Introduction: A Marjolin’s ulcer (MU) is a rare and aggressive cutaneous malignancy arising within chronic wounds, most commonly burn scars and chronic ulcers. Development within a chronic laparotomy wound is exceptionally uncommon. Case Report: A 65-year-old man was referred for management of a chronic abdominal wall wound with recurrent enterocutaneous fistula (ECF). The wound originated following multiple laparotomies for a gunshot injury more than 30 years earlier and had remained persistently open despite conservative management. Progressive wound deterioration prompted biopsy, demonstrating moderately to poorly differentiated squamous cell carcinoma (SCC) consistent with an MU. Staging computed tomography (CT) and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) showed extensive abdominal wall involvement without regional or distant metastases. The patient underwent radical resection of the abdominal wall tumor, with a large elliptical incision to incorporate the ECF. Approximately 25 cm of small bowel was found adherent to the tumor, which was removed en bloc. The large defect was reconstructed and reinforced with fully resorbable monofilament mesh in an in-lay fashion. Histopathology confirmed a 115 mm moderate-to-poorly differentiated squamous cell carcinoma, invading through abdominal wall and into the wall of the adjacent small bowel with macroscopically and microscopically clear resection margins. There was no perineural invasion, with equivocal lymphatic spread. His postoperative course was complicated by wound breakdown and development of a high-output enteroatmospheric fistula requiring prolonged nutritional and medical support. The patient was discussed at the cancer multidisciplinary meeting, with a consensus decision not to offer adjuvant therapies due to histopathological clear margins and the absence of metastatic disease. Despite this, local recurrence and a large hepatic metastasis developed eight months later. Immunotherapy was commenced. However, the patient deteriorated and died after one month. Conclusion: Marjolin’s ulcer arising within a chronic laparotomy wound is exceedingly rare. This case highlights the malignant potential of longstanding abdominal wounds, particularly in the setting of chronic inflammation and ECF. Early biopsy of suspicious wound changes and definitive management of chronic wounds are essential, as MU demonstrates aggressive biological behavior with high rates of recurrence and metastasis despite apparently curative resection.
Introduction: Isolated fallopian tube torsion (IFTT) is the rotation of a fallopian tube without involvement of the ovary or adjacent vascular structures. It is a profoundly rare gynecologic emergency. Diagnosis is challenging because presenting symptoms and imaging findings are nonspecific and may be even more challenging during pregnancy due to the gravid uterus and attributing the pain to an obstetrical origin. Case Report: We describe a case of a 20-year-old G1P0 patient who presented at 36 weeks and 6 days of gestation with acute right lower quadrant abdominal pain. Abdominal ultrasound was non-diagnostic, and abdominal magnetic resonance imaging demonstrated a nonspecific loculated fluid in the right lower quadrant. Fetal status was reactive and reassuring. Due to persistence of the pain despite administration of opioids and high levels of suspicion for adnexal torsion, the patient had a primary cesarean section and pelvic exploration that revealed a purple-black, edematous, necrotic right hydrosalpinx twisted more than six times. The patient had a concurrent salpingectomy. She was discharged from the hospital on postoperative day 2 with a healthy newborn. Conclusion: This case highlights the importance of maintaining a high index of suspicion for IFTT in pregnant patients with severe, narcotic-refractory abdominal pain. Early recognition and prompt intervention are critical to optimize pregnancy outcomes.
Acute appendicitis is a common, usually benign inflammatory process of the appendix. It is typically treated with antibiotics or surgery. Transection of the appendix during surgery can be performed using a stapler, endoloops, or clips. We present the case of an 87-year-old male with acute appendicitis on chronic steroids who failed conservative management with antibiotics. He was treated with laparoscopic appendectomy using a powered stapler. We believe this is an unusual case reporting staple line failure after laparoscopic appendectomy in a patient with an intact staple line through viable tissue at the conclusion of surgery.
Introduction: Splenic artery aneurysms (SAAs) are a rare pathology of the visceral vessels with a prevalence of less than 1%. While usually silent, spontaneous rupture represents a surgical emergency. This case report details the successful multidisciplinary management of an acute, massive intragastric rupture of a 9.5 cm giant SAA in a previously healthy 39-year-old male, emphasizing the diagnostic challenges and critical therapeutic transitions. Case Report: A 39-year-old male experienced a sudden syncopal episode while on duty. He developed massive hematemesis, and an emergency upper gastrointestinal endoscopy revealed an ulcerated mass at the fundus of the stomach with active massive hemorrhage. Initial targeted embolization attempts failed to control the proximal inflow, and the patient rapidly deteriorated into severe hemorrhagic shock. Intraoperatively, a giant aneurysm was identified at the origin of the splenic artery, which had directly eroded through the posterior gastric wall into the gastric lumen. The splenic artery was rapidly dissected and ligated, the aneurysm was excised, the posterior gastric wall defect underwent primary repair, and a splenectomy was performed. Measuring 9.5 cm on pathological examination, the case presented herein represents the largest recorded splenic artery aneurysm presenting with an acute intragastric rupture in the medical literature. Conclusion: Acute intragastric rupture of a giant splenic artery aneurysm is a life-threatening emergency that mimics routine upper gastrointestinal bleeding. When endovascular interventions fail or hemodynamic instability worsens, immediate open surgical control is definitive. This case highlights the critical importance of maintaining a high index of suspicion and utilizing rapid, multidisciplinary coordination between interventional radiology, surgery, and critical care.
Primary Sjogren’s syndrome (pSS) is an autoimmune disorder primarily affecting the exocrine glands, with systemic involvement being increasingly recognized. Presentation with gastrointestinal involvement is a rare presentation of the disease. We report the case of a 72-year-old woman who presented with cholestatic jaundice, fever, and acute pancreatitis. During hospital stay, she also developed pulmonary involvement and an active urinary sediment, which significantly complicated the diagnosis. Serological testing revealed a strongly positive antinuclear antibody (ANA) titer along with anti-Smith antibodies, raising a strong suspicion for systemic lupus erythematosus (SLE). However, renal biopsy demonstrated a plasma cell predominant tubulointerstitial nephritis without immune complex deposition. This pattern effectively ruled out lupus nephritis and established the diagnosis of primary Sjogren’s syndrome. This case highlights the diagnostic challenge posed by overlapping autoimmune features and reinforces the importance of tissue biopsy in differentiating autoimmune mimics. Early recognition of atypical extra-glandular manifestations of pSS is essential for appropriate management and improved outcomes.
