Asian Journal of Case Reports in Surgery

Diverse Therapeutic Approaches to Ankyloglossia in Children: A Case Series

Olando Kevin D’souza — 2026-01-09

Ankyloglossia is a congenital developmental anomaly characterized by a short or thick lingual frenulum, resulting in restricted tongue mobility and functional impairments, particularly speech difficulties. Early recognition and timely intervention are essential to improve oral function and quality of life in affected children. This case series describes the management and outcomes of three pediatric patients with severe ankyloglossia treated using different surgical modalities.

All cases presented to the Department of Pediatric and Preventive Dentistry, Goa Dental College and Hospital, with speech impairment and limited tongue movement. Clinical examination confirmed severe Class III ankyloglossia according to Kotlow’s classification. The children exhibited difficulty in articulating lingual and alveolar phonemes. Surgical management included conventional scalpel frenectomy, diode laser–assisted frenectomy, and electrocautery-assisted frenectomy, each performed under local anesthesia following standard aseptic protocols.

Postoperatively, all patients demonstrated satisfactory hemostasis and uneventful healing. Suturing was required only in the scalpel-treated case, while laser and electrocautery techniques achieved adequate coagulation without sutures. Complete wound healing was observed at the one-month follow-up. Tongue mobility exercises were advised to enhance postoperative functional outcomes (improved tongue range of motion and speech articulation).

Although limited by a small sample size and short follow-up period, this case series highlights the clinical feasibility and effectiveness of different surgical approaches for managing severe pediatric ankyloglossia. The findings are clinically relevant in guiding clinicians in selecting appropriate treatment modalities based on available resources, operator expertise, and patient-specific considerations.

Clinical and Radiological Outcomes of Dega Pelvic Osteotomy in Developmental Dysplasia of the Hip: A Case Series of 12 Hips in Children

Abou El Jaoud Hind — 2026-03-20

Introduction: Developmental dysplasia of the hip (DDH) diagnosed after walking age often requires surgical correction to restore adequate femoral head coverage and prevent long-term joint degeneration. Among pelvic osteotomies, the Dega osteotomy is widely used in skeletally immature patients because it allows controlled acetabular remodeling while preserving pelvic stability.

Methods: We conducted a retrospective case series including 12 dysplastic hips in 8 children treated with Dega pelvic osteotomy between December 2020 and December 2023 in a tertiary pediatric orthopedic center. Clinical outcomes were assessed using the modified McKay classification. Radiological evaluation included the acetabular index (AI), lateral center-edge angle (LCEA), Wagner index, and Tönnis and Severin classifications.

Results: The mean age at surgery was 4 years (range: 2–6 years) with a female predominance (75%). At final follow-up (mean: 18 months; range: 6–36 months), satisfactory clinical outcomes (McKay grades I and II) were observed in 87.5% of patients. The mean acetabular index improved from 30.9° preoperatively to 11.3°at final follow-up, while the mean lateral center-edge angle increased from 16° to 28.9°. The Wagner index normalized with a mean value of 90%. Radiological outcomes according to the Tönnis and Severin classifications were satisfactory in all hips. Complications were limited and included transient stiffness, one recurrence and one patient presented an avascular necrosis of the hip.

Conclusion: In this retrospective case series of 12 hips in 8 children with a mean follow-up of 18 months, Dega pelvic osteotomy proved to be a reliable surgical option for the treatment of pediatric hip dysplasia, providing significant improvement in acetabular coverage and satisfactory clinical outcomes with a low complication rate. Longer follow-up studies are required to confirm the durability of these results.

Mobility-based Intraoperative Decision-making in Reconstruction after Lateral Oral Tongue Resection: A Prospective Case Series

Rajnish Talwar — 2026-04-15

Background: Oral tongue squamous cell carcinoma (OTSCC) demands a reconstructive approach that prioritises functional recovery over geometric defect restoration. Traditional algorithms based on percentage of tongue resected or defect size may inadequately account for the single most important functional predictor: residual tongue mobility. This case series prospectively documents a mobility-first reconstructive philosophy applied over three consecutive years.

Methods: Twenty-nine consecutive patients undergoing lateral oral tongue resection for OTSCC at a single tertiary oncology unit were included. All were assessed intraoperatively for residual tongue mobility following resection. The choice between primary longitudinal closure and microvascular free flap reconstruction was determined by a defined, reproducible, on-table mobility test. All patients provided written informed consent. No validated scoring instruments were applied; the primary functional endpoint was clinical assessment of the three core domains — speech intelligibility, swallowing progression, and oral clearance — collectively termed the "3S" framework.

Results: Eleven patients (37.9%) achieved satisfactory 3S outcomes with primary longitudinal closure alone. Eighteen patients (62.1%) required microvascular reconstruction on account of floor-of-mouth resection (planned or margin-driven) or intraoperative tethering on trial closure. Of the reconstructed cohort, three patients received a radial forearm free flap (RFFF) and fifteen a thin anterolateral thigh (ALT) free flap. Flap survival was 100%. Two ALT donor sites developed superficial wound infections managed conservatively. No major donor-site morbidity was recorded. Functional recovery of 3S domains was achieved in all patients before discharge from the surgical unit.

Conclusion: This prospective case series suggests that a mobility-based intraoperative assessment may be a useful aid in reconstructive decision-making after lateral tongue resection. Primary closure was feasible in selected patients with preserved tongue mobility, while thin ALT free flap reconstruction provided acceptable early functional outcomes in patients with floor-of-mouth tethering or restricted mobility. These findings are clinically encouraging but should be interpreted cautiously given the small sample size, single-centre design, non-validated outcome assessment, and limited follow-up.

Extensive Iatrogenic Tracheal Laceration Following Difficult Intubation in Elective Surgery: A Case Report

L. Moya Edisson — 2026-04-16

Aims: Iatrogenic tracheal rupture is a rare but potentially life-threatening event. This report describes a complex case of extensive post-intubation tracheal injury (PITI) during elective surgery, focusing on diagnostic distractors like pneumoperitoneum and the critical need for early intervention.

Presentation of Case: A 63-year-old female patient underwent elective abdominal surgery (ventral hernia repair and abdominoplasty). Intubation was technically challenging, requiring three attempts. Postoperatively, she developed progressive dyspnea and cervicothoracic subcutaneous emphysema at 72 hours. Initial CT imaging showed pneumomediastinum and subdiaphragmatic pneumoperitoneum, raising suspicion of hollow viscus perforation. After negative findings in exploratory laparoscopy and endoscopy, fiberoptic bronchoscopy identified a 3.5 cm longitudinal laceration in the posterior membranous trachea. Urgent surgical repair via anterior cervicotomy and protective tracheostomy were performed. Despite successful surgical closure, the patient developed mediastinitis and septic shock, eventually resulting in death.

Discussion: PITI often presents with non-specific symptoms. The presence of pneumoperitoneum can act as a diagnostic distractor, leading to unnecessary abdominal exploration. Fiberoptic bronchoscopy remains the gold standard for defining the injury. Management is guided by the Cardillo classification, where lesions exceeding 2 cm or involving unstable patients usually mandate surgical intervention.

Conclusion: PITI must be a priority differential diagnosis in any patient with postoperative emphysema. Early diagnostic bronchoscopy and structured preoperative airway assessment are critical for prevention and survival.

Monofocal Nonbacterial Osteitis of the Distal Radius in Children: A Case Report

Tayeb Ben Tayeb — 2026-01-01

Introduction: Chronic bacterial osteitis is a rare inflammatory disease in children that can mimic certain tumor lesions, particularly eosinophilic granuloma. Forms localized to a single site, particularly at the lower end of the radius, are uncommon and make the diagnosis difficult.

Observation: A 7-year-old girl was referred for chronic pain in her right forearm. X-rays showed a metaphyseal cystic lesion of the lower end of the radius, associated with significant thinning of the cortex. Magnetic resonance imaging initially suggested an eosinophilic granuloma due to a well-defined lesion, with hypersignal on water-sensitive sequences and hyposignal on T1-weighted sequences, without collection or soft tissue invasion.

This suspicion of a tumor led to a bone biopsy. The examination revealed a weakened cortex containing a clear, non-hematic fluid. The pathological study revealed non-specific inflammatory osteitis, and microbiological samples were negative, leading to a diagnosis of chronic non-bacterial osteitis.

