A 40-year-old female patient presented to a secondary facility with dull lower abdominal pain and a persistent low-grade fever. Her laboratory results showed elevated inflammation markers. A CT scan revealed two abscesses in the lesser pelvic region in direct contact with the apex of the appendix, the posterior wall of the uterus, and the right-side appendages. The patient responded well to intravenous antibiotics, and an MRI scan revealed the cause to be an appendiceal rupture. The patient was scheduled for an appendectomy. The procedure started laparoscopically but had to be converted to an open one with a midline infra-umbilical incision in order to protect the right appendages. A standard appendectomy was conducted, and the histology report revealed rupture of the appendix with concomitant wall inversion in the context of fibrous adhesions as well as obstruction due to a fecalith. Patient recovery and follow-up were excellent. Acute appendicitis, while frequently encountered in surgical practice, can present a diagnostic conundrum when it manifests in an atypical manner. This unique form of inversion appeared to confer a protective role against peritonitis, primarily through the mechanism of obstruction occurring centrally to the rupture. We suggest that this case should be included in current classifications as a partial inversion of the appendix after rupture and inflammation.

Endometriosis is defined as the presence of functioning endometrial tissue outside the uterine cavity. Abdominal wall or cutaneous endometriomas are quite uncommon with an incidence of less than 1%. Abdominal wall endometrioma can occur in a previous surgical scar, commonly following obstetrical and gynecological surgeries. Cutaneous endometriosis is difficult to diagnose because of its nonspecific symptoms and is often confused with other dermatological and surgical diseases thereby delaying the diagnosis and management. We are reporting a case of scar endometriosis at the site of previous cesarean scar involving the rectus sheath. The pathogenesis, diagnosis, and treatment of this rare condition are being discussed. Awareness of the clinical features and presentation of this rare condition is essential for timely diagnosis and management.

Gastric banding was one of the first operations to gain popularity within the field of bariatric surgery. This case details one patient\'s presentation and subsequent management of gastric band erosion with the hope of guiding other physicians and supporting the decreased use of gastric banding. The patient, a 61-year-old Caucasian female, presented to the bariatric clinic complaining of a multiyear history of epigastric pain and acid reflux, which was refractory to treatment with proton pump inhibitors. She had a history of laparoscopic adjustable gastric band (LAGB) placement in 2007. She was initially successful in achieving weight loss and maintained regular band adjustments but was lost to follow-up and regained a body mass index (BMI) of 41.59 kg/m2. Evaluation with upper gastrointestinal (GI) endoscopy was recommended and performed. This revealed a LAGB in its entirety with tubing within the gastric fundus. Removal with dual endoscopy and abdominal laparoscopy was recommended and scheduled. During attempts to remove the band using an endoscopic snare, significant difficulty was encountered. Ultimately, an endoscopic rat-tooth grasper was used to lyse the band and tubing into four sections for complete removal. The subcutaneous port of the band was successfully removed laparoscopically, and the patient was discharged from the operating room. She reported limited pain in the postoperative suite but was lost to follow-up regarding long-term symptom relief. This report describes the presentation and management of one patient\'s experience with a known complication of LAGB-band erosion. This complication necessitated two additional procedures with anesthesia and placed the patient at increased risk for esophageal perforation, complications related to sedation, and the development of abdominal adhesions. Her case aims to support the decreasing prevalence of LAGBs within bariatric surgery and hopes to guide other physicians challenged with the management of similar cases.

UNASSIGNED: Actinomycosis is an uncommon subacute or chronic suppurative bacterial granulomatous infectious disease with clinical heterogeneity. The majority of actinomycosis cases were of extra-abdominal origin, with oro-cervico-facial cases representing 55%, abdominopelvic representing 20%, and thoracic representing 15% of total reports. Currently, abdominal actinomycosis incidence is approximately 1 case per 119,000 people, being found three times more frequently among males. We report two rare clinical presentations of abdominal actinomycosis affecting the mesentery and the retroperitoneum, respectively.
UNASSIGNED: A 58-year-old Caucasian male presented to our clinic with abdominal pain in the right upper quadrant. Pre-operative evaluation, although inconclusive, showed a mesocolic mass infiltrating the right and transverse colon. The patient underwent exploratory laparotomy. After partial resection of the mass, the histopathology report demonstrated mesenteric actinomycosis.
UNASSIGNED: A 40-year-old Caucasian male presented to our clinic complaining about a mucopurulent material from an orifice at the right inguinal region. After appropriate work-up, a large abdominopelvic, stellate mass (75 x 22.8 mm) in the retroperitoneum was revealed. Surgery along with the appropriate antibiotics was used to treat the patient.
UNASSIGNED: Preoperative suspicion and diagnosis of actinomycosis are very challenging, with a high rate of misdiagnosis often resulting in delayed treatment. Our case reports highlight that abdominal actinomycosis should always be part of differential diagnosis, especially when there is involvement of multiple organs. The gold standard treatment of actinomycosis is surgical excision with prolonged antibiotic treatment.

BACKGROUND: Blunt abdominal trauma has rarely been reported as a cause of acute appendicitis in the literature. However, the coexistence of the two conditions can cause issues for the patient. We present here a systematic review of cases of traumatic appendicitis as well as our own experience with a 12-year-old male patient.
METHODS: A 12-year-old male was admitted 3 d after abdominal trauma, experiencing peritoneal syndrome. A pelvic formation was discovered during abdominal ultrasound, and surgical exploration revealed a perforated appendix. A literature review was conducted applying the keywords \"appendicitis,\" \"abdominal,\" and \"trauma\" to the PubMed, Embase, and Medline databases. Our initial search included 529 papers published between 1991 and 2022, of which 33 papers were finally included. They revealed 51 reported cases. The trauma mechanisms included road traffic accidents, falls, assaults, ball accidents, a horse kick, and a colonoscopy. Eight patients underwent surgical exploration with no prior radiological investigation, and twenty-six patients underwent an initial radiological examination. All reports indicated a perforated appendix.
CONCLUSIONS: Acute traumatic appendicitis represents a diagnostic quandary that can be misdiagnosed resulting in significant morbidity and potential mortality. A high level of suspicion combined with radiological examination may aid in the diagnosis and treatment of this condition.

