Ovarian cystic teratomas constitute 10-15% of all ovarian tumours and are the most common ovarian neoplasms found in adolescence and during pregnancy. Nevertheless, ovarian cystic teratomas have also been described in patients aged 1-91 years. We report an unusual case of a benign ovarian cystic teratoma presenting as a rectal mass that was managed surgically using radical resection by a multidisciplinary team. This case report highlights the importance of preoperative investigations including colonoscopy and radiological investigations. A dedicated pelvic radiologist/pathologist and the involvement of a multidisciplinary team at the time of initial diagnosis and a gynaecologist and colorectal surgeon at the time of surgery will lead to an accurate diagnosis and the most appropriate treatment. Although rare, erosion of an ovarian dermoid into the rectum should be considered in young women who have an atypical presentation and are found to have a lesion in the rectum with biopsies indicating benign pathology. 2011; 93: e46-e48
Ann R Coll Surg Engl
Acute acalculous cholecystitis, like calculous cholecystitis,generally shows diffuse inflammation throughout the gallbladder and cystic duct obstruction.Nonvisualization of the gallbladder on hepatobiliary scanningWe report an unusual case of acute acalculous cholecystitis in which acute inflammation was focal but severe enough to result in perforation. Hepatobiliary scanning showed both a patent cystic duct (i.e., gallbladder filling) and free intraperitoneal spill of radionuclide.
Case ReportA previously healthy 39-year-old man came to the emergency room with crampy right upper quadrant pain. He was afebrile and had a normal WBC count. Plain radiography of the abdomen was unre-
Technetium-99mdisofenin scan afforded prompt visualization of the gallbladder on the 5-mm film. Excretion of radionuclide into the small bowel was noted on the 2-hr images. This delay was thought to be from spasm of the sphincter of Oddi caused by narcotics administered in the emergency room. Extrabiliary and extraintestinal activity was seen beginning on the 25-mm film; extravasation continued on later films (Fig. 1).The patient underwent cholecystectomy.The pentoneal cavity contained bile, and a pinpoint perforation was seen in the fundus of the gallbladder. No stones were identified within the peritoneal cavity, nor were any seen on an intraoperative cholangiogram.Cultures of gallbladder bile showed no growth. After surgery, the patient made a relatively uneventful recovery.
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