UNASSIGNED: Actinomycosis is a rare, chronic bacterial infection caused by Actinomyces species. While it commonly affects the cervicofacial region, thorax, and abdomen, appendicular involvement is extremely uncommon. This case report details the presentation, diagnosis, and management of a 45-year-old female patient with acute appendicitis secondary to actinomycosis.
METHODS: A 45-year-old woman, with an 8-year intrauterine device history, presented with three-day right iliac fossa pain, vomiting, and stable vital signs. Laboratory tests revealed an inflammatory syndrome. Suspecting acute appendicitis, a CT scan confirmed a swollen 10 mm appendix. Laparoscopic surgery revealed a phlegmonous appendix, leading to an uncomplicated appendectomy. Pathological examination confirmed actinomycotic granules, supporting the diagnosis of actinomycosis appendicitis. The patient received 18 million units of intravenous penicillin G daily for 6 weeks followed by a 6-month course of oral amoxicillin (1 g three times daily) thereafter, showing favorable progression with no symptoms. Normal clinical and ultrasound follow-ups were observed at one year.
UNASSIGNED: Appendiceal actinomycosis is a rare condition. Women, especially those with intrauterine contraceptives, experience an increase in cases due to chronic inflammation. Typically underdiagnosed, actinomycosis mimics other conditions, presenting with nonspecific symptoms. Laboratory results offer limited assistance, and histological confirmation is crucial. Histopathological examination is mandatory for diagnosis confirmation. Management involves surgical resection and prolonged penicillin-based antibiotics, providing a favorable prognosis with low mortality.
CONCLUSIONS: This case underscores the importance of considering rare etiologies, such as actinomycosis, in the differential diagnosis of appendicitis. Timely recognition and management are crucial for optimal patient outcomes.

Amyand\'s hernia is a rare condition, in which the appendix is found in the inguinal hernia sac. Many patients remain asymptomatic and this pathological condition is most commonly diagnosed intraoperatively. We report a case of a 66-year-old male who was admitted to the hospital for an inguinal hernia repair and the presence of the appendix in the inguinal hernia sac was discovered intraoperatively. We performed a reduction of the appendix in the abdominal cavity and a hernia repair with a mesh and a plug. There are few studies in literature about the appropriate method of treatment and, because of that, the therapeutic approach remains controversial. Therefore, we also conducted a review of the literature in order to obtain some conclusions regarding the management of Amyand\'s hernia.

UNASSIGNED: Renal ectopia, a rare congenital anomaly, can occur in various body regions and may be associated with other abnormalities. It is often asymptomatic, commonly found incidentally, as in our 70-year-old patient during appendicitis exploration. This case highlights the importance of recognizing renal ectopia and associated anomalies, such as vascular abnormalities and renal malrotation, which may predispose patients to potential complications and require vigilant monitoring for urinary tract infections and lithiasis events, as well as potential challenges during laparoscopic surgical procedures, as in our appendectomy case.
METHODS: A 70-year-old female presented with right iliac fossa pain and elevated inflammatory markers. Abdominopelvic CT scan confirmed uncomplicated appendicitis and revealed a right ectopic and malrotated kidney. Laparoscopic appendectomy was performed without complications. Postoperative recovery was uneventful, and discharge occurred one day post-procedure. A four-week follow-up was scheduled to monitor for urinary infection and stone formation, with initiation of hygienic and dietary measures.
UNASSIGNED: Renal ectopia, a congenital anomaly, frequently positions the kidneys in the pelvic region. Iliac ectopias are often confused with pelvic or abdominal ectopias. Ectopic kidneys can result in complications like vesicoureteral reflux, urinary tract infections, or kidney stones. Despite being typically left-sided, our patient presented with right-sided renal ectopia with malrotation. Despite lacking urinary symptoms, a urological consultation was advised due to the potential risk of infection or kidney stones. Surgical intervention is reserved for complication management.
CONCLUSIONS: Renal ectopia, a rare congenital anomaly, can be asymptomatic but often coincides with other renal or vascular issues. Early detection and accurate imaging are essential, emphasizing clinical vigilance and interdisciplinary collaboration for better patient care.

