The world is suffering from the COVID-19 pandemic. Nature has thrown a new challenge towards the healthcare professionals in the form of this new virus. As if that was not enough, we found an extremely rare, interesting and challenging case of mesenteric immature teratoma in this pandemic. Teratomas take origin from totipotent cells and may give rise to neoplasms that contain, in a helter-skelter fashion, bits of bone, epithelium, muscles, fat, nerves and other tissues. They are usually smaller than 10 cm, with cystic space, which is filled with a thick sebaceous secretion containing matted hair and sometimes teeth protruding from a nodular projection, which are unbrushed and may be carious. Though the usual sites are ovaries, occasionally testes, extragonadal sites may be affected. Classically the teratoma originates in the midline position. But in the abdomen, it usually takes the position of one of the paravertebral gutters, as in the present case, perhaps due to its size and weight of the solid part of the constituent elements. Due to its rarity it deserves the attention of the world and therefore we present to u this interesting case.
Jejunal diverticulitis is a rare disease, with jejunal perforation as its rarest complications due to low intraluminal pressure. Since the current pandemic of COVID-19 it has shown to be affecting gastrointestinal system in a proportion of patients, and worsening of pre-existing GI conditions. We encountered a case of a 75 years old gentleman, suffering with severe COVID-19 pneumonia, who during the course of the disease presented with spontaneous Jejunal perforation, secondary to jejunal diverticulosis. Jejunal diverticula are the least common type of small bowel diverticula & perforation as their complication is the rarest of all complications. Their presentation is variable from asymptomatic to chronic abdominal symptoms and the complications such as perforation as described in our case. Their relative clinical rarity and varied presentation may make diagnosis both delayed and difficult.
Filariasis of the breast is a very rare condition. In India, largest number (around 600 million) of people live in endemic areas. Despite the huge number, it is quite rare to find microfilaria in routine smears and body fluids and it is even more rare to find it in breasts. A 40 years old female, presented with a history of lump in the right breast approximately 3x3 cm in size in the right lower quadrant. Findings were confirmed by clinical examination which did not reveal any palpable ipsilateral or contralateral axillary lymph nodes. FNAC showed it as a benign lesion. After local excision, histopathology revealed a filarial worm. Filariasis of the breast is a rare disease. The presence of microfilaria in breasts using FNAC has been reported at times but the presence of the filarial worms can only be confirmed on histopathology, hence a core biopsy or an excision biopsy is a must in all the cases. A presumptive diagnosis of filariasis can be made on sonography if the worms are alive and active, the typical presentation on USG is the filarial dance. Surgical excision of the lump followed by DEC therapy is the treatment of choice for filarial lump of the breast.
Left sided gallbladder is a rare entity and can be associated with other anomalies of portal vein and biliary system. It can be dangerous as it can create clinical confusion and hence radiological identification with the help of CT scan or USG is of great importance. A 60 years old lady, presented with pain and tenderness in the epigastrium and right hypochondrium, on USG got diagnosed with acute cholecystitis. Intra operatively she was found to have a gangrenous left sided ectopic gallbladder (GB). The incidence of ectopic GB is only 0.1-0.7% and can be found in wide range of locations including the lesser omentum, the retro-duodenal area, falciform ligament, abdominal wall muscles. Mal-positioning of the gallbladder can confound presenting signs and symptoms of the disease creating technical problems during surgical procedures and hence it is advised to always resect it out whenever diagnosed.
Most reported cases of enteroliths causing obstruction occur in large bowel. If in small bowel, it is usually associated with underlying pathology. This is a curious case of a large enterolith in a normal small bowel, causing obstruction without any underlying pathology at the site of impaction, makes this case a rare one.
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