needle is an exceedingly rare condition mildly documented in the literature. Given the needle's tendency to migrate, it must be removed as soon as possible, and the minimally invasive technique should be tried first.

Chilaiditi's sign: A rare differential diagnosis of pneumoperitoneum.

Chilaiditi sign is a rare condition typically mistaken for pneumoperitoneum. CT scan can confirm the diagnosis. Its management is conservative that is why it should be well known by surgeons to avoid unnecessary exploratory laparotomies.

Bilateral pulmonary hydatidosis associated with uncommon muscular localization.

INTRODUCTION: The lung is the second most commonly affected organ by hydatidosis, and the bilateral involvement is rare even in endemic regions. CASE PRESENTATION: We report the case of a 27-year-old patient who presented with right basithoracic pain and cough evolving for three months. Thoracic CT scan revealed two homogeneous, rounded cystic formations enhancing after injection of the contrast media, located in the lateral basal segments of the lower lobe. An abdominal CT scan was performed to rule out a hepatic localization of the hydatid cyst, revealed a cystic formation of the left psoas muscle. The diagnosis of bilateral hydatid lung cyst associated with hydatid psoas muscle location was then made. The patient underwent a two-stage thoracic surgery. The second step involved partial cystectomy of the psoas muscle hydatid cyst via a left iliac incision and using an extraperitoneal approach. The postoperative course was uneventful. DISCUSSION: Management of bilateral pulmonary hydatid cyst is controversial. Some authors recommend operating bilateral cysts in two-stage surgery, with an interval of three to four weeks between procedures. The involvement of the psoas muscle is rare and is generally secondary to the rupture of splenic, hepatic or renal hydatid cysts. Generally, its diagnosis is delayed as the latter is most of the time asymptomatic. CONCLUSION: Bilateral pulmonary hydatidosis associated with hydatid cyst of the psoas muscle is a rare entity. Radiological investigations and especially CT scan are the mainstay of diagnosis. Surgery remains to be the treatment modality of choice.

Large pedunculated colonic lipoma: a rare cause of colorectal intussusception in adults.

Colo-rectal intussusception is rare in adults and is often secondary to malignant lesions, rarely benign lesions such as colonic lipomas can also be the cause. We present the case a 60-year-old man who presented to the emergency department with acute abdominal pain. On physical examination, the abdomen was distended with diffuse tenderness. CT scan of the abdomen revealed a colo-rectal intussusception secondary to a rectal lipoma with parietal pneumatosis of the invaginated loop. An emergency laparotomy was performed. Intraoperatively the radiological findings were confirmed. A rectosigmoid resection (Hartmann's procedure) taking off the lipoma and the invaginated segment of the colon was performed and the patient had an unevent full recovery. Histopathology confirmed a 6cm sub-mucosal lipoma without evidence of malignancy. As the diagnosis of a benign disease in patients presenting with colonic intussusception can only be made on pathological examination, this entity should be managed as a malignant lesion due to the high incidence of malignancy.

[Gastric necrosis secondary to gastric volvulus complicating hiatus hernia]. / Nécrose gastrique secondaire à un volvulus gastrique compliquant une hernie hiatale.

Acute gastric volvulus is a rare condition complicating 4% of hiatus hernias. It is a more or less complete rotation of the stomach around a transverse or longitudinal axis. It can lead to perforations due to ischemic gastric wall necrosis with very poor prognosis (30% of mortality). We here report the case of an 89-year old female patient with chronic bronchopathy, presenting with epigastralgias associated with vomiting which had progressed for 03 days. Physical examination showed febrile patient at 38.5 with dyspnea (SpO2 88% at room air). Her appearence suggested infection, the abdomen was soft, tender at the level of the epigastrium. Laboratory test showed SBI (WBCs= 22000, CRP= 80). Abdominal CT scan showed hiatus hernia associated with significant gastric distension with wall defect in the anterior face of the stomach associated with pneumatosis in the gastric wall. The patient underwent surgery using a median approach, which showed voluminous hiatus hernia containing the greater curvature of the stomach. Distended stomach was restored to its normal intra-abdominal position. The anterior face of the greater tuberosity was the seat of several areas of necrosis. Total gastrectomy with manual oesojejunal anastomosis associated with Roux-en-Y gastric bypass was performed. The postoperative course was complicated by acute respiratory distress syndrome (ARDS). The patient died on day 8 after emergency hospital admission. Gastric volvulus is a rare condition, which can lead to extremely severe consequences. CT scan allows for thoracic lesion assessment and to study stomach vitality. The treatment of choice is based on surgery.