Introduction
The current Royal College of Surgeons commissioning guideline on colonic diverticular disease suggests that patients should undergo endoscopic evaluation of the colonic lumen after an episode of computed tomography (CT) proven acute diverticulitis to rule out malignancy. The necessity of routine endoscopic assessment of CT proven diverticulitis remains debatable.
Aim
To establish whether routine endoscopic assessment should be carried out for patients after an episode of acute diverticulitis.
Method
Data was collected retrospectively from all patients diagnosed with acute diverticulitis on CT and who subsequently had follow up endoscopic assessment from January to July 2019.
Results
Total number of patients were 64.Median age of the cohort was 58.Of all patients, 48 had diagnosis of uncomplicated diverticulitis whereas 16 patients had diagnosis of complicated diverticulitis on CT scan. All patients had follow up colonoscopy after an acute attack with following findings: 2 patients had no pathology, 56 patients had diagnosis of only diverticulosis, 4 patients had both diverticulosis and polyps and 2 patients had bowel cancer. All 4 cases of polyps had benign pathology and uncomplicated diverticulitis on CT scan. Two bowel cancer patients, one had complicated diverticulitis with thickening of proximal sigmoid and the other patient had abnormal sigmoid colon suggestive of malignancy on CT scan.
Conclusion
Recent meta-analysis showed no difference between diverticulitis and normal population group in terms of risk of bowel cancer. Routine colonoscopy may not be appropriate in patients with acute uncomplicated diverticulitis but endoscopic assessment after an episode of complicated diverticulitis is necessary.
The world is suffering from the COVID-19 pandemic. Nature has thrown a new challenge towards the healthcare professionals in the form of this new virus. As if that was not enough, we found an extremely rare, interesting and challenging case of mesenteric immature teratoma in this pandemic. Teratomas take origin from totipotent cells and may give rise to neoplasms that contain, in a helter-skelter fashion, bits of bone, epithelium, muscles, fat, nerves and other tissues. They are usually smaller than 10 cm, with cystic space, which is filled with a thick sebaceous secretion containing matted hair and sometimes teeth protruding from a nodular projection, which are unbrushed and may be carious. Though the usual sites are ovaries, occasionally testes, extragonadal sites may be affected. Classically the teratoma originates in the midline position. But in the abdomen, it usually takes the position of one of the paravertebral gutters, as in the present case, perhaps due to its size and weight of the solid part of the constituent elements. Due to its rarity it deserves the attention of the world and therefore we present to u this interesting case.
Jejunal diverticulitis is a rare disease, with jejunal perforation as its rarest complications due to low intraluminal pressure. Since the current pandemic of COVID-19 it has shown to be affecting gastrointestinal system in a proportion of patients, and worsening of pre-existing GI conditions. We encountered a case of a 75 years old gentleman, suffering with severe COVID-19 pneumonia, who during the course of the disease presented with spontaneous Jejunal perforation, secondary to jejunal diverticulosis. Jejunal diverticula are the least common type of small bowel diverticula & perforation as their complication is the rarest of all complications. Their presentation is variable from asymptomatic to chronic abdominal symptoms and the complications such as perforation as described in our case. Their relative clinical rarity and varied presentation may make diagnosis both delayed and difficult.
Aspergillosis is a fungal infection caused by certain types of mold. Although they are found commonly throughout nature, these molds normally don’t cause problems. Aspergillosis is an uncommon fungal infection in which primary cutaneous sites are very rare. Most cases occur in immunodepressed patients and are disseminated in the blood. We report a 32 year old female with primary cutaneous aspergillosis in an otherwise immunocompetent female with no other systemic manifestation. 32 year old female presenting with left lower chest lump fixated to chest wall. It was thought of as neoplasm clinically and radiologically mostly soft tissue neoplasm and was planned for wide excision of lump with segmental excision of involved rib segment. On histopathological examination of the specimen, it showed aspergillus organisms. It is a case of primary cutaneous manifestation of aspergillosis as fixed chest wall lump with otherwise no Broncho-pulmonary or systemic involvement in an immunocompetent patient. Primary cutaneous aspergillosis presenting as isolated chest wall lump without any Broncho pulmonary or systemic involvement in an otherwise immunocompetent individual is an extremely rare manifestation.
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