A Bochdalek hernia is a congenital diaphragmatic hernia that results from a failure of closure of the pleuroperitoneal folds during embryologic development. While it is most often diagnosed in neonates and infants, Bochdalek hernias can rarely present in adulthood for the first time. We describe the case of a 42-year-old lady who presented with sudden onset of severe abdominal pain following a Zumba dance session. Her chest radiograph showed an elevated left hemi-diaphragm with visualization of a gastric bubble in the thorax. A computed tomography (CT) scan of the abdomen showed a defect in the left hemi-diaphragm with herniation of the stomach and abdominal viscera through the defect. The patient was taken for diagnostic laparoscopy, and the diaphragmatic defect was repaired with a synthetic mesh. Perioperatively, perforation of the anterior wall of the stomach was noted, and a diagnosis of Bochdalek hernia with gastric strangulation was made. This case demonstrates a rare presentation of Bochdalek hernia in an adult with strangulation and perforation of the stomach. Clinicians need to be aware of this rare but life-threatening clinical entity in order to secure a timely diagnosis and institute appropriate management.
HighlightsAmyand’s hernia is uncommon in females.The initial presentation as an abdominal wall abscess is very rare in the contemporary literature.An index of suspicious, early diagnosing and surgical intervention lead to favorable recovery.The management should follow general guidelines of appendectomy, hernia repair and dealing with the associated pathology if present.
Patient: Male, 31-year-old Final Diagnosis: Esophageal perforation Symptoms: Chest pain Medication: — Clinical Procedure: — Specialty: Surgery Objective: Unusual clinical course Background: In most cases, esophageal perforation is caused by ingested foreign bodies which can migrate through the esophageal wall, damaging nearby vital organs like the aorta or pericardium, thereby having potentially fatal outcomes. Early diagnosis and intervention are key to decreasing morbidity and mortality. Appropriate treatment involves extracting the foreign body, repairing the esophagus and other injured organs (aorta, trachea, or pericardium), and draining and cleaning the mediastinum. Case Report: A 31-year-old man presented with a 2-h history of severe chest pain radiating to the back and associated with profuse sweating after eating. The patient had ingested a sharp metal object that injured the thoracic esophageal wall close to the aorta and the left atrium, causing hemopericardium. The presence of pericardial effusion on echocardiogram examination raised a high suspicion of cardiac and/or aortic injury. Left thoracotomy was done because the injury was in the distal third of the esophagus. Therefore, exploration of the pericardium and drainage of the mediastinum was essential, along with the use of resuscitative endovascular balloon occlusion of the aorta (REBOA) to control the proximal aorta while exploring the thoracic aorta. Conclusions: In cases of esophageal injury when aortic involvement is suspected, we suggest using REBOA in selected cases, when an expert team is available, as a mean of gaining better proximal control over the aorta to safely explore and repair any possible injuries. This is an unusual case management scenario that needs further literature and clinical support.
Purpose: in this case series we aim to highlight rare metastasis of gastric and esophageal cancers metastasizing to unusual locations causing a diagnostic challenge on presentation. We also review pertinent literature of rare locations of metastasis of gastro-esophageal cancer (GEC). Materials and methods: this is a retrospective analysis of four patients managed at our institution with one year follow up between 2020-2021. We include baseline patient characteristics, presenting symptoms, diagnostic work up and management of each individual case. Results: Out of the 4 cases with GEC; two had gastric adenocarcinoma, one esophageal adenocarcinoma and one gastroesophageal junction adenocarcinoma which metastasized to various locations throughout the body. Among the rarest locations of metastasis of gastric cancer is skeletal muscles. The locations of metastases were: ovaries and peritoneum from gastric adenocarcinoma, brain and liver from gastric adenocarcinoma, skeletal muscles from esophageal adenocarcinoma, and skeletal muscles and breast from GEC adenocarcinoma. The main diagnostic tool to identify these rare sites metastasis was Positron emission tomography scan (PET/CT). Conclusion: Studies have shown that not all gastroesophageal malignancies present with these alarm symptoms and up to 40% of patient can present without alarming symptoms. In our study; we shed the light on the possible rare metastatic sites that could have been missed with the regular presentation. Some of the rarest location of metastasis is to the skeletal muscles, which was present in two of our patients with an origin of gastric and esophageal cancer, which was identified with PET/CT. This study clarifies the importance of including whole body PET/CT scan in the staging process for patients with esophageal and gastric cancers to identify such rare sites metastasis that will alter the stage and clinical management of GEC patients.
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