Background: Lemmel syndrome is a rare and misdiagnosed etiology of obstructive jaundice due to a periampullary duodenal diverticulum causing a mechanical obstruction of the common bile duct. It represents an obstructive jaundice with the absence of choledocholithiasis or pancreaticobiliary tumors. It is an underreported entity due to the absence of specific pathognomonic signs. Case presentation: A 77-year-old-woman admitted for sepsis, due to an ascending cholangitis, underwent a MRCP and a gastroduodenoscopy revealing Lemmel’s syndrome. Due to failure of ERCP, the patient underwent surgical derivation. Conclusion: Lemmel syndrome represents an uncommon diagnosis of obstructive jaundice, that shouldn’t be neglected if no other organic cause is detected. It is usually asymptomatic, however some patients can develop symptoms and complications such as cholangitis, as is the case of our patient. Imaging allows diagnosis, with MRCP as the modality of choice to confirm diagnosis. Endoscopy is the first line treatment.

The jejunostomy procedure is an alternative to oral feeding for patients incapable of oral nutrition or ones suffering from severe malnutrition.The most used surgical technique is the Witzel technique, it hasa very low complication rate but can cause severe complications such as perforation or bowel ischemia.We describe the case of an 80 years old female patient admitted to the ER foracute abdominal pain 9 days after a jejunostomy procedure, with an abdominal CT-scan showingperitonitis and pneumoperitoneum secondary to a jejunum perforation and intra-peritoneal displacement of the jejunostomy tube.

Brown tumors are non-neoplastic bone lesions caused by an abnormal remodeling of the bone that may occur with primary or secondary hyperparathyroidism. Their radiological aspect: lytic and aggressive can easily be misdiagnosed for a malignant origin hence the importance of knowing that diagnosis is to be considered through both clinical context and radiological semiology, which will be detailed via this case of a 32-year-old female patient with an end-stage kidney disease, admitted for facial disfiguration and palpable masses corresponding to brown tumors affecting the maxilla and the mandibular bone.

Background: Acute pancreatitis (AP) is a common cause of hospitalization in gastroenterology. Drug-induced AP is a rare event, and only a few cases of corticosteroids induced AP are described in the literature. Case Presentation: A 39-year-old woman with ankylosing spondylitis was hospitalized for an acute epigastric pain with vomiting 3 days after receiving a methylprednisolone bolus for an outbreak of her chronic disease. Her serum lipase concentration was found to be particularly elevated. She was then diagnosed of AP. An abdominal non-contrast CT demonstrated an exudative pancreatitis with a peripancreatic collection. The liver enzymes, her corrected calcium, and lipid profile were normal. An autoimmunity IgG4 screening was also found negative. The magnetic resonance imaging of the biliary tract found a normal pancreatic gland with a non-dilated common bile duct. Conclusion: Due to the events chronology, the diagnosis of a methylprednisolone induced AP was retained after the exclusion of other causes of pancreatitis. It is important to think about this etiology when the most common causes have been ruled out.

Biloma is a severe complication that can result from bile duct disruption or hepatic trauma. It can occur after biliary surgery such as cholecystectomy or an endoscopic retrograde cholangiopancreatography manipulation and endoscopic biliary sphincterotomy. We present the case of a 59-year-old man admitted for jaundice, with pain in his right flank and fever, 10 days after an endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for an ill-defined pancreatic lesion, associated with an infected biloma. Severe complications can occur after an EUS-FNA; therefore, this diagnosis should not be neglected after the intervention in symptomatic patients, to ensure an early and proper treatment.

Actinomycosis is a slowly progressive chronic granulomatous bacterial infection caused by an anaerobic gram-positive bacillus: Actinomyces Israeli.Thinking about thisdiagnosis in the right iliac fossa is uncommonas it usually shows through a clinical aspect of acute appendicitis, a Crohns disease or even a tumor of the ileocolic region. We report the case of a young female patient admitted for an iliac fossa pain and a palpable mass, mimicking a Crohns disease during laparoscopic exploration, only to conclude its a retained diagnosis of actinomycosis, after doing an ileocecal resection and anatomopathological analysis The purpose of this case report is to focus on the different aspects of this infection in the ileocecal regionwhich can be mistaken at firstand that is only supposed to be treated medically by antibiotics for months, with a simple biopsy to confirm the diagnosissince surgery can be mutilating.

Hydatidosis is an endemicdisease in Morocco. Localization in the pancreas is very rare especially when isolated. We report the case of a patient admitted in the emergency room for a suppurated pancreatic collection, about 15 cm in diameter, resembling a fistulized Pseudo-pancreatic cyst, or a cystic pancreatic tumoror a pancreatic hydatid cyst. In spite of an initial empirical antibiotic therapy, the unfavorable evolution led us to perform an exploratory laparotomy which confirmed the diagnosis of an isolated pancreatic hydatid cyst. The classic surgical treatment by subcutaneous laparotomy is still effective in this situation, and consists of cyst drainage and a cysto-jejunal bypass on a Y loop to compensate for the pancreatic cyst-channel fistula. Because of the emergency context, large volume, lack of diagnosis certainty and the slow evolution of this cyst, we preferred surgical treatment to per cutaneous or endoscopic drainage.

Lymphatic malformations are benign tumors rarely located in the gastro-intestinal tract. They are usually asymptomatic; however, they can cause clinical discomfort when enlarged. Imaging leads to diagnosis, but the confirmation can only be done through histology findings. We report the case of a 59-year-old male patient, admitted in our ward for melena, to which esophago-gastroduodenoscopy showed budding formations in the second portion of the duodenum wall, with Magnetic Resonance Imaging features and histological examination confirming diagnosis of a duodenal lymphatic malformation.