A congenital band is an uncommon abnormality that can be found anywhere along the gastrointestinal tract. Intestinal obstruction caused by an anomalous congenital band is very rare in children. To the best of our knowledge, no cases of congenital bands extending from the descending colon to the jejunum have been reported in the English literatureHerein, we present the case of a 12-year-old Syrian patient with intestinal obstruction due to a congenital band extending from the mesentery of the descending colon to the mesentery of the jejunum with an entrapped loop of jejunum between the band and the mesentery. The location of the obstruction was determined by upper gastrointestinal contrast radiography, but the cause of the obstruction was diagnosed intraoperatively. The band was excised without intestinal resection.Prediagnosis of congenital bands can be challenging, and surgery is required. When making a bowel obstruction differential diagnosis, it is important to keep this type of band in mind. Small bowel obstruction (SBO) caused by an abnormal congenital band is extremely rare in children . ObstrucA 12-year-old Syrian boy was transferred to our hospital with complaints of recurrent bilious vomiting, constipation, and crampy abdominal pain for 6 days. His physical examination showed abdominal distention and tenderness. The vital signs were stable, and there was mild dehydration. All laboratory results were normal. Plain X-rays revealed a dilated bowel with air–fluid levels. An upper gastrointestinal contrast study showed dilated bowels in the upper part of the abdomen, including the stomach, duodenum, and jejunum Fig. . Histoloet al. described eight cases of bands, the most common of which were between the right colon and ileum, as well as the Treitz angle and the terminal ileum, the right lobe of the liver and the ileum, and the right lobe of the liver and the right colon [et al. reported ten patients ranging in age from 1 day to 9 years. The most common anatomic location of congenital bands (five patients) was jejunum–jejunum [et al. reviewed the records of 14 children aged 4 days to 12 years who had intestinal obstructions caused by anomalous congenital bands. In four cases, congenital bands were found between the ascending colon and the mesentery of the terminal ileum [In children, intestinal bands caused by inflammation and surgery are the most common causes of intestinal obstruction . Congeniht colon . There hht colon , 9. Kerk–jejunum . Basak Eal ileum . The chial ileum .Although radiologic examinations such as abdominal radiography or computed tomography scans can help differentiate between diseases, they are ineffective in making a correct preoperative diagnosis of intestinal obstruction caused by a congenital band.Once a congenital band is suspected, it should be determined whether malrotation exists .et al. recently reported that laparoscopy in the diagnosis and treatment of a congenital band may be safe and feasible [In our case, the radiographic evaluation did not assist us in diagnosing this condition. On contrast, the location of the intestinal obstruction was determined, and some other causes of obstruction were ruled out by the upper gastrointestinal contrast study. The appearance of the intestine was normal, with no malrotation. Surgical treatment is essential in the management of a congenital band. Laparotomy has traditionally been recommended, but with the advent of minimally invasive surgery, laparoscopy has been proposed as an alternative. Wu feasible . The decA congenital band is a rare malformation that can exist anywhere along the gastrointestinal tract. It is extremely rare to see these bands between the colonic and jejunal mesenteries. Prediagnosis can be challenging, and surgery is necessary to avoid further complications. When making a bowel obstruction differential diagnosis, it is important to keep this type of band in mind.


Mesentero-axial gastric volvulus (MAGV) is an uncommon subtype of gastric volvulus (GV). However, reports of such cases in adult patients are very rare. We present an unusual case of idiopathic MAGV in an old woman.An 84-year-old woman was referred to the emergency department for vomiting and abdominal pain. An abdominal computed tomography scan revealed a mesentero-axial gastric volvulus, which could be corrected endoscopically, and the symptoms were relieved. Contrast-enhanced examination was performed before the elective surgery to confirm the presence of short-axis dorsal 180-degree volvulus. The patient underwent laparoscopic surgery on a wait-and-watch basis. After releasing the torsion, the stomach returned to normal position. The gastric fornix was sutured to the left diaphragm and the gastric body and antrum were sutured to the abdominal wall using non-absorbable thread. Symptoms did not flare after the surgery.We experienced a rare case of adult MAGV presenting with incomplete obstruction. Laparoscopic gastropexy is useful when gastric decompression is achieved. The definition of gastric volvulus is basically an acquired rotation of the stomach by 180 degrees or more, resulting in a closed loop obstruction , 3. HoweAn 84-year-old woman was referred to the emergency department for vomiting and abdominal pain. She had a history of similar symptoms and had been hospitalized. She was relieved with conservative treatment since a diagnosis could not be reached. She had abdominal distension, but no tenderness or muscular defenses. Her vital signs were stable. No abnormal values were found in the blood test findings.Erect chest and abdomen X-ray demonstrated a double air-fluid level Fig. . AbdominGastric volvulus is a rare condition occurring in both adults , 3 and cIn this case, no clear underlying cause was identified. MAGV is a rotation of the stomach around its short axis that causes the anterior wall of the stomach to fold, bringing the pylorus and antrum into close proximity to the gastro-esophageal junction . FluorosIn this case, nasogastric decompression improved symptoms, but it was decided to perform a gastropexy to prevent recurrence. The goal of surgical intervention is to fix the stomach to repair the volvulus and reduce the chance of recurrence . The preWe present a rare case of adult MAGV presenting with incomplete obstruction. Understanding that the disease is due to this condition and that laparoscopic gastropexy is useful when gastric decompression is achieved.


Plasmacytomas are a collection of plasma cells that occur as a solitary lesion or in conjunction with multiple myeloma. Intracranial location is uncommon but should be considered as management differs. Plasmacytomas in the suprasellar region are rare but should be considered in the differential diagnosis of suprasellar masses. Clinical presentation and imaging findings have similarities and overlap between pituitary adenomas and plasmacytomas, so the diagnosis depends on biopsy and pathological evaluation. Immunohistological staining is often necessary due to structural similarities to adenomas. Isolated cases may be treated with radiation alone and surgery is reserved for symptoms due to mass effect. Systemic therapy is given if there is evidence of multiple myeloma. In this case report, we present a 52-year-old male who presented with worsening blurry vision associated with headaches and epistaxis of four months duration. CT of the head showed a large mass involving the sella and skull base. Labs showed normal calcium, creatinine, and intact pituitary function. Biopsy of the mass was initially diagnosed as a pituitary adenoma but repeat pathology revealed plasmacytoma. Body imaging revealed diffuse lytic lesions. Bone marrow biopsy and serum electrophoresis were consistent with a diagnosis of multiple myeloma. The patient underwent radiation therapy to the suprasellar mass followed by systemic therapy for multiple myeloma with bortezomib, lenalidomide, and dexamethasone. The patient achieved a very good partial response. Multiple myeloma and plasmacytomas are plasma cell neoplasms that can occur independently or together. Multiple myeloma makes up 1.8% of all new cases of cancer in the United States. It more commonly affects men and specifically African American men. The median age of diagnosis is 69 years . PresentPlasmacytomas are a collection of malignant plasma cells. If systemic symptoms/spread is present, multiple myeloma is diagnosed. Plasmacytomas are typically further classified into solitary bone plasmacytomas and solitary extramedullary plasmacytomas. Solitary bone plasmacytomas occur in the bone while solitary extramedullary plasmacytomas most often are seen involving the soft tissues of the head, neck, respiratory tract, and gastrointestinal systems without boney involvement and are less common .Patients with plasmacytomas of the sellar region often present with headaches, cranial nerve deficits, visual disturbances, bloody nasal discharge, and eye and craniofacial pain . A biopsA 52-year-old male with a medical history of rheumatoid arthritis presented with a chief complaint of visual changes of four months duration associated with headaches, epistaxis, and fatigue. He was initially seen at another medical facility and imaging of the head revealed a large soft tissue mass. Transsphenoidal subtotal resection of the mass was attempted and halted due to significant blood loss during the surgery. He had improvement in visual symptoms but had persistent epistaxis. The pathology of this initial specimen revealed a diagnosis of pituitary adenoma with negative stains for prolactin, adrenocorticotropic hormone (ACTH), and growth hormone.Within weeks from his subtotal resection, visual symptoms recurred with rapid worsening with persistent epistaxis. He was transferred to the current medical facility where a CT of the head showed a 6.4 x 7.1 cm destructive soft tissue mass involving the sella and skull base. MRI of the head showed similar findings as well as invasive features such as mass effect on optic chiasm, invasion into the cavernous sinuses displacement of internal carotid arteries, extension into the right middle cranial fossa, sphenoid sinuses, posterior ethmoid air cells, and clivus, and extension into the prepontine cistern adjacent to the basilar artery , CD79a, Ki67) were done, which established the diagnosis of a plasmacytoma Figure . FurtherThe patient then underwent radiation therapy to the base of the skull to target residual mass. He also underwent palliative radiation to target painful areas including his right arm and left hip. He was then started on the standard of care systemic therapy. Due to logistical challenges, he was initially started on CyBorD  and later switched to vRD . He tolerated the treatment well and responded well. Per IMWG criteria, he was able to achieve a very good partial response (VGPR) and is currently undergoing evaluation for autologous stem cell transplantation.The differential for suprasellar masses is broad and includes adenomas (most common), meningiomas, aneurysms, infection, and plasmacytomas among many others. In one study examining the diagnosis of suprasellar masses at an institution over a roughly 11-year period, one out of 2598 masses was diagnosed as a plasmacytoma . Even amPlasmacytomas are a collection of abnormal white blood cells. They most commonly form in bone but can also form in soft tissues, most commonly the head, neck, and respiratory and gastrointestinal systems . AlthougTreatment for plasmacytoma and multiple myeloma requires collaboration between sub-specialties including medical oncologists, radiation oncologists, surgeons as well as hematologists/oncologists specializing in stem cell transplants. When a solitary plasmacytoma is diagnosed, surgery or radiation is often the treatment of choice.However, as our patient was diagnosed with multiple myeloma, his care was targeted in a multi-disciplinary fashion Figure . ImmediaHowever, if there is evidence of disease elsewhere or evidence of end-organ damage, systemic therapy is often required. With the introduction of proteasome inhibitors and multi-drug regimens to combat resistance, the overall survival of patients has increased dramatically over the past few years . The comQuick efforts in the management of this patient’s care allowed us to attain a challenging diagnosis and start treatment immediately. Unfortunately, his vision in the right eye was compromised but we were able to achieve a VGPR or near-complete response per IWMG criteria, allowing the patient to be considered for autologous stem cell transplantation.Despite efforts in using multi-drug regimens to combat resistance, relapses remain common in the course of multiple myeloma and plasmacytomas. Careful evaluation of a patient's symptoms, laboratory work, and imaging if necessary should be done at periodic intervals.Presentation of plasmacytomas can be variable among patients and diagnosis requires careful evaluation of symptoms with laboratory and pathological evaluation. Plasmacytomas are a collection of malignant plasma cells. If systemic symptoms/spread is present, multiple myeloma is diagnosed. Intracranial lesions can present as an initial presentation of plasmacytoma. Biopsy-dependent diagnosis and immunohistochemical staining are often necessary due to structural similarities to adenomas on microscopy. In conclusion, we would like to highlight the rareness of plasmacytomas in the suprasellar region and would like to emphasize the importance of considering such a diagnosis in the differential diagnosis of intracranial lesions as a delay in diagnosis can lead to a delay in treatment and can be detrimental to overall outcomes.


