Aggressive angiomyxoma and cellular angiofibroma are uncommon mesenchymal tumors. Imaging plays an important role in suggesting their diagnosis and in delineating the extent of the lesion. Additionally, histopathological examination provides the definite diagnosis. An understanding of their histological features and correlating that with the key imaging features on radiology helps in narrowing the differential diagnosis, and thereby aids in management and outcome. We herein present a case of both entities in patients presenting with history of a palpable peri-anal mass. We describe the radiological and histological features of aggressive angiomyxoma and cellular angiofibroma and highlight the similarities and differentiating factors between them.

A 39-year-old female patient who took isotretinoin for severe acne for around six months presented with severe upper abdominal pain, as well as abdominal distention. Initially, she was diagnosed with acute cholecystitis due to the presence of gallstones on ultrasound. However, additional imaging showed mural thickening of the bowel, for which she underwent further work-up. Laboratory investigations showed raised inflammatory markers along with eosinophilia. Concurrently, bedside paracentesis showed raised levels of eosinophils. The patient underwent an endoscopic assessment, which revealed eosinophilic esophagitis and gastroenteritis likely to be induced by isotretinoin. Following the discontinuation of isotretinoin and the initiation of corticosteroid therapy, the patient's clinical condition improved significantly. The diagnosis of eosinophilic gastrointestinal disorders, though rare, must be kept in mind when patients on long-term isotretinoin treatment or with other risk factors present with symptoms such as dysphagia, abdominal pain, odynophagia, nausea, and vomiting.

Abstract Introduction Perforation due to foreign body ingestion leading to pyogenic liver abscess is an unusual but fatal event. We present a rare case of accidentally ingested toothpick that perforated the duodenum and migrated to the liver causing abscess. Case Presentation A 40-year-old gentleman presented with symptoms and signs of sepsis. He reported having eaten dry fish and chicken with bones 4 days prior to presentation. Abdominal computed tomography (CT) scan revealed hepatic collection containing a linear object in the middle. Non-operative management improved patient’s general condition but an increase in the size of collection lead to operative management. Discussion Usual course of formation of a pyogenic liver abscess is due to ascending cholangitis or infections causing hematogenous spread. Such an event due to a foreign body perforating the gastro-intestinal tract and migrating to liver is rarely seen. Presentation ranges from mild abdominal pain to full blown septicemia. Diagnosis is challenging as patients may present with vague symptoms, or sometimes don’t even remember having ingested an indigestible object. A trial of conservative management can be given to stable patients who improve, but deterioration necessitates surgical intervention. Conclusions Pyogenic liver abscess due to foreign body ingestion leading to intestinal perforation and displacing to liver is seldom encountered, and a toothpick leading to such an event is a very rare event. Patients may improve clinically with non-operative management; definitive management lies in the surgical removal of foreign body.

Appendiceal mucoceles represent abnormal accumulation of mucin in the appendix. They are rare and can be due to neoplastic and nonneoplastic causes, the most common cause being low-grade appendiceal mucinous neoplasm (LAMN), also known as mucinous cystadenoma of the appendix. We present the case of a 48-year-old woman who had complaints of abdominal pain for 2 months. Imaging showed mucocele of the appendix. She was taken for open appendectomy which revealed a huge (16.5 × 7 × 6 cm) mucocele, and histology proved it to be a LAMN with negative margins.

Pilonidal sinus is a common problem encountered in proctology clinics. It has a wide spectrum of clinical picture ranging from a single asymptomatic pit to a more complex disease with multiple sinuses and secondary openings. Hence, the treatment options could range from observation or simple excision to a more radical approach like flap surgeries. Ultrasonographic assessment could help in mapping the extent of the pilonidal sinus. It can also identify whether the sinus is infected or has formed an abscess. With the above-mentioned information provided by the point of care ultrasound, the surgeon can tailor the surgical approach to each individual case and improve the overall outcome. In this article, we are highlighting some examples of cases managed in our proctology unit where ultrasound was done preoperatively and guided the management.