Treatment with anti-inflammatory drugs led to rapid improvement. Radiology showed gradual filling of the lesion, with complete healing after one year.

Conclusion: This observation illustrates a monofocal form of chronic non-bacterial osteitis mimicking an eosinophilic granuloma on imaging. Biopsy remains essential to rule out a tumor or infectious lesion. The prognosis is favorable with anti-inflammatory treatment.

Congenital Arteriovenous Malformation of the Hand and Forearm: Integration of Clinical Staging, Vascular Imaging, and Treatment Outcomes in a Rare Anomaly

Nabajyoti Paul — 2026-01-03

Congenital arteriovenous malformations (AVMs) involving the hand and forearm are exceptionally rare developmental vascular disorders and pose considerable diagnostic and therapeutic challenges because of their complex vascular anatomy. These lesions arise from anomalous direct arterial–venous connections, resulting in high-flow circulation that may progressively lead to pain, swelling, and impairment of hand function. Although AVMs are more frequently described in the central nervous system, their occurrence in the hand remains infrequent and clinically challenging.

We report the case of an 11-year-old female child presented with progressively increasing pain and swelling of the right hand. Clinical and Radiological evaluation with magnetic resonance imaging and angiography established the diagnosis of a congenital arteriovenous malformation, corresponding to Schobinger stage III. Management was planned in a staged and multidisciplinary manner. Initial endovascular embolization was performed to reduce blood flow within the lesion, followed by complete surgical excision. Careful identification and ligation of the principal feeding vessels were central to achieving effective intraoperative hemostasis and complete R0 resection.

The postoperative recovery was uneventful, with significant relief of symptom and preservation of hand and upper limb function. No recurrence was detected during the follow-up period. This case demonstrates that careful preoperative assessment, appropriate staging, and a combined endovascular and surgical approach can result in satisfactory outcomes in congenital AVMs of the hand.

Osteomyelitis of Great Toe Masquerades Giant Cell Tumor

Mahmoodul Hasan Yusuf M.R. — 2026-01-05

Giant cell tumor of bone is an uncommon benign but locally aggressive neoplasm that rarely involves the small bones of the feet. We present a case of giant cell tumor involving the distal phalanx of the great toe, emphasizing diagnostic challenges and management strategies. However, its presentation in the distal phalanx of the great toe remains relatively uncommon, presenting diagnostic and management challenges. In addition to it, the patient had done debridement to the same site which resulted in an ulcer that masquerades to have an osteomyelitis beneath it. The patient underwent surgical excision with marginal resection and achieved excellent functional outcomes at follow-up. This case emphasizes the importance of recognizing atypical presentations of giant cell tumor that projects as an osteomyelitis of great toe and highlights the role of comprehensive imaging and tissue diagnosis in guiding definitive surgical management.

A Case of Obstructed Ventral Hernia with Intraoperative Findings of Multiple Colonic Diverticulitis with Faecal Evisceration

Rohan Katihalli Jayappa — 2026-01-09

Ventral hernia refers to any protrusion of intestine or other tissue through a weakness or gap in the abdominal wall. We report a rare case of a 75 years old female presented with features of obstructed infraumbilical hernia without signs of peritonitis. USG abdomen was suggestive of infraumbilical defect with omentum and bowel loop as contents. Patient was taken for emergency open ventral hernioplasty. On exploration, surprisingly we found sigmoid diverticulitis with fecal evisceration. Although colonic diverticular disease is widely prevalent, perforated diverticulitis occurring within an obstructed hernia sac is an uncommon clinical finding, making this case particularly rare. On table decision was taken to proceed with Hartamann's procedure and primary closure of ventral hernia defect without mesh placement. This case emphasizes the need for preoperative investigations, adaptability, timely action during surgical intervention and intricate surgical strategies employed to address the unique combinations of pathologies.

A Case Report on Multiple Tumors in a Giant Bladder Diverticula

Mehmet Gürcan — 2026-01-10

Background: Bladder diverticula are outpouchings of the bladder mucosa through the muscularis propria and are most commonly acquired in elderly men secondary to bladder outlet obstruction. Although often asymptomatic, diverticula may lead to significant complications, including recurrent urinary tract infections, stone formation, and malignancy. Tumors arising within bladder diverticula are uncommon but are associated with an unfavorable prognosis due to the absence of a muscular layer.

Case Presentation: We report the case of a 74-year-old male who presented with long-standing lower urinary tract symptoms, recurrent cystitis, and a sensation of incomplete bladder emptying. Imaging studies revealed multiple bladder diverticula, including a giant left-sided diverticulum measuring over 11 cm in diameter, with a nodular lesion suspicious for malignancy. Diagnostic cystoscopy demonstrated three papillary tumors located exclusively within the left-sided diverticulum, which were unsuitable for transurethral resection. The patient subsequently underwent open bladder diverticulectomy. Histopathological examination revealed high-grade invasive urothelial carcinoma arising within the diverticulum.

Conclusion: Carcinoma developing in bladder diverticula is rare but carries a high risk of early invasion due to the lack of a muscularis propria. This case highlights the importance of thorough evaluation of patients with large or symptomatic diverticula and recurrent urinary tract infections. While transurethral resection may be considered for selected intradiverticular tumors, open surgical management remains a definitive and appropriate option when endoscopic treatment is not feasible.

A Rare Case of Non-Functional Adrenocortical Oncocytic Neoplasm Presenting as a Left Flank Pain

Rajdeep D. Vachhani — 2026-01-14

Introduction: Adrenocortical oncocytic neoplasms (AONs) are rare tumors of the adrenal cortex characterized by oncocytic histology. Due to their rarity, variable malignant potential, and nonspecific clinical presentation, preoperative diagnosis remains challenging.

Case Presentation: A 38-year-old female presented with left flank pain to Orthopedics OPD for which Contrast-enhanced computed tomography was done. It revealed a large, well-defined left adrenal mass without evidence of invasion. After which she was referred to Urology OPD for further management. Clinical evaluation and hormonal workup suggested a non-functioning adrenal tumor. The patient underwent open left adrenalectomy. Histopathological examination confirmed an adrenocortical oncocytic neoplasm of uncertain malignant potential based on Lin–Weiss–Bisceglia criteria. The postoperative period was uneventful, and the patient remains disease-free on follow-up.

Conclusion: AONs are rare adrenal tumors that may present with mass effect rather than hormonal symptoms. Complete surgical excision is the treatment of choice. Long-term follow-up is essential due to unpredictable biological behavior.

Multimodality Imaging and Sclerotherapy Success in Pediatric Axillary Venous Malformation: A Case Report of 6-Year-Old Girl

Samreen Kazmi — 2026-01-17

Venous vascular malformations are rare congenital anomalies of the venous system that may remain clinically silent until childhood. We report a 6‑year‑old girl who presented with acute onset swelling and fever in the left axilla. Clinical examination revealed a soft, compressible mass that decreased in size on pressure. Initial ultrasonography demonstrated conglomerate lobulated suppurative lymphadenopathy with liquefied components, raising the possibility of an abscess. High‑resolution real‑time ultrasonography further showed a well‑defined multiloculated subcutaneous cystic mass with inter‑muscular extension and absent internal flow on colour Doppler, suggesting a lymphatic or venous malformation. MRI using T1, T2, STIR and post‑contrast sequences revealed a large hyperintense multiloculated lesion with fluid–fluid levels, internal septations and adjacent soft‑tissue involvement, without invasion of surrounding muscles or chest wall, features highly suggestive of a venous vascular malformation with haemorrhagic components. Based on the imaging findings, the patient was treated with multiple sessions of sclerotherapy using sodium tetradecyl sulfate under general anaesthesia. Progressive reduction in lesion size and resolution of symptoms were observed on follow‑up, with the child returning to normal activities. This case highlights the crucial role of multimodality imaging in accurate characterization of pediatric venous vascular malformations, guiding minimally invasive treatment, and preventing complications through early diagnosis and multidisciplinary management.

