Ovarian vein thrombosis: a rare but not to be forgotten cause of abdominal pain

A healthy 38-year-old woman, with no significant medical or surgical history, was referred to the gynaecology emergency department with acute low quadrant abdominal pain and nausea. On examination, painful palpation of right iliac fossa, abdominal guarding and positive Blumberg’s sign were noted. An abdominal-pelvic CT scan showed a hypodense tubular structure with peripheral enhancement to the right of the inferior vena cava, suggestive of thrombosis of the right ovarian vein. The only risk factor identified was the use of the combined contraceptive pill.

Prostate leiomyosarcoma: A rare tumor

Leiomyosarcoma is a rare neoplasm with a poor survival rate. Between June 2018 to January 2019 we treated a rare case of Prostate Leiomyosarcoma initially metastatic to the lung and the liver with multiple pelviclymph nodes. Five cycles of chemotherapy and palliative radiotherapy have been delivered with a mean follow up of 1 year .Chestabdominal-pelvic CT scan with MRI and bone scan are necessarily to assess clinical staging. The objective of this study is to review our experience in the management of Prostate Leiomyosarcoma at the Casablanca Cancer Center of Mohammed VI University of Health Sciences with a literature review of this rare neoplasm.

The radiologic roadmap for treatment of an acute appendicitis patient who tested positive for coronavirus disease 19

Objective: In this study, we aimed to emphasize the role of radiological imaging in determining the treatment of a patient, who tested positive for COVID-19 and diagnosed with acute appendicitis during the pandemic. Methods: A 31-year-old patient presented to the emergency department due to abdominal pain. Ultrasound examination, thoracic and pelvic CT scan were performed. Results: Non-complicated appendicitis can be treated conservatively with antibiotics. Treatment can be maintained by starting with IV antibiotics and bridging therapy with oral antibiotics. Conclusion: This study aims to summarize how radiological follow-up can be used to decide on the suitability of the patient for appropriate medical treatment as an alternative to surgery in a patient, whose gold standard treatment is emergency surgical intervention, which is frequently encountered in the emergency department during the COVID-19 pandemic.

The management of a patient with multiple infarcts with different etiologies

72 yo male, presents for abdominal pain and motor deficiency of the left upper limb. Clinical examination reveal severe general condition, left brachial hemiparesis, right arm blood pressure (BP) 240/120 mmHg, left arm BP 210/100 mmHg, heart rate (HR) 110 bpm, arrhythmic, abdominal pain at superficial palpation, without other abnormalities. Biological: negative hs troponin I, positive D-dimers, positive CRP, GFR 38 ml/min/m2, potassium 2.97 mmol/l. ECG: Atrial fibrillation. Abdominal ultrasound: abdominal dilated aorta, dissection flap. Abdominal and pelvic CT scan: right renal infarction, multiple splenic infarction, abdominal aortic aneurysm with dissection. Underwent interventional treatment of the abdominal aortic dissection (EVAR). Particularity of the case: concomitant diagnosis of multiple infarction with different etiologies, for which therapeutic decision was challenging.

Amyand's hernia complicated with appendicitis

Introduction: The finding of a vermiform appendix within the peritoneal sac of an indirect inguinal hernia occurs in approximately 1% of cases. However, the presence of appendicitis within an inguinal hernial sac is found only in 0.08% of the general population.Case report: We present the case of a 58-year-old male patient that was admitted with abdominal pain associated with a small non-reducible right groin mass.Discussion: To establish the correct diagnosis preoperatively, an abdominal and pelvic CT scan is mandatory.Conclusion: Acute appendicitis in an Amyand's hernia is a very rare entity that can be easily misdiagnosed preoperatively. CT is extremely useful in reaching the correct preoperative diagnosis.

939 Enterovaginal Fistula; Could It Be Gallstones?

This is a rare presentation of an impacted gallstone leading to a ileovaginal fistula. A 76-year old female presented with a 4 week history of faecal vaginal discharge and weight loss on a background of endometrial cancer treated with chemotherapy and radiotherapy 9 years ago. She was initially investigated with a pelvc MRI which showed a collection in the vaginal stump. A further abdominal and pelvic CT scan revealed a cholecystoduodenal fistula complicated by an ileovaginal fistula at the point of impaction. The patient underwent a laparotomy with small bowel resection and anastomosis. She was admitted to the intensive care unit post operatively and recovered well. There are no previous reports of a vaginal fistula caused by gallstone ileus. This case highlights a rare complication of gallstones in a patient who has undergone pelvic radiotherapy.

Case Report of a 10 cm Subdued Abdominal Mass: Diagnosis and Management of a Rare Primitive Mesenteric Leiomyosarcoma

Introduction: Specific management schemes of the exceedingly rare primitive mesenchymal leiomyosarcomas do not exist. Reporting their behavior and management is necessary to be able to construct evidence-based directives. Case Report: We report a case of a 42-year-old Caucasian woman that presented with a large indolent abdominal mass evolving over 3 months. Two differential diagnosis were looked upon, either GIST or leiomyosarcoma. The abdomino-pelvic ct-scan proved that this tumor could be completely resected, so the patient was successfully operated within 2 weeks of the preliminary diagnosis. A monobloc negative margin resection was performed and the patient recovered on the surgical floor. The anatomopathological studies and immunohistochemistry tests confirmed the presence of a primitive mesenchymal leiomyosarcoma. The patient was recommended a follow up every 4 months with a thoraco-abdomino-pelvic ct-scan due to her economic status. Conclusion: The management of rare tumors is always challenging due to the lack of knowledge concerning its behavior and response to the various treatment modalities. Reporting this rare case of mesenchymal leiomyosarcoma and similar cases will enable a better understanding of this disease and its treatment.

Unusually High PSA Level Allows Diagnosis of a Metastatic Prostate Cancer in Older Man

Prostate cancer is now the most commonly diagnosed cancer amongst men in France despite the absence of a generalized screening program. Prostate-specific antigen (PSA) level can be used as a screening test. We report the case of an 86-year-old patient, whose metastatic prostate cancer was diagnosed on an unusually high PSA level (over 5000µg/L), without urologic signs. The diagnostic was then confirmed by a thoracicabdominal-pelvic CT scan, which found diffuse metastases, before hormonal therapy started.

Large presacral abscess in a patient with Crohn’s disease

A presacral abscess with sacral osteomyelitis and gluteal abscesses is a very rare complication of Crohn’s disease and is often clinically unsuspected or overlooked. We report a case of a 58-year-old male who presented for right hip pain after a fall. An abdominal and pelvic CT scan showed an atypical presacral abscess with a fistulizing tract extending through the sciatic notch and lateral to the gluteus medius and minimus muscles forming an intramuscular abscess. The endoscopic transanal approach was used to drain the presacral abscess. This method of drainage was successful and the patient had a favorable prognosis.

Isolated colon metastasis of vaginal cuff squamous cell carcinoma; a case report

Primary vaginal squamous cell carcinoma (SCC) is one of the rarest kinds of cancer in gynecological cancer. We report a 40-year-old presented with abdominal pain in her right lower quadrant with past-medical history of vaginal cuff SCC without any metastasis about 2.5 years ago which was treated with a combination of surgery and radiotherapy. Ultrasonography and abdomino–pelvic CT scan suggested an inflammatory phlegmon in RLQ probably due to a complicated appendicitis or malignancy. Ultrasonography-guided biopsy was performed which showed a poor differentiated SCC. Chest and abdominopelvic CTs showed no metastasis. Patients underwent laparotomy and ileocecal resection then end-to-end anastomosis was performed. A study of specimens showed a non-keratinizing SCC.