Bouveret syndrome is a rare condition that occurs due to migration of a gallstone into the duodenum through fistula formation between the gallbladder and duodenum, leading to gastric outlet obstruction. Mirizzi’s syndrome is a rare condition where cholelithiasis leads to external compression or even erosion into the common hepatic duct (CHD). Here, we present a unique case that showcases severe presentations of both phenomena in a male presenting with sudden‐onset pain and vomiting for 3 h. The decision for a one‐stage approach of fistula takedown, cholecystectomy, duodenectomy, Roux‐en‐Y, and hepaticojejunostomy was made given the patient’s young age and good health status after failure of stone retrieval through esophagogastroduodenoscopy (EGD). Beyond anatomic necessity, simultaneous stone clearance and cholecystectomy avoid the recurrent lithiasis, interval cholecystitis, and ongoing erosion into adjacent structures associated with a staged approach. This case underscores that operative planning should be guided by anatomic complexity rather than age or ASA class alone, provided patient selection is appropriate.
Diversion colitis (DC) is an inflammatory condition that develops in a bowel segment excluded from the fecal stream after colostomy or ileostomy. We report a case of symptomatic DC successfully treated with synbiotic stimulation via the efferent limb of an ileostomy. A 75‐year‐old man underwent endoscopic mucosal resection (EMR) for a transverse colon polyp. During the procedure, thermal injury caused a perforation at the splenic flexure, necessitating emergency partial resection of the transverse colon, including the perforated site, and creation of an ileostomy. Two weeks after surgery, the patient developed recurrent hematochezia. Colonoscopy revealed severe mucosal atrophy and friability predominantly in the excluded right colon, leading to a diagnosis of DC. Because the inflammatory changes were more prominent in the right colon, synbiotic stimulation was administered anterogradely via the efferent limb of the stoma. Follow‐up colonoscopy performed 1 month later demonstrated marked improvement in the mucosal findings. The patient subsequently underwent stoma closure, and the postoperative course was uneventful. This case suggests that synbiotic stimulation via the efferent limb may be an effective treatment option for symptomatic DC and may improve the condition of the excluded bowel before stoma closure.
Neurotrophic tyrosine receptor kinase‐rearranged spindle cell neoplasms (NTRK‐SCNs) are rare mesenchymal tumours defined by oncogenic rearrangements involving NTRK genes. NTRK fusions are exceedingly rare in the gastrointestinal tract and can closely resemble wild‐type gastrointestinal stromal tumours (GISTs), posing a diagnostic challenge in the absence of molecular testing. We report a case of a 36‐year‐old woman with a distal gastric mass initially suspected to be a GIST. Surgical resection revealed a spindle cell tumour with low mitotic activity and perivascular hyalinisation. Immunohistochemistry demonstrated expression of CD34, S100 and pan‐TRK and was negative for KIT/CD117 and DOG1. Molecular testing confirmed an LMNA::NTRK1 fusion, consistent with NTRK‐SCN. This case highlights the importance of considering NTRK‐SCN in KIT/DOG1‐negative gastric spindle cell tumours.
Metastatic osteosarcoma most commonly involves the lungs and typically presents as peripheral pulmonary nodules amenable to limited resection. Endobronchial extension of metastatic osteosarcoma resulting in critical central airway obstruction, however, is rare. We present a woman in her late 60s with a history of distal femoral osteosarcoma treated 15 years earlier who developed progressive respiratory symptoms initially treated as pneumonia. Imaging demonstrated a large right‐sided endobronchial mass causing obstruction of the right mainstem bronchus and impending compromise of the left mainstem bronchus. Urgent flexible bronchoscopy was performed with rigid bronchoscopy and extracorporeal membrane oxygenation available on standby as rescue measures. Tumor debulking using hot snare resection and forceps restored ventilation to the left lung and stabilized the airway. Because of extensive hilar and endobronchial involvement, definitive surgical management required right pneumonectomy via a serratus‐sparing posterolateral thoracotomy. Pathologic examination demonstrated a 14.5‐cm metastatic osteosarcoma originating in the right middle lobe with negative bronchial, vascular, and parenchymal margins and no lymph node involvement. The patient recovered without major complications. This case highlights a rare presentation of metastatic osteosarcoma causing life‐threatening central airway obstruction and demonstrates the importance of multidisciplinary management, bronchoscopic airway stabilization, and definitive surgical resection in carefully selected patients.
Background Peptic ulcer disease (PUD) is rare in children, with complications like perforation being especially uncommon. Malaria, a major health burden in endemic regions, is associated with severe complications, but giant duodenal perforation as a direct consequence is remarkably rare. This report presents a 5‐year‐old girl with a giant duodenal perforation secondary to malaria, highlighting the need for prompt diagnosis and intervention. Case Presentation A 5‐year‐old girl from a malaria‐endemic area presented with fever, vomiting, and diarrhea. Diagnosed with severe malaria, she developed acute abdominal pain and signs of peritonitis. Imaging confirmed duodenal perforation, which was surgically repaired. Postoperative recovery was successful, and Helicobacter pylori infection was ruled out. Conclusion Giant duodenal perforation can occur as a rare complication of severe malaria in children without typical peptic ulcer risk factors. Early recognition and timely surgical and antimalarial treatment are critical to improving outcomes in malaria‐endemic settings.
