Appendiceal duplication: a case report of horseshoe-shaped appendix and implications for patient safety.

Appendiceal anomalies, particularly double appendices, are rare and mainly detected during non-appendiceal surgery in adults. Misrecognizing them can have serious consequences, both clinically and legally. It is critical that surgeons pay attention to the anatomical variations of the vermiform appendix, and always consider the possibility of duplicated appendix when diagnosing a right iliac fossa pain. Misdiagnosis can lead to life-threatening medical complications for the patient, with medico-legal implications.

Peritonitis on sigmoidal perforation in a cocaine user: A rare case report.

INTRODUCTION AND IMPORTANCE: Cocaine, the second most abused drug in Morocco after cannabis, has been associated with multiple cardiac, pulmonary, neurological, and digestive complications. Colonic perforation following cocaine abuse is relatively lesser-known and requires attention as abuse rates are increasing, and existing evidence is scarce. Only a few cases have been reported in medical literature. CASE PRESENTATION: We report the case of a 42-year-old male cocaine addict who presented with acute peritonitis. A laparotomy revealed a 3 cm perforation in the sigmoid, The absence of radiological, biological, and pathological evidence confirms the toxic origin of the perforation. CLINICAL DISCUSSION: Cocaine-induced ischemic colitis is a rare occurrence in a surgeon's clinical experience. This condition is typically confirmed through colonoscopy and often resolves without the need for surgery, although a small number of cases may advance to peritonitis, necessitating surgical intervention. CONCLUSION: Cocaine's adverse effects should be taken into account in the differential diagnosis of acute ischemic events in young adults. A general understanding of the significant complications associated with cocaine can aid in achieving early diagnosis and prompt treatment.

Gastroenteric-anastomosis in the setting of marked stomach dilatation associated with gastric pyloric obstruction secondary to Sarcina ventriculi.

Sarcina ventriculi is an anaerobic gram-positive bacterium capable of surviving in the acidic environment of the stomach and causing gastrointestinal symptoms. We report the case of a 51-year-old patient with no notable medical history who presented with abdominal distension, nausea, and vomiting. Initial endoscopic evaluation revealed a distended stomach in stasis with pyloric stenosis. Biopsies revealed the presence of Helicobacter pylori and S. ventriculi. A therapeutic protocol was administered, but no symptomatic relief was observed. Subsequently, the patient was referred to our institution, where computed tomography imaging of the abdomen was performed. The results corroborated a presentation suggestive of a high obstruction attributable to a right anterior para-duodenal internal hernia. Ultimately, surgery was undertaken, ruling out the diagnosis of right para-duodenal internal hernia and resulting in gastroenteric anastomosis with satisfactory improvement in clinical symptoms.

Association between pancreatic cancer and diabetes: insights from a retrospective cohort study.

BACKGROUND: Studies investigating the prevalence of pancreatic cancer have revealed a heightened risk of 1.5 to 2.0 times among individuals with long-standing type 2 diabetes mellitus. AIMS: We aimed to estimate the prevalence of diabetes among patients with pancreatic cancer, and identify the factors associated with type 2 diabetes mellitus in this population. METHODS: This retrospective observational and analytical study was carried out in the Department of Gastroenterology of the Mohammed VI University Hospital over a period of 5 years, between 2018 and 2022, including all patients with confirmed cases of pancreatic adenocarcinoma. RESULTS: Out of the 197 patients, 38.1% had a history of diabetes, among them, 42.7% had new-onset diabetes, while the remaining 57.3% had long-standing diabetes. Diabetic patients were significantly older than nondiabetic patients (mean age of 67.2 vs. 63, P = 0.009). Diabetes was more prevalent among obese patients (66.7%, P = 0.01), and less frequent among individuals with chronic alcohol consumption (20% vs. 80%, P = 0.04), and tobacco smokers (24.4% vs75.6%, P = 0.03). Among patients with an ECOG score ≥ 3, DM, 54.5% were DM-patients (P = 0.033). The same significant association was found for the Nutritional Risk Index, Patients who had moderate or severe malnutrition were more likely to be diabetic 74.7% (P = 0.004). Diabetic patients were less likely to undergo surgery due to comorbidities and general health deterioration. However, no significant differences were observed in sex, tumor stage or location. CONCLUSION: Our study has shown an increased prevalence of diabetes in pancreatic cancer and highlights the importance of considering this cancer in cases of recent onset or uncontrolled diabetes, especially in elderly individuals.