Plantar Myositis Ossificans: A Rare Case Report and Review of the Literature

H. Lahmidi — 2026-01-20

Myositis ossificans (MO) is a benign heterotopic ossification process that most commonly affects large skeletal muscles and typically develops within 2–12 weeks following trauma. Non-traumatic forms and atypical localizations are uncommon and may represent a diagnostic challenge. Plantar involvement is particularly rare and may closely mimic malignant soft tissue tumors.We report a rare case of long-standing plantar myositis ossificans of the heel in a 45-year-old man presenting with a slowly progressive mass evolving over a 12-year period and associated with progressive functional impairment. This case highlights the diagnostic difficulties encountered in atypical presentations of myositis ossificans, the limitations of biopsy in such settings, and the contribution of magnetic resonance imaging to lesion assessment. A focused review of the literature is also provided, with particular emphasis on differential diagnoses, imaging characteristics, and the diagnostic and therapeutic role of complete surgical excision.

A Case Report on Primary Umbilical Endometriosis

Akash Panda — 2026-01-30

Background: Endometriosis is a benign gynecological condition characterized by ectopic endometrial glands and stroma, most commonly affecting pelvic organs. Umbilical endometriosis is a rare extra-pelvic manifestation, and primary (spontaneous) umbilical endometriosis associated with an umbilical hernia can pose a diagnostic challenge, as it may clinically mimic an obstructed hernia.

Case Report: A 38-year-old woman presented with a progressively enlarging nodular swelling at the umbilicus over two years, accompanied by severe cyclical pain during menstruation. Over the preceding six months, the lesion developed pigmentation and cyclical bleeding. Clinical examination revealed a firm, black umbilical nodule measuring approximately 2 × 1.5 cm, with no cough impulse or signs of intestinal obstruction. The clinical features raised suspicion of umbilical endometriosis, which was confirmed on histopathological examination following surgical excision.

Discussion: Umbilical endometriosis is uncommon and often misdiagnosed due to its resemblance to hernia and other umbilical lesions. Imaging modalities such as ultrasonography, computed tomography, and magnetic resonance imaging have limited diagnostic accuracy but can help delineate lesion characteristics and guide surgical planning. Definitive diagnosis is established histologically.

Conclusion: Primary umbilical endometriosis should be considered in women presenting with cyclical umbilical pain, swelling, or bleeding. A high index of clinical suspicion is crucial, and surgical excision remains the treatment of choice with histopathological confirmation.

A Case Report of an Abdominal Wall Desmoid Tumor Treated by Dual-Mesh Reconstruction

Anwar Rahali — 2026-01-31

Background: Desmoid tumors, also known as aggressive fibromatosis, are rare benign fibroblastic neoplasms characterized by locally aggressive behavior and a high risk of recurrence. Involvement of the abdominal wall is uncommon and may present significant reconstructive challenges following wide surgical excision. Abdominal wall desmoid tumors predominantly affect young women and may occur sporadically or in association with familial adenomatous polyposis.

Aim: The aim of the study is to present a case of a large abdominal wall desmoid tumor managed surgically, with particular emphasis on the role of dual-mesh prosthetic reconstruction in addressing extensive parietal tissue loss.

Case Presentation: We report the case of a 22-year-old woman with no significant medical history who presented with a one-year history of constipation associated with right lower quadrant and lumbar pain. Physical examination revealed a large, mobile parietal mass in the right iliac fossa. Abdominal magnetic resonance imaging demonstrated a large right-sided mass arising from the right rectus abdominis muscle. An ultrasound-guided core needle biopsy confirmed the diagnosis of a desmoid tumor. The patient underwent complete surgical resection with wide margins, including total excision of the infraumbilical portion of the right rectus abdominis muscle. Abdominal wall reconstruction was performed using a dual-face prosthetic mesh fixed to the peritoneum and covered by the remaining aponeurosis. Postoperative recovery was uneventful, and the patient was discharged on postoperative day three. Follow-up at 15 days was satisfactory.

Conclusion: This case underscores the value of dual-mesh prostheses in abdominal wall reconstruction after extensive resection of desmoid tumors, enabling safe coverage of large parietal defects with favorable short-term outcome.

Granular Cell Tumor of the Ulnar Nerve at the Wrist: A Rare Case Report

Raviraj A — 2026-02-11

Granular cell tumours usually involve skin and subcutaneous tissue. There are only few reports of such tumours arising from the peripheral nerves and we report one such rare case arising from ulnar nerve at wrist level. A 17-yr old girl presented to the out-patient department with complaints of paraesthesia in left hand along the ulnar nerve distribution for a period of 4 weeks. Patient was treated for right femur shaft fracture and left elbow lateral condyle fracture 9 months prior. Granular cell tumors most often present in extra neural sites such as skin and subcutaneous tissue, the tongue and breast. They can rarely present in the respiratory and gastrointestinal tracts3. Neural origins of this tumour have been demonstrated in case reports only. Clinical and radiological examination of the granular cell tumors offer no distinguishing factors to help the physician anticipate the differential diagnosis. This explains the high recurrence rates of this tumour. Sufficient evidence does not exist to offer a treatment algorithm for this tumour.

Delayed Gastric Perforation by a Retained Fish Bone in a Patient on Chronic Pantoprazole Therapy: A Case Report

Azzra Ikram — 2026-02-14

Background: Gastric perforation from foreign body ingestion is rare, as the stomach’s high acidity and robust muscular wall typically facilitate digestion or safe transit. However, chronic proton pump inhibitor (PPI) therapy induces pharmacologic hypochlorhydria. This reduced acidity may compromise the breakdown of organic objects, such as fish bones, increasing the risk of retention and transmural injury.

Aim: This case report highlights about Delayed Gastric Perforation by a Retained Fish Bone in a Patient on Chronic Pantoprazole Therapy

Case Presentation: A 47-year-old man on pantoprazole therapy for six months presented with a two-week history of worsening epigastric pain, fever, and vomiting. He had no history of Nonsteroidal anti-inflammatory drugs (NSAID) use or recent trauma. Contrast-enhanced computed tomography (CECT) revealed a 3.6 cm linear hyperdense foreign body associated with a complex fluid collection between the stomach and pancreas. Exploratory laparotomy confirmed gastric perforation at the lesser curvature caused by a fish bone, complicated by an abscess. The patient underwent distal gastrectomy with Roux-en-Y reconstruction and made a full recovery.

Discussion: Chronic acid suppression disrupts gastric defence mechanisms by elevating pH and inhibiting enzymatic degradation, which can facilitate foreign body retention and gradual perforation. Diagnosis is challenging due to nonspecific symptoms and the frequent inability of patients to recall ingestion. While plain radiography is often inconclusive, CECT is critical for identifying radiolucent bones and guiding management.

Conclusion: This case highlights the potential link between chronic PPI use and gastric perforation from occult foreign bodies. Clinicians should maintain a high index of suspicion in patients on acid-suppression therapy presenting with persistent abdominal symptoms. Timely CECT and surgical intervention are essential for successful outcomes.

Transanal Long Tube Drainage for Anastomotic Leakage after Left Hemicoloctomy: First Reported Case

Daichi Ishikawa — 2026-02-17

Introduction: Anastomotic leakage after colectomy is a potentially life-threatening complication. We report the first case treated by the nonoperative management using the transanal long tube for major leakage after colectomy.

Presentation of Case: We report a 50-year-old woman who underwent a laparotomy for left hemicolectomy with end-to-end anastomosis to treat a cancer of the descending colon, as well as total hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy to address endometrial cancer. On postoperative day (POD) 3, ascites containing feces was detected in her abdominal drainage tube, consistent with a major anastomotic leak. The general conservative treatment such as fasting and intravenous antibiotics did not improve her condition. On POD6, a long transanal drainage tube was inserted beyond the anastomosis and placed at the splenic flexure. Adequate drainage was achieved, and ascites drainage from the abdominal tube was soon reduced. The patient’s symptoms, fever, and laboratory inflammatory parameters improved and the fistula closed on POD 51. At the 2-year follow-up she was alive and well without recurrence.

Discussion and Conclusion: Managing anastomotic leakage after colectomy using transanal long drainage tube might be effective in clinically stable patients with localized peritonitis. Due to the inherent limitation of a single case report, the further studies are warranted for development of the nonoperative approach.