Introduction: Gastrointestinal stromal tumors (GISTs), the specific kit-positive mesenchymal tumors, are rarely found in the anorectum and account for 5% of all GIST cases. Surgical excision remains the main treatment for anorectal GIST. The available techniques include enucleation transanal excision or sometimes an abdominoperineal resection for large or low tumors. Case Study: We present a middle-aged female with a complaint of intermittent rectal pain for 1 year. Diagnostic workup detected a mass in the rectovaginal septum. A transvaginal excision was performed. Final histopathology showed rectal GIST. On regular follow-up visits, there was no detectable recurrence, and her anal pain disappeared completely. Discussion: Colorectal GIST accounts for only 0.1% of all colorectal tumors; this infrequency has led to a controversy in its diagnosis and management. Nevertheless, surgery remains a cornerstone element in the management of rectal GISTs. Different resection methods have been described in the literature, ranging from less-invasive approach such as transanal excision to a more radical one like an abdominoperineal resection. As there is no standard approach, choosing which one to perform depends on the tumor size, its location, and the surgeon’s preference. Conclusion: Transvaginal excision could be considered a safe minimally invasive approach for low-lying rectal GISTs.

COVID-19 is an ongoing pandemic that was identified in December 2019 in Wuhan, China. Patients admitted to the hospital with COVID-19 present with many coagulation abnormalities, precipitating a hypercoagulable state which exposes them to thrombosis for which they receive thromboprophylaxis therapy with enoxaparin. Over the course of this therapy, some patients develop spontaneous bleeding episodes in different regions of the body of varying degrees and sometimes require radiological angioembolisation to control the bleed. This case series sheds light on three patients who were admitted in Rashid Hospital, Dubai, UAE, with COVID-19 and developed spontaneous bleeds. Amongst the three patients, two of them developed retroperitoneal bleed and one patient developed a chest wall haematoma. One of them underwent radiological intervention (angioembolisation), while the other two underwent conservative management and were monitored for haemodynamic changes. There are limited studies demonstrating the correlation between high dose of enoxaparin and bleeding episodes amongst COVID-19 patients. However, we advise the need for further guidelines and data to advocate the relation between enoxaparin and bleeding episodes.

Background: Perianal fistulas can present significant morbidity and detriment to a patient’s quality of life. This study aimed to quantify the incidence of perianal fistulas and attempted to identify any risk factors for their development. Materials and Methods: This retrospective study reviewed all patients who underwent drainage of first-time perianal abscesses in Rashid Hospital from 2014 to 2018. Noncryptoglandular causes of fistula formation were excluded after which incidence and risk factors were investigated. Results and Discussion: A total of 445 records were reviewed of which 131 met the inclusion criteria (103 males and 28 females). The median age of patients was 37 with ranges of 15–85. There was no statistically significant finding relating to gender (p value = 1.00), smoking (p value = 1.00), location of perianal abscess (p value = 0.347), and postoperative antibiotics (p value = 0.694). There was no statistically significant finding relating to patients below or above 40 (p value = 0.846), and logistic regression testing revealed no statistical significance in age relating to development of perianal fistulas. There was a 13.2% increased proportion of nondiabetics to develop perianal fistulas as compared to diabetics (32 vs. 19%), but it was not found to be statistically significant (p value = 0.236). Conclusion: None of the risk factors studied were found to be statistically significant in the development of perianal fistulas after drainage of perianal abscesses and the incidence was found to be 29.8%.

Splenic abscess is an aggressive disease with a non-specific etiology and symptoms that are systemically detrimental. During the current COVID-19 pandemic, there has been a noted rise in the incidence of splenic abscesses. The aim of this article was to explore whether infection with the SARS-CoV-2 virus increases the risk of developing splenic abscesses. We reviewed three cases with SARS-CoV-2 infection who developed splenic abscess. The clinical characteristics, treatment course, management and outcome are reported. We perceived that hypercoagulability status, superimposing infections and immunosuppression were related to SARS-CoV-2 infection. These were common factors in these three observed cases of splenic abscess as a complication related to the new viral pandemic. SARS-CoV-2 infection might be a risk factor in development of splenic abscess. SIMILAR CASES PUBLISHED: To the best of our knowledge only one case similar to our case series was published.