Pancreatic cancer: experience from an emerging country in North Africa.

PURPOSE: Pancreatic cancer is a major global health problem, it's a highly aggressive and often has a poor prognosis. The aim of this work is to carry out a retrospective epidemiological study on pancreatic cancer in a university hospital in a North African country. METHODS: This is a monocentric, descriptive and analytical retrospective cohort study carried out in the Gastroenterology department of the Mohammed VI University Hospital of Oujda, Morocco, between January 2018 and December 2022. Analysis were performed using IBM SPSS Version 21.0 RESULTS: During this period, 197 cases of pancreatic cancers were collected, the median age was 64.6 years, the majority of patients (90.9%) were over 50 year's old. and there was no significant difference in gender distribution. Among the patients, several risk factors were prevalent, including chronic tobacco smoking (22.8%), alcohol consumption (12.7%), diabetes (38.1%), obesity (7.6%), and a family history of pancreatic cancer (3%). The most common symptoms at presentation were abdominal pain and obstructive jaundice. Imaging revealed that the majority of cases were located in the head of the pancreas (80.7%). Only 19.8% of the cancers were diagnosed at a resectable stage and adenocarcinoma was the predominant histological type (96.4%). Patients with advanced cancer stages showed higher levels of CA 19-9 and hypoalbuminemia. CONCLUSION: Our study aligns with previous research, indicating an increased incidence of pancreatic cancer among elderly individuals, particularly those with several risk factors such as chronic tobacco smoking, alcohol consumption, diabetes. A small proportion of cancer cases are deemed resectable at the time of diagnosis.

Endoluminal Leiomyoma of the Gastric Antrum: a Report of a Rare Case.

Endoluminal gastric leiomyoma (GL) of the antrum is a rare benign tumor. In this paper, we report a case of a 72-year-old patient that presented for a 1-month episode of epigastric pain. Imaging found a well-limited tumor in the antrum with extrinsic compression on ulcerated congestive mucosa. A surgical resection based on Finsterer's antrectomy with end-to-side trans-mesocolic gastro-jejunal anastomosis was performed. The histopathological examination in combination with immunohistochemistry diagnosed GL and found a diffuse and marked staining of smooth muscle actin (SMA) and h-caldesmon (h-CD) and negative expression of CD117 and DOG1. The patient was discharged without post-surgical complications and is still alive at the time of this case report writing.

Primary hepatic origin of a neuroendocrine tumor: A rare case report.

Introduction: Neuroendocrine tumors are mainly located in gastrointestinal tract, pancreas and lungs. The primary hepatic origin of neuroendocrine tumors is extremely rare. Case presentation: A 57-year-old female with a history of cholecystectomy presented to our hospital for right upper abdominal pain lasting for 2 months. Abdominal computed tomography revealed a large exophytic soft-tissue mass in the left liver lobe. Tumor markers were within the normal range. Octreoscan confirmed the primary hepatic origin of neuroendocrine tumor. The patient underwent left hepatic resection. Pathological and immunohistochemical examination of the resected specimen showed a well-differentiated grade 2 neuroendocrine tumor. Clinical discussion: Primary hepatic neuroendocrine tumors represent rare hepatic tumors. These tumors may occur at any age with an average of 50 years. Diagnosis algorithm includes two key steps: firstly, the confirmation of the endocrine nature of the tumor and secondly the confirmation of its primary nature. Conclusion: Neuroendocrine tumors are a very rare entity. The primary hepatic location is exceptional. The diagnosis is based on pathological and immunohistochemical examination as well as the result of the octreoscan.

First case report of uterine perforation and bowel incarceration following a clandestine abortion in Morocco.