Duplicate Gallbladder Diagnosed on Ultrasonography Alone and Managed Conservatively in an Obese Patient: A Rare Case Report

Prashant Oli — 2026-02-20

Duplication of the gallbladder is a rare congenital biliary anomaly with significant clinical and surgical implications. Most cases are detected incidentally during surgery or advanced imaging, and preoperative diagnosis remains challenging, particularly in resource-limited settings. We report a rare case of gallbladder duplication diagnosed solely on ultrasonography in an obese adult presenting with postprandial upper abdominal pain. The patient was managed conservatively with dietary modification, proton pump inhibitors, and antispasmodics, resulting in complete symptom resolution. This case highlights the diagnostic value of ultrasonography and demonstrates that conservative management may be appropriate in carefully selected patients with uncomplicated duplicate gallbladder.

Surgical Management of a Giant Zenker's Diverticulum with Intrathoracic Extension: A Case Report

Mohamed Bouzroud — 2026-02-25

Introduction: Zenker's diverticulum (ZD) is an acquired outpouching of mucosa and submucosa through the Killian triangle whose management, particularly for giant cases, remains a subject of discussion. Classic clinical signs, such as Boyce's sign, are crucial for diagnosis but are not always present.

Aim: To report the clinical features and surgical management of a giant Zenker’s diverticulum with intrathoracic extension and discuss its challenges and outcomes.

Case Presentation: We present the case of a 62-year-old male with a long-standing history of progressive dysphagia, regurgitation, and a positive Boyce's sign on physical examination. A contrast-enhanced computed tomography scan and a barium swallow study revealed a giant ZD with a remarkable caudal extension down to the T2 vertebral level. The patient was successfully managed with an open transcervical diverticulectomy associated to a cricopharyngeal myotomy. His post-operative course was uneventful. At one-year follow-up, he reported complete and sustained resolution of all symptoms and had resumed a normal diet.

Conclusion: This case highlights that for giant Zenker's diverticula, the traditional open surgical approach remains a safe and highly effective treatment option. It provides the distinct advantages of complete excision and a controlled myotomy, leading to excellent long-term functional outcomes. Furthermore, it underscores the diagnostic importance of classic physical findings in the clinical evaluation of this condition. While minimally invasive endoscopic therapies are rightly the first choice for most standard cases, the open surgical approach should be considered the standard of care for patients with exceptionally large or complex diverticula and must remain an essential skill for surgeons managing this pathology.

Superior Mesenteric Artery Syndrome Associated with a Malrotated Ectopic Left Kidney: A Rare Case Report and Surgical Considerations

H. K Majhi — 2026-02-27

Background: Superior mesenteric artery (SMA) syndrome, also referred to as Wilkie syndrome, represents an uncommon aetiology of proximal intestinal obstruction, arising from extrinsic compression of the third portion of the duodenum between the abdominal aorta and the superior mesenteric artery. The syndrome is frequently precipitated by rapid or significant weight loss, which results in a reduction of the mesenteric fat pad and consequent narrowing of the aortomesenteric angle. While most cases are acquired, congenital anatomical variations contributing to SMA syndrome are relatively rare. Furthermore, the simultaneous occurrence of SMA syndrome with renal ectopia and intestinal malrotation is exceedingly uncommon, with only a limited number of cases documented in the literature. Recognition of these atypical associations is crucial for accurate diagnosis and appropriate management.

Aim: To report a rare case of SMA syndrome associated with a malrotated ectopic left kidney and to emphasize the importance of detailed preoperative imaging and anatomical understanding in surgical planning.

Case Presentation: An 18-year-old female presented with chronic postprandial epigastric pain, recurrent bilious vomiting, early satiety, and significant weight loss. Symptoms were exacerbated during menstruation and partially relieved in the supine position. Contrast-enhanced computed tomography (CT) with angiography demonstrated a markedly reduced aortomesenteric angle and distance, confirming SMA syndrome. Additionally, a malrotated ectopic left kidney was identified in the pelvis with anomalous renal vasculature. Conservative management failed, following which the patient underwent an elective retrocolic side-to-side duodenojejunostomy, resulting in complete symptomatic resolution.

Conclusion: This case highlights a rare association of SMA syndrome with a malrotated ectopic kidney. Awareness of such anatomical anomalies and meticulous preoperative imaging are crucial to prevent iatrogenic vascular injury during surgery due to distorted retroperitoneal architecture. This case report highlights the presence of a rotational vascular anomaly and a condition that does not require prior structural anatomical alteration, but rather specific phenotypic characteristics, which could potentially confuse the physician in their diagnostic approach

Mesenteric Neuroendocrine Tumor Presenting as Ileal Stricture and Acute Small Bowel Obstruction: A Case Report

Swarnava Chanda — 2026-02-27

Background: Neuroendocrine tumors (NETs) are uncommon neoplasms arising from the neuroendocrine cells distributed throughout the body. These cells are most frequently found in the gastrointestinal tract. Mesenteric NETs are extremely rare and may present with features of small bowel obstruction due to fibrotic or desmoplastic reactions.

Case Presentation: A 72-year-old male, known diabetic, presented with abdominal distension and obstipation for three days. Imaging revealed multiple air-fluid levels and a mesenteric soft-tissue mass with distal ileal stricture. Exploratory laparotomy showed dilated proximal small bowel loops and a 5x5 cm greyish-white mesenteric mass encasing the ileocolic artery. Right hemicolectomy with distal ileal resection and ileo-transverse anastomosis was performed with proximal covering ileostomy. Histopathological examination confirmed a well-differentiated neuroendocrine tumor of the mesentery.

Conclusion: Though mesenteric NETs are rare, it should be considered in elderly patients presenting with intestinal obstruction and mesenteric mass. Early diagnosis is important and complete surgical excision remains the cornerstone of management.

The Vanishing Leg Swelling: A Rare Case of Muscle Herniation

Shaikh Mohd Shaad — 2026-02-28

Muscle hernias of the lower limb are rare clinical entities resulting from focal defects in the deep fascia that permit protrusion of underlying muscle fibers. They are frequently underdiagnosed because of intermittent presentation and nonspecific findings. We report a case of a 34-year-old male with symptomatic tibialis anterior muscle herniation presenting as an intermittent swelling over the left shin. Dynamic ultrasonography demonstrated a 2 cm fascial defect with muscle protrusion during contraction. The patient underwent primary fascial repair with 2-0 polypropylene sutures. Postoperative recovery was uneventful, and no recurrence was noted at three months. This case highlights the importance of dynamic imaging, appropriate defect size assessment, and individualized surgical planning. A brief review of etiology, classification, and treatment strategies is discussed.

Gestational Gigantomastia in a 37-Year-Old Woman: Managed Successfully by Multidisciplinary Approach

Md. Shah-paran Islam Probal — 2026-03-13

Gestational gigantomastia (GG) is an extremely rare condition characterized by excessive breast enlargement during pregnancy and may lead to serious maternal morbidity. Due to its rarity, standardized management guidelines are lacking, particularly in resource-limited settings. To the best of our knowledge, this is the first reported case of gestational gigantomastia from Bangladesh and contributes valuable regional evidence to guide clinical and surgical decision-making. A 37-year-old woman at 33+ weeks of gestation presented with massive bilateral breast enlargement over seven months, complicated by respiratory distress and an infected ulcer wound. Right and left breasts were weighed approximately 15kg and 13 kg respectively, with associated skin ulceration and accessory breast tissue. Imaging revealed diffuse edematous breast parenchyma without malignancy, and core biopsy for histopathology confirmed a benign proliferative lesion. After multidisciplinary consultation, pregnancy was terminated via lower-segment cesarean section. Following delivery and clinical stabilization, the patient was treated conservatively with the dopamine agonist cabergoline. Post-treatment, the patient demonstrated a significant reduction in breast size with resolution of respiratory distress. She was discharged in stable condition with a plan for delayed reduction mammoplasty, which she later declined. At follow-up, breast volume had decreased, although residual skin laxity remained. Early recognition of gestational gigantomastia is essential, particularly when rapid breast enlargement leads to systemic complications.

