Open Access Case Report

A Rare Case of Endometriosis Presented as Acute Appendicitis

Hasbillah Mazlan, Shafiq Rahman, Norly Salleh

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

Background: Endometriosis is a common condition that can affect up to 15% of women of childbearing age and 2–5% of post-menopausal women. Endometriosis commonly involves the adnexa but can be present anywhere in the peritoneal cavity. Endometriosis involving the appendix is rare and preoperative diagnosis is difficult. Endometriosis of the appendix has been identified in less than 1% of patients with pelvic endometriosis. It is generally asymptomatic but may be associated with appendicitis, perforation and intussusception.

Case Presentation: A 22-year-old lady, with a regular menstrual history, presented with 5 days history of right iliac fossa pain. Examination revealed tenderness over right iliac fossa. Blood results were normal. Diagnosis of acute appendicitis is made. Open appendicectomy was performed which revealed an inflamed appendix. Histopathological examination of appendix reported as appendix endometriosis.

Conclusions: Appendiceal endometriosis affects women of childbearing age and may presents as acute appendicitis. As such, laparoscopic appendicectomy should be the gold standard for the treatment of acute appendicitis in women.

Open Access Case Report

Cystic Schwannoma of Plexus Brachialis

Marco Mele, Katrine Rye Hauerslev, Soren Redsted, Pernille Vahl, Anne Kristine Larsen

Asian Journal of Case Reports in Surgery, Page 5-13

Schwannoma of the Plexus Brachialis is a benign nerve sheath tumor and is a rare entity.

We report a case of a Cystic schwannoma (CS) from the left brachial plexus in the axilla, our surgical management of the case and a literature review.

Open Access Case Study

Paediatric Airway Foreign Bodies Masquerading COVID-19 Pneumonia- A Diagnostic Challenge in COVID-19 Pandemic: Case Report

Lokesh Kumar P., Benazir Begum, Nipun R., Sunil Kumar Saxena

Asian Journal of Case Reports in Surgery, Page 14-17

Foreign body aspiration (FBA) is not very uncommon in the paediatric population. Its presentation can vary from a simple cough to dangerous pneumonia. This study presents cases with a negative history of FB where the presentation is delayed, findings are masked, and a rigid diagnostic bronchoscopy is done as a supplementary procedure that helped rescue the children from adverse outcomes. The child's grandmother revealed a history of the child playing with ripe tamarind fruit a day before the arrival. We consider the differential diagnosis of croup, Foreign body aspiration and COVID-19 pneumonia. RT-PCR for COVID-19 antigen was negative. The child was treated like a case of viral/bacterial pneumonia. We consider Rigid diagnostic bronchoscopy as the CT findings were suggestive of aspiration pneumonitis. We suggest repeated probing about FBA, a high index of suspicion, earlier radiological investigations like high-resolution CT scans or virtual bronchoscopies, and a quick referral to ENT to help rescue these children faster.

Open Access Case Study

Feeding Jéjunostomy and Intestinal Intussusception: About a Case

Rebbani Mohammed, Mohamed Bouzroud, Faisal El Mouhafid, Yasser El brahmi, Mohammed Elfahssi, Abderrahman Elhajouji, Abdelmounaim Ait Ali, Aziz Zentar

Asian Journal of Case Reports in Surgery, Page 18-21

Jejunostomy is an important adjunct procedure in surgery that facilitates early enteral feeding and maintains a satisfying nutritional intake in undernourished patients. However, it is associated with complications especially bowel obstruction by intussusception that is an exceptional surgical emergency in adults. We report the case of a patient who underwent a partial gastrectomy for antrum adenocarcinoma with insertion of a feeding jejunostomy. Postoperative courses were marked by intestinal intussusception on jejunostmy tube. Clinical and biological contribution to diagnosis was nonspecific. The abdominal CT scan examination evoked the diagnosis by showing a small bowel occlusion in upstream of “target” picture around the feeding tube. Surgical treatment was the resection of the intestine, remaking the foot of the loop, wide washing and drainage. By this case, we aim to bring clinical, biological, radiological and therapeutic specificities of this rare complication.

Open Access Case Study

Pyogenic Liver Abscess Leading to IVC Syndrome

Jasmine Singh, Vipul Gupta, Ashwini Kumar Dalal, Ravinder Kaur, Narinder Kaur, Vishal Guglani

Asian Journal of Case Reports in Surgery, Page 22-26

Introduction: Inferior Vena Cava (IVC) syndrome is caused by compression of IVC in the abdominal cavity. It is characterized by abrupt onset of ascites, hepatomegaly, splenomegaly and fluid retention below the diaphragm with edema of the lower extremity. In clinical practice, it is encountered much less frequently than Superior Vena Cava Syndrome. Amoebic liver abscess has been reported as a cause of IVC syndrome but that is very rare. We hereby present a case of pyogenic liver abscess presenting as IVC syndrome, which is the first reported case to the best of our knowledge.

Case Report:  A 3 year old male child with fever and pain abdomen for 15 days was referred to our institute with outside ultrasound (USG) abdomen suggestive of liver abscess. USG abdomen done in our institute confirmed the findings. Child was admitted and started on empirical IV antibiotics. On day 3 of admission, child developed swelling of bilateral lower limbs, scrotum and abdominal distension, findings consistent with inferior vena cava syndrome. CECT abdomen was done to rule out malignancy. It showed significant IVC compression. The pus culture sent from ultrasound guided tap showed Methicillin resistant Staphylococcus aureus and Klebsiella pneumoniae grew in the subsequent attempt to relieve compression. IV antibiotics were adjusted according to sensitivity but there was no relief of symptoms. Surgical drainage of abscess through posterior thoracotomy was done which led to resolution of symptoms in the next 48 hours.

Discussion: Although a rare occurrence, IVC syndrome can be a distressing and difficult to treat condition when accompanied with mass effect. In such circumstances, surgical drainage might be the only option and must be sought once USG guided drainage fails.