The impact of cotrimoxazole in idiopathic granulomatous mastitis treatment.

INTRODUCTION AND IMPORTANCE: Idiopathic granulomatous mastitis (IGM) is a benign inflammatory breast disease, commonly presented with a sensitive breast lump and developing scars. Currently, there is no definitive treatment for IGM but Antibiotics, steroids, immunosuppressive drugs or a surgical treatments are the usual options. This case series aimed to evaluate the effectiveness of cotrimoxazole in treatment of IGM as there is no clinical consensus on the best and most widely acknowledged therapeutic management for IGM. CASE PRESENTATION: All IGM patients were treated by Cotrimoxazole (800 mg BD for one week), and they were assessed at a month, 3 months, and 6 months after that. The primary outcome was an improvement in presenting complaints and symptoms such as palpable mass, bulging, pain, erythema and hypersensitivity of breast skin, breast discharge and fluctuation. The secondary outcome was the refractory rate within 6 months. Number of 20 patients were included. At the baseline, participants exhibited various symptoms such as bulging, pain and erythema (100 %), breast discharge (80 %), and fluctuation (30 %). After the intervention, there was a significant decrease in the prevalence of symptoms over the study period. The prevalence of bulging and pain, erythema, discharge, and fluctuation symptoms were decreasedto 5 %, 0 %, and 0 %, respectively. The refractory rate of IGM within six months of cotrimoxazole treatment was estimated 30 %. CLINICAL DISCUSSION: In this study, the treatment approach did not involve corticosteroids and invasive procedures and the recurrence rate of IGM within the six months was lower than in similar studies that employed steroids alone or any more invasive treatments. Additionally, our study showed a high healing rate with resolution of inflammation, pain, discharge, and fluctuation. These results suggest that cotrimoxazole may be a more favorable option than high-dose corticosteroids and a comparable alternative to low-dose corticosteroids regarding recurrence rates. CONCLUSION: Cotrimoxazole may be an effective treatment option for idiopathic granulomatous mastitis. However, further research is needed on different treatment options.

Colocolic intussusception due to lipoma in an adolescent with refractory anal fissure; case report and literature review.

INTRODUCTION AND IMPORTANCE: Intussusception is uncommon in older patients, making its diagnosis challenging and necessitating a high level of clinical suspicion. While pediatric intussusception typically presents with a triad of symptoms including abdominal pain, bloody diarrhea, and an abdominal mass, the majority of adult patients experience chronic abdominal pain and partial obstruction. Consequently, the diagnosis of adult intussusception may be delayed due to the similarity in presentation with other conditions. CASE PRESENTATION: In this article, we have presented a 13-year-old boy with chronic and refractory anal fissure. The patients also complained of constipation for a year, intermittent abdominal pain, and bloating. Although he was treated with conservative laxative medications, the constipation was not relieved. Incidentally, a colocolic intussusception was found through an MRI. CLINICAL DISCUSSION: We have provided a comprehensive description of an unexpected intussusception at an uncommon age which was found incidental. Medical literature was reviewed for better optimal planning in surgery. CONCLUSION: Intussusception in a teenager is unexpected, and this case shows the importance of considering it even in the presence of nonspecific symptoms. This case serves as a reminder to healthcare professionals to consider intussusception as a potential diagnosis in similar cases.

Emergency laparotomy and perioperative COVID-19: a single-center retrospective cohort study.

Concerning the perioperative outcomes of patients diagnosed with COVID-19 who underwent emergency laparotomy, more data must be collected. Because COVID-19 can affect multiple organs, cause various complications, and act as a risk factor for surgery, in this study, we aimed to compare the outcomes of emergency laparotomy between SARS-CoV-2 infected and uninfected patients. This retrospective cohort study was conducted on patients who underwent emergency laparotomy from December 2021 to December 2022. Postoperative outcomes were compared between patients with and without confirmed perioperative SARS-CoV-2 infection. The primary outcome was 30-day mortality. Secondary outcomes were postoperative intensive care unit admission, hospital length of stay, re-operation, and postoperative complications. Data were analyzed by SPSS statistic version 27. In this study, 50 patients in the COVID-19 group and 91 patients in the non-COVID-19 group were assessed. The 30-day mortality in the COVID-19 group was significantly higher than in the non-COVID-19 group (34% vs. 12.1%, respectively, P = 0.004). Postoperative complications were significantly higher in the COVID-19 group (64% vs. 26.4%, P < 0.001). The frequency of ICU admission and need for re-operation were significantly higher in the COVID-19 group (P = 0.003 and P = 0.039, respectively). Length of hospital stay was significantly lower in the non-COVID-19 group (P = 0.021). In patients with confirmed COVID-19, emergency laparotomy is associated with increased postoperative morbidity and mortality. Additionally, emergency laparotomy is associated with increasing postoperative complications, length of hospital stay, intensive care admission, and additional surgery requirement.

Cecal Perforation Induced by Migrated Biliary Stent as a Rare Complication of ERCP: A Case Report and Literature Review.