Lower Rectal Carcinoma with Delayed Treatment-A Consequence of Social Factors: A Case Report

Victor Wagozie — 2026-03-16

Rectal cancer is an emerging public health concern in Nigeria, with increasing incidence and late presentation in many tertiary centers. Lower rectal carcinoma commonly presents with painless rectal bleeding, a symptom frequently attributed to benign anorectal conditions, resulting in diagnostic delay. We report the case of a 63-year-old Nigerian female with type 2 diabetes mellitus who initially presented in 2018 in a private facility with rectal bleeding and underwent polypectomy. In 2022, she was diagnosed with stage I lower rectal carcinoma and was said to have received neoadjuvant chemotherapy instead of the standard neoadjuvant chemoradiotherapy. Also declined definitive surgical management. Subsequent overseas evaluation reportedly showed dysplasia; however, documentation was unavailable. She presented to us for the first time in 2026 with recurrent rectal bleeding. Digital rectal examination upon evaluation revealed a fungating mass 4cm from the anal verge. Colonoscopy with biopsy confirmed moderately differentiated adenocarcinoma of the rectum. This case highlights the multifactorial causes of delayed rectal cancer diagnosis and treatment in Nigeria, including symptom overlap with benign disease, fragmented continuity of care, sociocultural resistance to stoma formation, and lack of structured surveillance systems. Strengthening patient education, documentation practices, and multidisciplinary management is critical to improving outcomes.

Traumatic Upper Rectal Perforation Associated with Seatbelt Sign Following Motor Vehicle Collision: A Case Report

Zainulabideen Ahmed — 2026-03-19

Background: We report a rare case of traumatic upper rectal perforation in a 35-year-old female restrained passenger after a front-impact motor vehicle collision with airbag deployment. The patient presented with abdominal and back pain and a lower abdominal seatbelt sign. Vital signs were stable.

Case Report: FAST examination was negative; however, contrast-enhanced CT of the abdomen and pelvis demonstrated pneumoperitoneum and radiologic features suspicious for hollow viscus injury; CT also identified an L2 vertebral fracture. Emergency exploratory laparotomy revealed a 0.7 × 0.7 cm anterior rectal wall perforation just below the rectosigmoid junction and small-bowel contusion 50 cm proximal to the ileocecal valve. The rectal defect was repaired primarily in two layers and a pelvic drain placed. Peritoneal fluid culture grew Escherichia coli; subsequent wound culture grew ESBL-producing E. coli. The patient recovered on ertapenem with resolution of abdominal symptoms, return of bowel function, and improvement of inflammatory markers; superficial surgical site infection was managed with local care.

Conclusion: This case highlights the need for high index of suspicion and prompt operative source control in blunt-trauma patients with seatbelt sign and CT pneumoperitoneum, and supports selective primary repair for small, non-destructive intraperitoneal rectal perforations with appropriate antimicrobial stewardship.

Endoscopic Retrieval of Impacted Ingested Cow Skin-Kpomo in an Adolescent Female: A Case Report Highlighting a Cultural Dietary Risk Factor

Victor Wagozie — 2026-03-19

Background: Oesophageal food bolus impaction is a gastrointestinal emergency requiring prompt endoscopic intervention. While meat bolus impaction is well documented in Western literature, regional dietary practices, such as the ingestion of cow skin (kpomo), may predispose to impaction in adolescents.

Case Presentation: A 16-year-old female presented with sudden retrosternal chest pain, vomiting, and dyspnoea after swallowing unchewed kpomo. Initial management included intravenous proton pump inhibitor therapy and failed nasogastric tube insertion, suggesting complete oesophageal obstruction, which is a red flag sign. Upper gastrointestinal endoscopy revealed distal oesophageal impaction. Initial retrieval with a basket was unsuccessful; successful extraction was achieved using a polypectomy snare following distal manipulation. Post-procedure recovery was uneventful.

Conclusion: This case highlights kpomo as a culturally specific risk factor for oesophageal impaction and underscores the importance of timely endoscopic management to prevent complications.

Refining the Bulbous Nose: Advances in Tip Rhinoplasty

M. R. Haranadha Reddy — 2026-03-20

The nasal tip plays a central role in determining overall nasal aesthetics and facial harmony. A bulbous nasal tip represents a common aesthetic concern characterized by widened domal angles, thick soft-tissue envelope, convex lower lateral cartilages, and poorly defined tip-defining points. Advances in rhinoplasty over the past decade have shifted surgical philosophy from aggressive cartilage resection toward structural preservation and cartilage reshaping techniques. Modern tip rhinoplasty utilizes suture techniques, conservative cartilage modification, and graft-based structural support to achieve refined nasal tip contour while maintaining functional stability.

This article presents a detailed case report of a 26-year-old female patient presenting with a bulbous nasal tip and dissatisfaction with nasal aesthetics. The patient underwent open structural tip rhinoplasty involving cephalic trim of the lower lateral cartilages, transdomal and interdomal suturing, cartilage reshaping, and shield graft placement for improved projection and definition. The surgical procedure is described step-by-step from the surgeon’s perspective, highlighting modern principles of structural rhinoplasty.

Postoperative follow-up at one, three, and six months demonstrated significant improvement in nasal tip definition and overall facial harmony. The patient reported high satisfaction with the aesthetic outcome.

Recent advances in tip rhinoplasty emphasize individualized surgical planning, conservative cartilage modification, and strategic grafting techniques. These methods provide predictable long-term outcomes while minimizing complications such as alar collapse, pinched tip deformity, and nasal valve dysfunction.

Fecal Peritonitis Due to Caecal Perforation Following Appendicectomy: A Case Report

R. Amruthavarshini — 2026-03-20

Fecal peritonitis is a life-threatening surgical emergency resulting from gastrointestinal tract perforation. We report a 52-year-old male who presented with abdominal pain, distension, and feculent discharge from a postoperative wound following appendicectomy. Ultrasonography suggested bowel perforation with intra-abdominal contamination. Emergency exploratory laparotomy confirmed caecal perforation with fecal peritonitis, which was managed surgically along with intensive supportive care. Early recognition and prompt surgical source control are essential to reduce morbidity and mortality.

Traumatic Pisiform Dislocation Associated with Distal Forearm Fracture in an Adolescent: A Case Report and Literature Review

Abou El Jaoud Hind — 2026-03-20

Aims: To report an exceptionally rare case of traumatic pisiform dislocation in a pediatric patient, associated with a displaced forearm fracture, and to review the diagnostic and therapeutic options available in the current literature.

Presentation of Case: A 14-year-old male presented following a fall onto his outstretched left hand. Clinical examination revealed a forearm deformity with complete functional impairment. Radiographs demonstrated a displaced fracture of both forearm bones at the distal quarter, with concomitant anterolateral dislocation of the pisiform onto the ulnar border of the triquetrum. Closed reduction of the forearm fracture achieved simultaneous spontaneous relocation of the pisiform, without additional carpal intervention. Postoperative course was uneventful. At six-week follow-up, the patient achieved full painless wrist motion with no evidence of instability or recurrence.

Discussion: Fewer than fifty cases of traumatic pisiform dislocation have been reported in the literature since the first description by Gras in 1835. Diagnosis is primarily radiological and may be missed on standard views; supplementary projections such as Garraud's 30-45 degrees supination lateral view are recommended. When associated with a displaced forearm fracture, indirect reduction through fracture management may suffice. Otherwise, open reduction with temporary K-wire fixation or pisiform excision are accepted alternatives.

Conclusion: Pisiform dislocation is rare and easily overlooked, especially when associated with other injuries. Systematic radiographic assessment of the carpus in any distal forearm trauma is essential to ensure early diagnosis and optimal functional outcomes.

Bilateral Palpebral Pseudotumoral Edema Revealing Systemic Amyloidosis: A Case Report

A. Denial — 2026-03-24

Background: Amyloidosis is a rare disorder characterized by extracellular deposition of insoluble fibrillar proteins in tissues and organs. Ocular involvement is uncommon but may affect several structures including the eyelids, conjunctiva, lacrimal gland, and orbit. Because clinical manifestations are often nonspecific, diagnosis may be delayed. We report a case of bilateral palpebral pseudotumoral edema revealing systemic amyloidosis.

Case Presentation: A 63-year-old patient presented with progressive bilateral periorbital swelling associated with bluish discoloration of the eyelids and conjunctival masses that had evolved for more than two years without any history of trauma. Several ophthalmological and dermatological consultations had been performed, and symptomatic treatments were prescribed without clinical improvement. Laboratory investigations revealed hypergammaglobulinemia on serum protein electrophoresis. Histopathological examination of an eyelid biopsy confirmed amyloid deposition. Further systemic evaluation revealed additional organ involvement consistent with systemic amyloidosis. The patient underwent chemotherapy and symptomatic treatment. Surgical excision of infiltrated eyelid tissue followed by reconstructive surgery was proposed but declined by the patient. Clinical follow-up showed improvement in ecchymosis and ocular comfort, although eyelid swelling persisted.

