Mesenteric lipoma with small bowel volvulus: A rare cause of upper gastrointestinal obstruction (a case report and literature review)

Introduction

Small bowel volvulus due to mesenteric lipoma is a rare clinical entity. It poses both a diagnostic and therapeutic challenge. Small bowel mesenteric lipoma is a rare cause of small bowel obstruction. We present the case of a patient admitted to our emergency department for a small bowel volvulus due to a mesenteric lipoma with small intestine obstruction.

Patient and method

A 61 years old man, with diabetes since 25 years with antidiabetics oral medication, vaccinated against Covid 19 (two doses) who presented with peri-umbilical pain for two months, constipation and melaena, complicated 3 days before his admission by obstructive symptoms and vomiting with apyrexia and overall health state alteration. The physical examination noticed abdomen distension and the abdominal CT scan revealed a large fatty mass of the hypochondrium and left flank, roughly oval with regular borders, well limited measuring 124 × 86 mm of height of 126 mm thought to be a liposarcoma. The patient underwent enbloc resection of 20 cm of small bowel with the mass and end to end anastomosis of the ileo-ileum. The postoperative course was uneventful and he was been discharged from hospital on day 5.

Discussion

Mesenteric lipomas are diagnosed incidentally after laparoscopy or laparatomy. Ultrasound shows a well defined homogenous echogenic mass, and so can distinguish it from a mesenteric cyst. Computed Tomography (CT) is the standard imaging of diagnosis and shows homogenous tumor of adipose tissue. The treatment is surgery and the prognosis is better.

Conclusion

The mesenteric is an uncommon location of lipoma. When there is small bowel obstruction with intra-abdominal mass, the mesenteric lipoma could be recalled.

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Mesenteric lipoma is rare.

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Small bowel volvulus due to lipoma is a rare clinical entity.

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The diagnosis and management

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Although they are benign, the mesenteric lipomas discovered must be treated.

Small bowel adenocarcinoma a rare cause of upper gastrointestinal obstruction (a case report and literature review)

INTRODUCTION

Small bowel adenocarcinoma is a rare but increasing disease. It poses both a diagnostic and therapeutic challange. Small bowel adenocarcinoma is a rare cause of small bowel obstruction. We present the case of a patient admitted to our emergency department for a bowel obstruction due to a mass of the jejunum and whose anatomopathological diagnosis was adenocarcinoma.

PATIENT AND METHOD

It is a 62-year-old woman with unparticular history, admitted to the emergency of visceral surgery of Ibn Rochd University Hospital for subocclusive syndrome evolving for one year, with early postprandial vomiting becoming stenosing two months ago. The abdominal CT scan showed thickening jejunal wall of 46 mm with upstream distension. She underwent a segmental bowel resection of 50 cm of small bowel with 3 cm stenotic mass located at 40 cm from the duodenojejunal angle. The pathophysiology revealed an invasive liberkhunian adenocarcinoma. The postoperative follow-up was simple, feeding allowed at D4 with discharge allowed at D6 and functional improvement at the time of the control performed three months after the intervention.

DISCUSSION

Small bowel adenocarcinoma is rare and represents only 1-3% of all gastrointestinal cancers. The incidence of SBA is 24 to 66 times lower than that of colorectal cancer (CRC). Due to its non-specific clinical manifestation and less accessible location, SBA is diagnosed at an advanced stage, and often at specimen analysis. The treatment is resection and the overall survival is increased when diagnostic is early made.

CONCLUSION

Small bowel adenocarcinoma is a rare but increasing cause of gastrointestinal malignancy, being both a diagnostic and therapeutic challenge. In front of the occlusive syndrome of small bowel appearance, adenocarcinoma must be ruled out.

Lactococcus lactis ssp lactis a rare cause of liver abscesses: A case report and literature review

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Lactococcus lactis is a rare cause of liver abscesses.

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Lactococcus lactis ssp lactis can cause liver abcesses in immunocompetent people.

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The exposition to unpasteurized dairy products may lead to liver abcess due to L. lactis ssp lactis.

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Young and immunocompetent people can develop liver abscesses, even for bacteria considered as non-pathogenic.

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Antibiotics and percutaneous drainage are the first line for treatment of liver abscesses and have improved the death rate.

Introduction

We present a liver abscess due to Lactococcus lactis ssp lactis.

Case presentation

It is a 27-year-old male patient without history who presented the right hypochondrium pain over 10 days. The physical examination noted right hypochondrium pain and hépatomegally. The ultrasound showed hepatomegaly with liver abcess for the segments IV and V as well as VII and VIII measuring 13 × 8 cm and 7.6 × 4.3 cm respectively. A computed tomography (CT) revealed an abscess for segments IV and V and VI and VII measuring respectively 107 × 89 mm and 55 × 50 mm. He underwent a surgical drainage after a radiologic drainage and antibiotherapy failure with success.

Discussion

Liver abscesses are rare; affect men over 60 years with co-morbidities and those due to L. Lactis ssp lactis are exceptional. Their prevalence is 0.29–1.47% in series of autopsies and 0.008 to 0.16% in hospitalized patients. The most frequently found germs are gram-negative bacilli (40–60%) and anaerobic bacteria (40–50%). Ultrasound and CT scan make the diagnosis in 90% of cases and orients to the etiology. Percutaneous drainage is the first line for treatment, surgical drainage is reserved for percutaneous drainage failures.

Conclusion

Liver abscess due to Lactococcus lactis ssp lactis is very rare. The clinic, diagnostic methods and treatment of this abscess are identical to other abscesses due to other etiologies. The antibiotics and percutaneous drainage of abscesses have improved the death rate from 40% to 10%–25%.