RESUMO
Left-sided gall bladder (LGB) is a rare anomaly seldom encountered by surgeons in clinical practice. Accurate preoperative diagnosis is rare due to the atypical localisation of pain in the right hypochondrial quadrant and the rarity of occurrence. This feature poses intraoperative challenges that mandate quick improvisation. Hence, all surgeons should gain knowledge of left-sided gall bladders, which can be associated with the risk of biliovascular injuries compared to normally positioned gall bladders. We present an interesting case of the intraoperatively diagnosed left-sided gall bladder, where a few minor modifications in laparoscopic technique could salvage the situation with marked improvement in surgical ease and consequent outcomes.
RESUMO
Pulmonary sarcomatoid carcinomas (PSCA) are a rare subset of Non-Squamous-Cell Lung Carcinoma (NSCLC), the most common pathological subtype of lung cancers which are the most common malignancy in the world. These rarest of rare tumours may have gastrointestinal metastasis and present as an acute abdominal surgical emergency with bowel obstruction or bleeding, as in our patient, who did not have a diagnosis of lung cancer till then. Use of novel immunohistochemistry markers like thyroid transcription factor-1 (TTF-1) may help diagnose the site of the primary tumour with accuracy in this clinical setting. Further evaluation of these patients with positron emission tomography (PET) scans helps determine the tumour burden and degree of dissemination. The aim of this article is to emphasize this rare presentation which may be unsuspected as a cause of bowel obstruction by surgical teams on the acute surgical take due to its rarity. It is vital that nihilism is avoided in these patients as a subset of these patients can still be offered curative metastectomy and treatment of the primary tumour with reasonable outcomes.