Although syringoma is a common benign tumour of the sudoriferous gland, there is also an extremely rare malignant form known as syringoid eccrine carcinoma (SEC). SEC usually exhibits slow growth with deep invasion and a frequent tendency to relapse. The treatment of choice is radical wide resection, which poses a difficult reconstructive problem, especially when the tumour is located in the centre of the face.In this case, a 70-year-old man was diagnosed with an SEC at the same location as a benign syringoma of the upper lip and nasal base that had undergone primary excision 7 years prior. Primary radical resection was performed with immediate Abbé flap reconstruction. Nevertheless, histology revealed positive margins, and 3 additional re-excisions were needed to achieve clear margins. Four months after the initial resection, the patient had undergone an innovative reconstruction technique including not only the Abbé flap but also a turbinate flap harvested with functional endonasal surgery and a three-stage forehead flap.To the best of our knowledge, this is the first case report of a suspect malignant transformation of a benign syringoma after 7 years. In addition, from oncoplastic and reconstructive points of view, the bilateral use of the turbinate flap for reconstructing the intranasal lining of the alar base is unusual, and the use of functional endonasal surgery in nasal reconstruction for reducing the risk of damaging the vascular supply of the flap is innovative. Primary eccrine tumours form a very diverse group of benign and malignant tumours with a broad histological spectrum, which probably creates inconsistencies in the classification and terminology of these tumours –4.Syringoma is a common benign tumour originating from the eccrine ducts. It most often occurs in middle-aged women in the area around the eyelids; however, various other clinical variants and localisations have also been described . A very The clinical manifestation lacks a uniform image, but most lesions are nodular or planar with a size of over 1 cm on the head or neck  and less often on the trunk or extremities . SEC is In the management of SEC, no standard of care has been established, but wide surgical excision has been effective in 70–80% of cases . HoweverModern principles of nasal reconstruction are based on several basic principles, mostly established or confirmed by Millard, Burget and Menick at the end of the twentieth century –12. The The patient was a 70-year-old retired Caucasian man who was originally treated for swelling of the base of the upper lip with a small palpable lesion and upper incisor toothache at the Department of Oral and Maxillofacial Surgery in 2010 , followed by a diagnostic biopsy. Histology revealed significantly enlarged submucosal stroma that was captured and infiltrated by small, predominantly solid cell pins with a hint of luminal formation or tadpole configurations in some places. The cells were medium in size and cytologically uniform, with vesicular nuclei, small nucleoli and hyperchromic foci. Mitosis was not detected. The tumour extended between the fibres of the skeletal muscle, and perineural propagation was also evident. No necrosis was present. Cytologic features were similar to the benign counterpart (syringoma); however, there were some malignant signs that distinguished the SEC from the syringoma, in particular, infiltrative growth and perineural invasion. Immunohistochemically, the cells were positive for cytokeratin AE 1/3, CK5/6 and p63, as well as CK7 very rarely and p53 weakly and focally. The cells were negative for CK20, epithelial cell adhesion molecule (Ber-EP4), B cell lymphoma 2 protein (Bcl2), smooth muscle actin (SMA), S-100, epithelial membrane antigen (EMA), carcinoembryonic antigen (CEA), oestrogen receptor (ER) and progesterone receptor (PR). The Ki67 proliferation index was up to 5%. Histologically, the findings indicated an adnexal tumour, most likely SEC, with a probability of over 50%  showed a small hypodense soft tissue mass in the upper lip. In addition, there was no evidence of bone invasion or destruction.Staging positron-emission tomography (PET)/CT showed no distant metastases.Radical resection was planned with immediate reconstruction of the upper lip from the lower lip using an Abbé flap. The nasal base and septum were also included in the resection. Assessment of the intraoperative frozen sections of the mass revealed negative margins. According to the definitive histology of the resected tissue, however, the tumour reached the edges of the excision area in the left nasal entrance, and close margins were found bilaterally on the lip. the second, more radical resection of the nasal base was performed under general anaesthesia, including half of the columella and both lip margins. The frozen section again showed negative margins; but similar to the previous procedure, according to the definitive histology, a close, positive resection margin of 1 mm was found at the right nasal ala. In the third operation under local anaesthesia, the pedicle of the Abbé flap was disconnected, and the right nasal ala was re-excised. Bilateral commissuroplasty was also performed for contracture of the oral opening, also described as microstomia. The Fairbanks and Dingman technique was used for the vermilion , and theAfter 4 months without recurrence, the nose base was reconstructed with two nasolabial flaps reinforced by the implantation of a double cartilaginous graft from the rest of the nasal septum. The defect of the right nasal ala was adjusted with a composite graft containing both skin and subcutaneous tissue with cartilage from the helix of the left ear. Unfortunately, during the postoperative period, necrosis developed in the caudal half of the composite graft, and over the next 10 months, the necrosis affected half of the right nasal ala, the patency of the right nostril became limited, the colloid and tip of the nose collapsed and mild microstomia persisted. Therefore, a team of plastic and maxillofacial surgeons decided that a new, complex, three-stage nasal reconstruction procedure would be performed, including adequate reconstruction of the intranasal lining and improvement of the nasal support system to withstand severe scarring.Seventeen months after the first operation and 14 months after the complete resection of the tumour without recurrence, the nasal reconstruction procedure was performed in parallel with another commissuroplasty. After the skin of the nose was elevated, the nasal skeleton was exposed and returned to its original dimensions. Simultaneously, the cartilage was taken from the right sixth rib and the cavum conchae to reconstruct the nasal septum and nasal alae, respectively. For reconstruction of the missing intranasal lining of the lower half of the nostrils, the turbinate flap was selected. Each turbinate flap was obtained by functional endonasal surgery (FES) and sewn into the defect of the intranasal lining. Then, the skeleton of the nose was completed, a central pillar from the costal cartilage was constructed to support the newly created nasal ala, and the nasal alae were reinforced with the use of the (harvested) conchal cartilage. The missing skin cover of the right nasal ala and the front of the columella was replaced using a left paramedian forehead flap. Recovery lasted 6 weeks Fig. D. In phaDuring a follow-up and clinical examination, an ultrasound of the cervical nodes with subsequent PET/CT did not show any regional or distant metastases. The patient has remained recurrence-free now for 60 months after the tumour resection. The patient was satisfied with the aesthetic result of the reconstruction.This case report is exceptional for the following reasons. Firstly, histopathologically, there is no other mention of the suspect malignant transformation of a benign syringoma 7 years after excision in the available medical literature, and SEC is still extremely rarely described. In 2015, Frouin et al. reported 30 French patients with eccrine carcinoma from 1995 to 2008. In their cohort, the immunohistopathology of only 5 patients was SEC . SimilarThe main method of treatment for localised lesions is radical surgical excision with negative margins. Therefore, Mohs’s micrographic surgery is the method of choice for the treatment of this tumour, and it is preferred over controlled excision. In the case of a metastatic process, both chemotherapy and radiotherapy have been described in the literature . Unfortu2, with a flap length of 2.8 cm (1.7–4.0 cm) and a width of 1.7 cm (1.5–2.0 cm) [The failure of the initial nasal reconstruction can be attributed to the unreliability of the composite graft in the alar area, especially when its size approached the referenced maximum adherent size of 1 cm for a composite graft . The sec–2.0 cm) . We harvThe cartilage from the 6th right rib was used as a strut graft for the columella, as it provides sufficient strength and is available in sufficient quantity to reconstruct the support for the tip of the nose . ConchalIn our case, the tumours’ histopathological findings show that malignant transformation of a benign syringoma in SEC is a likely possibility. In patients with SEC, it is critical to achieve negative margins with controlled excision, after which reconstruction can be performed. For reconstruction of large complex defects of the nasal base, the turbinate flap harvested by FES represents alternative thin and pliable tissue suitable for the reconstruction.