Introduction and Importance. Endoscopic retrograde cholangiopancreatography (ERCP) is a non-surgical method utilized to manage biliary tract obstruction, but the complication of biliary stent migration occurs in 5-10% of patients. Though migrated stents are commonly passed through the gastrointestinal tract without harm, intestinal perforation is a rare but severe complication, affecting less than 1% of cases. Case Presentation. We report a case of a 65-year-old woman who presented to the emergency department with symptoms of abdominal pain, nausea, and loss of appetite. According to clinical examination and evidence, the patient underwent surgery with high suspicion of appendicitis, which unexpectedly uncovered a perforated cecum with a protruding biliary stent. Clinical Discussion. Our report describes a unique and unexpected finding of cecal perforation caused by a migrated biliary stent in a patient. We also conducted a review of current literature on ERCP complications, including risk factors for stent migration, relevant statistics, and appropriate interventions. Conclusion. Surgeons should be aware of the risk of stent migration and complications in patients with a history of ERCP. Removal of migrated biliary stents is recommended, regardless of the presence of complications. Additional assessments for alternative diagnoses are recommended for older patients with abdominal pain complaints. Flexible plastic stents should be used for patients at risk of stent passage.

Peritoneal tuberculosis pretending an acute abdomen; a case report and literature review.

INTRODUCTION AND IMPORTANCE: Peritoneal tuberculosis (PTB) is an infrequent clinical condition that frequently eludes diagnosis. The scarcity of PTB cases underscores the necessity for heightened vigilance within clinical settings to detect its presence. Notably, there has been a noticeable increase in PTB incidence in recent years. Mycobacterium tuberculosis is the causative agent responsible for PTB, affecting multiple gastrointestinal components such as the peritoneum and hepatobiliary system. Peritoneum is a rare site for TB with broad unspecific symptoms. It can be asymptomatic to periodic signs or mimic the positive peritonitis examinations like our case. CASE PRESENTATION: We have reported a case of 19-year-old male experiencing progressive abdominal pain. The presence of generalized tenderness and guarding on physical examination prompted us to perform an urgent laparotomy due to suspicion of peritonitis. During the surgery, we observed the peritoneum exhibiting widespread nodularity, resembling a disseminated seeding pattern, along with mild ascites, which raised our suspicion of peritoneal tuberculosis. Subsequently, cytological analysis of the ascitic fluid and histopathological examination of the lesions confirmed our diagnosis of peritoneal TB. CLINICAL DISCUSSION: We have shared our experience in facing PTB and reviewed recent papers to find further relevant information. The common presentations, probable causes, the role of imaging in diagnosis and the management are discussed for better management strategy and the best surgical decision. CONCLUSION: Peritoneal tuberculosis is a rare condition with challenging diagnosis. Key symptoms include vomiting, abdominal pain, ascites, weight loss, and fever. Prompt recognition and treatment are vital for better outcomes.

Spontaneous ventral gallbladder hernia complicated with perforation; a case report and literature review.

INTRODUCTION AND IMPORTANCE: Ventral gallbladder hernia is a rare condition mostly related to past acquired abdominal wall defects, but spontaneous ones are scarce. It happens more in elderly patients. Etiology and causes are still unspecified, but the most related known causes of spontaneous gallbladder herniation are carcinoma, biliary tracked occlusion or abdominal wall weakness in elderly patients, respectively. CASE PRESENTATION: We have presented a complicated 90-year-old woman with a bulged and warm area at the right upper abdomen with tenderness and positive rebound tenderness. In help with imaging, we found a ventral gallbladder hernia perforated in the subcutaneous layer. Then cholecystectomy and herniation site repair was performed. CLINICAL DISCUSSION: We have explained this infrequent scenario and reviewed recent similar papers to find further relevant information. The common presentations, probable causes, the role of imaging in diagnosis and the management are discussed for the best surgical planning. CONCLUSION: The spontaneous ventral herniation of the gallbladder is an exceedingly uncommon occurrence. The diagnosis of this condition heavily relies on imaging, with computed tomography (CT) scan utilizing both intravenous and oral contrast being the optimal modality. Management of this condition can be accomplished via both laparoscopic and laparotomy approaches. It is our recommendation to perform cholecystectomy and hernia repair simultaneously and expeditiously in all cases. We advise against conservative management strategies.

Small bowel volvulus and mesenteric ischemia induced by mesenteric cystic lymphangioma in an adult and literature review; a case report.

INTRODUCTION AND IMPORTANCE: Mesenteric cystic lymphangioma (MCL) is a rare benign intraperitoneal mass with congenital origin, and it is extremely rare in adults. Mesentery is an unusual location for cystic lymphangioma too. Clinical presentations are nonspecific, and diagnosis is challenging. It can mimic other surgical complications like appendicitis or any acute abdomen causes, so the review of cases is necessary for the best management and surgical planning. CASE PRESENTATION: We have presented a 22-year-old man presented with complaints of abdominal pain, nausea and vomiting. In laparotomy, a cyst was found with large size around the small intestine which caused mesenteric ischemia and changed the color of the small bowel to an ischemic view. The resected cyst was sent and confirmed by the pathology as lymphangiomatosis. MCL is a rare cause of obstruction, which was found accidentally in this case. CLINICAL DISCUSSION: MCLs are clinically challenging lesions with unspecific broad spectrum of clinical presentation ranges. We discuss a rare finding in an adult with intestinal volvulus and mesenteric ischemia. Medical literature and reviews have been searched to find more relevant information about MCLs for the better optimal planning in surgery. CONCLUSION: MCL is a challenging and infrequent case of surgery. Most of the time, it does not cause any complications, but it can also cause some life-threatening conditions like mesenteric ischemia or volvulus and lead to emergent surgery. Complete tumor removal is optimal for managing intra-abdominal cystic lymphangioma with the slightest chance of recurrence.