Conclusion: Palpebral amyloidosis is a rare condition that may represent the first manifestation of systemic amyloidosis. Early histopathological confirmation and comprehensive systemic evaluation are essential for accurate diagnosis and appropriate management.

Surgical Correction of Deviated Nasal Septum via Rhinoplasty and Cartilage Reduction: A Detailed Case Report

Godvine — 2026-03-24

Background: Deviated nasal septum (DNS) is a common structural abnormality causing nasal obstruction, snoring, headaches, and aesthetic deformity. Surgical intervention is indicated when conservative management fails.

Case Presentation: A 24-year-old male presented with long-standing nasal obstruction, snoring, intermittent headaches, and visible nasal deviation following childhood trauma. Clinical examination and computed tomography revealed a severe C-shaped septal deviation with dorsal nasal asymmetry. The patient underwent open septorhinoplasty with septal cartilage reduction and reconstruction.

Surgical Technique: An open septorhinoplasty approach was performed with elevation of mucoperichondrial flaps, correction of septal deviation while preserving the dorsal and caudal L-strut, cartilage reshaping and grafting, and osteotomies for nasal realignment.

Outcome: Postoperative recovery was uneventful. At one-, three-, and six-month follow-up, the patient demonstrated significant improvement in nasal breathing, resolution of snoring, and satisfactory aesthetic outcome.

Conclusion: Open septorhinoplasty with cartilage reduction is an effective and reliable technique for managing severe septal deviation with associated nasal deformity, providing both functional and aesthetic benefits.

Dehydrated Amniotic Membrane as Adjunctive Therapy for Recurrent Immunological Corneal Ulcer: A Case Report

A. Denial — 2026-03-24

Introduction: Amniotic membrane transplantation has become an established therapeutic approach for ocular surface reconstruction. It is commonly used in persistent epithelial defects, corneal ulcers, chemical burns, and after pterygium surgery. Dehydrated amniotic membrane (DAM) is a processed form of human amniotic tissue that can be stored at room temperature and easily applied in outpatient settings. DAM provides anti-inflammatory, anti-angiogenic, and epithelial regenerative properties. The aim of this report is to highlight the therapeutic role of dehydrated amniotic membrane in the management of recurrent immunological corneal ulcers.

Case Presentation: We report the case of a 68-year-old woman with dermatomyositis treated with systemic corticosteroids, associated with Raynaud’s phenomenon and livedo. She presented with a painful red left eye and decreased visual acuity. Five months earlier, the patient had developed a corneal ulcer in the same eye that healed slowly after intensive medical therapy.

On admission, visual acuity was limited to hand motion perception. Slit-lamp examination revealed a deep marginal corneal ulcer measuring approximately 10 × 5 mm with positive fluorescein staining. Corneal sensitivity was preserved and the Schirmer test measured 20 mm, suggesting reflex tearing. The anterior chamber was well formed and a total white cataract prevented fundus visualization. The contralateral eye showed mild ocular surface disease with diffuse superficial punctate keratitis, tear break-up time of 5 seconds, and Schirmer test of 9 mm.

Initial management included preservative-free lubricating agents and antibiotic prophylaxis. Due to the absence of clinical improvement, a dehydrated amniotic membrane was applied in order to promote corneal epithelial healing.

Complete epithelial healing was observed within 10 days after membrane placement.

Conclusion: Dehydrated amniotic membrane represents a safe and effective adjunctive therapy for immunological corneal ulcers, particularly in settings where access to cryopreserved amniotic membrane is limited.

Incidental Low-Grade Biliary Intraepithelial Neoplasia Following Laparoscopic Cholecystectomy: A Case Report

Anant Pore — 2026-03-28

Biliary intraepithelial neoplasia (BilIN) is a noninvasive precursor lesion that has the potential to progress to cholangiocarcinoma. A 70-year-old hypertensive female presented with complaints of recurrent abdominal pain associated with flatulence. Abdominal ultrasonography revealed cholelithiasis with no evidence of biliary dilatation or mass lesion. Histopathological examination of the cholecystectomy specimen revealed features consistent with low-grade BilIN. Routine histopathological examination is recommended for cholecystectomy patients to catch precancerous lesions in early stages for better patient management with improved outcomes.

Adult Adenoid Hypertrophy Mimicking a Nasopharyngeal Mass: A Diagnostic Challenge

Soumya Kori — 2026-03-28

The adenoids, also known as the nasopharyngeal tonsils, come from lymphoid tissue in the pharyngeal mucosa. They are part of Waldeyer’s ring, which is a circular arrangement of lymphoid tissue. This ring includes the pharyngeal (adenoid), palatine, lingual, and tubal tonsils. These tonsils are located at the entrance of the aerodigestive tract.

They play an important role in mucosal immunity during early life by trapping inhaled pathogens and helping with antigen presentation. This contributes to both humoral and cell-mediated immune responses.

Adenoid hypertrophy is predominantly a pediatric condition and rarely persists into adulthood due to physiological involution after puberty. When present in adults, it may clinically and radiologically mimic various nasopharyngeal pathologies, including malignancy.

We report a case of a 51-year-old woman presenting with long-standing left-sided nasal obstruction. She also presented with snoring, mouth breathing and headache. Clinical examination revealed a deviated nasal septum and a suspected nasopharyngeal mass. Radiological evaluation demonstrated a soft tissue lesion in the nasopharynx, raising suspicion of a neoplasm, for which a biopsy was performed.

Histopathological examination revealed respiratory epithelium overlying dense lymphoid tissue with well-formed follicles and prominent germinal centers, consistent with reactive lymphoid hyperplasia, without evidence of atypia or malignancy.

This case highlights the importance of considering adenoid hypertrophy in adult nasopharyngeal masses and underscores the essential role of histopathology in ensuring accurate diagnosis and appropriate management.

Pediatric Primary Parotid Tuberculosis: Case Report and Literature Review

Meryem Mourai — 2026-04-03

Tuberculosis (TB) is an airborne infection disease, caused by Mycobacterium tuberculosis or Mycobacterium bovis considered among the leading causes of mortality in India. The present case describes a rare case of primary parotid gland tuberculosis in a 12-year-old child, and highlights the diagnostic challenges associated with this condition. A 12-year-old child with no significant medical history presented with a progressively enlarging, painless swelling of the right parotid region. Physical examination revealed a soft, mobile mass measuring approximately 3 cm, with no facial nerve involvement or intraoral purulent discharge. MRI suggested a cystic lesion, initially favouring a pleomorphic adenoma. Laboratory investigations were normal except for a mildly elevated erythrocyte sedimentation rate. The patient underwent a conservative parotidectomy, and histopathological analysis of the specimen revealed epithelioid and giant cell granulomas with caseous necrosis, confirming tuberculosis. Antituberculous therapy was administered for 6 months. Parotid tuberculosis is extremely rare, especially in children, and may mimic benign or malignant parotid tumours. Clinical, radiological, and biological findings are often nonspecific, making the diagnosis challenging. Fine-needle aspiration cytology and PCR-based methods can aid diagnosis and reduce unnecessary surgery, but histopathology remains the gold standard. Management is primarily medical, with prolonged antituberculous therapy leading to favourable outcomes. Although exceptionally rare in children, primary parotid tuberculosis should be considered in the differential diagnosis of parotid masses, particularly in endemic regions. It is recommended that early recognition and appropriate medical management can prevent unnecessary surgery and ensure rapid recovery.