Small bowel obstruction (SBO) is a common cause of emergency admission to surgical ward. The etiologies for the majority of these cases include postoperative adhesions and hernia. However, acute appendicitis presenting with SBO due to appendico‐ileal knotting is a very rare and unsuspected condition in an emergency scenarios. We report a case of acute SBO in a 30‐year‐old female patient who was explored, and found to have appendico‐ileal knotting causing SBO. Small bowel obstruction is one of the most common causes of emergency admission with abdominal pain often requiring surgical intervention. Small bowel obstruction (SBO) is a common cause of emergency admission to surgical ward. The etiologies for the majority of these cases include postoperative adhesions and hernia. However, acute appendicitis presenting with SBO due to appendico‐ileal knotting is a very rare and unsuspected condition in an emergency scenarios. Small bowel obstruction is one of the most common causes of emergency admission with abdominal pain often requiring surgical intervention. Successful management depends on comprehensive knowledge of the etiology and pathophysiology of the small bowel obstruction, familiarity with imaging methods, good clinical judgment, and sound technical skills. Intra‐abdominal adhesions related to prior abdominal surgery account for up to 75% of cases of small bowel obstruction followed by hernia.Knowledge of this unusual entity is important for clinical suspicion and successful management. Here, we report a case of 30‐year‐old female who presented to us with features of small bowel obstruction and on exploration; there was terminal ileum encirclement due to appendicular knotting. The patient was treated by appendico‐ileal knot releasing and appendectomy.2A 30‐year‐old female patient presented to surgical emergency department, Wachemo University Nigist Elleni Mohamed Memorial Comprehensive Specialized Hospital on 28/01/2020 G.C with referral paper from Doyogena primary hospital, Southern Ethiopia. The patient presented with crampy periumblical abdominal pain that gradually increased to involve her whole abdomen over 15 days duration. Associated with this she has a history of several episodes of projectile vomiting of ingested matter which latter becomes bilious for 14 days duration.She has a history of failure to pass both faeces and flatus of 8 days duration. She has also an abdominal distention of 7 days duration and history of loss of appetite of the same duration. Otherwise, there was no history of previous abdominal surgery and known chronic medical illness.On physical examination, she was acutely sick looking in pain. She was tachycardia to the level of 120 bpm, BP = 117/72, and she was maintaining her saturation on atmospheric oxygen 96% with a respiratory rate of 24 breath per minute. Her temperature was 36.7°C. Her abdomen was grossly distended that moves with respiration with hypoactive bowel sound, hypertympanic percussion note, and mild periumbilical area tenderness on deep palpation. Digital rectal examination reveals normal anal tone with empty rectum. Full blood count shows WBC = 15200/μl with neutrophils (81.1%).Plain abdominal X‐ray in erect position showed dilated small bowel loops with multiple air fluid levels and absent rectal gas shadow Figure .The provisional diagnosis of small bowel obstruction secondary to small bowel volvulus is made and patient is prepared and taken to the operation theater for exploratory laparotomy after detailed informed consent. Under general anesthesia and endotracheal intubation abdomen was entered through midline incision.Intra‐operative finding was ~1L of reactive fluid in the general peritoneal cavity and the greater omentum was found migrated to the right lower quadrant. The whole small bowel is dilated and there is a constricting ring around the terminal ileum created by gangrenous appendicitis with its tip adherent to the ileal mesenteric border. There is no sign of ischemia at the site of obstruction and large bowel is collapsed Figure .The Appendico‐ileal knotting was at a 50cm distance proximal to the ileoceacal valve. The entangled part of the distal ileum was viable with the gangrenous appendix forming knot. The whole length of the appendix was gangrenous involving the base of appendix. The tip of the gangrenous appendix was adherent to the terminal part of the mesenteric border of the ileum forming ring‐like structure with herniation of the terminal 10cm length of the ileum through the ring Figure . The othThe reactive fluid was sucked out. The appendiceal knotting band was released from its attachment to the ileum and appendectomy was done. Retrograde milking of small bowel content was done, peritoneal cavity lavaged with warm saline, and the abdominal wall was closed in layers. The postoperative period was uneventful until the 5th postop day. On the 5th postop day, she developed abdominal distension and loss of appetite but her vital signs were normal. Abdominal examination reveals clean surgical wound with hypertympanic percussion notes and hypoactive bowel sounds. With an impression of postoperative ileus she was managed conservatively by keeping her NPO, IV fluid and NGT decompression. On the next day, the 6th postop day, the abdominal distension subsided and regained her appetite. On the 7th postop day, she was discharged improved with PO analgesics and appointment for follow‐up.The appendix was not sent for histopathology examination. She was seen subsequently at surgical referral clinic of our hospital and the patient had smooth postoperative course on follow‐up. The surgical wound is clean and surgical stich removed on 14th post‐operative day.3Acute SBO is one of the most common surgical clinical problems. A wide range of etiologies has been reported for small bowel obstruction. Acute appendicitis is a very rare cause of small bowel obstruction. Appendix is a mobile organ and has a variable position. Hence, during appendicitis it has the tendency to get adhered to surrounding structures resulting in mechanical small bowel obstruction and an increased length seems to facilitate the knotting phenomenon.Appendicitis as a cause of SBO has been known in the literature since 1901 when Lucius Hotchkiss reported three successful surgeries for intestinal obstruction due to appendicitis.In 2009, Bhandari et alStrangulation may result from a long standing closed loop obstruction, which can be due to the long appendix constricting around a loop of the small bowel, or when it is adhered to the surrounding structures and a part of the bowel herniates through the gap Figure .In 2005, Assenza et alAmong the mechanical causes, the vast majority are due to the formation of an appendicular abscess that compresses the loops of the small bowel, and postoperative adhesions that occur years after treatment.There are only ten cases reported in the literature reviewed by O’Donnell et alThis entrapment results not only in intestinal obstruction and strangulation of the entrapped bowel but also in ischemia of the appendix itself due to compression, which was probably the reason of gangrenous appendix in our case.The reported complications are: intestinal obstruction, volvulus, strangulation of the small bowel, and strangulation of the appendix itself.A diagnosis of acute bowel obstruction is made initially based on clinical judgment based on the history and physical examination of the patient. The cardinal symptoms and signs are colicky abdominal pain, vomiting, absolute constipation, and abdominal distension, all of which were present in this patient. Confirmation of bowel obstruction is then usually made with an erect plain abdominal X‐ray, which provides the surgeon with several information including whether there is small or large bowel obstruction and the degree of obstruction. In the present case, dilated loops of the small bowel indicated acute small bowel obstruction. The straight X‐ray of the abdomen may be helpful in the diagnosis of small bowel obstruction, but it often fails to identify the etiology. In the early inflammation phase, CT (Computerized Tomography) may help to clinch the diagnosis. After resolution of appenditis, its role is very limited.Thorough history and clinical examination, imaging findings, and high index of suspicion may help in diagnosis. Diagnostic laparoscopy may be a valuable option. Treatment is straightforward and depends on intraoperative findings.The management depends on the extent of the strangulation and the part of the bowel involved. A midline laparotomy is advisable to rule out other causes of obstruction. It may range from appendectomy to right hemicolectomy.It may require small bowel or ileocaecal resection when there is strangulation. Release of the appendiceal band and appendectomy is adequate when the herniated bowel is viable and if intervened early, as it was in our case. Resection of the nonviable intestine and anastomosis or stoma creation is necessary in the presence of nonviable gut. Closed loops and strangulating obstruction of the small bowel are serious lesions that require emergency surgery. An accurate and early diagnosis of intestinal strangulation is essential in patients with small bowel obstruction to minimize the risk of morbidity and mortality. Delayed operation potentially results in high mortality.4Small bowel obstruction is a rare complication of acute appendicitis. Appendiceal knot is a rare cause of this and very few cases have been reported. As a surgeon dealing with acute abdomen in day‐to‐day practice, knowledge about the diagnosis and management of this rare scenario is very helpful. A high index of clinical suspicion is of utmost importance in identifying and correctly managing this rare condition.AT and TC: performed the surgery, Writing—Original Draft. BB: Writing—Review and editing it critically for intellectual content. All authors read and approved the final manuscript.The authors declare that they have no conflicts of interest.The report conformed to the principles outlined in the Declaration of Helsinki and was approved by the Hospital Medical ethics and research ethics committee at Wachemo University Nigist Elleni Mohamed Memorial Comprehensive Specialized Hospital, Ethiopia.Written consent has been obtained from the patient for publication of this report.


