Abstract:Gallbladder carcinosarcomas are rare and usually present insidiously. However, our patient, a 51-yearold lady with history of gallstone pancreatitis, presented with acute abdominal pain. Imaging suggested gallbladder cancer and histology confirmed early gallbladder carcinosarcoma. Thus, acute presentations may help with early diagnosis. Surgical resection involving a radical cholecystectomy and chemotherapy may be considered to improve prognosis.
A 33-year-old man presented to our outpatient department after a large appendicolith was incidentally found on lumbar computed tomography (CT) for unrelated lower back pain. Follow-up dedicated CT of the abdomen and pelvis revealed a dilated appendix containing moderate-sized appendicoliths with associated calcification. Despite a soft and non-tender abdomen on examination, on further history the patient described concurrent and vague rightsided abdominal pain. Given the tubular and suspicious appearance of the appendix, the patient underwent an elective laparoscopic appendicectomy. Intra-operative examination demonstrated the proximal appendix intussuscepting into the caecum of the large bowel ( Fig. 1). Caecectomy was also subsequently performed. The appendix was successfully removed and the operation was uneventful. The patient progressed well post-operatively and made an uncomplicated recovery. Histopathology was benign, merely revealing an early inflammatory process.Intussusception of the appendix is extremely rare, with an incidence of 0.01% in all appendectomy procedures. 1 There are a variety of causes; however, the underlying abnormality involves irregular peristalsis of the appendix secondary to local irritation. 2 The causes of intussusception should be classified into anatomical and pathological. 2 Predisposing anatomical factors include increasing mobility of the appendicular wall, capable of active peristalsis, and a large appendicular lumen, with the diameter of the proximal lumen larger than the distal portion. 1 Similarly, there are many pathological causes, ranging from inflammatory (endometriosis, fibroma and follicular lymphoid hyperplasia), benign (faecaliths, polyps and mucocoele) and malignant (carcinoid, adenocarcinoma and metastases). [3][4][5] McSwain describes an anatomical classification based on the region of appendix that undergoes intussusception. 2 There are five anatomical classifications of appendiceal intussusception:
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