Asian Journal of Case Reports in Surgery

Aims: To report the biliopancreatic limb obstruction due to non-recurrence in pancreatic cancer patient.

Afferent limb obstruction has been under reported in the literature and should be recognized early and treated aggressively to prevent disasters.

We present one such case.

Aims: A persistent vitellointestinal duct is a rare finding, typically occurring in the pediatric population. Most commonly presenting as Meckel’s diverticulum, it is extremely rare for it to present as intestinal obstruction in the adult population.

Presentation: The present case report describes a 20 years old male presenting with features of small bowel obstruction due to obliterated fibrous remnant of the duct extending from the umbilicus to the terminal part of the ileum. Early resuscitation and timely intervention ensured that the patient was managed by laparoscopic assisted resection of the vitellointestinal duct and involved ileal segment followed by quick recovery.

Discussion: Intestinal Obstruction due to persistent vitellointestinal duct is an uncommon and very challenging preoperative diagnosis. While in few such case reports they have been managed by laparotomy and sometimes requiring resection of gangrenous small bowel, very rarely it has been treated laparoscopically. The clinical presentation and investigation justified early diagnostic laparoscopy in our patient which enabled a laparoscopic assisted bowel resection with lower morbidity, decreased hospital stay and early return to work.

Conclusion: Diagnosis and management of intestinal obstruction in an adult without history of previous surgery can be challenging. Surgeons must be aware of this uncommon cause of small bowel obstruction to ensure prompt management and better patient outcome.

Aim: Foreign body aspiration in an otherwise healthy adult is a rare condition. We wanted to present our patient who could survive after aspirating multiple foreign bodies.

Presentation: A 50 years old man aspirated multiple stones and with the urgency operation removed the gravels and cleaned airway. He discharged the next day.

Discussion: Foreign body aspiration is very dangerous in both adult and children. In case of emergency, such as foreign body aspiration, either the airway should be intubated or the foreign body removed by rigid bronchoscopy.

Aims: Angiomatoid fibrous histiocytoma, a tumour of uncertain differentiation and intermediate behaviour, is rarely seen in the head and neck region. We report its dramatic presentation in the neck as a progressive, large mass mimicking malignancy clinically as well as cytologically, to share our challenges in diagnosing and treating this condition.

Presentation of Case: A healthy 40-year-old gentleman presented to our centre with a 2-year history of a slowly progressive large right neck mass, without any constitutional symptoms.  Examination showed a large right neck mass and subsequent fine needle aspiration revealed metastatic carcinoma.  Loss in follow up, he returned 2 years later without any progression. This unusual behaviour raised suspicion and subsequent incisional biopsy revealed a spindle cell neoplasm suggestive of a sarcoma.  Excision of the lesion showed a well-encapsulated tumour, and subsequent histopathological examination revealed an angiomatoid fibrous histiocytoma of the neck.

Discussion: Angiomatoid fibrous histiocytoma presents a diagnostic dilemma to clinicians as: clinically, it may display similar appearance to a lipoma, haematoma or haemangioma and pathological examination of the lesion may mimic metastatic carcinoma or melanoma, even in the presence of distinctive morphology. The mainstay of treatment is surgical excision and in the rare case of recurrence or metastasis; chemoradiotherapy.

Conclusion: A slowly progressive neck mass reported as metastatic carcinoma should be investigated with caution.

Aims: Schwannoma is a neurogenic tumour, originating from the nerve sheaths may either be malign or benign. In this case, was presented a giant mass and its an abnormal vascular structure.

Presentation: In this case, the location of the big mass was also the posterior sulcus. The mass has been dissected extrapleural from the thoracic wall by a posterolateral thoracotomy. The venous return was detected to be towards to the azygos vein.

Discussion: When excising a resectable giant schwannoma mass, the possibility of abnormal vessels or arteries should be kept in mind.