We report the case of a teenager with neurofibromatosis type 2 (NF2) presenting a locked‐in syndrome due to a brainstem ischemic syndrome. The presence of sudden or rapidly worsening onset of neurological deficits in NF2 patients should evoke this underknown entity and not only tumors as predisposed by NF2. Bilateral vestibular schwannomas are pathognomonic. So, the most common entry into the disease is through hearing impairment, which usually occurs in the second decade of life. But, unlike adults, children most frequently present with ocular, dermatological, and neurological symptoms. Brainstem ischemic syndrome, which is an under‐recognized entity of unknown origin, occurs in teenagers without any previously known NF2 diagnosis, presenting as an acute or subacute event, which involves the midbrain or pons.2A 15‐year‐old girl was transferred from a primary care institution for headache, acute left hemiparesis, and left paresthesia. Her history revealed left hypoacusis, left voice cord palsy, and left unreactive mydriasis of unknown origin for over a 3‐year period. The admission brain CT scanner had shown heterogeneous parenchymal damage within the right side of the pons (not shown). Three years earlier, the girl underwent brain magnetic resonance imaging (MRI), which was described as normal.The brain MRI at admission showed a heterogeneous T2/FLAIR hypersignal on the right thalami, cerebral peduncle, midbrain, and pons, displaying marked restriction of free water diffusivity featuring cytotoxic edema on diffusion‐weighted (DW) views. A few pontine subareas disclosed low signal intensity on both T2 and diffusion weightings suggesting foci of hemorrhagic transformation Figure . Other mOn Day 14, the left hemiparesis worsened, and the girl exhibited swallowing difficulties and bilateral facial palsy. The MRI, carried out on Day 18, revealed a progression of the right‐sided pontine lesion with persistent mosaicism of acute ischemic lesions with high T2/FLAIR signal intensity with lowered apparent diffusion coefficient (ADC) and strongly hypointense areas with susceptibility artifacts on gradient‐echo T2‐weighted views featuring hemorrhagic transformation , cardiac‐carotid and vertebral ultrasonography, and hemostasis evaluation were unremarkable. Aspirin treatment was initiated, and she was transferred to a rehabilitation center. Three months later, she was able to carry out head movements, which helped her communicate, as well as some arm movements.NF2 gene, c.1376dup (p.Glu460GlyfsTer35).The NF2 diagnosis had meanwhile been confirmed by revealing a heterozygous pathogenic variant on 3The locked‐in syndrome is a neurological disorder that is characterized by quadriplegia and anarthria with preserved cognitive functioning. Patients usually retain eye movements, thereby facilitating nonverbal communication. This clinical diagnosis may prove challenging, given that the children are often considered as being in coma or in an unresponsiveness state, or as displaying akinetic mutism. A normal electroencephalogram (EEG) should alert the physician.As illustrated by our case, differential diagnosis of brainstem lesions can be challenging. We reviewed the brainstem disorders in pediatric patients in an effort to guide the clinician in this difficult yet essential differential diagnosis. Usually, brainstem lesions tend to become quickly symptomatic. A small and single lesion can produce severe and mixed deficits related to the large number of essential structures localized within this area including cranial nerves nuclei, the reticular formation, and ascending, descending, and cerebellar pathways. Brain MRI is generally carried out early in the diagnostic approach. The resulting findings can help clinicians in regard to differential diagnosis.Among the causes of brainstem pathologies in children, vascular, toxic, metabolic, infectious, inflammatory, or neoplasia processes appear to play a role, as previously reported. As degenerative diseases are rather rare in this specific area, they will not be discussed here. The clinical presentation of brainstem lesions is roughly uniform with multiple cranial nerve palsy, motor deficiencies, and headaches, whereas the clinical context, brain MRI features, and laboratory testing results may be quite useful in further directing the clinicians Table .2In our case, the diagnosis was difficult, given that the lesion progression led us to suspect the presence of a tumor, within the NF2 setting.NF2 gene encoding the protein merlin whose main function is to regulate cellular proliferation.NF2 has been associated with brainstem ischemia. Another hypothesis raises the possibility of a digenic process, given that this syndrome is relatively rare in NF2 patients.NF2 is an autosomal‐dominant disorder, caused by a variant inactivating the 4Brainstem ischemic syndrome is a rare and under‐recognized entity of unknown origin, occurring in teenagers without any previously known NF2 diagnosis. The adolescents suffer from cranial nerve palsy, dysarthria, hemiparesis, or a locked‐in syndrome. The clinical context and MRI provide the diagnosis. So, it is essential to consider this syndrome in NF2 patients and not only tumors as predisposed by NF2. Aspirin can be employed. The prognosis is variable ranging from full remission to persistent locked‐in syndrome.AB contributed to the collection of the case information, reviewing the literature, designing, and writing the manuscript. CL contributed to the interpretation of brain MRI and was involved in drafting the manuscript. TD contributed to the interpretation of brain MRI, revised the manuscript critically for important intellectual content, and reshaped it. MCN contributed to the collection of the case information, reviewed the literature, established the diagnosis, revised the manuscript critically for important intellectual content, and reshaped it. All authors read and approved the final version of the manuscript.The authors have no conflicts of interest to declare.Written informed consent was obtained from the patient's parents to publish this report in accordance with the journal's patient consent policy.


Chylous ascites is a rare but significant complication of a variety of surgical procedures. It is an uncommon complication of laparoscopic Roux-en-Y gastric bypass (LRGYB). The underlying etiology is assumed to be an internal hernia, in which the hernia causes lymphatic channel engorgement and lymphatic extravasation. We present the case of a 34-year-old male who had a history of LRGYB a year back and had been experiencing gradually worsening, colicky abdominal pain radiating to the right flank for the last 24 hours. Laparoscopic exploration revealed chylous ascites due to internal herniation owing to the complication of LRYGB. Classic signs of internal hernias such as mesenteric swirl were absent on the computed tomography scan of the abdomen. Chylous ascites is a creamy-colored intra-abdominal accumulation of fluid with a triglyceride concentration of more than 110 mg/dL .The underlying etiology of chylous ascites in LRGYB is assumed to be an internal hernia, in which the hernia causes lymphatic channel engorgement and lymphatic extravasation . ClassicA 34-year-old male with a history of LRYGB a year back presented with a complaint of gradual onset, colicky, worsening, mild to severe generalized abdominal pain with radiation to the right flank for the last 24 hours. The pain was associated with nausea and anorexia without vomiting. There were no modifying factors, prior episodes, fever or sick contacts. Abdominal tenderness was present, and vital signs were normal. There were no significant findings on general systemic examination. Differential diagnosis included kidney stones, diverticulitis, urinary tract infections, appendicitis, diverticulitis, small bowel obstruction, and midgut volvulus.CT scan of the abdomen suggested prior gastric bypass surgery. Rotation of the mesentery root with a misty mesentery appearance was observed. There was no evidence of bowel obstruction to suggest midgut volvulus Figure .There was no evidence of obstructive nephropathy on ultrasonography. Laparoscopic exploration suspecting bowel obstruction revealed mild purulence in the right paracolic gutter and perihepatic space Figure . The spaThe bowel did not appear to be necrotic at any portion. Given its viability, the decision was made not to resect this part of the Roux limb and jeopardize the continuity of the alimentary tract. A peritoneal drain was inserted to remove the fluid collected in the peritoneum. The patient was given pain control after exploratory laparoscopy and then transferred for higher care.Chyloperitoneum is the medical term for the accumulation of lymphatic fluid in the peritoneum as a result of a leak or rupture in the lymphatic system. Three things are thought to be responsible for this buildup: (1) When a tumor obstructs a vessel, the vessel may burst or exude fluid through dilated lymphatic channel walls. These persons frequently have enteropathies that lose protein, (2) a fistula develops between the lymphatic vessels and the peritoneum or mesentery as a result of adhesions, injury, or surgery, and 3) retroperitoneal massive lymphatic leakage, commonly brought on by congenital diseases, with or without fistula symptoms [ retroperPrior to the introduction of Roux-en-Y gastric bypass surgery, the paraduodenal hernia was the most prevalent internal hernia, accounting for more than half of all occurrences . HoweverThe typical RYGB surgical method starts with the gastric fundus being used to build a tiny gastric pouch while the excluded stomach is kept intact ,11. To cInternal hernia symptoms are ambiguous and non-specific, making diagnosis challenging. When they initially come, the majority of patients report hazy gastrointestinal symptoms such as nausea and vomiting . There iAfter LRYGB, a CT scan has proven to be an effective tool for diagnosing internal hernias. There are certain CT scan imaging findings that, if present, raise suspicion for an internal hernia even if distorted anatomy makes it challenging to establish the diagnosis. Seven symptoms that can indicate an internal hernia in a CT scan were studied by Lockhart et al. in 2007 for their specificity and sensitivity . These sThis instance shows that chylous ascites is a sign of an internal herniation brought on by a mesenteric defect after an LRYGB. These instances might present hazy or misleading symptoms. In post-LRYGB patients, doctors should have a high index of suspicion for internal hernias, even if patients only have mild to moderate symptoms of colicky abdominal pain when they first present. If an internal hernia is detected too late, the chance of developing an acute small intestinal obstruction increases. In such cases, bariatric surgery or laparoscopic exploration should be considered since it is the most accurate and sensitive diagnostic procedure available, as compared to imaging like a CT scan, which is inadequate for diagnosis . In the In conclusion, our case presented a patient who, a year after undergoing an LRYGB, acquired chylous ascites but no internal herniation was present. Chylous ascites in adults is most frequently caused by cancer, although it can also manifest in an unusual way due to an internal herniation brought on by a post-LRYGB mesenteric abnormality. In many cases, chylous ascites presents with relatively mild and ambiguous symptoms, which may lead to a different differential diagnosis than a probable internal hernia. As a result, all LRYGB patients who present with minor abdominal symptoms with chylous ascites should not be suspected of an internal hernia and should be treated accordingly.


