Abstract:Midgut malrotation is an anomaly of intestinal rotation which occurs during fetal development and usually presents in the neonatal period. It is rare for malrotation to present in adulthood. The main purpose of this paper is to show how the clinical picture may be expected to vary and to emphasize the importance of "shock" in massivevolvulus. We present a case of midgut volvulus in an adult male patient (60 year old) who presented with cramping generalized right abdominal pain and vomiting of two days duration. An abdominal ultrasound showed peritoneal effusion and greek distension. An emergency laparotomy showed typical Ladd's bands and small bowel distension. All the intestine from the duodenum to the left colic flexure was found to be suspended on a single dorsal mesentery. This mesentery arose from a narrow base high up in the abdomen and reached down to the pelvic brim. There were numerous areas of fine shiny fibrosis on the small bowel corresponding to sites of previous constriction when a midgut volvulus occurred. A detorsion of the twisted mesentery, lysis of the bands, appendectomy were performed. Complete resolution of symptoms is noted. Acute volvulus of the small intestine is one of the most serious abdominal emergencies. Diagnosis may be difficult and delay in operative intervention can be disastrous.
Biliary tuberculosis is a very rare disease especially in its isolated form that can present with an obstructive jaundice mimicking other non-infectious causes such as cholangiocarcinoma. It poses difficulty in diagnosis and often requiressurgical intervention to exclude underlying malignancy. Here we report a case of obstructive jaundice which was initially thought to be due to a cholangiocarcinoma but postoperatively it was found to be tuberculosis.
Different contents in the femoral hernia have been reported in the literature, but herniation of the fallopian tube in a femoral hernia is very rare due to its normal anatomical position. CASE Report: A 58 year-old woman, mother of 5 children, she has admitted to surgical ward with a painful lump in the right groin. It had recently increased in size. Clinical examination revealed a 4 cm × 3 cm tender, irreducible, nonpulsatile mass in the right groin just under the inguinal ligament. There was no cough impulse. A diagnosis of a femoral hernia was made. Exploration of the mass confirmed the diagnosis of the femoral hernia, but sac contained the right fallopian tube. The uterine tube was easily reduced back into the abdomen as it looked healthy and the hernia defect was repaired with Mac Vay technique. The patient made good recovery. CONCLUSION: This case is educational as it highlights the importance of managing women with femoral masses with care.
Inflammatory pseudotumor of the spleen (IPTS) is an extremely rare benign condition of uncertain etiology. Preoperative diagnosis of this entity is usually difficult, only the histological study allows the diagnosis to be made. We report an observation of a 35-year-old women patient, hospitalized for left hypochondrium pain with vomiting. Physical examination noted tenderness of the left hypochondrium and splenomegaly, CT scan showed a large tissue mass, measuring 14x15x9.6 cm, probably at the expense of the upper pole of the spleen, containing central calcifications. Exploratory laparotomy revealed a splenic tumor. A splenectomy was performed. IPTS diagnosis was made after histological and immunohistochemical study of the splenectomy specimen.
Background: Mesenteric Fibromatosis (MF) is a proliferative fibroblastic lesion of small intestinal mesentery. It constitutes 8% of all desmoid tumours, which represent 0.03% of all neoplasm. It is histologically benign but may invade locally and recur after excision. It occurs sporadically or in association with familial adenomatous polyposis (FAP).Case Report: wepresent a case of a 59-year-old man presenting with three months inguinal hernia non-complicated.On physical exam, his abdomen was distended with abdomial mass. Ultrasonography and CT scan showeda retroperitoeal mass suggestive of GastroIntestinal Stromal Tumor. Colonoscopy and endoscopy showed no polyps. Exploratory laparotomy revealed a mass in ileal mesentery. It was excised along with 30cm of ileum and end to end anastomosis in two layers. Histopathologically was in favor of mesentericfibromatosis.Postoperative days were uneventful and discharged on 7th day. Follow-up for three years which included abdominal utrasonography and colonoscopy did not reveal any new pathological lesions.Considering the rarity of this tumour and difficulties in diagnostic and therapeutic ambit, we believe it is justified to describe this case which came to our observation.
A gastric bezoar is a foreign materiel occur in the stomach & can be extended through duodenum, jejunum and colon. Trichobezoar, is an underdiagnosed entity, has to be considered in children and adolescents (especially females suffering from trichotillomania and trichophagia). The disease is usually underdiagnosed so showed by threatening complications: occlusion, bleeding of perforation. The present report concerns a 19-year-old girl presenting with abdominal pain. On the abdominal exam an acute peritonitis which rapidly evolved to septic shock and an emegercy laparomy was performed, by supraumbilical laparaotomy and anterior gastrotomy objictived peritonitis jejunal perforation caused by large gastrojejunal trichobezoar. Acute peritonitis following hollow viscus perforation caused by tichobezoars is an therapeutic emergency in order to avoid visceral spillage, peritonitis & mortality.
Intestinal cystic pneumatosis (ICP) is a rare disease, defined by the presence of gaseous cysts in the digestive wall with intestinal predilection. The first case was described in autopsy specimen in 1730 by Duo Vernoi. rare condition characterized by multiple gas-filled cysts in the intestinal wall and can be caused by many conditions. As patients with PCI are mostly asymptomatic, they are not likely to seek medical care. It affected any portion of gastrointestinal tract with the cysts being either confined to the mucosa, submucosa, or subserosa or involving all three layers. It is primary in 15% of cases and complicates an underlying pathology in 85% of cases. We report the case of a 47-year-old chronic smoker who had a history of epigastralgia, admitted to the emergency room for an acute abdominal pain with septic shock. A laparotomy was performed showing necrosis ileum with ICP associated to ulcerative pyloric stenosis & ulcer perforation peritonitis. Therapeutic management consisted of specific treatment of the pathology associated with grelic resection of the necrosis ileum affected by ICP. The patient died during his stay in intensive care on 3th day due to multi-visceral failure despite all intense resuscitation efforts.
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