scholarly journals Subhepatic caecum and appendix - a rare variant in an adult male cadaver

2013 ◽  
Vol 02 (02) ◽  
pp. 093-096
Author(s):  
P. Savithri

AbstractIn unusual cases of malrotation or incomplete rotation of caecum , the appendix is not located in the lower right quadrant. When the caecum is high [subhepatic caecum] the appendix is located in the right hypochondriac region and the pain in these cases is located there, not in the lower right quadrant. In this position , the symptoms and signs of acute appendicitis may mimic acute cholecystitis, diagnosis in such cases is a great diagnostic challenge. The author observed this less frequent anomaly in a middle aged male cadaver. After opening the abdomen while tracing peritoneal reflections abnormality was identified. The caecum and appendix were present in relation with inferior surface of liver. Embryologically, the caecal swelling appears as a small conical dilation of the caudal limb of primitive intestinal loop and it is the last part of the gut to reenter the abdominal cavity. It is temporarily located in the right upper quadrant directly below the right lobe of liver. From here it descends into the right iliac fossa. The failure to descend leads to subhepatic caecum.

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mohammed Nagdi Zaki ◽  
Aafia Mohammed Farooq Gheewale ◽  
Nada Ibrahim ◽  
Ibrahim Abd Elrahman

Abstract Background An adenomyoma is a well circumscribed form of adenomyosis and can be located within the myometrium, in the endometrium as a polyp, or extrauterine with the last being the rarest presentation amongst the three. With the ongoing advancement in gynecological surgery, the use of electromechanical morcellators have made the removal of large and dense specimens possible with minimally invasive techniques. However, it has also caused an increase in complications which were previously rare. Whilst the tissue is being grinded within the abdominal cavity, residual tissue can spread and remain inside, allowing for implantation to occur and thereby giving rise to recurrence of uterine tissue as a new late postoperative complication. Case presentation A 45-year-old woman presented with worsening constipation and right iliac fossa pain. Her past surgical history consists of laparoscopic supra-cervical hysterectomy that was indicated due to uterine fibroids. Computerized tomography and magnetic resonance imaging were done, which showed an irregular lobulated heterogeneous mass seen in the presacral space to the right, located on the right lateral aspect of the recto-sigmoid, measuring 4.5 × 4.3 × 4.3 cm in size. A transvaginal ultrasound revealed a cyst in the left ovary. The patient had a treatment course over several months that included Dienogest (progestin) and Goserelin (GnRH analogue) with add-back therapy. In line with the declining response to medications, the patient was advised for a laparoscopic ovarian cystectomy. During the surgery, an additional lesion was found as a suspected fibroid and the left ovarian cyst was identified as pockets of peritoneal fluid which was sent for cytology. The surgical pathology report confirmed adenomyosis in both specimens, namely the right mass and the initially suspected fibroid. Conclusion In this case report, we showcase a rare occurrence of an extrauterine adenomyoma presenting two years post laparoscopic morcellation at hysterectomy. This poses questions regarding the benefits versus risks of power morcellation in laparoscopic hysterectomy.


2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Naoki Enomoto ◽  
Kazuhiko Yamada ◽  
Daiki Kato ◽  
Shusuke Yagi ◽  
Hitomi Wake ◽  
...  