Uterine perforation is a rare complication of abortion. It becomes much rarer when associated with a small bowel incarceration at the uterine breach. Its diagnosis can be suspected clinically, but radiology remains more sensitive for diagnosis. Surgery is the cornerstone in treating this entity as it provides both diagnostic and therapeutic management. A multidisciplinary therapeutic approach should be immediately performed to ensure a good prognosis. In this report, we describe a case of small intestine incarceration in the breach of a uterine perforation that occurred in the weeks following a clandestine abortion.

A febrile occlusion revealing a biliary ileus.

Biliary ileus is a consequence of the migration of a gallstone from the gallbladder to the digestive tract, most often via a biliodigestive fistula that causes a bowel obstruction. The clinic is atypical and capricious, including bowel obstruction and signs of cholecystitis, causing a delay in diagnosis. The therapeutic objective is to remove the intestinal obstacle by an enterotomy with stone extraction, with or without treatment of the biliary pathology (cholecystectomy and biliary fistula cure). The surgery remains the treatment of choice; laparoscopy and endoscopy present a less invasive alternative and are beginning to prove their effectiveness. The morbi-mortality remains high for biliary ileus, this is principally caused by the delay in diagnosis.

Mesenteric cystic lymphangioma in an adult: An unusual case report.

Introduction: Cystic lymphangioma is a benign malformation tumor of the lymphatic system. Its location is variable, and mesenteric localization remains extremely rare. Case presentation: We describe a rare case of cystic lymphangioma of the mesentery in a 26 years old woman. The diagnosis was suspected following an abdominopelvic computed tomography (CT) and magnetic resonance imaging (MRI), showing a large polylobulated cyst in contact with the stomach, the tail of the pancreas, the spleen, and the antero-external cortex of the left kidney. The patient underwent laparoscopic surgery with a pericystectomy. Pathological examination confirmed the diagnosis of cystic lymphangioma of the mesentery. The patient's postoperative recovery was uneventful. After a Follow up of one year after surgery, there was no evidence of recurrence. Clinical discussion: Cystic lymphangioma of the mesentery is a benign malformation tumor of the lymphatic system. Its clinical aspects are very polymorphic; the diagnosis is evoked by radiological imaging but requires pathological confirmation. Surgery is the gold standard in the management of this pathology. Conclusion: We highlight the importance of radical surgical resection to avoid Cystic lymphangioma complications and minimize the recurrence risk.

Retroperitoneal desmoid tumor in a patient with familial adenomatous polyposis: A case report.

Desmoid tumors are benign fibroblastic neoplasms, with locally invasive features and a tendency of recurrence. They are considered an aggressive non-metastatic fibromatosis. The retroperitoneal location is extremely rare. Their exact mechanism of occurrence is still controversial, but could be related to a genetic predisposition, hormonal factors or traumatic factors, including surgery. This entity faces management difficulties due to its rarity, the variable circumstances of its discovery, and the non-specific clinical manifestations. Their sensitivity to chemotherapy and radiotherapy is limited and surgery remains the only curative treatment in symptomatic cases, however observational waiting could consist the most appropriate management in selected asymptomatic patients, moreover it could avoid unnecessary morbidity from surgery or radiotherapy, which makes the management of this condition a multidisciplinary decision and should be adapted to fit the patients individually. We report a case of a retroperitoneal desmoid tumor in a 31-year-old woman with a history of familial adenomatous polyposis, through which we will discuss this extremely rare neoplastic entity.

Primary peritoneal high-grade serous carcinoma in a man: A case report.

Introduction and importance: Primary peritoneal serous carcinomas (PPSC) are exceedingly rare in male patients. Only a few cases were reported in the medical literature, it's diagnosis is difficult before surgery. Case presentation: In this article, we describe the case of a patient who presented a high-grade primary peritoneal carcinoma, the diagnosis was suspected radiologically following an abdominopelvic computed tomography (CT).the patient underwent exploratory laparoscopic surgery with biopsy of several peritoneal nodules. Pathologic analysis of specimen confirmed the diagnosis of Primary peritoneal serous carcinomas. The patient died one month after his diagnosis while undergoing chemotherapy and palliative care. Clinical discussion: PPSC is an inoperable malignancy, histology staining confirms the diagnosis, the chemotherapy and palliative care are the only offered treatment. The evolution of the disease is very dark with a poor prognosis. Conclusion: We highlight the important of testicular examination to predict apparition of PPSC in the future.

