Small-bowel volvulus caused by a congenital band is an uncommon etiology of small-bowel obstruction in adults, particularly in young patients without prior abdominal surgery. We report the case of a 20-year-old woman presenting with acute small-bowel obstruction. Contrast-enhanced computed tomography (CT) demonstrated dilated proximal bowel loops with a focal transition point, associated with a beak sign, fatty notch sign, and mesenteric whirl sign, suggestive of volvulus due to a single obstructing band, without signs of bowel ischemia. Surgical exploration confirmed a congenital band between two ileal loops, which was successfully divided with an uneventful postoperative outcome. This case highlights the diagnostic value of recognizing specific CT features that may suggest congenital bands and facilitate timely surgical management.
Retropharyngeal infection and emphysema are rare clinical entities, with only eight reported cases in the literature. One of the uncommon risk factors is a recent history of adenotonsillectomy, which may be associated with an increased risk of retropharyngeal infection. Thereby, we report a case of a 2-year-old female who presented with a high-grade fever and neck stiffness following adenotonsillectomy. Neck X-ray and computed tomography scan of the neck confirmed the diagnosis of retropharyngeal infection with emphysema. The patient was effectively managed with an intravenous course of dual broad-spectrum antibiotics. Early identification and prompt management are essential to avoid serious complications. The current case demonstrates a rare complication with a delayed onset compared to the previously reported cases, and it further emphasizes the importance of the high index of clinical suspicion to diagnose and promptly manage similar cases.
Primary retroperitoneal mucinous cystadenoma (PRMC) is a rare cystic tumor with unclear etiology and nonspecific clinical and radiological features, making preoperative diagnosis difficult. Due to its rarity, the optimal surgical management remains uncertain. We report a 60-year-old woman presenting with diffuse, colicky abdominal pain. Computed tomography and magnetic resonance imaging revealed a large, well-defined cystic mass in the right retroperitoneum measuring 12 × 9 × 10 cm, without evidence of local invasion. The patient underwent successful laparoscopic excision. Histopathological examination demonstrated a unilocular cyst lined by non-atypical mucinous epithelium without stromal invasion, confirming PRMC. The postoperative course was uneventful, and no recurrence was observed during follow-up. PRMC should be included in the differential diagnosis of retroperitoneal cystic masses. Histopathological evaluation is essential for definitive diagnosis. Complete surgical excision remains the treatment of choice, while laparoscopy may represent a safe and effective approach in selected patients when careful operative technique is applied.
We report a rare case of cecal volvulus around Ladd's band in a 45-year-old woman with previously undetected intestinal malrotation despite two prior laparotomies. The patient presented with subocclusive bowel syndrome and underwent emergency surgical exploration after computed tomography demonstrated cecal volvulus with pneumatosis intestinalis and intraperitoneal fluid. Intraoperative findings revealed incomplete common mesentery with small bowel positioned entirely on the right and colon on the left. Remarkably, the cecum had volvulated around a Ladd's band serving as the primary torsion axis, rather than the typical mesenteric pedicle. Right hemicolectomy with ileocolic anastomosis was performed. This case highlights several important teaching points: the potential for congenital anomalies to escape detection during prior surgeries, the atypical mechanism of volvulus around Ladd's band, diagnostic challenges despite advanced imaging, and ongoing controversies in surgical management of adult malrotation presenting with acute complications.
Caroli disease is characterized by segmental, non-obstructive dilatation of the intrahepatic bile ducts, leading to bile stasis, recurrent cholangitis, hepatolithiasis, and an increased risk of cholangiocarcinoma. Caroli's disease, together with hepatic fibrosis, is termed Caroli's syndrome, which may lead to portal hypertension. Caroli's disease often requires treatment in symptomatic patients. Symptoms include recurrent cholangitis due to intrahepatic stones in dilated ducts or cirrhosis due to fibrosis. Liver transplantation remains the definitive treatment for diffuse disease. However, owing to organ shortages and long waiting lists, liver resection is an alternative for localized disease. Here, we present a rare case of an 18-year-old male with symptomatic, right-lobe-predominant Caroli's disease and hepatolithiasis who underwent surgical resection (right hepatectomy, stone extraction from exposed ducts at the resection margin, and intrahepatic-jejunostomy) with symptom resolution. This case highlights the role of liver resection in localized disease and reinforces the importance of individualized interventions in resource-limited settings.