Sinus pericranii is a rare cranial venous malformation resulting in a subcutaneous mass due to abnormal communication between intracranial and subperiosteal/interperiosteal veins. To date, to the best of our knowledge, there are no reports of sinus pericranii associated with syntelencephaly, a subtype of lobar holoprosencephaly. We herein report a case of sinus pericranii associated with syntelencephaly. This report can provide us better understanding of the etiology of sinus pericranii, the potential risks, and the treatment options for these patients.A 2-year-4-month old female patient who received the diagnosis of syntelencephaly as a neonate presented with a subcutaneous mass in the parietal region. The mass was soft, nonpulsatile, 3 × 2 cm in size, and showed enlargement in the lying position. Color cranial Doppler ultrasound, head magnetic resonance imaging (MRI), and cerebral angiography revealed a dilated vessel passing through the parietal bone and forming a communication between the superior sagittal sinus and scalp veins. Based on these findings, sinus pericranii was diagnosed. The head MRI also showed coronal craniosynostosis, a tight posterior fossa. At age 2 years and 7 months, the patient underwent a transection of the sinus pericranii and the mass resolved without any complications or recurrences for more than 2.5 years to date.Sinus pericranii is a rare cranial and venous malformation sometimes accompanied by brain malformations or craniosynostosis that may become more apparent as the brain and skull develop. Since this condition can be complicated by intracranial hemorrhage and sinus thrombosis, early detection is necessary to determine the treatment options. Physicians should be alert to the possibility of this condition if they observe a soft cranial mass that appears to decrease in size in the sitting position and bulge in the lying position. Sinus pericranii is a rare venous malformation presenting a subcutaneous venous mass resulting from abnormal communication between the intracranial and subperiosteal/interperiosteal veins . SynteleCases of sinus pericranii associated with holoprosencephaly , to our knowledge, thus far have not been reported. Since this condition can be complicated by intracranial hemorrhage and sinus thrombosis, early detection is necessary to determine the treatment options. For the better understanding of the rare condition of sinus pericranii, we herein report a case of sinus pericranii associated with syntelencephaly and discuss the treatment options, the potential risks for these patients, and the causal relationship between sinus pericranii and congenital malformations of the brain and/or skull.A 2-year-4-month old female patient who received the diagnosis of syntelencephaly as a neonate presented with a subcutaneous mass in the parietal region. Syntelencephaly was diagnosed based on head magnetic resonance imaging (MRI) findings, including an abnormal midline connection between the cerebral hemispheres of the posterior frontal lobes and cingulate gyrus, agenesis of the corpus callosum and septum pellucidum, and hypoplasia of the cerebral falx Fig. a. Head cShe presented with a soft, nonpulsatile, subcutaneous mass 3 × 2 cm in size in the parietal region. The mass grew in size in the lying position and shrank in the sitting position. Head circumference at 2 years and 7 months was 48.4 cm, exhibiting age-appropriate development. Routine blood tests, including coagulation tests, were normal. Head computed tomography (CT) and MRI revealed abnormal vessels communicating the superior sagittal sinus with the distended, subcutaneous veins of the scalp via parietal bone defects along the sagittal suture and immediately next to it in the parietal region Fig. c, d. TheWe reported a case of syntelencephaly, a rare brain morphological abnormality that was complicated by sinus pericranii, a rare venous malformation. To our knowledge, no cases of sinus pericranii associated with syntelencephaly have been reported, although several cases associated with craniosynostosis, as seen in this case, have been reported. In general, the factors contributing to sinus pericranii development include: 1) congenital, such as vascular and brain malformations; 2) acquired, such as increased intracranial and venous pressure; 3) physical, such as trauma; and 4) idiopathic [In the present case, it is suggested that the congenital venous anomaly associated with syntelencephaly and the increased intracranial pressure due to craniosynostosis, impaired venous return due to tight posterior fossa, and increased physiological cerebral blood flow during infancy are complexly involved in the apparent sinus pericranii. Holoprosencephaly, including syntelencephaly, is often associated with various midline structural anomalies, including malformations of the cerebral sinuses, arteries, and veins, and the meningeal vessels . CraniosSinus pericranii is often asymptomatic, as in this case; however, there are reports of intracranial and extracranial bleeding due to trauma or spontaneous rupture, posttraumatic air embolism, venous sinus thrombosis, and increased intracranial pressure due to venous congestion –12. SincThere is little evidence on which the treatment of sinus pericranii can be based. Transection may be performed to prevent the complications mentioned above and for aesthetic reasons . HoweverAs a general rule, surgery for craniosynostosis should be performed before surgery for sinus pericranii because sinus pericranii may serve as major draining veins of the intracranial venous blood in cases of craniosynostosis. Also, without reducing the intracranial pressure, sinus pericranii may recur. However, craniosynostosis repair was not performed in our case for the following reasons: 1) Sinus pericranii may have been present congenitally, and craniosynostosis was not considered a major cause of sinus pericranii. 2) No other vascular morphological abnormalities were found. 3) The head circumference developed well, and no skull deformities or symptoms of intracranial hypertension, such as headache, nausea, vomiting, or upgaze palsy, were observed . In addiSinus pericranii is a rare cranial and venous malformation sometimes accompanied by brain malformations or craniosynostosis that may become more apparent as the brain and skull develop. Since sinus pericranii carries the risk of bleeding and thromboembolism, surgical treatment should be considered. The better understanding of sinus pericranii and causal relationship between sinus pericranii and congenital brain abnormalities is important for physicians to detect it early and to provide the treatment options for these patients. Physicians should be alert to the possibility of this condition if they observe a soft cranial mass that appears to decrease in size in the sitting position and bulge in the lying position. Early, neurosurgical intervention may be considered in such cases.


Porokeratosis ptychotropica represents an unusual form of porokeratosis characterized by symmetrical dyskeratotic skin lesions on the gluteal clefts. Herein, we report a case of porokeratosis ptychotropica.A 33-year-old man, who complained of itching papules and plaques in the gluteal cleft and the buttocks for the last 7 years. Clinical examination showed a large well-defined reddish brown verrucous plaque located on both buttocks along with satellite papules on the inner thigh. Dermoscopy and histopathological findings were consistent with porokeratosis.He was diagnosed with porokeratosis ptychotropica.No significant improvement was observed following treatment with oral acitretin and a topical retinoid.The case report highlights the need for awareness amongst dermatologists for porokeratosis ptychotropica as a differential diagnosis for pruritic papules in the gluteal fold. Interestingly, another rare variant, porokeratosis ptychotropica, localized to the gluteal cleft and the buttocks, was first reported by the Lucker et al in 1995. Herein, we present the case report of a patient with porokeratosis ptychotropica, an unusual diagnosis, and describe the findings of clinical routine, dermoscopy and histology.Porokeratosis is a spectrum of clinical disorders characterized by the histological features of a cornoid lamella. Several variants have been described, including linear porokeratosis, classical porokeratosis of Mibeli, disseminated superficial actinic porokeratosis, and prokeratosis plantaris and palmaris.A 33-year-old Chinese male presented with a 7-year history of itching brown papules and plaques on the gluteal cleft and the buttocks. The lesion began as a small brown scaly papule and increasingly coalesced to form larger plaques. There was no discernable history or underlying cutaneous diseases. He did not respond to treatment with topical glucocorticoid and antihistamine drugs. Physical examination revealed a large well-defined reddish brown verrucous plaque located on both buttocks, and satellite papules were found at the inner thigh Figs.  and 2. D,3,4 Porokeratosis ptychotropica the preferred term, is localized to the gluteal folds, buttocks and genitalia with a butterfly morphology. It increasingly progresses through satellite lesions that develop and coalesce, accompanied by mild-to-severe itching. Moreover, this disease is more likely to occur in males, as in the present case.Porokeratosis ptychotropica was previously referred to as verrucous porokeratosis or genitogluteal porokeratosis is rare.,5 Interestingly, none of these factors were implicated in our case. The prevalence of malignant transformation of the porokeratotic rash is 7.5%, especially the linear and large-sized lesions. Previously, a case of a 6-year-porokeratosis ptychotropica transforming into invasive squamous cell carcinoma has been reported. Periodic follow up plays a vital role in the early diagnosis of potential transformation, especially to malignant basal cell carcinoma, squamous cell carcinomas or malignant melanoma.To date, several scholars have suggested that numerous factors are associated with porokeratosis ptychotropica, including repeated trauma, organ transplantation, HIV infection and other diseases related to immunosuppression, but its pathogenesis remains unclear. but not a specific manifestations of porokeratosis ptychotropica.Dermoscopic findings revealed a sharply demarcated annular lesion with a thick, peripheral light brown rim, limiting an erythematous non-atrophic center with regular dotted vessels, which were vital clues suggesting a subtype of porokeratosis. Cornoid lamellae are present throughout the lesion in porokeratosis ptychotropica, while in the other variants, these are localized to the periphery. Multiple of cornoid lamellae were present in our patient.Among histological features, the differences between porokeratosis ptychotropica and other variants are in the number and distribution of the cornoid lamellae.,11 Surgical excision may be a good option for early-stage lesions.,11Differential diagnosis includes psoriasis, tuberculosis verrucosa cutis, and lichen planus verrucose. Numerous conventional treatments, including acitretin, corticosteroids, 5-fluorouracil, cryotherapy, and laser therapy are available but their efficacy is limited for porokeratosis ptychotropica.In summary, dermoscopic findings are helpful, but the clinical characteristics and histological examinations have significant roles in the definite diagnosis of porokeratosis ptychotropica. This case report is expected to raise awareness of porokeratosis ptychotropica, an identified diagnosis variant of porokeratosis. We also hope to improve diagnostic accuracy and prevent the long-term complications related to the disease.The patients in this case have given written informed consent to publication of her case details.Conceptualization: Yu Xiao, Xiangjun Li, Wenzheng Ye, Muping Fang.Data curation: Yu Xiao, Shanshan Peng, Tianyi Mao, Xiangjun Li, Wenzheng Ye, Muping Fang.Formal analysis: Yu Xiao, Wenzheng Ye, Muping Fang.Funding acquisition: Yu Xiao.Investigation: Yu Xiao.Methodology: Yu Xiao.Resources: Yu Xiao.Software: Yu Xiao, Muping Fang.Supervision: Shanshan Peng, Xiangjun Li, Wenzheng Ye, Muping Fang.Validation: Yu Xiao, Muping Fang.Visualization: Yu Xiao, Muping Fang.Writing – original draft: Yu Xiao, Shanshan Peng, Tianyi Mao, Wenzheng Ye, Muping Fang.Writing – review & editing: Yu Xiao, Wenzheng Ye, Muping Fang.


