“Type C appendicular duplication with patent vitello-intestinal duct—an unforeseen association”—a case report

Background Gastrointestinal duplications are uncommon occurring in 1 in 5000 live births. Small intestine is commonly involved, while appendicular duplications are extremely rare. Vitelline duct anomalies arise due to failure of involution of the omphalomesenteric duct. Their spectrum ranges from a simple umbilical sinus to completely patent omphalomesenteric fistulae. We report here a rare association of complete appendico-cecal duplication with patent vitello-intestinal duct (PVID). Case presentation A 14-year-old girl who presented with complaints of scant, foul smelling, and feculent discharge from umbilicus intermittently since birth was evaluated and diagnosed to have a patent vitello-intestinal duct. At laparotomy, a patent vitello-intestinal tract opening unusually at the ileo-cecal junction was noted. In addition, an appendico-cecal duplication cyst bearing an appendix on the mesenteric side and a 4-cm long orthotopic appendix on the native cecum was found with the duplex cecum sharing a common wall and blood supply. The terminal ileum with the duplication and patent vitello-intestinal duct were excised in toto, and an end-to-end ileo-ascending anastomosis was done. The child is well at 1 year follow-up. Conclusion A complete appendico-cecal (Type C) duplication with ectopically inserted patent vitello-intestinal duct is reported here as an unusual association, discussing its management and the probable disarray in the embryological development.

Acute Abdomen – Rare Cause, Accurate Diagnosis, Simple Solution

Jejunal diverticulitis is a rare disease with higher prevalence among patients between 60 and 70 years and slightly more common in men. They are false diverticula located predominantly on the mesenteric side of the bowel but 10% develop complications which result in major surgery and high overall mortality. Authors report a case of a 63-year-old patient who presented to our department with small bowel perforation. Patient was taken to the operating room where he underwent exploratory laparotomy; intra-operatively a perforated jejunal diverticula with thickened adjacent mesentery and fibrinous debris was found. The surgical option was segmental enterectomy of 20cm, 15cm apart from the angle of Treitz. Perforation of jejunal diverticula should be considered in the differential diagnosis in elderly male patients presenting with an acute abdomen at the emergency department. The diagnosis is challenging and bowel resection with primary anastomosis is the treatment of choice. Although the disease is extremely rare it is important to be aware of the mortality rates associated with delay in the diagnosis and intervention.

An atypical presentation of a mesenteric Meckel’s diverticulum in a 7-year-old warmblood mare: case report

Background Meckel’s diverticula are a rare cause of small intestinal strangulation, diagnosed at laparotomy or necropsy. This congenital anomaly of the gastrointestinal tract originates from a remnant of the vitelline duct. In reported equine cases, they present as a full-thickness diverticulum on the antimesenteric border of the distal jejunum or proximal ileum. Case presentation On laparotomy a Meckel’s diverticulum positioned at the mesenteric side was found to be the cause of small intestinal strangulation. This position is very uncommon and to the best knowledge of the authors there is no unambiguous description of another case. Conclusions Meckel’s diverticula should be on the list of differential diagnoses in cases of small intestinal strangulation. As in humans, equine Meckel’s diverticula can have the standard antimesenteric as well as a more exceptional mesenteric location. This case adds to the series of anecdotal reports of anomalies with regard to Meckel’s diverticula in the horse.

Giant Mesenteric Cyst and Right Sided Syndrome in a 15-Year-Old Boy

Giant mesenteric cyst is a rare benign abdominal tumor. It usually arises from the mesenteric side of the small bowel. Right side syndrome is the term used for congenital absence of right kidney and right testis. We report on a 15-year-old male who presented with progressive abdominal distension, early satiety, and difficulty walking or running. Abdominal ultrasound and computed tomography (CT) revealed a giant mesenteric cyst, absence of the right kidney, and left moderate hydronephrosis. After excision of the cyst, the patient was fully recovered. Our report shows that both conditions may occur in the same patient and therefore an association of these two diseases cannot be excluded.

Enteric Duplication

Enteric duplications have been described throughout the entire gastrointestinal tract. The usual perinatal presentation is an abdominal mass. Duplications associated with the foregut have associated respiratory symptoms, whereas duplications in the midgut and hindgut can present with obstructive symptoms, perforation, nausea, emesis, hemorrhage, or be asymptomatic, and identified as an incidental finding. These are differentiated from other cystic lesions by the presence of a normal gastrointestinal mucosal epithelium. Enteric duplications are located on the mesenteric side of the native structures and are often singular with tubular or cystic characteristics. Management of enteric duplications often requires operative intervention with preservation of the native blood supply and intestine. These procedures are usually very well tolerated with low morbidity.

Ileal hypertrophy and associated true diverticulum as a cause of colic in a horse

A 4-year-old Thoroughbred gelding underwent an explorative celiotomy for a suspected small intestinal obstruction. During surgery, an impacted diverticulum of the ileum was suspected, necessitating a jejunocaecostomy. The owner opted for euthanasia. On post-mortem examination and histopathology, a true diverticulum on the mesenteric side of the ileum, with ileal hypertrophy, was diagnosed.

A case of duplicated appendix in a patient presenting as acute appendicitis

A 20 years old male patient presented to KHMC emergency room in the fifth of August 2015 with typical picture of acute appendicitis. Patient was admitted and decision for appendectomy was taken for the next two hours. Appendectomy done as usual through a small grid iron incision and a normally looking appendix removed which didn’t explain what happened with patient earlier, so we decided to look for other pathologies (like meckel’s diverticulum) and upon gently pulling out terminal ileum a second appendix shown in the field originated from ileocecal junction toward ileal mesenteric side 4 centimeter posterior to first appendix which was looking severely inflamed and was removed as usual.

Jejunal Diverticular Perforation Causing Small Bowel Obstruction in a Type 4 Hiatal Hernia: A Rare Case Report of a Nonagenarian Patient and Review of Relevant Literature

Type IV paraesophageal hernia (PEH) is very rare and is characterized by the intrathoracic herniation of the abdominal viscera other than the stomach into the chest. We describe a case of a 90-year-old male patient who presented at our emergency department complaining of epigastric pain that he had experienced over the past few hours and getting progressively worse. On the day after admission, his pain became severe. Chest radiography revealed an intrathoracic intestinal gas bubble; emergency exploratory laparotomy identified a type IV PEH with herniation of only the jejunum with perforated diverticula on mesenteric side through a hiatal defect into mediastinum. There are a few published cases of small bowel herniation into the thoracic cavity in the literature. Our patient represents a rare case of an individual diagnosed with type IV PEH with herniation of jejunum with perforated diverticula.

Traumatic mesenteric pseudocyst

Introduction. Mesenteric pseudocysts have rarely been described in literature. They belong to a group of mesenteric cysts that are very rare intra-abdominal pathology regardless of the origin. The diagnosis is often difficult to make, because of the diversity of clinical symptoms. The definitive histopathological diagnosis determines the origin and further course of treatment. Case report. We reported a patient with post-traumatic mesenteric pseudocyst. It was localised on the mesenteric side, in the direct contact with the small intestine. We surgically re-moved the pseudocyst along with a part of the small intestine with success. The patient?s recovery was eventless, with no complications. Conclusion. Only by complete cyst removal, the definitive, accurate histopathological diagnosis and classification can be made.