The Extracapsular Lymph Node Extension Predicts Outcomes in Colorectal Cancer: A Short Review.

BACKGROUND: The extension of the metastatic lymph nodes through the capsule to the adipose tissue in the perinodal or extra-nodal defines the extra-nodal extension (ENE). ENE represents an important prognostic factor in multiple cancers, which is considered as a prognostic parameter in different tumor-node-metastasis (TNM) classifications. INTRODUCTION: Colorectal cancer (CRC) is ranked third in order of frequency, after successively lung and breast cancer. Lymph node metastasis has been validated as a significant negative prognostic factor for survival in colorectal cancer (CRC), which is improved by the adjuvant. Despite the use of ENE as an important and validated prognostic factor in multiple cancers, ENE is not yet taken into account in the CCR staging system. METHOD: The present short review aims to discuss the prognostic impact of ENE on CRC according to the emerging evidence. To conduct this study, we have reported the results of all available studies following the scientific rationale in three parts: retrospective studies, prospective studies, and meta-analyses. RESULT: ENE has a negative impact on the prognosis of colorectal cancer but is not yet used in practice in colorectal cancer. CONCLUSION: We, therefore, propose to carry out randomized clinical trials to study this subject better and strengthen its value in management strategies.

An Exceptional Clinical Presentation associating an occipital stroke, a Superior and Inferior Mesenteric Thrombosis following Covid 19 disease, case report.

INTRODUCTION: The Covid 19 pandemia since the first reported case in 2019 had a direct socioeconomic impact related to morbi-mortality and indirect in response to protection and isolation strategies. To our knowledge thrombo-embolic complications can be a mode of revelation complicating the management. CASE PRESENTATION: We present an exceptional case of a patient with a history of Covid 19,admitted 21 days later for disturbed consciousness, in whom an ischemic occipital stroke ,intestinal and colonic ishemia had been objectified. Our objective through this presentation is to remind the thrombo-embolic particularity of Covid 19, to take the viral attack as a serious antecedent in the periods following theinfection and to put the point on the primordial place of early rehabilitation in patients with stroke. DISCUSSION AND CONCLUSION: We discuss through this report the recommendations of anticoagulation in Covid 19 patients and the place of early rehabilitation in patients with stroke. We also report a new case among the rare cases described in the literature that associates several thrombo-embolic manifestations secondary to Covid 19, in particular the neurological and digestive association.

Management of a Left Lateral Aortic Paraganglioma During Pregnancy: A Rare Case Report.

Paragangliomas are rare neuroendocrine tumors mostly diagnosed in young adults. Their association with pregnancy is even rarer, and their impact is even more serious in the absence of adequate management, which may vitally involve maternal and fetal prognosis. In this report, we present a rare case of a left lateral aortic paraganglioma in a pregnant woman in her third trimester during her 31 weeks of gestation, who consulted for a hypertensive peak; the methoxylated derivatives were positive. An abdominal MRI showed a left lateral aortic mass, suggesting a paraganglioma. After a multidisciplinary discussion, the patient underwent laparoscopic surgical resection of the mass after preoperative medical preparation. Pathological examination confirmed the diagnosis of paraganglioma. The overall stay was six days without any short-term complications, including anything related to fetal viability, with a vaginal delivery at 37 weeks of amenorrhea. The patient was followed up for six months with no complications. We highlight the importance of preoperative medical preparation followed by surgical resection in the framework of a multidisciplinary consultation for an improved maternal-fetal prognosis.

Strangled gravidic uterus, an exceptional complication of umbilical hernia during pregnancy, a case report.

