HighlightsPresacral tumors are rare variety of space occupying lesions which due to their location, etiological heterogeneity and difficult surgical approach, present a challenge to treating physician.Surgical excision remains the treatment of choice for presacral masses.Posterior surgical approach, if applied judicially, in carefully selected cases, remains an attractive option as it provides better surgical exposure, is more direct approach, commodious to adopt, easy to learn with quicker post-operative recovery.
HighlightsSurgical diagnosis of conditions causing acute abdominal pain in situs inversus is complicated by the mirror image anatomy.Chest X-ray and Ultrasonography abdomen can be helpful in diagnosing this condition.Laparoscopic cholecystectomy in situs inversus is problematic for right handed surgeons.We describe a modified 4 port configuration where right handed surgeons can use the left mid-clavicular port for dissection.
Highlights55 year old male patient presented with features of acute intestinal obstruction.On exploratory laparotomy, malrotation of gut with compression of duodenum and terminal ileum by the superior mesenteric artery pedicle was found along with multiple jejunal diverticula.No ladd's bands or midgut volvulus was noted.Malrotation may present in adult age group as acute or chronic obstruction and surgeons must keep a flexible approach toward management.
INTRODUCTIONIleal pouch anal anastomosis (IPAA) after total proctocolectomy is a frequently performed surgery for medically refractory ulcerative colitis (UC). Volvulus of the ileal pouch as a complication of IPAA is extremely rare. We present a case of volvulus of S-type ileal pouch.PRESENTATION OF CASEA 28 year old male, with history of total proctocolectomy with IPAA for severe UC in 2009 presented with signs of bowel obstruction. Emergency laparotomy was done and a volvulus of the S-type ileal pouch was derotated and pouchpexy done.DISCUSSIONThe IPAA has a wide spectrum of complications, with obstruction of proximal small bowel occurring frequently. Volvulus of the ileal pouch is extremely rare with only 3 reported cases. Early diagnosis and intervention is important to salvage the pouch. Computed tomography (CT) may aid the diagnosis in stable patients.CONCLUSIONThe diagnosis of ileal pouch volvulus although rare, should be kept in mind when dealing with patients complaining of recurrent obstruction following IPAA.
International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. Agenesis of gallbladder is a rare (13-65 cases/100,000) anomaly, in which about 23% patient presents with symptoms of biliary disease. In these patients, ultrasonography (USG) abdomen frequently falsely reveals shrunken or contracted gallbladder and sometimes non-visualization of gallbladder (GB) in GB fossa. Basis of these misinterpreted reports these patients undergone unnecessary surgery and may encounter iatrogenic biliary tract injuries and portal injuries because of excessive dissection to find out the absent gallbladder and ectopic gallbladder.Case Report: A 40-year-old female attended surgical outdoor with complain of pain right hypochondrium and dyspepsia since last four years patient followed-up with USG abdomen which was suggestive of chronic cholecystitis with cholelithiasis, and common bile duct (CBD) was normal in diameter on the basis of clinical symptoms and USG findings patient admitted and planned for laparoscopic cholecystectomy. On laparoscopy after removing the adhesions, exploration done up to the porta but gallbladder could not be visualized.On postoperative day-1 patient was sent for MRCP with MRI abdomen. On MRCP gallbladder and cystic duct were not visualized. CBD was normal in caliber. Liver and pancreas were normal. Hence the diagnosis of agenesis was made. Conclusion: Agenesis of gallbladder is an unusual anomaly in which about 23% presents as biliary disease. These patient frequently undergone surgery because of misinterpreted reports of USG abdomen, ERCP and CT abdomen. So, in cases with ultrasonographic diagnosis of scleroatrophic or non-visualization or suspicious of ectopic gallbladder and absence of wall echo shadow (WES) triad or double arc shadow, when non-visualization of gallbladder is present during laparoscopy or open exploration intraoperative cholangiogram, intraoperative ultrasound and postoperative MRCP or Endoscopic ultrasound (EUS) can help in the diagnosis of agenesis or ectopic gallbladder.
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