Multilocular cystic nephroma of the kidney in a young adult: Case report

We report the case of a 20-year-old female patient who presented with a left abdominal mass of 4 years duration. Ultrasonography showed a multicystic left renal mass, and intravenous urography revealed a non-functioning kidney. Based on these findings a multicystic renal cell carcinoma was suspected and radical nephrectomy was performed. Histological examination of the resected specimen confirmed the diagnosis of multilocular cystic nephroma. This is a very rare renal tumor with only few cases described in the literature. Based on our case and a review of the literature the epidemiology, pathogenesis and diagnostic features are discussed.     

Cystic nephroma: A rare clinical entity

We report a rare benign renal tumor, the cystic nephroma (CN) in a 35-year old man. CN should be considered in the differential diagnosis when clinical and radiological examinations reveals a multilocular cystic renal mass, but histopathological examination is the unique diagnostic mean.     

Pouch of Douglas pelvic hernia: a rare entity managed laparoscopically

Pouch of Douglas hernias are uncommon forms of pelvic hernia. They are most commonly seen in multiparous, elderly women and those having undergone previous pelvic surgery (Stamatiou et al. in Am Surg 76(5):474–479, 2010). Herein, we present a case of a 77-year-old female presenting with groin pain due to a Pouch of Douglas hernia. She had no previous abdominal or pelvic surgery. This was repaired via a trans-abdominal pre-peritoneal approach and the patient’s symptoms resolved. To our knowledge, this is the first case report in the literature of an idiopathic Pouch of Douglas hernia managed laparoscopically.     

Spontaneous transdiaphragmatic intercostal hernia: a rare clinical entity

The herniation of abdominal contents through a diaphragmatic and chest wall rent has been uncommonly reported in literature. Also known as a transdiaphragmatic intercostal hernia (TDIH) or intercostal pleuroperitoneal hernia, it occurs when the disruption of diaphragmatic or intercostal muscles leads to an acquired herniation of abdominal contents. It is usually seen to occur following a traumatic incident. We report the case of an elderly male who presented with a reducible lump in the left chest and breathlessness on exertion, in the absence of any trivial or occult trauma, and how this was managed adequately via surgery alone.     

Primary tubercular caecal perforation: a rare clinical entity

Background  

Intestinal tuberculosis is a common problem in endemic areas, causing considerable morbidity and mortality. An isolated primary caecal perforation of tubercular origin is exceptionally uncommon.     

Bilateral segmental pelvic and femoral fractures in a young female: A rare casereport

The management of multiple complicated injured patients remains a great challenge despite advancements in modern medical care. We present a rare case of bilateral unstable pelvic fractures associated with bilateral segmental femoral shaft fractures. We have proposed a mechanism of such complex injury pattern and discussed the plan of management. We believe that a timely and aggressive surgical intervention to fix all the major fractures soon after medically stabilizing the patient helped our patient to overcome these serious and lethal injuries. It is necessary to establish an optimal protocol for management of such complex fractures by conducting prospective and multicentric studies in the future.     

Asymptomatic far-migration of an intrauterine device into the abdominal cavity: A rare entity

Uterine perforation is a serious problem which can happen after intrauterine device (IUD) insertion. Migration of the IUD to the pelvic and abdominal cavity or adjacent organs may be seen following perforation of the uterus. Migration of an IUD to a far intra-abdominal site is extremely rare. The patient reported here had undergone an IUD placement 30 years previously and had no problems during this period. The IUD was incidentally found at the left upper quadrant of the abdomen in the mesentery.     

Primary hydatid disease of the gallbladder: a rare clinical entity

Hydatid disease is endemic in Greece, and has been known from Hippocrates time to cause cysts in the liver. We report here three very rare cases of primary gallbladder hydatid disease without prior history or evidence of concurrent disease activity in any other location. To our knowledge, only two previous reports exist, each of one patient suffering from primary gallbladder hydatid disease. Unlike the insidious hydatid cysts of the liver, gallbladder hydatidosis in our patients was associated with early diagnosis, due to gallbladder dysfunction symptoms presenting early in its course. Moreover, the size of gallbladder cysts compared to liver cysts at diagnosis was small (maximal diameter, <5cm), making total cyst excision along with cholecystectomy feasible for all of our patients. During long-term follow up of the patients (up to 10 years), no disease recurrences were noted. We provide supporting evidence that primary gallbladder hydatidosis presents a different pathophysiological and clinical course, having better prognosis, when compared with the usual liver disease.     

Metastatic basal cell carcinoma of prostate in a young adult: A rare aggressive entity

Introduction

Prostate cancer is one of the commonest, malignancies affecting elderly males. Prostatic basal cell carcinoma, (PBCC) accounts for less than 0.01% of all prostate cancers.

