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.

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.

A ventral hernia containing appendix; a case report and literature review.

INTRODUCTION AND IMPORTANCE: Abdominal wall hernia is a protrusion of abdominal contents through an acquired or congenital weakness or wall defect. A ventral hernia, including an appendix, is a rare condition. The appendix in the hernial sac is already known as inguinal and femoral hernia and has been named Amyand hernia and De Garengeot hernia, respectively. CASE PRESENTATION: We have presented a 74-year-old woman with complaints of point tenderness in the right lower abdomen and para-umbilical and a palpable non-reducible mass over the para-umbilicus with some erythema on the skin, which started two days ago. With the help of imaging, diagnosis of abdominal wall hernia was made, with the appendix as the possible content, as there was evidence of an inflamed appendix lumen incarcerated through the abdominal wall. CLINICAL DISCUSSION: We have provided a detailed review of recent articles. Our comprehensive discussion includes an exploration of the typical manifestations, the significance of imaging in accurate diagnosis, and the appropriate measures to facilitate optimal surgical preparation. The treatment for ventral hernia typically involves appendectomy and abdominal wall hernia repair, with the specific approach depending on the severity of inflammation. CONCLUSION: Although abdominal wall hernia containing appendicitis is extremely rare, its clinical manifestations are hernia and acute appendicitis, the most common diseases in general surgery. Imaging may be helpful in diagnosis. According to our study, diagnostic laparoscopy could be used in case of clinical suspicion of abdominal wall hernia containing an appendix, although more studies are needed.

Bariatric Surgery and Femoral Vein Diameter in Morbidly Obese Patients: a Cohort Study in Iran.

INTRODUCTION: Considering the importance of health, the effect of obesity on the quality of life, the person's self-image, and the effect of obesity on various organs, especially the vessels, and the absence or presence of a study in Iran that investigated the effect of gastric bariatric surgery on the diameter of the femoral vein, in the present study, we investigated the effect of bariatric surgery on femoral vein diameter in morbidly obese patients referred to Imam Hossein hospital. MATERIALS AND METHODS: The present study was a prospective cohort study on morbidly obese patients referred to the center in 2022-2023. In this study, 31 morbidly obese patients with BMI above 30 kg/m2 who were candidates for bariatric surgery were examined. Demographic data were collected using a demographic profile checklist. BMI, the diameter of common femoral veins, and the great saphenous vein were measured and recorded before and 6 months after surgery. Ultimately, the data was collected and analyzed using SPSS V.24 software. RESULTS: In the current study, 31 patients (62 extremities) were examined. The mean age of the patients was 34.45, with a standard deviation of 8.86. Fourteen patients (45.2%) were male, and 17 (54.8%) were female. The mean diameter of the common femoral vein in the 6 months after surgery was significantly less than before surgery (11.58 (1.64) compared to 12.95 (1.84), P = 0.0001). The mean diameter of the great saphenous vein in the 6 months after surgery was significantly less than before surgery (7.30 (1.45) compared to 7.75 (1.45), P = 0.0001). CONCLUSION: It seems that bariatric surgery causes a significant decrease in the diameter of lower limb veins (common femoral vein and great saphenous vein) compared to before surgery. However, further studies in this field are recommended.

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.

Taenia saginata, the incidental find in case of intestinal perforation after blunt trauma and literature review.

INTRODUCTION AND IMPORTANCE: Taenia saginata (T. saginata) is one of the most common cestodes in humans. Isolated perforation of the small bowel after blunt abdominal trauma is infrequent and the diagnosis should be based on exclusion. CASE PRESENTATION: We report a case of a 34-year-old man who presented following a car-pedestrian accident. Clinical examinations and symptoms suggested an acute abdomen. Investigations led to the diagnosis of hollow viscus perforation, so emergency laparotomy was performed. At the exploration of peritoneal cavity, unexpectedly, a live tapeworm was found in the peritoneal cavity. The perforation was repaired and medication were continued by anthelmintic. He was discharged with good condition. CLINICAL DISCUSSION: We discuss this rare incidental finding in a patient with bowel perforation and suggest the taeniasis as a possible cause of intestinal perforation. The medical literature and reviews have been searched to find more information about taeniasis and its cause-effect in GI tract complications. CONCLUSION: Increasing the public knowledge about food hygiene and encouraging eat well-cooked meat can control the cycle of transmission of cestodes. Taeniasis should be considered a possible cause of intestinal obstruction or perforation, especially in endemic areas.