Background: Small bowel obstruction (SBO) is a common surgical condition that leads to emergency admission. Adhesions are the single most common cause for SBO, accounting for 60% of cases. The occurrence of adhesive SBO (ASBO) is higher following specific surgeries including colorectal, high gynaecological and paediatric surgeries. Initially, all patients are treated conservatively, but in case they fail to improve, surgical management is considered. Aim & Objectives: The objective of the study is to assess the number of patients admitted at Rashid Hospital with ASBO and the outcomes of their management. Materials and Methods: A retrospective study was conducted on patients who were admitted with ASBO from April 2017 until December 2019. A total of number of 85 patients who met the inclusion criteria were enrolled in the study. Those with underlying inflammatory bowel disease, abdominal tuberculosis and small bowel tumours were excluded. The outcomes of non-operative management (NOM) in terms of success rate, length of hospital stay and surgical intervention were assessed. Result: A total of 303 records were reviewed, of which 85 met the inclusion criteria (50 males and 35 females). The most common type of previous abdominal surgeries includes lower gastrointestinal (38.8%) and gynaecological surgeries (12.9%). Seventy-eight patients who underwent NOM had a success rate of 77.6% (n = 59) with a mean length of stay (LOS) of 3.5 days. Seventeen patients (22.4%) needed surgical intervention after a mean of 3.5 days. These patients were found to have intra-abdominal bands in 52.9% of the cases (P = 0.191). During the time period set for the study, the recurrence rate of patients who had successful NOM versus those who needed surgical intervention was 12% and 35.3%, respectively (P = 0.061). Sixty per cent of these recurrent cases were treated non-operatively on the second admission to the hospital whereas 40% required surgical intervention. Conclusion: NOM for ASBO has a shorter LOS and a lower recurrence rate as compared to those who required surgical management.

Dermatomyositis (DM) is a rheumatological disorder characterized by proximal myositis and distinctive dermatological manifestations. It can be an isolated clinical syndrome or, in rarer cases, can be the initial presentation for an underlying malignancy as a part of a paraneoplastic syndrome. In this case report, we describe a case of a 51-year-old lady who presented with proximal myopathy, typical DM skin rash, dysphagia, and markedly elevated creatine kinase. She was diagnosed with a seronegative DM and her malignancy screening revealed a mass in the ascending colon. During her hospital course, she also developed microangiopathic hemolytic anemia, another paraneoplastic disorder typically associated with late stages of malignancy, manifested as hemolytic anemia, thrombocytopenia, and low fibrinogen. The patient received intravenous corticosteroids and underwent tumor resection with following resolution of her both rheumatological and hematological manifestation. Unfortunately, due to her general poor health, she developed sepsis and died in the hospital.

Obscure gastrointestinal bleeding (OGIB) accounts for a small percentage of gastrointestinal (GI) bleeding. The underlying etiology includes small bowel lesions such as Meckel’s diverticulum, a differential to be considered in a young adult. Capsule endoscopy and double balloon enteroscopy (DBE) are important imaging modalities used in the evaluation of OGIB. We describe a case of a young adult male who presented with bleeding per rectum. Upper and lower GI endoscopies were negative and the patient was labeled to have OGIB. After further investigations, our patient was finally diagnosed to have Meckel’s diverticulum by DBE, strengthening its diagnostic utility.

