Sigmoid endometriosis in a post-menopausal woman leading to acute large bowel obstruction: A case report

AbstractIntroductionEndometriosis is usually a disease involving women of reproductive age. Colonic endometriosis is a rare sequelae. It usually presents vaguely with nonspecific abdominal pain, dyspareunia, fecal tenesmus, rectal bleeding or painful defecation. There are very few case reports of sigmoid endometriosis in the literature, more so ones involving post-menopausal women. Our report highlights such a case, mimicking a malignant rectosigmoid stricture leading to a large bowel obstruction.Case presentationA 63year old lady was referred by her General Practitioner for further investigation of recent altered bowel habit. She underwent an incomplete colonoscopy due to stricturing in the sigmoid. She subsequently was admitted with abdominal pain, distension and vomiting, with imaging consistent with a large bowel obstruction secondary to a stricturing mass within the rectosigmoid which was suspicious for malignancy. An emergency laparotomy and Hartmann’s procedure was performed. She had an uncomplicated post-surgical recovery. Histology revealed no underlying malignancy, but confirmed colonic endometriosis.ConclusionThis case report shows that colonic endometriosis, although rare, can be significantly infiltrative and lead to complications such as a large bowel obstruction. Diagnosing this condition can be challenging and usually requires histological confirmation

Isolated bladder rupture in an elderly patient after blunt trauma. Case report and review

A 74-year-old man presented to the hospital after having a mechanical fall at home on his left side of the body. On arrival he was stable, and investigation revealed fractured left humerus, and he was admitted for observation and pain management. Two days later he started to have severe lower abdominal pain and acute kidney injury. Urinary catheter inserted and about 2 liters of bloody urine emptied, and Abdominopelvic CT scan requested which showed massive fluid in the retroperitoneal area, subsequent CT Cystogram confirmed perforation of the bladder on the left lateral wall. The patient was hemodynamically stable and kept in a high intensive care unit for close observation, and he improved dramatically, and follow-up scan showed healing of perforated bladder. Bladder rupture is not a standard presentation after blunt trauma but should be kept in mind when dealing with elderly patients with pre-existing urinary retention or other medical comorbidities

A rare presentation of appendicitis inside the femoral canal: case report and literature review

Abstract Background Femoral hernia accounts for 3% of all the hernias, and in 0.5–5% of cases, the appendix can migrate through the femoral hernia and is called de Garengeot hernia. It is a very rare condition, and the incidence of appendicitis in this type of hernia is as low as 0.08–0.13%. Case presentation We bring into discussion a case of a 47-year-old female who presented to the emergency department with a painful right-sided groin lump for the past 2 days. After initial resuscitation, a CT scan was requested which showed the presence of inflamed appendix inside the femoral canal. She was taken to the operative theatre, and during the laparoscopy, the appendix was identified migrating through the femoral canal and it could not be retracted into the peritoneal cavity; therefore, the mesoappendix was divided and the operation converted to the open low approach. After identifying the femoral hernia sac and opening it, the appendix was removed and herniorrhaphy was performed. Our patient had an uneventful recovery and was discharged on the following day. Conclusion We report a rare case of de Garengeot hernia which was diagnosed preoperatively. Because of its non-specific presentation, patients are usually diagnosed with incarcerated femoral hernia and are taken to operative theatre and the final diagnosis is made intra-operatively. Due to its rarity, there is no standard approach for this condition, and emergency appendicectomy and concurrent herniorrhaphy is the mainstay of treatment. In this paper, we present different surgical methods for the treatment of this type of hernia

Perforation of the Meckel’s diverticulum with a chicken bone: a case report and literature review

Abstract Background Meckel’s diverticulum (MD) is the most common congenital abnormality of the gastrointestinal (GI) tract. Most of the people remain asymptomatic during their lifetime, but some can develop complications such as inflammation, haemorrhage or obstruction. Perforation of Meckel’s diverticulum is very rare, and we present a case of perforation by a chicken bone. Case presentation A 19-year-old man presented to the emergency department with abdominal pain, and based on examination and laboratory findings, he was diagnosed with appendicitis initially. Meanwhile, a CT scan was requested and a foreign object inside the Meckel’s diverticulum was noted, and on further questioning, he mentioned that he had chicken with bones 2 days ago. He was taken to the operating theatre, and during laparotomy, the perforated Meckel’s diverticulum was found, and it was resected with primary anastomosis. Conclusion Meckel’s diverticulum follows the ‘rule of twos’, and perforation of it with foreign object is rare. Patients usually present with signs and symptoms of acute abdomen, and appendicitis is the first diagnosis, and the final diagnosis is usually made intraoperatively. Perforation of Meckel’s diverticulum should be considered for the patients who present with acute abdomen, and with precise history taking and investigations, preoperative diagnosis can be achieved