Fibrolipomatous Hamartoma of the Palm: A Diagnostic Mimicker of Soft Tissue Tumors

Soumya Kori — 2026-04-04

Fibrolipomatous hamartoma, also known as Neurolipoma or lipomatosis of nerve, is a rare, non-cancerous growth that happens when fibro-fatty tissue grows around peripheral nerves. It most often affects the median nerve and may show up as a soft tissue swelling that slowly gets bigger and is linked to symptoms of compression. It can be hard to make a diagnosis before surgery, especially with cytology, because the signs are similar to those of other benign spindle cell lesions. We describe a case involving a 48-year-old male who exhibited a 3-month history of swelling in the right hand, accompanied by numbness and tenderness. A clinical exam showed a swelling. Fine needle aspiration cytology revealed aggregates of small, benign spindle cells, indicating a diagnosis of benign spindle cell lesion. Histopathological analysis of the excised specimen demonstrated fibro-fatty tissue containing distinctive nerve bundles situated within fibrocollagenous stroma and adipose tissue, indicative of Fibrolipomatous hamartoma. The case is presented due to its rarity, diagnostic challenges in cytology, and distinctive histopathological characteristics.

A case report on Delayed Presentation of Traumatic Diaphragmatic Hernia

Kaustubh Kulkarni — 2026-04-04

Aims: This case report highlights traumatic diaphragmatic hernias, their delayed presentations, and successful laparoscopic repair.

Case Presentation: We report a 36-year-old man with delayed presentation of TDH, 18 months after blunt thoraco-abdominal trauma. He presented with acute intestinal obstruction. Imaging revealed a 30 × 30 mm left diaphragmatic defect with herniation of the splenic flexure and omentum, complicated by obstruction and perforation. Laparoscopic exploration demonstrated a 3.5-cm defect with ischaemic colon and two perforations. The defect was repaired with non-absorbable sutures, and the ischaemic colon was resected with creation of a double-barrel colostomy. The postoperative course was uneventful, and the patient was discharged with a planned colostomy closure done at 8 weeks.

Discussion: Traumatic diaphragmatic hernia (TDH) in adults is uncommon and often under-diagnosed, with delayed presentations posing a significant risk of morbidity and mortality. Early surgical repair is advocated in most cases. Primary repair of the defect is sufficient, and in select cases, a mesh repair is preferred. With the advent of minimal access surgery, laparoscopic repairs are now the standard of care.

Conclusion: In stable patients, laparoscopic repair of TDH is a safe and effective approach, combining diagnostic accuracy with therapeutic benefit. Early recognition and intervention are crucial to prevent complications.

Pediatric Intra-Abdominal Lymphoma Mimicking Surgical Abdominal Mass: Imaging-Pathology Correlation in a 13-Year-Old Male

K. N. Harshath Kumar — 2026-04-04

“Pediatric intra-abdominal lymphoma is a rare malignancy, yet it remains a clinically valuable entity with vague symptomatology, resulting in delayed diagnosis”. Such early diagnosis is essential for timely therapy and better prognosis. The authors report a case of a 13-year-old boy who presented with constitutional symptoms and abdominal pathology. A Contrast-enhanced computed tomography (CECT) scan showed conglomerate nodal masses with vascular encasement and the typical sandwich sign. The positron emission tomography-computed tomography (PET-CT) showed an “uptake” intensity relating to the metabolism, indicating an active lymphomatous component. Histopathology examination revealed lymphoma. The use of multimodality imaging, especially PET-CT is highlighted in such cases in the context of disease characterization, staging, and treatment planning. The report provides certain characteristic points that would aid clinicians in the early recognition of pediatric abdominal lymphoma based on imaging findings with various modalities.

Unexpected Congenital Gallbladder Malformation Discovered During Laparoscopic Cholecystectomy: A Case Report

I. Bouali — 2026-04-06

Background: Congenital anomalies of the gallbladder are rare developmental variations that may affect its size, shape, number, or anatomical position. Most remain clinically silent and are detected incidentally during imaging or surgery. Despite their rarity, these anomalies are of considerable surgical importance because they may complicate laparoscopic cholecystectomy and increase the risk of biliary injury if not recognized intraoperatively.

Case Presentation: We report the case of a 19-year-old woman with no significant past medical history who presented with intermittent right upper quadrant abdominal pain associated with vomiting for one month. She had no fever, jaundice, or bowel disturbances. Laboratory investigations revealed mild hepatocellular cytolysis without cholestasis. Abdominal ultrasonography demonstrated a multilithiasic gallbladder without signs of acute cholecystitis or bile duct dilatation. The patient underwent elective laparoscopic cholecystectomy. Intraoperatively, unusual resistance was encountered during gallbladder extraction, prompting the use of a retrograde dissection approach and enlargement of the trocar site to facilitate specimen retrieval. Macroscopic examination of the opened specimen revealed an unexpected congenital morphological anomaly characterized by focal thickening of the gallbladder fundus associated with luminal narrowing, resulting in a pear-shaped configuration. The postoperative course was uneventful, and the patient recovered without complications.

Conclusion: Congenital gallbladder anomalies, although uncommon, are clinically relevant because they may be encountered unexpectedly during routine biliary surgery. Preoperative imaging may fail to identify subtle morphological variations. Surgeons should therefore maintain a high index of suspicion when operative findings appear atypical. Careful dissection, strict adherence to the critical view of safety, and readiness to modify the operative strategy are essential to ensure safe management and avoid bile duct injury.

A Case Report on Gallstone Ileus: Rare Cause of Small Bowel Obstruction in an Elderly Patient

Ethem Bilgiç — 2026-04-09

Gallstone ileus is an uncommon but clinically significant cause of mechanical small bowel obstruction, particularly among elderly patients. It accounts for approximately 1–4% of all small bowel obstructions, yet may represent up to 25% of non-strangulated obstructions in individuals over 65 years of age. We report the case of a 68-year-old female who presented with features of intestinal obstruction secondary to gallstone impaction. Computed tomography revealed pneumobilia, a cholecystoduodenal fistula, and small small bowel obstruction consistent with gallstone ileus. The patient underwent timely surgical intervention with enterolithotomy, resulting in an uneventful recovery. This case highlights the importance of early diagnosis, appropriate surgical decision-making, and individualized management strategies in elderly patients.

Laparoscopic Management of Small Bowel Perforation Following Blunt Abdominal Trauma from a Steering Wheel

Sudhir S. Jatal — 2026-04-10

Steering wheel impact during a motor vehicle accident can cause blunt abdominal trauma, which may lead to small bowel perforation. This injury typically occurs due to rapid compression, shearing forces, or increased intraluminal pressure, creating a “blow-out” effect or crushing force that pins the bowel against the vertebral column. The jejunum and proximal ileum are the most commonly injured sites because of their relatively fixed anatomical position. Early evaluation with CT scan of the abdomen is essential to detect free intraperitoneal air or fluid, which may indicate bowel perforation. However, isolated small bowel injuries following blunt steering wheel trauma are rare. Laparoscopic management of small bowel perforation resulting from steering wheel injury is considered a safe, effective, and both diagnostic and therapeutic approach in hemodynamically stable patients. Surgical procedures may include primary repair of the perforation or resection of the affected bowel segment, performed using intracorporeal suturing or laparoscopic-assisted extracorporeal techniques.

We report a rare case of small bowel perforation in a 35-year-old man who sustained blunt abdominal trauma following a tractor wheel injury to the abdomen. The diagnosis was made by X-ray chest and abdomen and CT scan of the abdomen showing free intraperitoneal air and fluid, and the patient was successfully managed laparoscopically. The patient had an uneventful postoperative recovery and was discharged on the fifth postoperative day in stable condition.

The study therefore concluded that, compared with open surgery, laparoscopic management is associated with less postoperative pain, faster recovery, shorter hospital stays, and potentially lower morbidity.

Periampullary Brunner’s Gland Hyperplasia Mimicking Carcinoma: A Diagnostic Dilemma for Surgeons and Review of Current Evidence

Ripan Miglani — 2026-04-10

Brunner's gland hyperplasia is a rare benign proliferative lesion of the duodenal submucosa that occasionally presents as a periampullary mass with biliary obstruction, closely mimicking carcinoma. We report a 70-year-old woman who presented with recurrent upper abdominal pain without jaundice, weight loss or gastrointestinal bleeding. Ultrasonography showed marked dilatation of the common bile duct with intrahepatic biliary radicle dilatation. Cross-sectional imaging with contrast-enhanced computed tomography and magnetic resonance cholangiopancreatography revealed a heterogeneously enhancing periampullary lesion measuring approximately 10 × 10 × 14 mm involving the distal common bile duct, ampulla and medial duodenal wall. The pancreatic duct measured approximately 4 mm producing a classical double-duct sign strongly suggestive of periampullary carcinoma. In view of these findings, the patient underwent pancreaticoduodenectomy. Histopathological examination of the resected specimen revealed Brunner’s gland hyperplasia without dysplasia or malignancy. Although nearly 200 cases of Brunner’s gland hyperplasia have been reported worldwide, periampullary localisation producing biliary obstruction and a double-duct sign is exceptionally uncommon and may closely mimic periampullary carcinoma, occasionally leading to radical surgery. This case highlights an important diagnostic pitfall and discusses imaging clues that may help differentiate benign periampullary lesions from malignancy.