UNASSIGNED: Obturator hernia accounts for less than 1 % of all documented cases of pelvic hernias. It most commonly presents as an obstructive syndrome in elderly, multiparous, slim women, characterized by a wider pelvis that facilitates the passage of the hernia sac through the obturator foramen alongside the obturator nerve. In this case, adhering to the SCARE (Updating Consensus Surgical CAse REport) checklist criteria, we present a typical scenario involving an elderly woman who was initially misdiagnosed with a fecaloma, concealing an obturator hernia.
METHODS: An 85-year-old patient, displaying prodromal signs of senile disease, presented for medical attention with incapacitating abdominal pain in the right iliac fossa, accompanied by nausea and vomiting. Rectal examination revealed the presence of a fecaloma, and glycerin administration was performed rectally. The patient\'s condition worsened with the development of mental confusion and hyperactive delirium. Abdominal Computer tomography scan (CT scan) revealed right obturator hernia with enteral segment insinuation and dilation of the proximal bowel. An infraumbilical laparotomy was performed. The herniation of an ileal segment and the right ovary through the obturator foramen was identified. The content proved irreducible to manual maneuvers, leading to obturator muscle section following the dissection of the Retzius space. The right round ligament of the uterus was sectioned, and we manage to preserve the Obturatory branch of the lumbar plexus throughout dissection. A polypropylene mesh was positioned and secured with non-absorbable sutures on the Cooper\'s ligament, iliac crest, and obturator muscle and segmental enterectomy with primary anastomosis using a linear stapler was performed.
UNASSIGNED: This demanding case brings to the spotlight the importance of reevaluating even the usual cases. We provide our experience bringing together an unusual diagnosis after the conduction of a once diagnosed fecaloma that almost went down to a perforated acute abdomen. Hence the importance of suspect obturator hernia in unknown obstructive abdomen in elderly women.
CONCLUSIONS: With this report we aim to raise awareness of careful propaedeutic inquiry of acute abdomen. We provide our experience bringing together the diagnosis that agrees with our literature review. Elderly patients commonly challenge the clinical evaluation, especially those with signs of senile disease. Thereby, inkling hidden diagnosis in typical scenarios can improve the patient\'s care in emergency settings.

Amyand\'s hernia (AH) occurs when the appendix becomes part of an inguinal hernia. Amyand\'s hernias are typically discovered incidentally during surgery due to their variable clinical manifestations and features, such as caecum and appendix forming the sliding component in the present case. Claudius Amyand operated it for the first time in 1735. Due to the simple presentations that these patients typically exhibit, the diagnosis is extremely challenging. The choice between surgical modalities is influenced by the numerous, logically accepted advantages and disadvantages of management modalities, which are subject to debate. That being said, we believe that, in the absence of sepsis or inflammation, open repair using mesh - as long as a clean operating room and competent surgical skill are available - should be the gold standard approach.

BACKGROUND: Robot-assisted nephroureterectomy for upper tract urothelial carcinoma has been increasingly performed as a minimally invasive procedure recently. However, there are concerns regarding its adoption in highly complex cases with dense adhesions.
METHODS: An 86-year-old woman presented to our hospital with gross hematuria one year after having undergone robot-assisted sacrocolpopexy using a mesh for pelvic organ prolapse. Cystoscopy revealed hematuria from the right ureteral orifice. Computed tomography suggested right hydronephrosis; retrograde pyelography showed a defect in the right renal pelvis with class V urine cytology of the urine from the right kidney. Based on these findings, a right renal pelvic tumor was diagnosed, and robot-assisted nephroureterectomy was performed. The patient was discharged on postoperative day 7 without complications.
CONCLUSIONS: To the best of our knowledge, this is the first case report in which robot-assisted radical nephroureterectomy was performed after robot-assisted sacrocolpopexy with a mesh. Dense tissue adhesions are encountered not only between the bladder and the anterior vaginal wall but also around the right ureter in the pelvis. In this case, dense adhesions were confirmed around the right ureter in the pelvis.
CONCLUSIONS: Robot-assisted nephroureterectomy may be considered an option for minimally invasive surgery in cases with a history of pelvic organ prolapse surgery using mesh.

Differentiated Thyroid carcinoma (DTC) with distant skeletal metastases is associated with a very poor prognosis and are unfortunately resistant to radioiodine therapy (RIT). Surgical removal of the metastases in such selected cases is a beneficial adjunct to RIT. We report two cases of DTC with sternal metastases whom we successfully managed with surgical resection of the sternal lesion with reconstruction of the chest wall defect using titanium mesh implant and myocutaneous flap.

