Intussusception as a cause of intestinal obstruction in adults is rare. There is invariably an underlying pathology which leads to intussusception in adults. A case of intussusception in an adult due to a small intestinal lipoma is presented in view of this association. Ultrasound and CECT may help in a preoperative diagnosis. However early surgical intervention is the mainstay of treatment in order to confirm the diagnosis of the underlying pathology, thereby avoiding misdiagnosis of an underlying cancer.
Hypertrophic pyloric stenosis is a congenital disease, presenting within two weeks of birth. However adult idiopathic hypertrophic pyloric stenosis (AIHPS) presents in middle age, predominantly in males and usually without any antecedent cause. Secondary variant may be due to intra gastric causes or extra gastric post-operative adhesions. Patient presents with symptoms of gastric outlet obstruction. Diagnosis depends on clinical, radiological and endoscopic findings. Treatment is subtotal gastrectomy. Pyloroplasty and endoscopic dilatation may be tried in debilitated patients. We present a case of AIHPS presenting as gastric outlet obstruction in a 16 year old female, that was surgically managed with an antrectomy.
Adrenal myelolipoma is a benign neoplasm of the adrenal gland that is the second most common primary adrenal incidentaloma, following adrenocortical adenomas. It is composed of elements of adipose tissue and with varying amounts of hematopoietic components. In the past, these tumors were discovered at autopsy, with an incidence ranging from 0.08% to 0.4%. Today, with the widespread use of radiological studies such as ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI), the incidental detection of myelolipoma has become more common, constituting up to 10-15% of incidental adrenal masses. The patient was hospitalized for a 3-month history of discomfort in the right flank, swelling over the right hypochondriac area, constipation, retrosternal burning sensation, and early satiety. His vitals were stable but per abdominal examination revealed a mass in the right hypochondrium. B-mode ultrasound screening revealed an adrenal tumor. A hematological examination revealed thrombocytopenia. The presence of unilateral adrenal mass with the absence of new-onset hypertension with CECT suggestive of mixed tissue density mass with multiple ill-defined heterogeneously hypodense fat attenuation led to the primary diagnosis of an adrenal mass After correction of thrombocytopenia, the mass was excised and subjected to histological evaluation. The histological study results corroborated with the original diagnosis of unilateral adrenal myelolipomas. The patient was followed up for 2 months postoperatively and was found to be relieved from the presenting symptoms with no postoperative complications. Adrenal myelolipoma is an uncommon, benign, and hormonally inactive adrenal gland tumor. It may present with symptoms due to compression of adjacent structures which warrants a surgical excision.
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