Double Cystic Artery Arising from the Right Hepatic Artery During Laparoscopic Cholecystectomy: A Case Report

Ethem Bilgiç — 2026-04-10

Anatomical variations of the cystic artery are frequently encountered during laparoscopic cholecystectomy and, if not properly identified, may increase the risk of intraoperative complications. Among these, the occurrence of a double cystic artery is an uncommon yet clinically significant variation that warrants careful recognition during surgical procedures. We report the case of a 52-year-old female patient who underwent elective laparoscopic cholecystectomy for symptomatic cholelithiasis. Preoperative ultrasonography revealed multiple millimetric gallstones within the gallbladder, and laboratory findings were within normal limits. During dissection of Calot’s triangle, two distinct cystic arteries originating from the right hepatic artery were identified. After achieving the critical view of safety, both arteries were individually clipped with two clips and divided. The procedure was completed laparoscopically without complications. The patient was discharged on postoperative day one, and histopathological examination revealed chronic cholecystitis. Awareness of cystic artery variations is essential to prevent intraoperative bleeding and ensure safe laparoscopic cholecystectomy.

Speck in the Sigmoid Epiploicae: A Case Report

Jithin T. Chand — 2026-04-15

This case report discusses about a 42-year-old lady, who presented to our outpatient clinic with a right inguinal solitary swelling for a duration of 45 days. She had a prior history of a dysplastic naevus over the suprapubic region for which she underwent a wide local excision 16 months prior to this presentation. Cutaneous melanoma metastasizing to the colon has an incidence of < 1%. Stage IV melanoma has a poor prognosis. But if the metastasis is limited and resectable, it reduces the tumor burden and improves the efficacy of immunotherapy, thereby prolonging the survival. In our case, the metastasis was to the appendices epiploicae of the sigmoid colon, which was not picked up on imaging. The present case highlights the importance of considering surgical intervention in patients with atypical and limited metastatic disease. Given the rarity of metastasis to the appendices epiploicae, preoperative diagnosis is inherently challenging. Imaging modalities such as contrast-enhanced CT and PET-CT may fail to detect small peritoneal or subserosal lesions, particularly in the absence of significant metabolic activity. Consequently, many such lesions are identified incidentally during surgical exploration or histopathological examination. We are possibly presenting the first case in literature where cutaneous melanoma has spread to the appendices epiploicae.

Trapped in the Cocoon: A Rare Case of Small Bowel Obstruction

Pimchanok Roongwarasopit — 2026-04-16

Introduction: Abdominal cocoon syndrome (ACS), or encapsulating peritoneal sclerosis (EPS), is a rare cause of small bowel obstruction characterized by fibrous encapsulation of the intestines. Its nonspecific clinical and radiological presentation makes it easily overlooked and delayed diagnosis can lead to significant worse patient outcomes. This case report aims to raise clinical awareness of ACS and underscore the importance of maintaining a high index of suspicion in patients presenting with small bowel obstruction.

Case Presentation: A 58-year-old male presented with clinical signs of complete small bowel obstruction. CT imaging revealed clustered small bowel loops within a sac-like structure. Exploratory laparotomy, performed for abdominal cocoon with small bowel obstruction, demonstrated that the small bowel was encased in a thick fibrocollagenous membrane with dense adhesions, without evidence of ischemia. Adhesiolysis was successfully performed to release the trapped bowel. Histopathology confirmed EPS without evidence of malignancy or tuberculosis. The patient remained asymptomatic at one-year follow-up.

Discussion: Preoperative diagnosis of the ACS remains challenging due to its uncertain clinical and radiological presentation. Although CT imaging may suggest the condition through characteristic findings, definitive diagnosis is typically made intraoperatively. Surgical excision of the fibrous membrane with meticulous adhesiolysis remains the treatment of choice, as non-operative management is rarely successful. Timely surgical intervention is key to preserve bowel viability and improve patient’s outcomes. Histopathologic evaluation is essential for diagnosis with subsequent management guided by the histopathologic findings.

Conclusion: Abdominal cocoon syndrome (ACS) is a rare but clinically significant cause of small bowel obstruction. Its characteristic findings from CT imaging plays a crucial role in preoperative diagnosis while early recognition and prompt surgical intervention with meticulous adhesiolysis resulted in complete resolution of obstruction and satisfactory outcomes.

Bilobed Gallbladder Presenting as a Double Hartmann’s Pouch: A Rare Anatomical Variant During Laparoscopic Cholecystectomy

Himanshu Agrawal — 2026-04-17

Anatomical variations of the gallbladder may increase the risk of biliary injury during cholecystectomy if unrecognized. We report a rare intraoperative finding of a bilobed gallbladder presenting as a double Hartmann’s pouch in a patient undergoing laparoscopic cholecystectomy for symptomatic cholelithiasis. Preoperative ultrasonography did not reveal this anomaly. Intraoperatively, two prominent pouch-like outpouchings were noted at the gallbladder neck. Careful dissection of Calot’s triangle enabled clear delineation of anatomy, revealing a single cystic duct and artery. The critical view of safety was achieved prior to division of structures. The procedure was completed laparoscopically without complications. This case highlights the importance of recognizing atypical gallbladder morphology and adhering to safe surgical principles to prevent bile duct injury.

Segmental Gangrene in an Hourglass Gallbladder: A Rare Morphological Variant with Surgical Implications

Ripan Miglani — 2026-04-18

Background: Hourglass gallbladder is a rare anatomical variant characterized by a constriction dividing the gallbladder into two compartments. It may be congenital or acquired and is frequently associated with chronic inflammation. Compartmentalized pathology within such a variant is exceedingly uncommon.

Case Presentation: A 70-year-old male presented with a one-day history of right upper quadrant pain, fever, and vomiting. Ultrasonography suggested acute cholecystitis with a bilobed gallbladder. Magnetic resonance imaging demonstrated an hourglass configuration with a constricted mid-body separating the fundal and neck compartments.

Management and Outcome: The patient underwent laparoscopic cholecystectomy. Intraoperatively, gangrene was confined to the fundal compartment, while the distal segment remained viable. The critical view of safety was achieved, and the procedure was completed laparoscopically without complications. Histopathological examination confirmed segmental gangrenous cholecystitis.

Conclusion: Selective segmental gangrene in an hourglass gallbladder is an extremely rare entity and poses diagnostic as well as intraoperative challenges. This case underscores the importance of recognizing anatomical variants, correlating preoperative imaging with intraoperative findings, and adhering to meticulous surgical technique to ensure safe outcomes.

Sternal Tuberculosis: A Rare Presentation of Extra-Pulmonary Tuberculosis

An Najjah Tanmami — 2026-04-20

Introduction: Sternal tuberculosis (TB) is an exceedingly rare entity, especially in post-operative patients following cardiac surgery. Its clinical presentation often mimics chronic pyogenic infections, leading to delayed diagnosis and inappropriate management.

Aim: To report a rare case of sternal tuberculosis and highlight its clinical and radiological features for early recognition and diagnosis.

Case Report: This case report discusses a case of sternal TB in a 76-year-old male with multiple comorbidities who developed a persistent sinus tract over the sternum years after coronary artery bypass grafting (CABG). The diagnosis was confirmed by acid-fast bacilli (AFB) staining and Mycobacterium culture and sensitivity (C&S) of pus aspirated from the lesion. Prompt initiation of anti-tubercular therapy (ATT) led to improvement of the infection without major surgical intervention.

Conclusion: This case underlines the importance of maintaining a high index of suspicion for TB in chronic sternal wound infections, particularly in high-risk patients. This case also illustrates a rare but important differential diagnosis in post-surgical wound infections—sternal tuberculosis. In high-risk patients with immunosuppression or persistent sternal sinus, TB should be considered, even in the absence of systemic symptoms.