Abstract Background Bochdalek hernia is a common congenital diaphragmatic defect that usually manifests with cardiopulmonary insufficiency in neonates. It is very rare in adults, and symptomatic cases are mostly left-sided. Diaphragmatic defects generally warrant immediate surgical intervention to reduce the risk of incarceration or strangulation of the displaced viscera. Case presentation A 47-year-old woman presented with dyspnea on exertion. Computed tomography revealed that a large part of the intestinal loop with superior mesenteric vessels and the right kidney were displaced into the right thoracic cavity. Preoperative three-dimensional (3D) simulation software visualized detailed anatomy of displaced viscera and the precise location and size of the diaphragmatic defect. She underwent elective surgery after concomitant pulmonary hypertension was stabilized preoperatively. The laparotomic approach was adopted. Malformation of the liver and the presence of intestinal malrotation were confirmed during the operation. The distal part of the duodenum, jejunum, ileum, colon, and right kidney were reduced into the abdominal cavity consecutively. A large-sized oval defect was closed with monofilament polypropylene mesh. No complications occurred postoperatively. Conclusion Symptomatic right-sided Bochdalek hernia in adults is exceedingly rare and is frequently accompanied by various visceral anomalies. Accurate diagnosis and appropriate surgical repair are crucial to prevent possible incarceration or strangulation. The preoperative 3D simulation provided comprehensive information on anatomy and concomitant anomalies and helped surgeons plan the operation meticulously and perform procedures safely.


2021 ◽  
Vol 26 (4) ◽  
pp. 113-117
Author(s):  
V.O. Shaprinskyi  ◽  
O.O. Vorovskyi ◽  
O.A. Kaminskyi ◽  
Ya.M. Pashynskyi

The results of treatment of 72 patients with echinococcosis of the liver were analyzed, women – 62 (86.2%), men – 10 (13.8%). Primary echinococcosis was detected in 69 (95.8%) patients, secondary – in 3 (4.2%). Among instrumental research methods, ultrasound and computed tomography examination were of diagnostic value. Single liver cysts were found in 63 (87.5%) patients, multiple – in 9 (12.5%). Among patients with solitary cysts, the right lobe was more often affected than the left – 48 (66.7%) vs 24 (33.3%) cases. Echinococcosis of central localization was less common and was noted in 8 (11.1%) cases. Echinococcosis complications were observed in 16 (22.2%) patients. Among them, most often there were suppurations of the cyst – in 13 (18.1%); a bursting of the cyst into the free abdominal cavity – in 1 (1.4%), in the pleural cavity – 1 (1.4%), in the biliary tract – in 1 (1.4%). Partial or complete liming of the hand was observed in 12 (16.7%) patients. In 20 (27.8%) cases, the operation was performed from the upper median access, in 42 (58.3%) – from oblique hypochondria accesses by Kocher or by Fedorov. Pericystectomy was performed in 48 (66.7%) patients, in 8 (11.1%) patients underwent resections of liver segments with an echinococcal cyst, in 4 (5.6%) – cyst opening with removal of contents and treatment of its cavity. Laparoscopic echinococectomy was used in 12 (16.7%) patients. In the postoperative period complications were observed in 16 (22.2%) patients. The use of the welding electrocoagulator EK-300M "Swarmed" in the thermal rehabilitation of the walls of the residual cavity after echinococectomy allowed to reduce blood loss from 2200±210 ml to 250±50 ml. With the use of laparoscopic echinococectomy, intraoperative blood loss was reduced by 9 times (р=0.0001); duration of operation – 2 times (р<0.05), stay in hospital – 3.3 times (р=0.002). There were no fatal outcomes. Before and after operation antirelapse antiparasitic therapy with albendazole (Vormil) was performed in two cycles of 28 days, separated by a 14-day break. The dose at body weight over 60 kg was 400 mg 2 times a day, and for less than 60 kg the drug was calculated at a rate of 15 mg/kg/day. There were 2 (2.8%) cases of relapse, there was no mortality.


Author(s):  
Odette Ndikumana ◽  
Fatima Zahra Badi ◽  
Oumar Djidda ◽  
Mouna Sabiri ◽  
Samia Elmanjra ◽  
...  

Incomplete 90° intestinal rotation in a clockwise direction results in complete common mesentery being placed in a mirror image to and with a similar appearance to complete common mesentery. This rotation places the colon in the right half of the abdominal cavity and the small intestine in the left half of the abdominal cavity. We report the case of a 19-year-old patient with a history of cerebral palsy secondary to meningitis who presented with melaena and inflammatory anaemia. CT enterography was performed which showed regular, non-stenosing circumferential wall thickening of the sigmoid colon and rectosigmoid junction compatible with Crohn's disease, which was confirmed by pathophysiology. It also revealed transposition of the colon to the right hemi-abdomen and the small intestine to the left hemi-abdomen, the caecum to the right iliac fossa, and the third portion of the duodenum to the left of the mesenteric vessels.


