An unusual appearance of giant Meckel’s diverticulum

Meckel's diverticulum (MD) results from incomplete involution of the proximal portion of the vitelline duct. Although MD is the most commonly diagnosed congenital gastrointestinal anomaly, it is estimated to affect only 2% of the population worldwide. Most cases are asymptomatic, and diagnosis is often made following investigation of unexplained gastrointestinal bleeding, perforation, inflammation or obstruction that prompt clinic presentation. While MD range in size from 1-10 cm, cases of giant MD (B5 cm) are relatively rare and associated with more severe forms of the complications. Herein, we report a 43-year-old male patient presented at the Emergency Department with a complaint of abdominal pain, associated with fever (38,5C), nausea and anorexia. The clinical examination revealed pain in the right lower quadrant, as well as abdominal guarding and rebound tenderness. The leucocyte count was elevated at 18 × 109/L. Plain abdominal xray depicted multiple air-fluid levels. An abdominal and pelvic CT scan revealed a fluid-filled structure in the pelvis adjacent to the distal small bowel. The surgical method of exploration can be either by laparoscopy or through an open incision. Exploratory laparotomy was performed and revealed oedema throughout the entire small bowel, dilation of small bowel segments, and a giant Meckel's diverticulum (10 cm long) with mushroom appearance on the antimesenteric border of the small bowel at 70 cm proximal to the ileocaecal valve . Resection of the small bowel was performed with a linear stapler and an ileoileal anastomosis was generated using a 80 mm endo-GIA stapler. Patient was discharged on post-operative day 4 without any complications. Histopathologic examination indicated Meckel's diverticulitis without gastric or pancreatic metaplasia.Pan African Medical Journal 2015; 2

Postsurgical Diagnosis of an Unusual Case of Primary Hepatic Lymphoma Presenting as Liver Abscess with an Uncommon Complication: A Hepatogastric Fistula

Primary hepatic lymphoma (PHL) is a very rare malignancy and constitutes 0.016% of all cases of non-Hodgkin’s lymphoma and 0.4% of extranodal non-Hodgkin’s lymphoma. We describe a rare case of primary hepatic lymphoma presenting as liver abscess which was complicated with the development of a hepatogastric fistula. A 58-year-old man presented with clinical signs of sepsis, high-grade fever, right upper abdominal pain, and weight loss which had progressed in the past 8 months. Noncontrast abdominal computed tomography (CT) revealed a heterogeneously hypodense lesion in the left lobe of the liver with multiple air foci within, which are seen to extend into the body of the stomach. The patient was initially misdiagnosed as a case of rupture of liver abscess into the stomach. Postoperative liver biopsy examination confirmed a diagnosis of diffuse large B-cell lymphoma. Systemic staging revealed no evidence of nodal or bone marrow involvement, so PHL was diagnosed. Chemotherapy was initiated, but discontinued due to the patient’s general condition. Finally, the patient succumbed to neutropenic fever following chemotherapy. Here, we present the exceptional case of a primary hepatic lymphoma with an unusual complication, a hepatogastric fistula, and try through the existing literature to show the difficulties involved in diagnosis and treatment