Caecal Volvulus Presenting as an Obstructed Inguinal Hernia: A Case Report.

Caecal volvulus (CV) is an uncommon cause of large intestinal obstruction due to the axial torsion of the caecum, ascending colon, and terminal ileum. We describe the case of a 37-year-old man who presented with bilateral inguinal hernias (the left larger than the right), diffuse abdominal pain, vomiting, difficulty passing stool, and flatus that were comparable to those of an obstructed hernia. Imaging tests revealed a collapsed ascending colon, free fluid collection, and a significantly dilated proximal ileum. An urgent laparotomy showed a perforated, clockwise-twisted caecum that required a right hemicolectomy. Postoperatively, the patient had a good recovery. CV is uncommon, and its symptoms are vague, making diagnosis difficult. For an accurate diagnosis and prompt action, imaging tools and a high index of suspicion are essential. This case serves as a reminder of the significance of taking rare entities into consideration in developing a differential diagnosis of complex abdominal presentations and the necessity for a differential diagnostic approach to choose the most suitable surgical course of action.

An Unusual Presentation of Nodular Hidradenoma.

Benign adnexal neoplasms are quite a common occurrence in adults, especially in the head and neck region. They raise suspicion for malignancy if there are red flag signs like rapid increase in size, pain, ulceration or recurrence. We hereby report a case of a middle-aged gentleman who consulted our surgical OPD with right-sided neck swelling, which was initially thought to be a dermoid cyst; on further evaluation, found to be a dermal sweat gland tumour with features of nodular hidradenoma. The point that is of interest but coincidence to note is that this swelling was preceded by a minor trauma. Characterising these swellings using simple imaging and pathological investigation modalities is important to study their behavioural pattern and add the same to our existing database. This will also help the treating surgeons to keep in mind the possibility of occurrence of such histologies in soft tissue swellings when they present with uncommon clinical features, instead of brushing them aside as the common epidermal or dermoid cysts. Incidence of malignancy is almost nil in nodular hidradenoma, which when found, is attributed to poor surgical clearance; hence the prudence to operate with adequate clearance is extremely significant in preventing the transformation of a mole into a mountain.