Alimentary tract duplication cyst refers to congenital malformations that involve the mesenteric side of bowel and share a common wall or blood supply with the bowel. Duplication cyst occurs in any segment of the gastrointestinal tract from mouth to anus, but is more commonly seen in the mesentery of the ileo-colic region. Duplication cyst presents more frequently in children with abdominal pain or swelling. In adults, the diagnosis of duplication cyst is incidental and can present with complications like bleed, fistula formation, inflammatory mass, and rarely malignant transformation. English-language literature review has shown only three cases of malignancies reported so far associated with jejunal duplication cyst. A case of incidentally detected metastatic adenocarcinoma in a jejunal duplication cyst is being reported here, along with literature review of malignancies associated with small bowel duplication cyst.
Acute idiopathic omental infarction is an uncommon cause of abdominal pain. Only about 300 cases have been reported in the medical literature so far.15% of cases occur in the pediatric age group. Omental infarctions are common on the right side and present as right iliac fossa pain. Clinical presentation usually mimics acute appendicitis and leads to unnecessary surgical intervention in majority of the cases. Acute idiopathic omental infarction presenting as left iliac fossa pain has not been reported till now in medical literature. Controversy exist regarding the management of acute omental infarction. While a few authors recommend surgical resection of the infarcted omentum, most authors recommend conservative management. Here we report a case 36 years old lady with acute idiopathic omental infarction presenting as the left sided abdominal pain. Diagnosis was made on contrast enhanced CT imaging. She was managed conservatively with NSAIDs and antibiotics. She was discharged after 2 days of in hospital. She improved clinically on outpatient follow up at 1 week, 1 month and 6 months. In short, acute idiopathic omental infarction is an unusual cause of left iliac fossa pain. Patients may benefit from conservative management, once the diagnosis is confirmed based on imaging. Further studies are necessary to devise a correct guideline on surgical intervention and conservative management in omental infarction.
Sclerosing encapsulating peritonitis, also known as abdominal cocoon, is a rare condition of unknown etiology which results in intestinal obstruction due to total or partial encapsulation of the small bowel by a fibrocollagenous membrane. A high index of clinical suspicion is required for preoperative diagnosis. The early clinical features are nonspecific and not recognized, which makes a definite preoperative diagnosis difficult. The radiological diagnosis of abdominal cocoon is now made on computed tomography scan. Surgery plays main role in the management of this disease. Careful dissection and excision of the thick sac with the release of the small bowel loops will lead to complete recovery in the vast majority of cases. Here, we are reporting a case of sclerosing encapsulating peritonitis presented with delayed intestinal obstruction.
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