Serous cystadenomas account for approximately 25% of benign ovarian tumors in patients of childbearing age. Their growth is insidious, and the diagnosis can be difficult as they are often asymptomatic, Patients with serous cystadenoma often experience symptoms only if the lesion is twisted or has a mass effect because of its size.This was the case in our patient, whose cough and low back pain prompted her To consult a doctor, which led to the definitive diagnosis and treatment.We report a case of a patient admitted for strangulated umbilical hernia with fortuitous discovery of a giant ovarian mass in the P35 visceral emergency department at the CHU ibn rochd hospital in Casablanca, Morocco.the patient were operated in the emergency room, approached by laparotomy with the exploration we found umbilical hernia with a 6 cm long neck and necrotic bowel content a left latero-uterine mass of 40 cm of solid-cystic aspect and tube and right ovary without abnormalities and uterus of normal size the patient had an Segmental resection of 10 cm at 2.60 m from the ADJ and 1 m from the JIC with T-T grelo-grelic anastomosis and a left adnexectomy with a left latero-uterine mass of 45 cm and Epipoic and parietal peritoneum biopsy and Examination of the patient's spicemen showed serous cystadenoma weighing 10 kg and measuring 30 × 36*20 cm adjoining a tubular formation measuring 11 × 10*5 cm with bowel resection showed ischemic and hemorrhagic necrosis related to the occlusion with acellular ascites fluid.Very Cystadenomas There are 2 types: Pleudomucinous cystadenomas or mucoid cysts, These are the most frequent neoplastic cysts of the ovary which are, in general, lumpy, multilocular, producing a gelatinous substance [8]. Their consistency is variable, some taut and firm, others semi-solid, spongy, thick, hollowed out “honeycomb” parts, which contain thick, stringy mucus. The coloration is variable: grayish white when the wall is thick, translucent in some places, with yellowish or white reflections, blue-black or reddish if there is spilled blood, grayish if there is cholesterol. on the other hand Serous cystadenomas or papillary cysts A little less frequent than mucoid cysts. Usually unilocular or paucicular, round or relatively flat, they contain protein-rich serous fluid. The coloration varies according to the content and thickness of the wall: light yellow or brown if the wall is thin, purplish red if there is blood, greyish white if the wall is thick. Consistency clearly fluctuates on the whole but can be hard in places, semi-solid, if there are abundant vegetations inside.Very large tumors have become curiosities in industrialized countries where the health care system is well developed. On the other hand, they are not rare in developing countries. The delay in diagnosis is most often due to the patient herself who does not consult out of ignorance or refusal of her pathology. But it can happen, and this is serious. •The largest tumors found in the human species are essentially represented by human species are essentially represented by ovarian tumors.•Its diagnosis is still very difficult.•The treatment Serous cystadenomas geant is in most cases surgical.•The diagnosis Serous cystadenomas is histological. And The first signs, which appear with the increase in size of the tumor, are not very specific and can mislead a doctor who is not very familiar with the disease. and can mislead an unwary doctor who would make the mistake of not performing a gynecological examination. This gynecological examination would have to suspect a pelvic pathology.However, they have not entirely disappeared for seThe diagnosis can thus be delayed, leaving time for the cyst to take on significant dimensions and reach a gigantic size.2She is a 63 years old patient having as medical history: operated for uterine myoma 20 years ago whose history of the disease goes back to 2 years by the appearance of a painless umbilical tumefaction reducible impulsive to coughing, complicated 4 days ago by becoming painful irreducible not impulsive to coughing associated with an occlusive syndrome made of stop of matter and gas with food vomiting, all evolving in a context of apyrexia and alteration of the general state.with clinical examination: conscious patient stable on the hemodynamic and respiratory plan The examination noted a distended abdomen, hypertympanic, Presence of a pfannestiel scar, Presence of a strangulated umbilical hernia with inflammatory sign opposite ., the reThe patient were operated in the emergency room, approached by laparotomy with the exploration we found umbilical hernia with a 6 cm long neck and necrotic bowel content , a left Examination of the patient's spicemen  showed sPatient follow-up was every 15 days with a complete clinical examination with primary care of the surgical wound with instructions to change the dressing every 2 days and take antibiotics, anticoagulants and antlagics for 15 days and to avoid carrying heavy loads until complete healing.The postoperative follow-up was simple and the patient was declared discharged on day 7 postoperatively.The surgical procedure was performed on a scheduled date with a correct pre-anesthetic assessment; the procedure was performed by an assistant professor in general surgery and two residents in the same specialty.The operation was performed in the operating room of the P35 visceral emergency department at the CHU ibn rochd hospital in Casablanca, Morocco the patient was satisfied with the intervention and the improvement of his health in the short and long term.The work has been reported in line with the SCARE 2020 criteria .3Cystadenomas There are 2 types: Pleudomucinous cystadenomas or mucoid cysts, These are the most frequent neoplastic cysts of the ovary which are, in general, lumpy, multilocular, producing a gelatinous substance ,4.Serous cystadenoma or Serous cyst of the ovary is a benign epithelial tumor of the ovary accounting for 20–25% of all benign tumors of the ovary. It grows on the coelomic epithelium (the epithelium covering the ovary) and accounts for 50% of all epithelial tumors .The epithelium lining the cystic cavities is cubic, uni-stratified, occasionally ciliated. The axis of these vegetations contains calcospherites, in varying numbers. The serous fluid, sometimes mucoid, is clear, yellowish or hemorrhagic. Cystadenoma, uni or plurilocular, may cause only a slight increase in size. A tumor variety specific to the ovary, these tumors are situated between morphologically benign lesions and malignant tumors. They should be singled out because of their frequency, their age of occurrence  and above all their excellent prognosis compared to that of malignant tumors. Macroscopically, they are usually cystic tumors with endocystic and sometimes exocystic vegetations .Serous cysts of the ovary preferably appear before the age of 40, but in fact they can be observed at any age. Usually they are benign tumors, but some are borderline or malignant.The serous cyst of the ovary is classically unilocular, but sometimes it is multilocular, measuring on average 10 cm in diameter; in some cases they can reach the size of 30–50 cm, with a volume varying from a few cubic centimetres to several tens of liters. Ovarian serous cysts are bilateral in 12–20% of cases ,12.The content of the cyst varies according to the nature of the cyst, sometimes a gelatinous substance, if it is mainly a mucoid cyst, sometimes a hematic liquid, homogeneous or mixed with yellowish and clear debris, if it is a serous cyst, and sometimes a blackish liquid containing hairs, which is found in the dermoid cyst and represents most cases ,14.In benign forms of serous cysts, the external surface is regular, smooth, shiny and rich in blood vessels; the cyst wall is thin, less than 3 mm thick, and sometimes translucent.Its contents are fluid, serous, like rock water or citrine and sometimes viscous ,15.The internal surface of the cyst is smooth and regular, but sometimes small endophytic vegetations in the form of papillary structures and also some fine septa are present in a localized manner .The epithelium lining the inner surface of the serous cyst is composed of tubular, regular, unistratified, cubic or sometimes cylindrical cells with basal nuclei. Some cells are clear and ciliated. This epithelium is comparable in many respects to the internal epithelium of the uterine tube.Malignant forms of serous tumors of the ovary represent 40–50% of all malignant tumors of the ovary. In fact, among serous ovarian tumors: 50–70% are benign; 10–20% are bilateral; 10–15% are borderline tumors, generally with a good prognosis; 25–30% are malignant tumors (serous cystadenocarcinomas) .These types of lesions are most often asymptomatic. When they are large, they are likely to cause pain, abdominal transit disorders, increased abdominal perimeter or dysuria . They maIn such a context, it is necessary to recall the interest of an extemporaneous examination in the management of an ovarian tumor suspected of malignancy. This should be requested if the tumor presents worrying macroscopic characteristics  and if the results of this examination are likely to modify the operative strategy. If this request for an extemporaneous examination is anticipated before the operation, the patient must be informed of the possible modifications that its conclusions may entail concerning the operative strategy  ,30.However, in cases where extemporaneous examination is not feasible or uncertain, the laparoscopic appearance described in this article should prompt the surgeon to defer extensive first-line surgical treatment .Laparoscopy can show the types of cyst, which is translucent if it is serous, bumpy and greenish if it is mucoid - can specify the existence or absence of exocystic vegetations - allows other pathologies to be eliminated, in particular, ectopic pregnancy (EP), non-ovarian genital masses and certain pseudocystic formations ,21.The procedure to be proposed in the case of a small anechogenous serous cyst is treatment by laparoscopic puncture, which persists despite hormonal blockade. On the other hand, small cysts less than 8 cm in diameter should be left to develop, because if it is a functional cyst, it will disappear with or without medical treatment after 3 months ,28.In the case of unilateral ovarian cysts in postmenopausal women, adnexectomy should be performed. In the case of large cysts, efforts should be made to retain as much ovarian parenchyma as possible, for which oophorectomy or adnexectomy by laparotomy or laparoscopy are theoretically indicated .(12) 2424(14)There are no macroscopic criteria to differentiate them from benign papillary cystadenomas on the one hand and malignant tumors or cystadenocarcinomas on the other. Histologically, the cells lining the cyst wall and the papillae reflect the proliferative nature of the lesion .There are pluristratifications of the epithelial lining, clumps of epithelial cells shedding into the cyst lumen, cytonuclear atypia, and mitoses. There is no infiltration of the stroma and The prognosis of serous tumors at the limit of malignancy is very good .4Very large tumors have become curiosities in industrialized countries where the health care system is well developed. On the other hand, they are not rare in developing countries. The delay in diagnosis is most often due to the patient herself who does not consult out of ignorance or refusal of her pathology. But it can happen, and this is serious, that this delay is caused by the doctor. Indeed, The doctor may falsely reassure the patient because of the lack of a good clinical examination, which is very often sufficient to evoke the diagnosis in the face of imprecise abdominal signs.I declare on my honor that the ethical approval has been exempted by my establishment.None.El wassi Anas: Corresponding author writing the paper and operating surgeon.Eddaoudi Yassine: Corresponding author writing the paper and operating surgeon.Bouali Mounir: writing the paper and operating surgeon.El Bakouri Abdelilah: study concept; El Hattabi Khalid: study concept; Bensardi Fatimazahra: study concept.Fadil Abdelaziz: correction of the paper.Researchregistry2464.DR WAS EDD.Written informed consent for publication of their clinical details and/or clinical images was obtained from the patient.Not commissioned, externally peer-reviewed.The authors declare having no conflicts of interest for this article.


