Open Access Case Report

Vitellointestinal Duct Remnant Inducing Small Bowel Obstruction in an Adult: An Unusual Entity

Sharada P. B, Rohit Krishnappa

Asian Journal of Case Reports in Surgery, Page 16-21

Introduction: Vitellointestinal Duct is an embryonic communication between the primitive yolk sac and the developing midgut which normally obliterates by weeks 5–10 of intrauterine life. Persistent duct can present as varied anatomical entities. Here, we report a case of small bowel obstruction due to Vitellointestinal duct remnant in an adult patient.

Presentation of Case: An adult male patient presented to the emergency room with features suggestive of acute intestinal obstruction which upon laparotomy was found to be due to volvulus around Vitellointestinal duct cyst.

Discussion: Vitellointestinal duct remnants can present as Meckel’s diverticulum, Patent vitellointestinal duct, Vitellointestinal sinus, Vitellointestinal cyst, Vitellointestinal mucosal polyp, Vitellointestinal fibrous band. Usually Asymptomatic in adults, when symptomatic can cause abdominal pain, rectal bleeding, small bowel obstruction, umbilical discharge which commonly occurs in children.

Conclusion: Although small bowel obstruction is a common surgical diagnosis, its aetiology never fails to surprise the operating surgeon. Persistent vitellointestinal duct can be considered as a possible etiology in patients with no past history of surgery and non-specific radiological findings for early diagnosis and better patient outcome.

Open Access Case Study

Clinical Challenges in Managing a Dengue Positive Patient Presenting as Perforated Duodenal Ulcer

Vethunan Tamalvanan

Asian Journal of Case Reports in Surgery, Page 1-5

Introduction: Acute abdomen in Dengue Fever patient poses a distinct and formidable challenge in diagnosis and management. Perforated duodenal ulcer is a rare presentation of Dengue Fever. Surgeons face formidable challenges in diagnosing, resuscitating and delivering optimum post-operative care for such patients.

Case Presentation: A 26 years old gentleman presented with acute abdominal pain for 3 days and peritonism over the right side of abdomen. His serology investigation and NS1 antigen was positive. Perforated duodenal ulcer was confirmed by a CECT abdomen.

He was taken for a laparotomy and the ulcer was repaired with the Heineke-Mikulicz pyloroplasty technique. Post-operative care was meticulous regarding the fluid status with account of the capillary leakage which occurs during defervescence phase of dengue fever. An oral contrast study was done on day 5 to confirm the integrity of the repair prior to commencement of oral feeds.

Conclusion: Managing this patient successfully highlights the importance of active participation from both physician and surgeon. An increased clinical vigilance to possible post-operative complications and close monitoring as the patient progresses to the defervescence phase of dengue fever are important to minimising the adverse physiological stress to this patient.

Open Access Case Study

2 Year Experience of Laparoscopic Inguinal Hernia Repair (TAPP) with Covid-19 Pandemic - A Debut at Non-Hernia Centre (HKL)

M. Palaniappa, O. Zakry, H. Hanif

Asian Journal of Case Reports in Surgery, Page 6-11

Hernia surgery has always been one of the commonest surgeries performed worldwide 2. Laprascopic approach has been the preferred mode of surgical intervention in recent times1,2,3 and multiple studies have been done to advocate and promote this method among surgeons. Here, we present a twoyear summary of inguinal hernia repairs via TAPP approach despite Covid-19 pandemic. Our results in a non-hernia specialized centre reveals promising outcomes advocating TAPP among new and junior surgeons.

Open Access Case Study

Perforated Marginal Ulcer as a Complication of Pancreaticoduodenectomy

Antonio Reguera-Teba, Eva Antonaya-Rubia, Araceli Rodríguez-Cano

Asian Journal of Case Reports in Surgery, Page 12-15

Complications at the gastrojejunal anastomosis are challenging in terms of diagnosis, therapy, and prevention. Perforated marginal ulcer after pancreaticoduodenectomy (PD) is a delayed complication. One case of perforated marginal ulcer after PD was reported at our hospital. The patient was treated with direct suture and omental patch, and no mortality was reported. This study aims at identifying these complications and discussing their management. Gastrojejunal anastomotic complications are frequent and occur within the first few days or up to several years after surgery. Stenoses or marginal ulcers are usually successfully treated nonoperatively. Laparoscopic repair, meanwhile, is an appropriate therapeutic option for perforated ulcers.

Open Access Case Study

Colo-colic Intussusception on a Coecal Tumour: A Case Report

Asmaa El-Karouachi, Ahmed Elmi Abdirahim, Zouhair Abdeladim, Bouali Mounir, El Bakouri Abdelilah, Bensardi Fatima-zahra, El hattabi Khalid, Fadil Abdelaziz

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

Introduction: Adult intussusception is a rare clinical condition (1) and about 70%-90% of adult intussusception cases (2). The principle causes are benign or malignant tumors. In adults, the most frequent localizations of intestinal invaginations are the ileo-cecal segment, ileum and colon as exclusive localization (3). the diagnostic and therapeutic methods must be adapted to each case (4).. We report a case of cecal-colonic intussusception treated surgically and review the characteristics and treatment of colonic intussusceptions in the literature.

Materials and Methods: Our work is a retrospective case report with a descriptive aim concerning a patient operated for a colonic intussusception within the department of general surgery of CHU Ibn Rochd Casablanca.

Case Report: A 61-year-old woman presented to the department with diffuse abdominal pain evolving for 4 months with alternating constipation and diarrheal debacle, without externalized digestive hemorrhage, all evolving in a context of apyrexia and alteration of general condition. On physical examination, the patient was conscious and stable on the respiratory and hemodynamic level and abdominal examination found a generalized abdominal tenderness without palpable mass. The abdominal CT scan showed an aspect of ileocolic intestinal invagination on a tumor-like thickening of the right colon wall measuring 2.5 cm, extended to the right colonic angle. It also showed that the right kidney was in a pelvic ectopic position. The operation was performed by laparotomy through a median incision. On exploration, we found an intussusception of the cecum at the level of the ascending colon on a cecal tumor of 5 cm, it was therefore a cecal-colic intussusception. The intervention consisted of a right ileo-hemicolectomy removing a cecal-colic intussusception with terminal ileo-colic anastomosis by separate stitches and with retro-anastomotic drainage and of the parieto-colic gutter.

Conclusion: Colonic intussusception is a rare cause of obstruction in the adult and its preoperative diagnosis remains difficult. Surgery remains the mainstay of treatment.