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Cureus Aug 2023Ganglioneuroma is a rare, benign, well-differentiated neurogenic tumor most commonly located in the posterior mediastinum or retroperitoneum. Giant ganglioneuromas are...
Ganglioneuroma is a rare, benign, well-differentiated neurogenic tumor most commonly located in the posterior mediastinum or retroperitoneum. Giant ganglioneuromas are even less common; this is only the 19th reported case in literature to date. We present a case of a giant retroperitoneal ganglioneuroma in a five-year-old child, which on imaging mimicked a mesenteric cyst and posed various challenges in its management. Histopathology later confirmed our misdiagnosis and revealed the tumor to be a ganglioneuroma. This unique case serves as a lesson for clinicians to not operate before receiving histopathological confirmation of their diagnosis.
PubMed: 37746449
DOI: 10.7759/cureus.43914 -
Journal of Surgical Case Reports Sep 2023Adrenal cysts are rare lesions that make up 4% of all adrenal masses. They are often found incidentally during imaging or surgery and can vary in symptoms depending on...
Adrenal cysts are rare lesions that make up 4% of all adrenal masses. They are often found incidentally during imaging or surgery and can vary in symptoms depending on their size and location; with cysts < 10 cm often being asymptomatic. These cysts are more common in adults in their 30s or 60s and can be divided into four histological subtypes, with epithelial cysts being less common. We present a case of a 17-year-old female who experienced recurrent right flank pain for a year. Ultrasonography revealed a cystic mass on the right kidney, and computerized tomography showed a well-defined suprarenal cyst measuring ~8 cm misdiagnosed as mesenteric cyst. However, during laparoscopy, an adrenal cyst was discovered, which was excised along with the right adrenal gland. Histopathology confirmed the diagnosis of an epithelial adrenal cyst. This case highlights the occurrence of adrenal cysts in younger individuals and the uncertainty of preoperative diagnosis.
PubMed: 37724068
DOI: 10.1093/jscr/rjad510 -
International Journal of Surgery Case... Sep 2023Chylolymphatic cysts are benign pathology in lymphatic vessels due to obstruction in the lymphatic system. Their incidence is still unknown. However, they account for...
INTRODUCTION AND IMPORTANCE
Chylolymphatic cysts are benign pathology in lymphatic vessels due to obstruction in the lymphatic system. Their incidence is still unknown. However, they account for approximately 3 % to 9 % of all pediatric lymphangiomas. Most of these lesions are asymptomatic and are discovered accidentally. They can present with non-specific abdominal pain, vomiting and changes in bowel habits. Rarely, Chylolymphatic cysts can cause fatal complications such as intestinal obstruction, volvulus or even torsion.
CASE PRESENTATION
A 3-month-old male presented to our unit with manifestations of acute intestinal obstruction. Abdominal examination revealed signs of generalized peritonitis and intestinal obstruction. Abdominal ultrasound revealed minimal turbid intraperitoneal collections and no motility of bowel loops. Plain erect abdominal radiograph revealed multiple small bowel air fluid levels. Abdominal exploration revealed a large Chylolymphatic cyst causing acute intestinal obstruction. Excision of the cysts was done with preservation of adjacent bowel loop. The patient was discharged in good health on the 6th day postoperative. A chylolymphatic cyst with a diameter of 5 cm was identified by histological investigation.
CLINICAL DISCUSSION
Mesenteric cyst is a rare intra-abdominal tumor with prevalence of about 1: 20,000 in pediatric age group. They are benign cystic pathology lined with a thin endothelium or mesothelium occur due to gross proliferation of isolated or ectopic lymphatics in mesentery that lack communication with the rest of the lymphatic system. Regarding pathology, mesenteric cysts are classified into four types including type 1 (Pedicled) and type 2 (Sessile), which are limited to the mesentery, hence can be excised completely with or without resection of the involved gut. Type 3 and type 4 are multicentric, so they require complex surgery and often sclerotherapy because of their extension into retroperitoneum. The majority of mesenteric cysts may present as asymptomatic abdominal mass or incidental finding on imaging or during laparotomy for other abdominal conditions. Preoperative diagnosis of mesenteric cyst in most cases is difficult as they have no definite characteristic features. Abdominal ultrasound which is the imaging modality of choice can reveal mesenteric cysts as cystic tumors. Surgical removal of the cyst is the standard treatment for chylolymphatic cysts.