UNASSIGNED: Hepatic hemangioma is among the most common benign liver lesions. However, giant pedunculated hepatic hemangiomas are exceptionally rare and associated with additional risks, such as torsion.
UNASSIGNED: We present the case of a 63-year-old female patient who presented with abdominal distension and pain. Barium meal examination and gastroscopy revealed a large, smooth-surfaced submucosal bulge located at the fundus of the stomach. Subsequent MRI examination identified a mass measuring approximately 6.4 x 7 cm in the left upper abdomen. Surgical intervention was planned for mass removal. However, intraoperative exploration revealed the origin of the mass to be the liver, and subsequent histopathological examination confirmed it as a hemangioma.
UNASSIGNED: We systematically summarized the characteristics of our case along with 31 previously reported cases. Giant pedunculated hepatic hemangiomas typically occur in the left lobe of the liver. Due to their atypical presentation, a combination of imaging methods such as ultrasound, CT, and/or MRI is essential for accurate diagnosis. Furthermore, surgical intervention is recommended due to the potential risks of bleeding, rupture, and torsion.

Hepatocellular carcinoma (HCC) has an affluent blood supply stemming from the hepatic artery. Subsequent spontaneous tumor rupture can lead to massive abdominal hematoma and shock, a rare fatal gastrointestinal incident. The diagnosis of rupture is complicated, with most patients presenting with abdominal pain and shock. Prompt correction of hypovolemic shock is the primary goal of treatment. This rare case presents a 75-year-old male who presented to the emergency department because of abrupt and increasing abdominal pain after a meal. Laboratory data revealed elevated alanine aminotransferase, aspartate aminotransferase, and alpha-fetoprotein levels. Immediate computed tomography demonstrated a defect in the right ventral abdominal wall. The patient underwent an emergency exploratory laparotomy. Despite massive intra-abdominal adhesions, the identified source of bleeding was from the left lobe of the liver at the base of the lesser sac above the pancreas. There was a maximum effort to cease bleeding and minimize blood loss. An ensuing biopsy of the liver revealed HCC. After improving, the patient received instructions to follow up on an outpatient basis. Two months after surgery, the patient endorses no complications. The success outlined in this case highlights the essence of prompt action in an emergency, which delineates the significance of surgical experience in handling unorthodox patient presentations.

Caecal volvulus is an uncommon surgical condition affecting mostly females in their second and third decade of life. It is of vital importance that the general surgeon recognises, resuscitates, diagnoses, and effectively treats these cases in a timely manner to maximise the chance of a positive outcome for the patient. Whilst there are several types of caecal volvulus, the treatment involves, in most cases, surgical intervention. There is a wide variety of surgical interventions that can be performed, ranging from caecopexy or fixation to lateral wall to performing a right hemicolectomy with primary ileocolic anastomosis. There are several factors that influence this decision and can also be based on an individual surgeon\'s expertise and experience. We present a case of a 21-year-old female who presented to our Emergency Department with lower abdominal pain, nausea, and vomiting. She was diagnosed with caecal volvulus with the aid of CT imaging, following which she underwent laparotomy in which caecal volvulus was noted. She underwent appendicectomy and caecopexy and was discharged after an uneventful recovery on post-operative day five and remains well on follow-up.

A 59-year-old male patient presented with abdominal necrotising fasciitis secondary to a bowel perforation through a previous drain site that he had waited at home with for two weeks. Enteric contents were found within the abdominal wall. Surgery required extensive abdominal wall debridement and the formation of a double-barrel ileostomy within the debrided area. The resulting abdominal wound was large, initially covering an area of approximately 424cm2, and had continuous contamination from enteric leakage that could not be isolated. Achieving wound healing was challenging due to the enteric output and resultant continuous contamination of the wound bed.

UNASSIGNED: Cystic lymphangioma (CL) is a benign tumor originating from the lymph vessels. Lymphangiomas in the abdominal cavity are extremely rare, particularly in adults.This article was designed to study the epidemiological, diagnostic difficulties, and therapeutic principles of intra-abdominal cystic lymphangioma (ACL) in adults.
UNASSIGNED: We conducted a single-center, retrospective study of 32 adult patients with ACL admitted to surgical department \"A\" in \"La Rabta Hospital\" in Tunis, from January 1998 through December 2020. The demographic, clinical, biological, radiological characteristics, histopathologic, and therapeutic data were collected, as well as the surgical intervention used and the postoperative immediate and late complications.
UNASSIGNED: Thirty-two adult patients with ACL were recruited, including 20 females and 12 males. The median age at treatment was 47 (range 14-80) years. The most prevalent sites were the retroperitoneum (25%), the mesentery (21.9%), and the paracolic gutters (n = 18. 7%). Twenty patients underwent open surgery (62.5%), whereas 12 cases (37.5%) had laparoscopic surgery. Twenty-eight patients received total cystectomy (87%). Three recurrences were observed during follow-up (9.4%).
UNASSIGNED: The clinical features of CL in adults remain unclear. The diagnosis is only confirmed by histopathological examination after complete surgical resection. The laparoscopic approach is considered safe and feasible.