Open Access Case Report

An Unusual Case of Gross Hematuira in a Two-Year-Old Boy

Noor AlHashimi, Saeed Al-Hindi

Asian Journal of Case Reports in Surgery, Page 10-14

Urachal cysts in children are rare with an incidence of 1 in 1,500 live births.

We present a case of a two-year-old boy who presented with hematuria, foul smelling urine, and a bladder mass, which up until histopathological examination had features strongly suggesting malignancy. On histopathological examination, a diagnosis of an infected urachal cyst was made.  This case report discusses a rare presentation of an infected urachal cyst and the multidisciplinary management approach taken.

Open Access Case Report

Hematochezia Due to Rare Small Bowel Lesions

V. B. Pathirana

Asian Journal of Case Reports in Surgery, Page 21-24

Aims: Small bowel lesions are important differentials in patients presenting with hematochezia and these two cases highlight the clinical challenges in diagnosis and management of such cases.

Presentation of Cases: Both of the patients present with fresh per rectal bleeding with variable degrees of hemorrhagic shock with no or minimal preceding symptoms like abdominal pain. Imaging was beneficial in accurately localizing the lesion in 1st patient and histologically gastrointestinal stromal tumour [GIST] was diagnosed. 2nd case illustrates the limitations of conventional endoscopy and unavoidable delays in decision making that can happen with small bowel lesions in a patient eventually found to have rare jejunal diverticula.

Conclusions: Small bowel lesions are rare and carry significant morbidity and mortality. They are difficult to diagnose and even with advance imaging and endoscopic facilities some cases can still be undiagnosed.

Open Access Case Study

Adenocarcinoma of Appendix Mimicking Acute Appendicitis

R. I. Divya

Asian Journal of Case Reports in Surgery, Page 1-3

Introduction: Acute appendicitis is one of the most common causes of acute abdomen. Obstruction of the lumen of the appendix due to fecolith, lymphoid hyperplasia and tumors can cause appendicitis. Appendicular tumors are rare, with carcinoids being the most common. Adenocarcinoma accounts for only 0.5% of all GI cancers, and for 0.05-0.2% of all appendectomies. Peak incidence is around 6th decade. Here we present one such case of adenocarcinoma of appendix presenting as acute appendicitis.

Materials and Methods: A 69-yearold male patient presented with complaints of right lower quadrant abdominal pain. He had a previous history of ERCP and CBD stent placement for cholangiocarcinoma. On examination, he had right iliac fossa tenderness. No icterus. Patient was evaluated with USG abdomen and pelvis, which showed inflamed appendix, 6.8mm in caliber. Patient was taken up for surgery and open appendectomy was done. Specimen was sent for histopathology. Perioperative period was uneventful.

Results: On histopathology, the external surface of the appendix was unremarkable. Cut section revealed obliterated lumen with tip of appendix showing mass of 2x1 cm. Individual cells arranged in glandular pattern with high N:C ratio, features suggestive of adenocarcinoma of appendix-metastatic/primary.

Conclusion: Adenocarcinomas are usually diagnosed postoperatively on histopathology. Although rare, it should be considered as one of the causes of acute appendicitis in the elderly. All appendectomy specimens should be sent for histopathology. Once diagnosed as adenocarcinoma, a right hemicolectomy is the preferred surgery. 

Open Access Case Study

Experience of Laparoscopic Appendicectomy in a Specialist Training Centre (HKL)

I. Idzman, O. Zakry, T. Mohanaraj, H. Hanif

Asian Journal of Case Reports in Surgery, Page 4-9

Appendicitis has always been one of the most common causes of surgical abdomen. With technological advancements, laparoscopic approach for surgical intervention has been suggested by many centres and multiple studies have shown its advantages over open appendicectomy. However laparoscopic appendicectomy has only begun to be more commonly used in our centre over the past 2 years, This is the experience we had with Laparoscopic appendicectomy in our centre.

Open Access Case Study

Rectal Endometriosis Simulating a Stromal Tumor of the Rectum

Rachid Boufettal, Oussama lafkih, Nassima Fakhiri, Amal hajri, Driss Erguibi, Saad Rifki Jai, Farid Chehab

Asian Journal of Case Reports in Surgery, Page 15-20

Introduction: Digestive endometriosis is one of the most severe forms of deep endometriosis, the rectum and sigmoid are most often affected, its clinical diagnosis is most often difficult due to the non-specificity of its clinical signs.

Case Report: We report the case of a 44-year old female patient  who presented with chronic pelvic pain, dysuria, frequency and constipation. hysterectomized for a polymyomatous uterusClinical examinations revealed the presence of a mass at the pelvic level which arrives at the intimate contact of the sigmoid with loss of the fatty border of separation by place, The patient benefited from an anterior colorectal resection taking away the pelvic mass and  The appendages to the uterus in monobloc with a colorectal anastomosis, with a protective ileostomy and a pelvic drainage. The postoperative follow-up of the patient was simple with an ablation of the salem probe at d4 and the patient was discharged at d6 postoperatively. The anapath of the surgical specimen showed a morphological aspect in favor of endometriosis.

Discussion: Rectal endometriosis is most often misdiagnosed as cancer of the rectum due mainly to a superficial clinical and paraclinical examination, hence the need for thorough investigations

Conclusion: Rectal endometriosis should always be considered as one of the differential diagnoses in women with a mass in the rectum. A good specimen is necessary to confirm the histopathologic diagnosis.