Presentation of the Diverticulum of the Caecum, Cause of the Acute Abdomen

Solitary caecal diverticulum is an uncommon entity and therefore it is difficult to diagnose except during surgery exploration. It is extremely difficult to differentiate it preoperatively from acute appendicitis. We report a case of an enlarged colon segment, presenting macroscopically as tumor diverticulum in a 27-year-old female patient, presenting with a 2 day history of a severe abdominal right lower quadrant pain with accompanying anorexia, nausea, vomiting and high body temperature. After clinical assessment, laboratory examination, X-ray, and CT are performed, the indication for surgical treatment is set.

Diagnostic and Therapeutic Implications of Cholelithiasis in Children

Introduction: Cholecystitis, for a long time considered as a disease of adults, has had an increased documented incidence of non-haemolitic cholelithiasis in the Pediatric Surgery practice in the last 20 years. Even though diseases of the gall bladder are rare in children, pediatric patients account for 4% of all cases with cholecystectomy. Cholecystitis and other diseases of the gall bladder should be considered in differential diagnosis in every patient with abdominal pain in the right upper quadrant, followed by jaundice, especially in children with history of hemolysis. Aim: The aim is to discuss the diagnostic and therapeutic modalities in 6 children with acute cholecystitis and cholelithiasis diagnosed and treated at the clinic of the authors. Patients and Methods: In the last 5 years, at UCCK, 6 patients under 12 years of age were operated, cholecystectomy was performed. The disease was more prevalent in female patients (66.66%—4 patients) than in male patients (33.33%—2 patients). Mean age was 8.6. Clinical manifestations presented: increased body temperature, abdominal pain and abdominal tenderness during examination. Other clinical manifestations included: vomiting in 4 patients (66.66%), jaundice in 2 patients (33.33%). Lab results showed leucosytosis in 3 patients (50%), disorders of the liver in 2 patients (33%). 2 patients were diagnosed with spherocytosis and splenomegaly, 1 patient had empyema of gall bladder (wall thickness of the gall bladder > 3.7 mm). Clinical diagnosis was confirmed with ultrasound. Ultrasound criteria are: gall bladder thickness (3.5 mm), stones ose sludge with acoustic shadow, and collection of liquid around gall bladder (pericholecystitis). Results: All patients were initially treated with naso-gastric tube (suction), fluids and antibiotics. Cholecystectomy was performed in 4 patients and cholecys-tectomy with splenectomy in 2 patients due to spherocytosis. Discussion and conclusion: Choleli-thiasis in children is most commonly associated with haemolitic and haemoglobin diseases (Hereditary Spherocytosis, Sideropenic Anaemia, Thalasemia etc.). The incidence of cholesterol stones is higher than pigment stones. Cholecystitis and cholelithiasis in children are more common than previously thought. Ultrasound confirms with great accuracy the presence of stones and acalculous cholesytitis. Treatment is usually surgical, laparoscopic or open surgery, depending on the stage of the disease and the experience of the surgeon.

Chronic Constipation and Megarectum in a 14-Year-Old Patient Operated of Anorectal Malformation—Case Report

The aim of this paper is to present the case of a female patient, 14 years of age, who developed a megarectum and overflow of fecal incontinence as a consequence of chronic and severe constipation, after the surgical repair of her vestibular fistula at the age one. The huge rectum was resected than dissected down to the pelvic floor and a new anus was reconstructed via a posterior sagittal anorectoplasty with excellent results.

Case Presentation of Preureteral Vena Cava and Review of the Literature

Retrocaval ureter, terms are anatomically descriptive but misleading in regard to development and results from altered vascular development. This anomaly is relatively uncommon, although it has clinical relevance. The ureter typically deviates medially behind the inferior vena cava, winding about and crossing in front of it from a medial to a lateral direction, to resume a normal course, distally, to the bladder. The renal pelvis and upper ureter typically appear elongated and dilated in a “J” or fishhook shape before passing behind the vena cava. Diagnoses were confirmed with intravenous urography and patient had an open surgical repair of the anomaly. The anomaly predominantly involves the right ureter, as was observed in these reported cases. Treatment is surgical allowing for correction of the anomaly with resolution of

Presentation of signet ring cell type at carcinoma ventriculi of the patient aged 20 years old

Introduction: Diffuse variant of GC is composed of gastric-type mucous cells, which generally do not form glands, but rather permit the mucosa and wall as scattered individual cells or small clusters in an “infiltrative” growth pattern. These cells appear to arise from the middle layer of the mucosa, and the presence of intestinal metaplasia is not a prerequisite. In this version, mucin formation expands the malignant cells and pushes the nucleus to the periphery, creating a “signet ring” conformation. If the signetring cells are more than 50% of the tumor, the tumor is classified as signetring cell carcinoma [1]. This case is important for reporting because we encountered for the first time such a carcinoma type, due to the new age and its atypical presentation. Case Presentation: We report a case of a 20 years Albanian old patient with Signet Ring Cell Type of Gastric CA. The patient was brought at the urgency with severe abdominal pain, nausea and peritoneal irritation. Clinical examination has been made in emergency, where we conclude the signs of peritoneal irritation, from native Ro no signs of pneumoperitoneum, while laboratory tests found a slight anemia (erythrocytes 3.36, HCT 25, HGB 8.6). Two hours later we repeated the native RTG and there were present the signs of pneumoperitoneum. It was indicated urgent surgical in-tervention. Intraoperatively, we found Ulcer duodenal perforation and?undertook the operation procedures by Roscoe Graham technique. Conclusions: At this age, it is rare, and it is difficult to detect in its early stages, because the signs and symptoms are often non-existent, non-specific, or mimic as an ulcer. The most common symptoms are early heartburn indigestion, abdominal pain or discomfort, vomiting, constipation, diarrhea or to feel of filling after a small meal, loss of appetite, weakness and fatigue. Less common symptoms are anemia and weight loss.