Inflammatory myo-fibroblastic tumor of appendix: A rare clinical entity

IntroductionInflammatory myo-fibroblastic tumor of appendix is one of the rarest clinical findings and less has been described in the literatures. So, we aimed to present the clinical case that we encountered at our institute.Presentation of a caseA 29-year-old lady presented with history of pain at the periumbilical area for one day which shifted to right iliac fossa. Clinical examination revealed tenderness and rebound at right iliac fossa with increased total leucocyte count and ultrasonography abdomen showed swollen appendix. Intraoperatively, a lump around 4 × 3 cm was evident at the tip of appendix with cut section revealing pus along with fecalith. Appendectomy was done with no spillage of the content within the peritoneal cavity. Histopathology revealed inflammatory myo-fibroblastic tumor of appendix. Patient is on regular follow up.DiscussionInflammatory myo-fibroblastic tumor of appendix is one of the rarest clinical findings that mimics malignancy. Presentation could be that of acute appendicitis and in most instances, diagnosis is made intraoperatively. Surgical removal is the mainstay of treatment with regular follow up of the patient for chances of recurrences. Histologically, edematous stroma consisting of inflammatory infiltrates composed of lymphocytes, plasma cells, eosinophils and focal formation of lymphoid follicles along with the proliferation of scattered spindle to ovoid cells with proliferating blood vessels with unremarkable over lying epithelium is evident. Myo-fibroblastic origin can be confirmed by immunostaining with smooth muscle specific vimentin and actin.ConclusionInflammatory myo-fibroblastic tumor of appendix can present with features of acute appendicitis and may mimic malignancy. Appendectomy with regular follow up is mandated if such clinical cases are encountered.     

Blunt traumatic iliac vein laceration without pelvic fracture: a rare entity.

Most blunt traumatic pelvic venous injuries are associated with pelvic fractures. We report the case of a 32-year-old man who suffered a common iliac vein laceration, without a pelvic fracture, during a motor vehicle accident. Laparotomy and venous repair were undertaken.     

Xanthogranulomatous pyelonephritis in childhood: a rare but important clinical entity

PURPOSE: Xanthogranulomatous pyelonephritis (XGPN) is extremely rare in children. The authors review their experience of this condition. METHODS: Medical records were investigated to conduct a retrospective study of 4 patients with XGPN (3 boys, 1 girl; age range, 2 months to 7 years) at the authors' institute over the past 14 years. RESULTS: Three of the 4 patients presented with fever of unknown origin and 1 with general fatigue. An abdominal mass was palpable in two cases at initial presentation. Although all patients had pyuria or hematuria, preoperative urine culture was positive in only 2 cases. Preoperative radiologic studies showed that 1 kidney was affected completely in 2 cases and affected partially in 2 cases. Preoperatively, the provisional diagnosis was XGPN in 3 cases, and Wilms' tumor in 1 case. Total nephrectomy was performed in 3 cases and enucleation in 1 case. XGPN was confirmed in all cases by histopathologic studies, but the underlying disease could be identified only in 1 case (cystinuria). All patients did well postoperatively and have had no further health problems over a mean follow-up period of 4.8 years. CONCLUSIONS: XGPN should be considered when there is a history of recurrent or therapy-resistant pyelonephritis. Preoperative radiologic investigation is paramount for diagnosis, and nephrectomy is the treatment of choice, although partial resection or enucleation are adequate for partially affected kidneys.     

Giant sigmoid diverticulum: A rare entity of high clinical significance

Aim-Background

Affecting about 35% of patients above the age of sixty, diverticular disease represents a common entity. However, giant colonic diverticulum is a rare complication of this disease with variant clinical presentation and high complication rate. This report describes one such case and includes a short review of the literature.

Case report

An 83-year-old Caucasian man was transferred to our Unit after having been hospitalized in the Department of Internal Medicine for 15 days due to high fever with chills and vague left lower abdominal pain. The clinical examination was normal and showed no signs of peritonitis or palpable mass, other than a mild abdominal tenderness in the left iliac fossa. The patient’s medical history included diabetes mellitus, hyperlipidaemia, and distal arteriopathy. The patient had undergone endovascular repair of abdominal aortic aneurysm five years earlier. Blood tests indicated hypochromic anaemia and a hemoccult test was positive for haematochezia. Blood, urine, and faeces cultures were negative.

Results

Diverticulosis of the sigmoid colon was diagnosed by colonoscopy. The abdominal CT revealed a large air density mass adjacent to the sigmoid colon and diverticulosis of the sigmoid colon was diagnosed by colonoscopy. We performed sigmoid resection followed by end-to-end colorectal anastomosis with protective loop ileostomy so as to eliminate the risk of septic complications. A giant pseudodiverticulum was confirmed by histology.

Conclusion

Giant colonic diverticulum is a rare complication of colonic diverticular disease with unclear aetiology and variable clinical presentation. Due to the substantial risk of complications and the low mortality associated with surgical treatment, elective surgical therapy has been recommended. Conservative management of an asymptomatic giant colonic diverticulum should be reserved only for high-risk elderly patients who cannot tolerate surgery or who are unwilling to undergo surgery.     

Adult intestinal intussusception: a case report of a rare clinical entity

Intussusception in adult is a rare entity that challenges the surgeon opening a wide range of issues in order to define the etiology and therapeutic strategy. Whether to resect or not the bowel is the main question. The answer can be given only after having seen the site of obstruction and the etiology. Colonic intussusception is best treated by resection. Also small bowel intussusception can require resection if a neoplasm is the cause. Peutz Jeghers can be one of these causes as is seen in the case we report.     

Multilocular cystic nephroma: A case report and review of the literature

Multilocular cystic nephroma is a rare cystic renal tumor, which is benign and has an excellent prognosis. However, preoperative diagnosis is challenging and is made exclusively by pathological findings. We reported a 41-year-old woman with chronic flank pain, and abdominal computed tomography revealed a multiloculated renal cystic tumor. The possibility of a cystic variant of renal cell carcinoma could not be excluded. Laparoscopic radical nephrectomy was performed, and diagnosis of multilocular cystic nephroma was made. In this report, we describe the clinical presentation, radiological finding, and histopathology of this case.