Background: Spontaneous splenic haematoma, in the absence of trauma is rare in young immunocompetent adult. Malignancy, infection, and medication are some of the aetiologies identified. Diagnosing spontaneous splenic haematoma is a challenge as it may mimic other disease. Case Presentation: A 21-year-old male presented to emergency district hospital with umbilical pain migrating to right iliac fossa. Physical examination revealed right iliac fossa tenderness but no peritonism. Provisional diagnosis of perforated appendicitis was made and patient was planned for open appendicectomy via Lanz incision. Reassessment revealed generalized abdominal pain and patient underwent lower midline laparotomy. Intraoperatively there was 1.8L of haemoperitoneum and haematoma was found at splenic hilum. Splenectomy was performed and patient was discharged well with prophylaxis antibiotic. Conclusion: Spontaneous splenic haematoma is rare and should be considered in young immunocompetent adult presenting with abdominal pain.
Introduction: Cholangiocarcinoma is a malignancy arising from biliary epithelium with incidence rate of less than 2 in 100000. It is the second most common primary liver malignancy. Cholangiocarcinoma usually presents with jaundice with or without abdominal pain. In advanced cholangiocarcinoma, it is extremely rare for cervical swelling to be the initial complaint and presentation. Case Presentation: A 69-year-old male with underlying diabetes mellitus presented to surgical clinic with painful neck cervical swelling for 1 month with no other associated symptoms. Blood investigations were within normal range. Contrast enhanced computer tomography showed multiple enlarged lymph nodes over the axilla, mediastinal and supraclavicular with small hypodense lesion identified at Segment IV of the liver. Excision biopsy of left supraclavicular was performed which revealed metastatic adenocarcinoma. Immunohistochemistry study with an elevated Ca 19.9 tumour marker confirmed the diagnosis of metastatic cholangiocarcinoma. Conclusion: Metastatic cholangiocarcinoma presenting with neck swelling in the absence of jaundice is a rare occurrence and confer diagnostic challenge especially in district hospital. Availability of immunohistochemical study is of paramount important in establishing the diagnosis.
Background: Phyllodes tumours are rare fibroepithelial lesion, which accounts for less than 1% of all breast neoplasm. However, Phyllodes tumours arising from ectopic breast tissue are even rarer, with less than 15 cases ever reported involving the axilla, vulva, and groin. Case Presentation: A 27-year-old lady presented to the surgical clinic with left axillary swelling measuring 5cm x 6cm. Ultrasound of the axilla revealed heterogenous homogenous mass displacing the left axillary artery and vein medially. Excision was performed, and histopathological examination confirmed the diagnosis of a benign Phyllodes tumour. Conclusion: Phyllodes tumour in ectopic breast tissue over the axilla is a rare occurrence, and our case is the fourth case ever reported. Despite its rarity, diagnosis and treatment modalities are similar to Phyllodes tumour of the breast. Regular follow-up is recommended due to the risk of local recurrence.
Myeloid Sarcoma (MS) or extramedullary myeloid tumor is a rare tumor affecting the skin, lymph node, and any part of the body except the bone marrow. MS may present differently depending on the site of involvement. A 61-year-old male with a known case of chronic myeloid leukemia presented to the emergency department of a district hospital with per rectal bleeding for two days. Examination revealed haematochezia with no evidence of rectal tumor. Hyperleukocytosis was noted from the blood investigation. Colonoscopy was performed, which revealed the rectosigmoid tumor. Histopathological examination confirmed the diagnosis of myeloid sarcoma. The patient was subsequently referred to a hematologist in a tertiary hospital for further care. MS may present a diagnostic challenge as it may present nonspecific symptoms depending on the site of involvement. Awareness of this condition is essential; thus, diagnosis and treatment can be initiated earlier.
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