2019 ◽  
Vol 2019 (7) ◽  
Author(s):  
Ayad Ahmad Mohammed ◽  
Sardar Hassan Arif

Abstract Hydatid disease is caused by a tape worm Echinococcus Granulosus that lives in the intestines of the definitive host which is the dog or other carnivore. Human is the accidental intermediate host and become infected by ingesting contaminated vegetables or water with the eggs of the parasite. A-37-year old male presented with right side abdominal pain for 2 months. Abdominal examination showed a large right side abdominal mass extending from the right subcostal region to the right iliac fossa. CT-scan showed two cystic lesions in the right lobe of the and a third one extending to the pelvis. During surgery aspiration of 10 liters of bile stained fluid done. Excision of the cysts done. Tube drain put inside the cyst cavity with omentoplasty. There was bile leak to the drain which stopped over one month. The patient received anthelminthic medication for 3 months.


Author(s):  
Uiase Bin Farooq ◽  
Adarsh Kumar ◽  
Rajni Chaudhary

The main objective of this study was to develop baseline topographical data of landmarks for locating liver and spleen and to generate sonographic calliper measurements along with dynamic parameters of these organs. Abdominal ultrasonography was performed on 50 native adult (Spiti horses and Himalayan hill mules) healthy unsedated equines of either sex. The thickness, character and echo-architecture of liver and spleen were recorded. In horses, the right lobe of liver was found from 8th to 15th intercostal space (ICS) and left lobe from 6th to 11th (±1) ICS, while in mules the right liver lobe was found between 6th to 15th (±1) ICS and left lobe between 6th to 9th (±1) ICS. The liver was recognized by its branching vasculature and architecture was found relatively homogenous. In addition ventral edges were distinctly sharp. Spleen was found from 8th to 17th ICS both in horses as well as in mules. The splenic parenchyma was homogenously granular in appearance with few blood vessels and most echogenic organ in the abdominal cavity of equines. The only measurement that was reliably obtained was the central thickness or depth of the spleen, which varied from 41.4 to 68.4 mm (Mean± SE= 50.84±4.61 mm) in horses and 37.9 to 51.6 mm (Mean± SE = 42.76±2.34 mm) in mules. Therefore detailed ultrasonographic examination of liver and spleen helped us to compile baseline data, which will be helpful in management of the affections of liver and spleen in future.


2019 ◽  
Vol 17 (1) ◽  
pp. 50-53
Author(s):  
Md Manir Hossain Khan ◽  
Jobaida Sultana

A 32 years old unmarried women presented with periumbilical colickey abdominal pain which shiftted to the right iliac fossa with anorexia, vomiting and low grade fever. She had history of open myomectomy 4 years back for menorrhagia with multiple fibroids (myomas). On examination, the pointing sign, Rovsing's sign, McBurney's sign &Blumberg's sign were positive. Then she was diagnosed as a case of acute appendicitis. Ultrasonography revealed nothing significant. Appendicectomy was done through right Grid Iron incision. Appendix was found inflammed, swollen and there was collection of fluid in the peritoneal cavity. During closure, incidentally a solid mass about 5 ><4 ><2.5 cm was found exterior to the peritoneum near the incision at the abdominal wall. The mass was excised. Subsequently histopathotology confirmed a leiomyoma (Myoma or parasitic fibroid). The parasitic myoma may develop spontaneously as pedanculatedsubcerousmyomaloose their uterine blood supply or iatrogenically from retained fragment of myoma from previous myomectomy or hysterectomy and get blood supply from abdominal wall. Even small bits displaced into the abdominal cavity can result in parasitic fibroids. This case is reported here to give emphasis on the surveilence of parasitic myoma during myomectomy or hysterectomy for fibroid uterus and all tissue pieces that are morcellated should be delligently removed for the prevention of further development of parasitic myoma. Journal of Surgical Sciences (2013) Vol. 17 (1) : 50-53


