Gallbladder torsion is a rare cause for acute cholecystitis. Gallbladder torsion is unlikely to respond to conservative management and requires urgent surgical intervention. We report a case of an 85-year-old female with gallbladder torsion. She presented with a clinical picture consistent with acute cholecystitis. Radiological findings showed signs that elude to the diagnosis and intra-operative findings showed a complete torsion with a free-floating gallbladder. This case highlights the need to have a high index of suspicion for gallbladder torsion as a differential diagnosis for right upper quadrant (RUQ) pain apart from the typical calculous acute cholecystitis, especially in high risk groups such as thin, elderly females. Prompt decision for cholecystectomy is necessary and is likely to result in a good outcome.
Intussusception is a common cause of abdominal pain among the paediatric population with up to 10% of cases occurring secondary to a pathological lead point. Burkitt's lymphoma (BL) is a highly malignant and rapidly growing B-cell neoplasm which in extremely rare cases can present as intussusception. We report a case in an otherwise healthy 15-year-old male who presented with atypical abdominal pain. Imaging subsequently indicated an ileocolic intussusception, and given that the suspicion of a pathological lead point mandates a laparotomy and bowel resection, he proceeded to surgery. The histopathology confirmed Burkitt's lymphoma as the aetiology responsible for this intussuscepted mass. A detailed discussion including a systematic review of all previous case reports explore the diagnostic dilemma of intussusceptions secondary to BL. This case report aims to highlight the clinical challenges in establishing such a diagnosis and an appreciation for the subtle variations in clinical features, as well as the differences in management between infants and adolescents.
Traumatic diaphragmatic injuries (TDI) are often challenging to diagnose. Research suggests that no single diagnostic study is sensitive or specific enough to identify such an injury, unless there is established herniation of intrabdominal contents. It is a rare cause of small bowel obstruction, which carries a substantial mortality rate. This report describes a case of a 41-year-old pregnant female who presented with irretractable vomiting and abdominal pain secondary to a delayed presentation of right-sided TDI. The most accepted mechanism regarding TDI is due to sudden elevation in the pleuroperitoneal pressure gradient. This case is unusual given its mechanism of injury during pregnancy and its right-sided location. She underwent laparoscopy which facilitated successful reduction of the hernial and closure of the defect. Postoperatively, she made an excellent recovery and was discharged within a few days. This report aims to increase the awareness amongst surgeons.
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