Urogenital tuberculosis: diagnostic difficulties in 5 cases

OBJECTIVES: The aim of this study is: to emphasize the difficulties of diagnosing genito-urinary tuberculosis because of its non specific symptoms; to incite the physician to seek it more frequently. MATERIAL AND METHOD: Five cases of genito-urinary tuberculosis have been diagnosed within a 10-years period and included in a retrospective study. RESULTS: We found one location in the kidney and one location in the bladder with 2 women diagnosed by repeated urianalysis and 3 cases of location in epididymis diagnosed after surgery. CONCLUSION: Symptoms of genito-urinary tuberculosis are misleading, pathologic findings are taking a more and more important place in the diagnosis, which the new techniques of serologic tests will surely improve.     

Trichobezoar: A rare cause of bowel obstruction

A bezoar is an intraluminal mass formed by the accumulation of undigested material in the gastrointestinal tract. A trichobezoar is a bezoar made up of hair and is a rare cause of bowel obstruction of the proximal gastrointes-tinal tract. They are seen mostly in young women with trichotillomania and trichotillophagia and symptoms include epigastric pain, nausea, loss of appetite and bowel or gastric outlet obstruction. We herein describe a case of a trichobezoar that presented as a gastric outlet obstruction and was subsequently successfully removed via a laparotomy.     

Primary lymphoma of the prostate: a rare cause of urinary obstruction

Primary lymphoma of the prostate is rare. It represents 0.09% of prostate neoplasias. The authors report the case of a 42-year old patient presenting urinary obstruction and renal failure due to primary lymphoma of the prostate. We discuss the clinical manifestations of this disease, emphasizing that systemic chemotherapy represents the initial and preferential therapeutic method.     

Distended urinary bladder and diverticulum-a rare cause of large-bowel obstruction

Hepatic alveolar echinococcosis is a serious disease that is characterized by tumor-like infiltrative growth. At present, complicated cases of the disease are few, and yet the treatment is controversial. In this article, we report a patient with a giant hepatic alveolar echinococcosis. Based on radiologic imaging, a radical operation with complete removal of the giant lesion was performed successfully.     

A rare cause of small bowel obstruction: Abdominal cocoon

INTRODUCTIONThe clinical manifestations of abdominal ‘cocoon’ are non-specific and hence its diagnosis is rarely made preoperatively and the management is often delayed. Surgery remains the main stay of treatment with satisfactory outcome and comprises excision of the fibrous membrane, meticulous adhesionolysis and release of the entrapped small bowel.PRESENTATION OF CASEA 45-year-old male patient presented with 6-month history of progressive subacute small bowel obstruction. After initial radiological investigations, he underwent diagnostic laparoscopy and was misdiagnosed as abdominal tuberculosis. He was started on anti-tuberculous therapy, but exploratory laparotomy was carried out after failure to respond to anti-tuberculous therapy. At laparotomy, the abdominal ‘cocoon’ which was encapsulating the entire small bowel was excised, and the adhesions were carefully lysed. The patient remained well and without recurrence at 1-year follow-up.DISCUSSIONAbdominal ‘cocoon’ is a rare cause of subacute, acute and chronic small bowel obstruction. Its diagnosis is rarely made preoperatively.CONCLUSIONAbdominal ‘cocoon’ should be thought of as a rare cause of small bowel obstruction. It may be mistaken with abdominal tuberculosis. Surgery remains the mainstay of curative treatment.     

Distended urinary bladder and diverticulum—a rare cause of large-bowel obstruction

A 76-year-old man presented to the emergency department with diffuse abdominal pain and constipation. In the few months before this admission the patient had complained of strenuous micturition. The diagnostic work-up included a plain abdominal radiograph and an abdominal computed tomography scan that revealed large-bowel obstruction with a rare cause. The colonic obstruction was secondary to external compression of the rectosigmoid colon against the sacrum by a distended bladder and diverticulum. The immediate management was insertion of an indwelling urinary catheter that resulted in quick relief of the obstruction. Later the patient underwent surgery to remove an enlarged benign prostatic adenoma, which was the underlying cause of the bladder distention.     

Intraurethral prostatic cyst: A rare cause of infravesical obstruction

A case is reported here of symptomatic intraurethral anterior midline prostatic cyst in a 52-year-old man whom transurethral resection of the cyst was performed successfully establishing the resolution of voiding symptoms.     