CONCLUSION
Most Chylolymphatic cysts in infants are asymptomatic, but they can cause fatal complications such as intestinal obstruction, volvulus or even torsion.
PubMed: 37683513
DOI: 10.1016/j.ijscr.2023.108789 -
International Journal of Surgery Case... Sep 2023Entamoeba histolytica is an anaerobic protozoan. It infects humans causing Amoebiasis. Most infections are asymptomatic; however, clinical manifestations include...
INTRODUCTION AND IMPORTANCE
Entamoeba histolytica is an anaerobic protozoan. It infects humans causing Amoebiasis. Most infections are asymptomatic; however, clinical manifestations include intestinal or extraintestinal. In rare instances, patients can present with Ameboma: a mass of granulation tissue consisting of a core of inflammation with peripheral fibrosis related to chronic amoebic infection usually found in the cecum/ascending colon.
PRESENTATION OF CASE
A 50-year-old patient presented with signs and symptoms of bowel obstruction. He had raised inflammatory markers and was HIV positive on treatment and virally suppressed. At laparotomy a hepatic flexure stricture with desmoid reaction, and wall thickening with induration at the mesenteric border of mid-transverse colon was found, with disseminated nodular disease. Histology confirmed entamoeba histolytica infection.
DISCUSSION
The parasite exists in two forms: a cyst stage and a trophozoite stage: the form causing invasive disease. The presentation of intestinal amoebiasis ranges from an asymptomatic carrier state, colitis, to abscess formation and bowel perforation The management principles: to eliminate the invading trophozoites and eradicate the organism's intestinal carriage and manage complications such as obstruction, fulminant colitis, or toxic megacolon with surgery.
CONCLUSION
This case identifies a rare cause of bowel obstruction in a patient without a travel history. Even with the lack of significant risk factors other than HIV, clinicians should be aware of the infective causes of colonic mass/stricture outside of malignant causes. Entamoeba histolytica is an infection of impoverished communities in developing countries, it should remain high on our differential for tumour-like granulation tissue in the colon.
PubMed: 37657387
DOI: 10.1016/j.ijscr.2023.108768 -
Journal of Indian Association of... 2023Intestinal malrotation is a congenital anomaly resulting from abnormal or incomplete rotation and fixation of the midgut during embryogenesis. It commonly presents in... (Review)
Review
BACKGROUND
Intestinal malrotation is a congenital anomaly resulting from abnormal or incomplete rotation and fixation of the midgut during embryogenesis. It commonly presents in the neonatal period (75%) with sudden onset bilious vomiting and rarely beyond infancy (<10%).
AIM
The aim of the study was to highlight the clinical features, radiological findings, and treatment outcomes of patients with malrotation presenting beyond infancy.
MATERIALS AND METHODS
Eleven consecutive cases of delayed presentation of malrotation presented over a period of 5 years (2017-2021). Data were analyzed retrospectively.
RESULTS
Out of the 11 patients, four were female and seven were male. The age of patients ranged from 14 months to 18 years. Patients beyond infancy present usually with diffuse pain abdomen compared to neonates which present with sudden onset bilious vomiting and therefore difficult to diagnose. Five patients had associated abnormalities such as intussusception or nutcracker syndrome or mesenteric cyst or jejunal stricture or mesenteric lymphadenopathy along with malrotation. Patients underwent ultrasonography, upper gastrointestinal contrast study, and contrast-enhanced computed tomography abdomen to confirm the diagnosis. All patients underwent the Ladd procedure with four requiring resection anastomosis and one requiring excision of the mesenteric cyst. Eight out of eleven patients had favorable outcomes, two develop adhesive intestinal obstruction and required re-exploration, and one had persistent complaints of hematochezia.
CONCLUSION
Malrotation beyond infancy is a rare diagnosis. Malrotation in older children is usually not suspected because of the wide range of symptoms. A high index of suspicion on ultrasound or computed tomography is required to demonstrate the reversal of superior mesenteric artery and superior mesenteric vein position and related conditions. Early intervention and treatment can prevent catastrophic events such as intestinal volvulus and intestinal ischemia in these patients.
PubMed: 37635889
DOI: 10.4103/jiaps.jiaps_2_23 -
Annals of Medicine and Surgery (2012) Aug 2023Lymphatic malformations (LM) refer to very rare hamartomatous benign lymphatic ectasias with an incidence of 1:250 000. They almost involve children more than adults,...
