Open Access Case Report

Ruptured Jejunal Gastrointestinal Stromal Tumor- An Unusual Presentation of a Rare Tumor

Nikhil Gupta, Raghav Yelamanchi, Ekta Yadav, C. K. Durga

Asian Journal of Case Reports in Surgery, Page 11-14

Aim: We report an extremely rare case of jejunal GIST presenting with acute abdomen and shock due to tumor rupture with hemorrhage.

Case Presentation: A 52 year male presented to the surgical emergency with complaints of acute onset abdominal pain and abdominal distention for 12 hours. On abdominal examination, there was a tender ill defined lump in the umbilical region associated with free fluid. Hemoglobin was 5.4 gm/dl. Ultrasound guided diagnostic peritoneal aspiration revealed blood. Patient underwent exploratory laparotomy with resection and anastomosis of the jejunal segment containing GIST.

Discussion: GISTs (Gastrointestinal stromal tumors) are one of the rare tumors of the gastrointestinal tract. Jejunum is less common site for the origin of GIST accounting for <10% of all gastrointestinal tumors. Ruptured small intestinal GIST is an extremely rare cause of acute abdomen.

Conclusion: The above case report is a very atypical scenario of small bowel GIST presenting with an acute abdomen. Early operative intervention is required to control bleeding and to prevent sepsis in cases of ruptured GIST.

Open Access Case Report

Post Caesarean Transmural Migration of Gauze Expelled Rectally Without Any Complication: A Favorable Outcome

Huriyah Muffedi, Aneela Malik, Misauq Mazcuri, Shahzad Mazcuri

Asian Journal of Case Reports in Surgery, Page 20-24

Gossypiboma (GP) is a feared complication for all surgeons. Transmural migration of gauze presents with gastrointestinal symptoms, rarely does it remain asymptomatic. It may require surgical intervention or rarely gauze is expelled per rectally. We would like to report a case of 30 year Primigravida patient that underwent an elective caesarean section, remained asymptomatic post operatively. During her first week of follow up abdomen was soft, wound healthy and no relevant signs or symptoms. After 4th week of surgery she developed colicky abdominal pain, nausea and vomiting for which she visited a doctor, no significant clinical signs or symptoms could be appreciated. Ultrasound was suggestive of gallstones for which she was prepared for laparoscopic cholecystectomy. On the pre-operative day for bowel preparation laxatives and enema was given after which she defecated the gauze piece. Computed tomographic scan with double contrast was done which reported bowel loop dilation and thickening with no signs of perforation. Patient remained asymptomatic after follow up.

Open Access Case Study

Cystitis Cystica as a Rare Cause of Obstructive Uropathy

Mohd Shafiq Rahman, Norly Salleh

Asian Journal of Case Reports in Surgery, Page 5-10

Background: Cystitis cystica, previously thought to be premalignant condition or associated with malignancy, is actually a benign condition. It may present with lower urinary tract symptoms, abdominal pain or haematuria. The exact aetiology is unknown. Cystitis cystica may cause chronic bladder outflow obstruction resulting in hydronephrosis and hydroureter.

Case Presentation: A 53-year-old male was referred to emergency department with incidental finding of deranged renal profile. Physical examination was unremarkable. Ultrasound revealed gross hydronephrosis and hydroureter with bladder wall trabeculae suggestive of chronic bladder outlet obstruction. Cystoscopy revealed small tumour over the bladder neck. It was subsequently confirmed to be a case of cystitis cystica.

Conclusions: Cystitis cystica can only be confirmed by histopathology. Unless confirmed by histopathology examination, all suspicious tumours should be treated as malignancy until proven otherwise.

Open Access Case Study

A Late Presented Fourth Degree Frostbite: A Challenging Experience in a Tropical Country

A. M. Omar Mohamed Ozaal, S. Raviraj

Asian Journal of Case Reports in Surgery, Page 15-19

Frostbite is a rare encounter for surgeons in tropical countries such as Sri Lanka. It is a severe form of cold exposure injury and has a challenging treatment protocol. We report a case of late presented fourth degree frostbite which had culminated in amputation. The purpose of this study is to highlight the surgical management of frostbite to healthcare professionals through our experience in treating this oddest case in our country. The patient was a Sri Lankan immigrant to Turkey and presented to us with bilateral gangrenous toes with delay in seeking medical care abroad. He underwent bilateral toe amputations and skin graft to wounds. Surviving frostbite starts in the field with maintaining adequate peripheral perfusion, appropriate rewarming, and timely surgical intervention along with supportive therapy. This case reinstates the necessity to be informed on the potential harms that can occur in a new climate zone. And displays the poor outcome of frostbite encountered due to time factor and the need of a well-trained medical team equipped to manage frostbite.

Open Access Original Research Article

Acute Intestinal Obstruction Following Laparoscopic Ventral Hernia Repair: An Unusual Complication in Immediate Post-operative Period

Chavali K. V. R. S. Prasanna Krishna, Alok Mazumdar

Asian Journal of Case Reports in Surgery, Page 1-4

Laparoscopic ventral hernia repair is one of the most common procedures performed in surgical practice worldwide. Intestinal obstruction is an extremely rare complication that can occur peri-operatively and needs to be dealt with extra caution. This article describes a case report of intestinal obstruction in the immediate post-operative period of a ventral hernia repair, technical details of how to deal with this complication and along with a review of literature on the topic.