A rare cause of mechanical bowel obstruction: mesh migration

The use of mesh has become the gold standard in hernia operations recently due to advantages such as lower recurrence rates, lower post-surgical pain and earlier return to work. Plug mesh application, first described by Robins and Rutkow [Robbins AW, Rutkow IM (1993) The mesh-plug hernioplasty. Surg Clin North Am 73:501–512], is a popular method of hernia repair. Although rare, there may be complications of surgery using plug mesh. This report presents a case of mechanic bowel obstruction due to mesh migration, 3 years after a left inguinal hernia repair with plug mesh method.     

Bouveret's Syndrome: A rare cause of gastric outlet obstruction

Bouveret's Syndrome is a rare cause of gastric outlet obstruction secondary to the impaction of a gallstone within a cholecystogastric or cholecystoduodenal fistula. It is a rare variant of gallstone ileus. Prompt diagnosis, appropriate investigations and proper treatment are essential. The aim of the present case report was to review the currently‐available literature regarding Bouveret's syndrome management approach and to share our experience. A 69‐year‐old man presented to our surgical unit with a 1‐week history of upper gastrointestinal bleeding and gastric outlet obstruction symptoms. The diagnosis of Bouveret's Syndrome was confirmed with computed tomography. He subsequently underwent a one‐stage open partial gastrectomy and cholecystectomy with Roux‐en‐Y anastomosis and controlled duodenostomy. Postoperative recovery was uneventful and the patient was discharged on postoperative day 11. With the current paucity of high‐level evidence regarding the management approach for Bouveret's syndrome, the gold standard management algorithm is yet to be developed. The management approach should be tailored, with an appropriate choice of treatment based on the patient's clinical presentation and comorbidities and the expertise available. Surgical approach should be considered if endoscopic treatment is not feasible or has failed.     

A rare cause of nasal obstruction: a solitary neurofibroma

This case represents a peripheral nerve sheath tumor as a cause of nasal obstruction. Nerve sheath tumors are relatively uncommon; however, most otolaryngologists will encounter them. These tumors develop from cranial and spinal nerve roots and from peripheral nerves. In total, approximately 25% to 44% of nerve sheath tumors occur in the head and neck region. Although the most important are cranial nerve tumors--the majority being acoustic neuromas arising from the vestibular nerve--they may also develop in the nasal cavity.     

Antral hyperplastic polyp: A rare cause of gastric outlet obstruction

INTRODUCTION

Gastric polyps are usually found incidentally during upper gastrointestinal endoscopic examinations. These polyps are generally benign, with hyperplasia being the most common. While gastric polyps are often asymptomatic, they can cause gastric outlet obstruction.

PRESENTATION OF CASE

A 64 years-old female patient presented to our polyclinic with a history of approximately 2 months of weakness, occasional early nausea, vomiting after meals and epigastric pain. A polypoid lesion of approximately 25 mm in diameter was detected in the antral area of the stomach, which prolapsed through the pylorus into the duodenal bulbus, and subsequently caused gastric outlet obstruction, as revealed by upper gastrointestinal endoscopy of the patient. The polyp was retrieved from the pyloric canal into the stomach with the aid of a tripod, and snare polypectomy was performed.

DISCUSSION

Currently, widespread use of endoscopy has led to an increase in the frequency of detecting hyperplastic polyps. While most gastric polyps are asymptomatic, they can cause iron deficiency anemia, acute pancreatitis and more commonly, gastric outlet obstruction because of their antral location. Although there are no precise principles in the treatment of asymptomatic polyps, polyps >5 mm should be removed due to the possibility of malignant transformation.

CONCLUSION

According to the medical evidence, polypectomy is required for gastric hyperplastic polyps because of the risks of complication and malignancy. These cases can be successfully treated endoscopically.     

Rectal tuberculosis: A rare cause of recurrent rectal suppuration

Tuberculosis affecting the rectum is a rare extra‐pulmonary form of the disease that needs recognition, because it requires specific treatment and avoids multiple, unwarranted surgical interventions. The following discussion is centred on a case of rectal tuberculosis, a disease that rarely affects the anorectal region. The condition was diagnosed on histology and was successfully treated medically with complete resolution.