2020 ◽  
Vol 16 (1) ◽  
Author(s):  
Moaied A. Hassan

Abstract Background Mesenchymal hamartoma is the second most common benign liver tumor in children, with 20% of the cases diagnosed during the neonatal period. The exact etiology in still unclear, and most investigators believe that it is a developmental anomaly rather than a true neoplasm. The presentation of these tumors is highly variable depending on the lesion’s size, ranging from small asymptomatic lesions to very large tumors with life threatening complications. Radical surgical excision, whenever possible, is the gold standard for treating these lesions to avoid the problems of local recurrence and possible malignant transformation. We present the rare occurrence of an entirely solid, giant hepatic mesenchymal hamartoma in a 3-week-old male newborn and discuss the mode of presentation, as well as the diagnostic and therapeutic approach. Case presentation A 3-week-old male newborn was referred to our institution with huge abdominal distension and respiratory distress. Imaging studies confirmed the presence of a very large solid intraabdominal mass occupying the majority of the abdominal cavity and abutting the inferior aspect of the right lobe of the liver, but did not reveal the diagnosis. At laparotomy, a huge solid mass was found attached to the right lobe of the liver. Complete excision was done, and histopathological examination confirmed the diagnosis of mesenchymal hamartoma. Conclusion Although rare, mesenchymal hamartoma of the liver can present as a neonatal surgical emergency. Emergency intervention is required in symptomatic patients. Radical surgical intervention is possible and is the treatment of choice to relieve the patient’s symptoms and avoid future complications.


2018 ◽  
Vol 5 (7) ◽  
pp. 2679
Author(s):  
Sivakumar Thirunavukkarasu ◽  
Atreya M. Subramanian

Thyroid tuberculosis although known to be a rare entity provides a diagnostic challenge to the clinician. Clinically, radiologically and even histologically proving to be difficult to arrive at a diagnosis. Its incidence according to literature is 0.1-0.4%. Tuberculosis may be found at multiple sites but incidence in the thyroid, pancreas, striated and cardiac muscle is extremely rare. Herein, we discuss a case of a 60 year old female complaining of a swelling in the front of the neck (more on the right side) since 45 days. Clinically it appeared to be a thyroid swelling. An ultrasound showed a bulky right lobe with heterogeneous echoes. FNAC showed features suggestive of a follicular adenoma. Intraoperatively a firm thyroid was palpable and total thyroidectomy was done. Histopathological examination was done revealing langhan giant cells and an area of caseous necrosis, confirming tuberculosis. The patient was started on thyroid replacement therapy and anti-tubercular therapy. The patient had no significant complications in the 6 months follow up period. In tuberculosis endemic areas, one must maintain a high index of suspicion for thyroid swellings which may show foci of tuberculosis, especially if they have an elevated ESR and other foci of tuberculosis. 


2020 ◽  
Vol 3 (2) ◽  
Author(s):  
Oscar Mauricio Poveda Ortiz

Introduction The intrauterine device is a planning method widely used in the world, however, it is not without complications, one of these is uterine perforation and migration of the IUD to the abdominal cavity, which although it is rare, has serious clinical repercussions and its study has been studied. relationship with the adequate or not insertion of the device, the size and configuration of the uterus, uterine anomalies or surgeries and the moment of insertion after delivery. Case report We present the case of a 36-year-old female patient with a 12-hour history of pain in the mesogastrium that radiates to the right iliac fossa of 9/10 weight intensity, associated with fever measured at 38.9º. He underwent diagnostic laparoscopy with a finding of acute appendicitis secondary to lumen obstruction by the IUD, so an appendectomy was performed. Conclusions The appropriate treatment when this complication occurs is surgical extraction either laparoscopically or laparotomy to reduce the risk of associated complications.


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