Patient: Female, 57-year-oldFinal Diagnosis: Gallbladder volvulusSymptoms: Abdominal and/or epigastric painMedication: —Clinical Procedure: Laparoscopic cholecystectomySpecialty: SurgeryObjective:Rare diseaseBackground:Gallbladder torsion is a rare entity of acute abdomen that can be fatal if not diagnosed and treated promptly. It presents in a multitude of ways but the most common is a presentation similar to acute cholecystitis. Diagnosis can be made clinically by abdominal ultrasound with Doppler flow, and treatment is detorsion with cholecystectomy.Case Report:A 57-year-old female presented to the emergency department with severe abdominal pain, bilious vomiting, and loose stools. An initial diagnosis of gastroenteritis was made, however, the patient did not respond to symptomatic treatment and continued having pain, nausea and vomiting. Abdominal ultrasound revealed signs of acute cholecystitis and the patient underwent an open cholecystectomy where the gallbladder was found to be black, gangrenous, and voluminous due to torsion. Detorsion and cholecystectomy were performed without any complications.Conclusions:Gallbladder torsion is a rare entity of acute abdomen that can be fatal if not diagnosed and treated promptly. Gallbladder torsion should be a part of the differential diagnosis of any patient presenting with an acute abdomen and unusual symptoms of acute cholecystitis.

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Splenosis is the autotransplantation of splenic tissue into abnormal locations due to trauma or iatrogenically. Usually, this causes no symptoms, but in rare cases the mass effect of the transplanted nodules can cause small bowel obstruction. Resection of the culprit splenic tissue is recommended, but not more extensive dissection of non-involved nodules. Our patient presented at 43 years of age with abdominal pain, distention and bilious vomiting. He had undergone a splenectomy at the age of 13 years due to splenic rupture after a motor vehicle collision. Computed tomography demonstrated a small bowel obstruction with multiple nodules suspicious of splenosis. The obstructing mass and compromised bowels. were resected. Final pathology confirmed the diagnosis. Splenosis is an uncommon aetiology of small bowel obstruction and must be considered in patients who had previous splenic trauma or surgery.

Highlights Duodenal diverticula is mostly found incidentally and it rarely complicates by perforation. Treatment is only indicated in complicated duodenal diverticula. Micro perforation in the absence of systemic signs are better treated with conservative management. Among surgical options diverticulectomy and single layer closure was performed. Other surgical intervention could involve segmental duodenectomy or pylorus-preserving duodeno-pancreatectomy.

Rare co-existance of disease or pathology Background:Incidental finding of ectopic liver is gaining more attention especially during laparoscopic cholecystectomy.It is reported to be found in different locations as gallbladder, stomach, spleen, umbilical ligament and other intra-peritoneal and intra-thoracic sites. Case Reports:We present 2 cases of ectopic liver found on gallbladder during elective laparoscopic cholecystectomy for 2 Lebanese females. Our findings were consistent with previous reports. The ectopic liver tissues measured 0.9 cm and 0.5 cm respectively, which were smaller than other reports. The liver tissue lacked a biliary system, which was similar to what has been previously reported in the literature. However, no malignant histological signs were seen when excised. Conclusions:These 2 cases highlight the fact that ectopic liver tissue may be encountered on the gallbladder during laparoscopic cholecystectomy. Awareness of this potential entity is beneficial to widen the differential diagnosis when identified on imaging studies pre-operatively or when found incidentally during surgery as in this case.

Highlights Adenomyoepithelioma is a rare tumor of the breast characterized by a biphasic proliferation. Variable spectrum of behavior ranging from benign to malignant, with tendency to local recurrence. Combine sentinel lymph node dissection (SLND), with simple mastectomy. Hematogenous spread is the more common means of spread. Adjuvant chemotherapy for malignant AME cases is recommended.

Liver haemangiomas are common, but their size very rarely exceeds 40cm. Most people with liver haemangiomas are asymptomatic, and diagnosis is usually made incidentally during imaging for other complaints. When a liver haemangioma is symptomatic or produces complications, surgical intervention may be warranted. Kasabach–Merritt syndrome is an uncommon complication reported in certain rare vascular tumours in children, with only a few cases reported in adults. The syndrome describes a consumptive coagulopathy initiated within a vascular tumour, mainly tufted angiomas and kaposiform haemangioendotheliomas and, less commonly, giant haemangiomas. The process can extend beyond the tumour and become disseminated in certain cases due to trauma or surgery. The definitive treatment for giant liver haemangiomas can include arterial embolisation, surgical excision, hepatectomy or even liver transplantation. We report the case of a 32-year-old woman with a 42 × 32 × 27cm (18,870ml) liver haemangioma associated with Kasabach–Merritt syndrome. The diagnosis was challenging, even with proper imaging, owing to the rarity of the condition. It was achieved with an exploratory laparotomy with biopsy.