Ovarian neoplasms are categorized based on histopathologic features into epithelial surface cell tumors, germ cell tumors (teratomas), sex cord-stromal tumors, and metastases. Teratomas are the most common ovarian germ cell neoplasms. They are generally slow-growing lesions and can get fairly large before becoming symptomatic. The lesions are often incidentally discovered during imaging for other diagnostic purposes. Complications are uncommon but occur more commonly with larger lesions and include torsion, malignant degeneration, rupture, and rarely infection. When sizable, ovarian dermoid can rarely rupture and result in spillage of proteinaceous content into the peritoneal cavity, which can lead to chemical peritonitis. Additionally, the lesion can fragment into smaller lesions and can get implanted at different sites within the abdomen and pelvis. We present a case with an atypical presentation of a ruptured dermoid in a patient presenting with right upper quadrant pain who underwent sonographic evaluation, which demonstrated acute calculus cholecystitis but incidentally was found to have a partially calcified right subphrenic mass. Subsequent evaluation with computed tomography (CT) demonstrated multiple scattered peritoneal and mesenteric masses containing fat and calcification, highly suggestive of a chronically ruptured dermoid cyst. Ovarian neoplasms are histopathologically categorized into epithelial surface cell tumors, germ cell tumors, sex cord-stromal tumors, and metastases. Teratomas are the most common ovarian germ cell tumors and arise from pluripotent primitive germ cells. Ovarian teratomas include mature cystic teratomas (dermoid cysts), immature teratomas, and monodermal teratomas  . TeratomA 46-year-old female with no pertinent medical history presented with a one-day history of right upper quadrant abdominal pain with associated nausea and non-bilious, non-bloody emesis. Physical examination was significant for right upper quadrant tenderness to palpation with concern for acute cholecystitis. The subsequent sonographic evaluation demonstrated an intraluminal echogenic shadowing structure within the gallbladder with gallbladder wall thickening and a positive sonographic Murphy's sign, suggestive of acute cholecystitis. Additionally, the sonogram demonstrated a heterogeneous, partially echogenic right subphrenic mass measuring approximately 2.9 cm along the hepatic dome with posterior acoustic shadowing Figure . SubsequMature ovarian cystic teratomas or dermoid cysts are germ cell neoplasms that can contain tissues of any or all the germ cell layers , including but not limited to adipose tissue, calcifications or dental tissues, hair and even heterotopic tissues , which impart them with a varied but characteristic appearance on imaging . Ultrasound is the preferred imaging modality owing to the lack of ionizing radiation and a dynamic mode of imaging with varying characteristics and can demonstrate a heterogeneous, complex cystic adnexal mass of varying echogenicity and echotexture depending on lesional composition. An echogenic interface at the edge of the lesion may obscure deeper structures (“the tip of the iceberg sign”) due to the composition of sebaceous or keratinaceous tissues . Hair within the lesion may demonstrate thin linear echogenic bands (dot-dash pattern). Echogenic shadowing foci may represent lesional calcification or dental components, whereas non-shadowing echogenic foci may represent sebaceous or adipose tissues. Fluid-fluid levels may also be seen at the interfaces of different tissues, which can layer anti-dependently in discrete pockets in cases of rupture. Additionally, a characteristic eccentric echogenic mural nodule may also be demonstrated within the lesion representing a dermoid plug (Rokitansky nodule), which can contain a wide range of tissues including sebaceous, adipose, calcific, dental, keratinaceous (hair) components .CT demonstrates high sensitivity for the diagnosis of cystic teratomas as well, however, is less utilized due to the risks of ionizing radiation. CT imaging characteristics classically show an adnexal/ovarian lesion containing regions of low or fat attenuation, which may contain fat-fluid levels, calcifications (maybe dentiform), and hair with or without the presence of a Rokitansky nodule .MRI imaging may be utilized for troubleshooting in difficult cases. Characteristically, the utilization of fat-suppression sequences and chemical shift imaging will identify the presence of fat within the lesion, improving diagnostic yield. Lesional signal characteristics will vary based on tissue composition, with post-contrast enhancement adding diagnostic value to identify solid enhancing and potentially invasive/malignant components . Complications, although rare, tend to occur in larger lesions (>6 cm) and include ovarian torsion, rupture, infection, and malignant transformation. The reported rate of a ruptured teratoma is less than 1% . RuptureFrank fragmentation of the primary lesion with scattered heterogenous fat-containing implants is highly suggestive of rupture, as in our case. Interestingly, the patient’s acute presentation was likely secondary to cholecystitis, and the incidental right subphrenic lesion likely represented sequela of a chronically ruptured dermoid cyst given the lack of pelvic pain and absence of characteristic imaging findings to suggest acute rupture, as previously described. Additionally, the patient did not report any prior typical symptomology or remote trauma to suggest prior dermoid rupture.Mature ovarian teratomas are relatively common benign lesions typically encountered in young premenopausal females. Complications are rare but typically occur in larger lesions (>6 cm) and include torsion, infection, rupture, and very rarely malignant degeneration. We summarized an interesting instance of a chronically ruptured dermoid cyst in a patient with right upper quadrant pain. Rupture is very rarely encountered, and fragmentation of the primary lesion with scattered peritoneal and mesenteric implants is a highly suggestive finding, as seen in our case.


A dentigerous cyst is defined as a cavity lined with epithelium originating from the expanded follicle located around the crown of an impacted tooth at the amelocemental junction. The cyst develops from the epithelial remnants of the enamel as a result of fluid accumulation within its strata.Dentigerous cysts are usually asymptomatic, but may cause an increase in volume and delayed tooth eruption.3On microscopic examination, these cysts have a cavity filled with fluid and a thin epithelial lining with 2–6 layers of cuboidal cells, generally being defined as non-keratinised. The interface between epithelium and cystic capsule is smooth. In some cases, it is possible to observe the presence of mononuclear inflammatory infiltrate in the cystic capsule.In the majority of patients, dentigerous cysts present as a single lesion. When they are bilateral or multiple, they usually are associated with developmental syndromes or systemic diseases such as mucopolyssacharidosis, basal cell nevus syndrome, cleidocranial dysplasia and Maroteaux-Lamy syndrome. The occurrence of multiple dentigerous cysts in the absence of systemic disease is rare.5The imaging findings show a unilocular radiolucent lesion linked with an unerupted tooth with well-defined sclerotic margins. More sophisticated image diagnosis, such as computed tomography, may reveal the cystic nature of these lesions in greater detail and reliability, which facilitates the diagnosis.The aim of the present report is to describe an unusual case of multiple dentigerous cysts and to provide an overview of the imaging findings in order to assist dentists in performing accurate analysis of these lesions.A 39-year-old male patient presented to the dental office for conventional dental treatment, reporting neither underlying diseases nor oral complaints. Extra-oral examination showed no changes, whereas intra-oral examination showed no inflammatory signs.The panoramic radiograph showed the presence of two bilateral mandibular lesions, one measuring approximately 2 cm located on the right side and other measuring approximately 1.5 cm on the left side, and one maxillary lesion measuring 1.0 cm located on the left side. All of the three lesions were asymptomatic, well-delimited and involved the crowns of unerupted third molars .Figure 1To determine the actual limits of the lesions and their relationships with the surrounding tissues, and consequently the best treatment approach, a Cone Beam Computed Tomography (CBCT) scan was performed.CBCT revealed that teeth #28, #38 and #48 were unerupted, as well as the presence of cystic lesions on the right maxillary hemi-arch and on both mandibular right and left hemi-arches. In addition, CBCT  showed integrity and expansion of buccal cortical bones of maxilla and mandible . CoronalClinical and radiographic findings were suggestive of odontogenic keratocyst and dentigerous cyst. Under local anesthesia, incisional biopsy of the lesions was performed and specimens obtained. The surgical specimens were stored in flasks containing 10% formaldehyde before being sent for histopathological examination in our pathology laboratory. Histopathological findings showed the presence of a cystic cavity with a thin, stratified, squamous, epithelial lining. The interface between epithelial lining and cystic capsule was smooth, presenting areas with significant extravasation of red blood cells. A diagnosis of dentigerous cyst was thus determined .Figure 4The lesions were excised under general anaesthesia and the unerupted teeth removed.A dentigerous cyst is the second most common type of odontogenic cyst, whose frequency is lower than that of root cyst.The treatment of dentigerous cyst is selected depending on the lesion’s size. The lesion can be enucleated if it is small, whereas marsupialisation can be necessary for complete removal of a larger cyst.In general, dentigerous cysts are asymptomatic, but may cause facial swelling and delayed tooth eruption. Also, a discomfort can be associated with the cyst once it is secondarily infected.The multiple occurrence of dentigerous cysts in a non-syndromic patient is very rare.In the literature, age range varies widely, from 3 to 57 years old, occurring more in children under the age of 15 years.The present case report demonstrates the necessity of radiographic examination to investigate unerupted teeth. All the teeth affected by the lesion were unerupted.Some lesions may share the same radiographic features of dentigerous cyst, such as odontogenic keratocyst and unicystic ameloblastoma. However, dentigerous cysts typically have a smooth periphery whereas odontogenic keratocysts typically have a scalloped periphery.In addition, findings may differ by imaging method, with certain modalities more suited for visualized the features of the cysts.The complementary use of CBCT is important to delineate the extension of the lesion as well as its relationship with adjacent structures, provides brings more security to the surgical approach. CBCT has become widely used for diagnosis of the dento-maxillo-facial area. CBCT is a rapid, convenient and necessary measure that may be used to evaluate the presence and extent of this kind of lesion.In conclusion, multiple dentigerous cysts very rarely affect normal individuals. Imaging findings are typically helpful for a proper diagnosis. This kind of lesion requires a comprehensive preoperative evaluation along with a logically chosen surgical approach, and CBCT as a newer imaging technique may be a the diagnostic tool of choice in those cases.The authors declare no conflicts of interest.