BACKGROUND: Appendiculocolonic fistulas, often arising from benign conditions like abscess-forming appendicitis, manifest subtly. This case emphasizes their rarity, intraoperative discovery during acute appendicitis, and explores diagnostic intricacies, sensitive imaging, and distinctions in managing benign versus malignant cases.
METHODS: A 23-year-old intellectually disabled patient, lacking regular medical follow-up and surgical history, presented to our emergency department with persistent right iliac fossa pain six months ago. Due to financial constraints, a CT scan was not performed despite an inflammatory syndrome, and the patient left against medical advice. Currently experiencing the same symptoms, investigations led to the diagnosis of acute appendicitis with a probable appendico-sigmoid fistula. Surgical exploration confirmed the appendico-sigmoid fistula and the presence of an uncomplicated Meckel\'s diverticulum. A conservative approach, including appendectomy, Meckel\'s diverticulum resection, and sigmoid fistula suturing, yielded favorable results.
UNASSIGNED: Appendiculocolonic fistulas often arise from acute or chronic appendicitis with local abscess formation. Our case highlights the unusual progression of untreated acute appendicitis, evolving into an appendico-sigmoid fistula. While generally benign, documented cases of malignant causes, such as appendiceal cancer, exist. Diagnosis is intricate, requiring diverse methods, with abdominal CT as a sensitive imaging tool. Conservative approaches are generally recommended for benign cases.
CONCLUSIONS: Appendiculocolonic fistulas, though rare, pose a clinical challenge due to their elusive symptoms. Primarily associated with benign conditions, notably abscess-forming appendicitis, or, as in our case, untreated acute appendicitis. This case underscores the role of abdominal CT in precise diagnosis, guiding treatment decisions based on the lesion\'s nature.

UNASSIGNED: Mirizzi syndrome, a rare complication of cholelithiasis, involves gallstones causing common hepatic duct compression. It poses diagnostic challenges with nonspecific symptoms. Early recognition and surgical intervention are crucial, emphasizing a multidisciplinary approach for this complex condition with potential complications.
METHODS: A 69-year-old woman presented with pruritus, jaundice, and a history of hepatic colics. Laboratory results showed no signs of inflammation but indicated cholestasis. Imaging suggested Mirizzi syndrome type 1, confirmed by MRI. The patient underwent surgery, revealing Mirizzi syndrome type II with the presence of a cholecystocholedochal fistula involving less than one-third of the circumference of the main bile duct. Subtotal cholecystectomy and suturing of the main bile duct onto a T-tube were performed, resulting in a favorable recovery and normalization of blood tests after 10 days.
UNASSIGNED: Mirizzi syndrome, named after surgeon Pablo Luis Mirizzi, was first detailed in 1948. Clinical symptoms include jaundice, colic pain, and complications such as cholecystocholedochal fistula and gallstone ileus. Blood tests and imaging aid diagnosis. Surgical management targets obstruction relief and defect repair. Dissecting Calot\'s triangle carries risks. In complex cases, cholecysto-choledocus-duodenostomy may be considered.
CONCLUSIONS: Mirizzi syndrome, a rare but significant condition, demands careful clinical attention to prevent underdiagnosis. Timely and appropriate management, utilizing imaging tests alongside ERCP, is essential for optimal outcomes and complication prevention.

UNASSIGNED: Chilaiditi\'s syndrome, characterized by the abnormal positioning of the intestine between the diaphragm and liver, and diaphragmatic eventration, a condition marked by the permanent elevation of one side of the diaphragm, are both exceedingly uncommon medical conditions. Their co-occurrence is even rarer, with only a handful of documented cases in medical literature.
METHODS: A 71-year-old male patient initially presented with shortness of breath and was subsequently diagnosed with both Chilaiditi\'s syndrome and diaphragmatic eventration. His medical history included episodes of abdominal pain, constipation, and a prior colonoscopy that revealed no abnormal findings. Thorough physical examinations and imaging studies confirmed these diagnoses, and the patient\'s treatment was conservatively managed with intravenous fluids and laxatives, resulting in a significant improvement in his symptoms. Subsequent regular follow-up assessments showed no recurrence of symptoms.
UNASSIGNED: Chilaiditi\'s sign/syndrome is a rare condition involving colon interposition between the liver and diaphragm, often diagnosed incidentally during imaging. It mainly affects older men and can cause abdominal symptoms. Management is typically conservative, but surgery may be needed if symptoms persist or complications arise, especially in cases of colonic volvulus or ischemia. When encountering diaphragmatic air, consider a differential diagnosis to avoid unnecessary surgery. Simultaneous hepatodiaphragmatic colonic interposition and diaphragmatic eventration is extremely rare, with uncertain causation.
CONCLUSIONS: This case highlights the rarity of the combination of Chilaiditi\'s syndrome and diaphragmatic eventration. Conservative management led to a significant improvement in symptoms, underscoring the importance of early recognition to prevent complications.