Patient: Male, 30Final Diagnosis: Torsion of appendixSymptoms: Abdominal pain • anorexia • nauseaMedication: —Clinical Procedure: Laparoscopic appendicectomySpecialty: SurgeryObjective:Rare diseaseBackground:Torsion of the vermiform appendix is a rare condition that presents with symptoms analogous to those of common acute appendicitis; therefore, it is often diagnosed during surgery. It was first described by Payne et al. in 1918. Since then, there has been wide recognition of a primary and a secondary form of the condition, affecting both the pediatric and adult populations. We present a case of an adult patient and conducted a literature review in the adult demographic.Case Report:We report the case of a 30-year-old man who presented with clinically acute appendicitis. Laparoscopically, we diagnosed a torsion of the vermiform appendix secondary to a mucocele process. Histology confirmed a low-grade mucinous cystoadenoma, with a hemorrhagic necrosis of the wall, in keeping with torsion.Conclusions:Torsion of the vermiform appendix is a rare condition that presents similar to acute appendicitis, and therefore is often diagnosed intraoperatively. Since first described, 33 cases in adults were identified in the English literature, and recognition of a primary or secondary form has emerged. Preoperative radiological imaging is rarely useful in diagnosis. To the best of our knowledge, this is the eighth reported case in the English literature of a torsion of the vermiform appendix secondary to a mucinous cystoadenoma.
We present an interesting and unusual case of a 57-year-old woman presenting with symptoms concerning for a bowel obstruction, and diagnostic imaging concerning for an internal hernia. The patient underwent an emergency laparotomy and was found to have chylous ascites throughout the abdomen, and the extravasation of chyle into the mesentery giving an appearance of a white mesentery. During this case, we will present all of the findings and discuss the unusual underlying pathology.
Superior mesenteric artery (SMA) syndrome is a rare condition resulting in small bowel obstruction. The third part of the duodenum becomes compressed because of the narrow angle between the aorta and the SMA. Those at risk of developing SMA syndrome include patients who develop rapid weight loss, malignancy, eating disorders, burns, trauma and substance abuse. We present a case of a 73-year-old man that presented 5 days post a total hip replacement with abdominal pain and profuse bilious vomiting for 2 days. A computed tomography scan of his abdomen showed gross distension of his stomach with an abrupt occlusion of the duodenum at the level of the SMA which was consistent with SMA syndrome. The patient was treated conservatively and was later discharged from surgical services once his symptoms resolved and he was able to tolerate diet.
A trichobezoar is an accumulation of ingested hair that forms a mass within the gastro-intestinal tract. Thrichobezoars usually consist of human hair and are known to cause obstruction and even perforation of gastrointestinal organs. There have been approximately seven reported cases of acute appendicitis with association trichobezoars found at the time of appendicectomy. We report a unique case of acute appendicitis with an associated trichobezoar of feline hair. A 15-year-old male presented with a 24-hour history of abdominal pain. A computed tomography scan demonstrated features of appendicitis with several hyperdensities within the base of the appendix. At the time of appendicectomy, the appendix was found to be perforated at the base. Faecoliths were identified containing numerous short, light-coloured hairs. Following the procedure, the family confirmed that they have a pet cat with short, light-coloured hair. The patient had an uneventful recovery.
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