Hepatolithiasis (HL) is defined as calculi in the biliary ducts proximal to the joining of the right and left hepatic ducts regardless of the presence of concurrent gallstones in either the gallbladder or common bile duct. Most HL cases are asymptomatic. When patients do present with symptoms, they are usually features of cholangitis. 43 year old Bengali male presented to the emergency department with signs of cholangitis and a past surgical history of recurrent cholangitis and multiple ERCPs. He was febrile with scleral icterus and right upper quadrant abdominal tenderness with a positive Murphy's sign. His labs showed and elevated white blood cell count, alkaline phosphatase, total bilirubin, and C-reactive protein. Computed tomography of the abdomen revealed multiple intrahepatic stones occluding the left hepatic biliary duct causing proximal dilation of the hepatic duct [Figure 1] and [Figure 2]. The patient was diagnosed with acute ascending cholangitis and a left hepatectomy was done. The post-operative period was uneventful. Hepatolithiasis is a rare disease found mostly in East Asia. The gold standard for its diagnosis is ERCP and PTC. The current options for treating HL include non-surgical endoscopic approaches and hepatectomy. Indications for its surgical management include presence of stones in one lobe (especially left-sided), multiple large stones that cannot be treated by other methods, complications secondary to cholangitis and suspicion of cholangiocarcinoma.

INTRODUCTION:Superior mesenteric artery (SMA) syndrome or what is called Wiklie's syndrome is one of the rare causes of small bowel obstruction. Its exact incidence is not known. It is due to decrease in Aortomesenteric angle. CASE PRESENTATION:A thirty-Four-year old male patient presented to our accident and emergency (department) with 3days history of epigastric pain, which was not radiating anywhere. It had no aggravating or relieving factors. Patient complained of repeated attack of vomiting as well. Contrast enhanced Computed tomography (CT) showed duodenal obstruction caused by superior mesenteric artery compression on 3rd part of duodenum. DISCUSSION:Superior mesenteric artery syndrome (SMA) is one of the rare causes of small bowel obstruction. Incidence of superior mesenteric artery syndrome reported in literature is ranging from 0.1 to 0.3%. The most common cause is significant weight loss which leads to loss of retroperitoneal fat. Treatment usually is conservative but surgical intervention should be considered if that failed. CONCLUSION:Superior mesenteric artery syndrome is a rare cause of intestinal obstruction but should be kept in mind. Persistent vomiting after history of weight loss should raise the suspicion of this diagnosis. Upper GI endoscopy may be necessary to exclude mechanical causes of duodenal obstruction. Contrast enhanced CT scan is useful in the diagnosis of superior mesenteric artery syndrome and can provide diagnostic information.

INTRODUCTION: Meckel's diverticulum is the most common anomaly of the gastrointestinal tract, occurring in 1-3% of the general population. The most common complication of Meckel's diverticulum is intestinal obstruction. In this report, we describe a rare cause of intestinal obstruction due to Meckel's; the phytobezoar. After thorough literature review, the authors found about ten individual reports of the same topic. In all these cases, diagnosis was established intra-operatively.CASE PRESENTATION: A forty-seven-year old male presented to the emergency department with a one-day history of abdominal pain associated with vomiting and constipation. Physical examination diagnostic tests revealed features of intestinal obstruction.DISCUSSION: The lifetime risk of complications in patients with a Meckel'sdiverticulum is usually small and occurs only in up to 4%. In adults' intestinal obstruction is the most common complication (40%).CONCLUSION: Complicated Meckel's diverticulum can have different clinical presentations and can cause bowel obstruction. An association with bezoars impaction is possible and it should be suspected in adult patients presenting with bowel obstruction of unknown causes especially those with high vegetarian diet. (C) 2016 The Authors. Published by Elsevier Ltd on behalf of US Publishing Group Ltd. This is an open access article under the CC BY-NC-ND license

The historical publication by Stone and Fabian (Stone HH, Fabian TC. Management of perforating colon trauma: randomization between primary closure and exteriorization. Ann Surg 1979; 190:430–6) has modernized the management of colonic injuries, ending the once ongoing debate following publication by Ogilvie (Ogilvie WH. Surgical lessons of war applied to civil practice. Br Med J 1945; 1:619–23). However, the recent introduction and popularity of damage control laparotomy has revived the debate on the safety of delayed primary repair for colonic injuries. As a tertiary referral trauma centre, Rashid Hospital, Dubai, frequently receives polytrauma patients with associated abdominal trauma requiring damage control laparotomies. The aim of this article is to review our experience of colonic injuries to find out if delayed primary repair has a place in practice and issues regarding its safety.

