Key Clinical MessageAlthough rare, clinicians must be alerted of Richter hernias in patients presenting with innocuous gastrointestinal obstruction symptoms, synchronous with an erythematous hernia. An incarcerated incisional hernia located in a previous laparoscopic insertion site further raises suspicion, while timely surgical management is essential to avoid bowel perforation or resection.
HighlightsWhile parathyroid adenomas account for approximately 80% of PHPT cases, they rarely present as giant parathyroid adenomas.Preoperative workup diagnosed the patient with PHPT and helped in accurate localization of the hyperactive parathyroid gland.Despite the size of the adenoma, it was successfully removed through minimal invasive parathyroidectomy, through a 2 cm incision.Post-surgical recovery was uneventful with normalization of parathormone levels and the patient relieved of her symptoms.
Intra-abdominal myositis ossificans, also known as heterotopic mesenteric ossification, defines the formation of bone-like lesions inside the abdominal cavity. It is a rare medical condition, usually following abdominal surgery or trauma. A 55-year-old male presented for closure of a Hartmann's colostomy, created 6 months ago because of sigmoid adenocarcinoma. Intraoperative findings consisted of an elongated bone-like lesion attached on the peritoneum and protruding inside the abdominal cavity, while two more stiff calcified nodules were found in the mesocolon. All lesions were excised. The presence of a hard consistency sigmoid stump led to cancelation of the operation. Heterotopous bone formation constitutes a challenging surgical condition, since its clinical presentation is innocuous and repetitive surgery acts a stimuli for additional bone creation. Computed tomography scan plays a major role in its diagnosis, while nonsteroidal anti-inflammatory drugs and cimetidine are helpful in preventing further recurrence of the disease.
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