INTRODUCTION: Strangulated pregnancy is a very rare presentation in which the intra umbilical strangulated form is exceptional. To our knowledge, we report the first Moroccan case and one of less than 10 cases published in the literature of a strangulated gravid uterus; in a woman admitted for treatment of umbilical pain. CASE PRESENTATION: Through this presentation, we report a sporadic case of hernial strangulation during pregnancy containing an evolving pregnancy in the umbilical harness bag. The suspicion of this diagnosis was clinical and the confirmation made by ultrasound and abdominal MRI for confirmation. The objectives of this publication are threefold: i), to report this new exceptional case ii), to highlight the place of imaging in the management of hernial pathology iii), and to recommend surgical treatment of umbilical hernias in women of childbearing age in order to avoid surgical complications and maternal and fetal morbidity and mortality. CONCLUSION: Our case report shows that we should consider this very rare presentation of strangulated pregnancy. Our work also reports another new case to the poor published literature on this subject and emphasizes the importance of surgical management of parietal pathology by focusing on the parietal impact of physiological change during pregnancy.

Degenerative Ulcerative Colitis After One Year of Evolution in a 20-Year-Old Patient.

Ulcerative colitis (UC) is an inflammatory bowel disease. Patients with this condition are considered to belong to a high-risk group for developing colorectal cancer (CRC). These are patients who are often not subjected to regular endoscopic monitoring and in whom the diagnosis of CRC degeneration is often a pathological discovery. The purpose of this work is to report the characteristics of a case of degenerate UC. This is a case of a 20-year-old patient, followed for UC, who was diagnosed with CRC during a flare-up of his disease, revealed by endoscopic exploration. This patient underwent a coloproctectomy with ileoanal J-pouch reconstruction by laparotomy. The operative specimen came back in favor of a moderately differentiated Lieberkunian adenocarcinoma after an anatomopathological study. The risk of developing CRC in patients followed for UC is rare at a young age, but it becomes higher after 10 years of evolution. This risk is incriminated by several factors: duration of evolution, the extent and severity of inflammatory lesions and the notion of CRC in the family. The discovery is often made by endoscopic exploration during disease surveillance.

Acute Intestinal Invagination: An Exceptional Method of Revealing Crohn's Disease.

Crohn's disease presents a public health problem. The clinical presentation is variable with gastrointestinal and extra gastrointestinal manifestations. The management is multidisciplinary while patients with Crohn's disease rarely require surgery. We present a rare case of a 57-year-old patient followed for 10 years for ankylosing spondylitis and admitted for abdominal pain on intussusception caused due to Crohn's disease which was probably symptomatic but not understood by your patient.

Hematemesis: An Exceptional Method of Revealing Gastric Metastasis From an Unknown Breast Cancer.

Breast cancer is a public health problem with an annual incidence exceeding two million new cases leading to its classification as first cancer in women. Its clinical presentation is variable and the palpation of a breast nodule allows the diagnosis to be suspected in the majority of cases. The treatment is multidisciplinary and has health, economic, and psychological impacts. We report a sporadic case of a 60-year-old woman followed for epigastralgia for three months. The current history of the present disease goes back to three days before her admission with the onset of several episodes of hematemesis motivating the patient to consult the ER and then get admitted to the ER for hematemesis. The initial clinical examination showed an epigastric sensitivity in a hemodynamically stable patient. The endoscopy revealed a gastric tumor and immunohistochemistry confirmed the gastric localization from a breast cancer unrecognized by the patient and discovered at the careful clinical examination after having stabilized the patient's condition.

Diffuse Large B-Cell Lymphoma Revealed by Splenic Abscess: A Case Report.

Diffuse large B-cell lymphoma (DLBCL) is one of the most common non-Hodgkin lymphomas. It has no typical or specific clinical features. DLBCL revealed by an abscess is a rare entity. CT is sensitive in detecting splenic abscesses, and it can define the exact location and extent of the abscess as well. The splenic abscess is associated with typhoid fever, AIDS, abdominal infections, pneumonia, bacterial endocarditis, and urogenital infections, parasitic abscesses, organ transplantation, or neoplastic diseases. DLBCL is not usually related to its etiology. Elective open splenectomy, both diagnostic and therapeutic, is the gold standard method of management today and has low morbidity and mortality rates, with even lower rates for laparoscopic splenectomy. The diagnosis of DLBCL is based on the anatomopathological and immunohistological examination. We report a case of a man with a splenic abscess initially treated as an abscess of bacterial origin; however, the lack of improvement in his condition led us to perform a splenectomy, and the anatomopathological study revealed a DLBCL.