INTRODUCTION:Intramural jejunal hematoma is a very rare condition with only few cases reported in the literature. It rarely occurs spontaneously, and is mostly seen in hemophiliac patients and is also associated with abdominal trauma. It occurs more commonly in children than in adults and can present with features of intestinal obstruction. CASE PRESENTATION:A 10year old boy presented with features of intestinal obstruction. He sustained a blunt abdominal trauma two days prior to presentation. Abdominal computed tomography (CT) revealed jejunal hematoma with signs of complete obstruction. A trial of non-operative management failed and eventually he was managed surgically. DISCUSSION:Blunt trauma to the abdomen is the principle cause of jejunal hematoma. The trauma in majority of cases is trivial and usually the patients present late. The symptoms range from mild abdominal pain to intestinal obstruction with acute abdomen. A trial of conservative management is justifiable in stable patient. If no clinical improvement surgical intervention is indicated. CONCLUSION:Intramural jejunal hematoma after blunt abdominal trauma is seen predominately in pediatric age group and can present as intestinal obstruction. It should be suspected when a child presents with intestinal obstruction and a concurrent history of blunt abdominal trauma. The mainstay of treatment is surgical intervention. Because of the rarity of this disease, the role of conservative therapy is undefined.

We are reporting a case of colorectal injury caused by a jet of compressed air directed from a distance towards the anus. The patient mentioned that it happened accidentally while his colleague was cleaning his clothes using compressed air. The patient presented with acute abdominal pain and distension. A contrast CT study did not show any free air or leakage. The patient was treated conservatively, progressed well and was discharged from the hospital on the fourth day.

INTRODUCTION: Seat belt injuries are not uncommon. The use of seat belts is associated with a unique injury profile collectively termed "the seat belt syndrome". The aim is to aid in the early diagnosis of seat belt injuries.CASE PRESENTATION: Two different patients presented to the emergency after sustaining a motor vehicle accident. Both were the drivers, restrained and had a frontal impact. On presentation they were hemodynamically stable with mild tenderness on the abdomen and the abdominal computed tomography (CT) did not show any signs of bowel or mesenteric injuries. The signs of peritonitis became obvious after 24 h in one case and after 3 days in the other.DISCUSSION: Early diagnosis provides better outcomes for patients with seat belt injuries, but this remains a challenge to trauma surgeons. The typical findings of peritonitis might not be present initially. The presence of abdominal wall ecchymosis (seat belt sign) increases the chance of intraabdominal injuries by eight folds.CONCLUSION: Clinical signs of intestinal injuries might not be obvious on presentation. In the presence of seat belt sign the possibility of bowl injury must be suspected. Admit the patient for observation even if no clinical or radiological findings are present at presentation. (C) 2016 The Authors. Published by Elsevier Ltd. on behalf of IJS Publishing Group Ltd.

The aim of this article was to analyse the results of the transanal haemorrhoidal dearteralization (THD) technique in the treatment of haemorrhoidal disease. A case series of 42 patients (36 men and six women) with grade II and III haemorrhoids who underwent THD between September 2011 and October 2012 was carried out. Patients were subjected to three to six ligations and those with prolapse had mucopexy. Following surgery, patients were evaluated after 1 week, 3 months and 1 year. Forty-one patients presented with bleeding per rectum as the main complaint and one had only discharge. All cases were carried out as day-case surgeries. Twenty-six patients had six ligations, and 16 had between three and five. The mucopexy was carried out in 34 patients. The mean operative time was 46.8 ± 9.4 minutes. Twenty-six patients (62%) had post-operative pain, four of whom had severe pain (score > 7) which required analgesia. Thirty-three patients (79%) did not have any complications and nine (21%) had an immediate post-operative complication which was not severe. After 1 year, seven patients (17%) had recurrence of bleeding. The THD technique has shown that it is effective in terms of less pain and fewer complications in the population we studied. It can be carried out safely as a day-case surgery.