UNLABELLED
Lymphatic malformations (LM) refer to very rare hamartomatous benign lymphatic ectasias with an incidence of 1:250 000. They almost involve children more than adults, and among them, infants under one age are mostly affected. Macrocytic LM is found to be more than 2 cm in diameter or 2×2 cm in volume. The proper treatment for mesenteric LM is complete surgical excision unless there is vital structure involvement.
CASE PRESENTATION
The authors report a mesenteric macrocytic LM in a 2-year-old girl complaining of vague abdominal discomfort and persistent vomiting in which ultrasonography revealed a cystic masse with seromucous components. She then underwent exploratory laparotomy. The operation and the follow-up duration were uneventful.
DISCUSSION
LMs are rare benign lesions of vascular origin with lymphatic differentiation, according to the latest International Society for the Study of Vascular Anomalies (ISSVA 2018). Under light microscopy, these malformations are characterized by their thin-walled endothelium and lymphatic tissue.These mobile lesions are incidentally found or appear with intestinal obstruction or acute abdomen scenarios.
CONCLUSION
Although benign, the LMs have the potential for invasion and recurrence. Thus, the examiner physician must keep such intra-abdominal lesions in mind.
PubMed: 37554902
DOI: 10.1097/MS9.0000000000000395 -
Cureus Jun 2023An abdominal inflammatory myofibroblastic tumor (AIMT), is a rare benign tumor composed of inflammatory and other mesenchymal cells. It can affect the entire body,...
An abdominal inflammatory myofibroblastic tumor (AIMT), is a rare benign tumor composed of inflammatory and other mesenchymal cells. It can affect the entire body, predominantly in children and young adults. The diagnosis is challenging considering the wide clinical presentation and can often be mistaken for malignant tumors. We report a rare case of a 46-year-old female patient, who presented with intermittent abdominal pain weight loss, and an abdominal palpable mass. Abdominal ultrasound found a well-defined 18 cm, rounded mass, with solid and cystic components. Abdominal CT demonstrated a well-defined, hypodense, retro gastric mass of 20 cm, with thickened wall and heterogenous enhancement. The mass had contact with the pancreatic tail, transverse colon, spleen, left kidney pedicles, abdominal aorta, superior mesenteric vein, and mesaraic trunk with no invasion signs. The mass was initially thought to be pancreatic cancer, but given the large size, other diagnoses like sarcoma, lymphoma, or abdominal hydatid cyst were suggested. Endoscopic ultrasound found a rounded retro gastric mass of 18/12 cm, with a thickened wall and well-limited calcifications. The content was both cystic and solid with mobile vegetations, with no visible Doppler flow. The mass had contact with the body and tail of the pancreas, spleen hilum, the upper pole of the spleen, and the hepatic pedicle behind, with no invasion sign. After a multidisciplinary team meeting, a decision was taken to perform surgical resection with mass resection, distal splenopancreatectomy, and transverse and sigmoid colectomy. Pathological and immunostaining results were consistent with inflammatory pseudotumor. The postoperative recovery was uncomplicated. The patient remains asymptomatic with no obvious signs of metastasis or recurrence. AIMT represents a reel diagnostic challenge. Clinical symptoms are unspecific. Radiological and endoscopic features can often be mistaken for malignant tumors. Surgical management remains to be the best therapeutic option. We report a rare case of AIMT treated by surgery with complete resection. We suggested a long-term follow-up given the local recurrence risk.
PubMed: 37525776
DOI: 10.7759/cureus.41213 -
Caspian Journal of Internal Medicine 2023Abdominal distension in children can be caused by fluid accumulation due to ascites or large cysts.
BACKGROUND
Abdominal distension in children can be caused by fluid accumulation due to ascites or large cysts.
CASE PRESENTATION
A 25-month-old girl was brought to the pediatric gastroenterology clinic with the chief complaint of nontraumatic acute abdominal pain. She had undergone paracentesis last year with a diagnosis of suspected ascites in another medical clinic. Moreover, a CT scan following paracentesis was reported to be normal. After a few months, she gradually developed abdominal distension again. Diagnostic evaluations along with biochemical parameters and imaging strongly suggested the presence of a cyst. The large mesenteric cyst was totally removed by surgery.
CONCLUSION
In conclusion, in the face of recurrence of abdominal fluid accumulation, mesenteric cysts should be considered despite the fact that abdominal CT scan is normal after paracentesis.
PubMed: 37520867
DOI: 10.22088/cjim.14.3.581