An Ovarian Teratoma Mimicking Complicated Acute Appendicitis: A Case Report and Literature Review.

Acute appendicitis is one of the most common causes of right iliac fossa (RIF) pain in the younger population. However, multiple other pathologies presenting with RIF pain can mimic acute appendicitis. In the female gender, the differentials for RIF pain are broader. Multiple pathologies can present with similar symptomatology that can mimic acute appendicitis, leading to an incorrect diagnosis, unnecessary surgical interventions, and complications. In females of reproductive age, gynaecological causes can present similarly. Here, we present a case of an ovarian teratoma mimicking acute complicated appendicitis. A female of reproductive age presented to our hospital with RIF pain of six days, associated with fever, nausea, vomiting, and anorexia. A clinical diagnosis of acute complicated appendicitis was suspected, and further imaging was arranged to confirm the diagnosis. Imaging showed a normal appendix with a right adnexal mass separated from the ovary, representing a teratoma. She underwent elective surgery for the excision of teratoma after further investigations. Ovarian teratomas are not a common mimicker of appendicitis. One should consider possible gynaecological causes as a differential for RIF pain. Due to the wide variety of differentials, when in doubt, especially in the female gender, further imaging should be considered for confirmation of diagnosis.

Gallbladder agenesis diagnosed during pregnancy- Case report and a literature review.

INTRODUCTION AND IMPORTANCE: Gallbladder agenesis (GA) is a rare congenital anomaly. It results from failure of the formation of gallbladder primordium from the bile duct. This cohort of patients can present with symptoms of biliary colic and get misdiagnosed as cholecystitis or cholelithiasis. CASE PRESENTATION: Here we discuss a case of gallbladder agenesis presenting with symptoms of typical biliary colics in a 31 year old female patient during her second pregnancy. She underwent two ultrasound scans (USS) which couldn't visualise a gallbladder. She eventually had a magnetic resonance cholangiopancreatography (MRCP) which confirmed the absence of a gallbladder. CLINICAL DISCUSSION: Diagnosis of gallbladder agenesis in adult life poses a diagnostic dilemma. This is partly due to misinterpretation of USS results. Still, some patients get diagnosed with this condition during attempted laparoscopic cholecystectomy. However, with a thorough understanding of the condition, unnecessary surgeries can be prevented. CONCLUSION: Misdiagnosis is possible and can lead to unnecessary surgeries. Appropriate and timely investigations can diagnose GA. One should have high index of suspicion when an USS result shows a non-visualisation of the gallbladder, contracted or a shrunken gallbladder. It is prudent to further investigate this cohort of patients to rule out gallbladder agenesis.

A rare presentation of iliopsoas abscess - A case report.

INTRODUCTION: Psoas abscesses are usually confined to the psoas compartment due to its fascial attachments. However, in rare situations, the infection can locally spread beyond the psoas sheath. CASE PRESENTATION: A 65-year-old patient presented with; 3 weeks of lower back and right hip pain, progressive inability to walk and one week of urinary incontinence. CT abdomen showed a right psoas abscess with pneumo-retroperitoneum extending to the right gluteus muscle, posterior compartment of the upper thigh and mediastinum. Exploration in theatre showed copious amounts of pus, visible between the fascial layers and muscles of the thigh, tracking to the level of the knee and the gluteal region. DISCUSSION: Psoas abscesses are usually confined to the psoas compartment. However, in this case, it was spread to the posterior compartment of the thigh, gluteal region and pelvis with fascial necrosis and pus. Due to the extensive nature of the disease and the patient's clinical deterioration, he underwent open drainage of the psoas abscess, exploration and debridement of the posterior compartment of thigh and gluteal region with a good outcome. CONCLUSION: Psoas abscesses can penetrate the psoas sheath to cause extra pelvic extension. A high index of suspicion and early imaging, if necessary, should be arranged if in doubt. Depending on the clinical severity, patients may need to be managed with open drainage and debridement than conventional CT-guided drainage.