Primary intestinal malignancies account for only 1%–3% of all malignant gastrointestinal tumors. Adenocarcinomas are uncommonly located in the ileum. Ileal adenocarcinoma (IA) is rare and difficult to diagnose because of its location. IA is common in older men and rare in young pregnant women. A 23-year-old pregnant woman was hospitalized several times for repeated vomiting and abdominal pain. Her symptoms were relieved after symptomatic treatment. She exhibited no typical manifestations of intestinal obstruction, such as abdominal distension, difficulty passing gas and defecation. Unfortunately, she was misdiagnosed with acute gastroenteritis. On the second day after delivery, the patient stopped passing gas and computed tomography (CT) revealed an intestinal obstruction. She was treated as paralytic ileus. However, in view of failed conservative management, she was decided for an exploratory laparotomy. A malignant ileal tumor 5cm from the ileocecal valve was found incidentally and was surgically excised accompanied with End-to-side anastomosis of ileal and transverse colon. The operation lasted 195 minutes. Pathological examination revealed an IA. Pregnant woman who experience symptoms of intestinal obstruction should be alert to the possibility of malignancy in the small intestine. IA is an insidious tumor in pregnant women. An “IA triad” can be defined as refractory vomiting, vague abdominal pain, and weight loss (or inadequate weight gain in pregnant women). Pregnant women with an IA triad should undergo investigation with endoscopy or, if necessary, magnetic resonance imaging (MRI). Primary intestinal malignancies account for only 1%–3% of all malignant gastrointestinal tumors. By subtype, 30%–40% are adenocarcinomas, 35%–44% are neuroendocrine tumors, 10%–20% are lymphomas, and 12%–18% are gastrointestinal stromal tumors  of her first pregnancy, complaining of vaginal bleeding for 2 days and vomiting and abdominal pain for 10 h.She experienced nausea and severe vomiting (approximately 5–10 times a day) during the first trimester. The vomiting did not stop at the end of the first trimester but was less severe than before. Weight gain was approximately 5 kg since the beginning of her pregnancy. Routine screening during her pregnancy suggested that the patient was heterozygous for the alpha-thalassemia gene, and her hemoglobin value fluctuated between 85 and 105 g/L . At 26 GWs, she was hospitalized because of vaginal bleeding and exacerbated vomiting. Her diagnosis was threatened premature labor and acute gastroenteritis. She was given symptomatic treatment (fluid rehydration and antiemetics). The vomiting abated and the vaginal bleeding stopped.At 30 and 5/7 GWs, the patient was admitted to our department for abdominal pain and recurrent exacerbated vomiting. She was diagnosed with acute cholecystitis based on a gallbladder stone revealed by ultrasonography and abnormal neutrophil counting. Antibiotics and antiemetics were prescribed accordingly. Dexamethasone was also prescribed to promote fetal lung maturation. Her symptoms abated quickly. At 33 and 3/7 GWs , the patient experienced lower abdominal pain and vaginal bleeding after vomiting. The vomiting, abdominal pain, and vaginal bleeding became worse and she was again hospitalized.Upon examination, the length of the gravid uterus was 26 cm, the abdominal circumference was 78 cm, and the cervix was dilated at 1 cm. The fetal heart rate was 130 beats per minute. No tenderness in the abdomen was obvious. Tests for polypeptides, antibodies against autoimmune hepatitis, and antibodies against hepatitis E, B, and C showed negative results. The amylase level was normal. The blood test results are listed in The patient denied any medical history of gastrointestinal symptoms such as emesis, melena, abdominal pain, or ileus before pregnancy. The patient and her family had no history of previous intestinal cancer. She was screened and was negative for hereditary non-polyposis colorectal cancer syndrome, Crohn’s disease, Peutz-Jeghers syndrome, celiac disease, and cystic fibrosis. Her grandfather had died of hepatic carcinoma.We prescribed glutathione to improve the patient’s liver function, nifedipine to inhibit uterine contractions, and magnesium sulfate to protect the fetus’s central nervous system. We also administered intramuscular dexamethasone sodium phosphate to promote fetal lung maturation.During the treatment course, she suffered repeated vomiting that was accompanied by pain in the lower abdomen. Her appetite was thereby affected, and she ate only a little porridge at a time. She emptied her bowels every day, but only in small quantities.We believed that her vomiting and pain would abate after delivery. She was treated symptomatically with mercoaluminum suspension to protect the gastric mucosa, metoclopramide to settle her stomach, and pethidine hydrochloride to relieve pain as necessary.A live baby boy weighing 2120 g was delivered prematurely on January 20, 2021. The infant had Apgar scores of 9 in the first minute and 10 in the fifth minute.Unfortunately, the patient still had postpartum nausea, vomiting, and abdominal distension and did not defecate for 2 days after delivery. On January 22, all bowel output stopped. Emergency CT indicated a small intestinal obstruction Figure 1There was still no anal discharge after non-surgical management for 2 days. Therefore, exploratory laparotomy with a vertical midline incision had to be performed for obvious abdominal distension. Approximately 200 mL of a yellow effusion was seen in the abdominal cavity. Intraoperatively, there was a hard constricting tumor measuring 2 cm × 2 cm located 5 cm from the ileocecal junction. The intestine was obstructed as evidenced by a dilated proximal bowel with blood, edematous fluid, and intestinal contents and collapsed distal bowel with many enlarged lymph nodes in the mesentery. Figure 2A tumor of approximately 2 cm × 1.5 cm × 1.3 cm in size was removed from the ileum. It was an ulcerative high-grade tubular adenocarcinoma, which had invaded the whole ileal wall Figure 3The patient was finally diagnosed with adenocarcinoma of the terminal ileum (pT4N2M0), abnormal liver function, gallstones, hypoproteinemia, preterm delivery (35 GWs), and alpha-thalassemia.The patient was discharged on February 3, 2021. Adjuvant chemotherapy was strongly recommended, but she chose traditional Chinese medicine (TCM) instead. She came to our department as an outpatient for a checkup in April 2021. Enhanced CT scanning of her whole abdomen revealed multiple niduses in the liver, the largest being 2.6 cm, which indicated metastatic lesions Figure 4Brucea javanica oil emulsion injection and other TCMs were used against the tumors. She underwent a chemotherapy regimen of oxaliplatin (100 mg) and bevacizumab (260 mg) administered on the first day of the cycle via intravenous infusion, plus oral capecitabine, 1 g twice a day for 14 days. This regimen was administered at 3-week intervals. The first, second, third, fourth, fifth, and sixth cycles of chemotherapy began on July 17, August 7, September 6, September 29, October 20, and November 15, 2021, respectively. CT revealed that the metastases in the liver were necrotic, but the metastases in the lymph nodes of the abdominal cavity had not changed. The patient’s last treatment was pelvic tumor angiography and perfusion chemotherapy with irinotecan.She was hospitalized in the Traditional Chinese Medicine Hospital of Zigong for abdominal pain on July 7, 2021. She suffered constant abdominal pain, and her weight dropped to 35 kg because her appetite was poor. She died on February 26, 2022.Small bowel adenocarcinomas account for only 5% of all gastrointestinal malignancies , which iThe rising incidence of IA has been linked to age and alcohol consumption, a high-fat diet, high-sugar diet, smoked foods, and red meat. In contrast, a high intake of fish, coffee, fruits, and vegetables may reduce the risk –10. In mThe most common clinical manifestations of IA are weight loss, vomiting, cramping abdominal pain, and occult gastrointestinal bleeding, but perforation is rare , 10–13. Flexible enteroscopy performed with balloon-assisted or spiral techniques to explore the terminal ileum is a predominant and effective method for diagnosing IA, but it is less accurate than CT enteroclysis or video capsule endoscopy (VCE) , 10, 15.Segmentectomy of the ileum and colon is the only cure for IA. Because lymph node metastasis strongly affects the prognosis, at least eight regional lymph nodes must be retrieved intraoperatively for evaluation . The comWhen malignancy is diagnosed during pregnancy, it is generally found at advanced stages . The lacIn our patient, IA caused only incomplete ileus, which was relieved after symptomatic treatment until the typical symptoms of ileus appeared after delivery. When the initial treatment of ileus failed, emergency surgery was needed, and only then was IA discovered unexpectedly. This is consistent with the report by Dabaja et al. that all cases of IA require emergency management .We propose an “IA triad” definition of refractory vomiting, vague abdominal pain, and weight loss (or inadequate weight gain in pregnant women). We believe that this IA triad can alert medical professionals to the possibility of a malignant tumor in young pregnant patients. Timely detection of tumors may contribute to earlier staging, which strongly affects the prognosis. To avoid misdiagnosis in similar cases, attention should be paid to important symptoms, including refractory vomiting, vague abdominal pain, and weight loss (or inadequate weight gain in pregnant women). Perhaps in the near future, artificial intelligence modules in medical management systems can help us solve these problems .Pregnant women who experience symptoms of intestinal obstruction should be alert to the possibility of small intestinal malignancy. IA is an insidious tumor in pregnant women. An IA triad can be defined as refractory vomiting, vague abdominal pain, and weight loss (or inadequate weight gain in pregnant women). Pregnant women with the IA triad should undergo investigation with endoscopy or, if necessary, magnetic resonance imaging.The original contributions presented in the study are included in the article/supplementary material. Further inquiries can be directed to the corresponding authors.Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. The patients/participants provided their written informed consent to participate in this study. Written informed consent was obtained for the publication of this case report.CX was responsible for the conceptualization, data collection and original manuscript drafting. QC and CC reviewed the literature. CCand XX corrected the data and revised the manuscript. YZ collected pathological data and revised the manuscript. All authors have read and approved the final manuscript.