Perforation of a duodenal ulceration, caused by chronic nonsteroidal anti-inammatory medication treatment, is a rare clinical event. Symptoms
are usually insidious and non-specic, so only clinical suspicion can lead to a proper diagnostic and optimal clinical management. We present a
case of perforated duodenal ulceration, with pneumoretroperitoneum, which presented to the hospital with diffuse abdominal pain, sub-fever and
altered general condition. CT scanning was essential in diagnosing the location, the extent and the nature of the lesion. No abnormalities were
evident at the initial inspection of the peritoneal cavity. After mobilization of the duodenum, a perforation was found on the medial wall of the
duodenum II, near the lower knee, through which the bile owed. Perforation suture, nasoduodenal tube and postoperative parenteral nutrition
were the key points of the surgical management.
Colonic malakoplakia is an uncommon granulomatous development of cells resulting from the impaired capacity of the mononuclear cells to eliminate the phagocytosed bacteria, and in rare cases it can also affect the gastrointestinal tract. We report the case of a 78-year-old female patient that was admitted to hospital by The Emergency Department with the diagnosis of bowel obstruction, confirmed by the clinical and paraclinical investigations. We decided to surgically manage the case for suspicious symptomatic colonic neoplasm. The histological examination of the surgical specimens revealed colonic malakoplakia, characterized by the presence of the aggregated granular histiocytes and Michaelis-Gutmann bodies. Through this paper, we want to raise awareness for Malakoplakia, which remains an extremely rare disease that may affect multiple organs, and because it does not present specific symptoms or clinical manifestations, the final diagnosis remains the histopathological study. The clinical conduct should be decided after taking into consideration all the aspects of this pathology along with the benefits and risks for the patient.
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