Inflammatory myofibroblastic tumor (IMT) is a rare mesenchymal neoplasm that can arise in various anatomical locations, while IMT originating from the broad ligament is exceptionally rare. Anaplastic lymphoma kinase (ALK) is a highly specific diagnostic biomarker for IMT. However, no standardized therapeutic algorithm has been established for ALK-negative IMT, largely due to the unclear risk of distant metastasis and recurrence. In cases with undefined tumor differentiation and no detectable molecular targets, close surveillance and individualized therapeutic strategies should be guided by the tumor's biological behavior and patient-specific risk factors. We present the case of a 21-year-old unmarried, nulliparous woman who reported a palpable abdominal mass, ultimately found to originate from the broad ligament. Exploratory laparotomy revealed a mass arising from the posterior leaf of the broad ligament along the posterior uterine wall. Histopathological analysis favored a diagnosis of ALK-negative IMT, although the origin and differentiation trajectory of the tumor remained undetermined. The patient did not undergo any adjuvant therapy, such as chemotherapy. Instead, a regimen of routine follow-up was implemented to monitor for disease progression or recurrence. At the 10-month follow-up, no clinical or radiological signs of recurrence or malignant transformation were observed. To date, surgical resection remains the mainstay of treatment for IMT. For ALK-negative IMT cases, molecular profiling to identify targetable genomic alterations may assist in selecting individualized targeted therapies.

Goblet cell adenocarcinoma (GCA) is a rare type of appendiceal carcinoma characterized by distinct histological features. It is extremely challenging to diagnose this entity on histopathology and even arduous to identify it on effusion cytology primarily due to its rarity and lack of sufficient literature. We hereby report a unique case of a 45-year-old female presenting with abdominal pain, distension, and bilateral ovarian masses. Radiologically, she was suspected of having an ovarian primary. Ascitic fluid smears and cell block sections revealed features of a metastatic adenocarcinoma, exhibiting some distinctive cytomorphological characteristics. The patient subsequently underwent exploratory laparotomy with total abdominal hysterectomy, bilateral salpingo-oophorectomy, appendicectomy, and omentectomy. Histopathological examination of the appendix and ovarian mass showed a tumor with features of GCA. This case highlights the importance of meticulous cytological evaluation and a systematic approach to rare entities, emphasizing the need for heightened awareness of this condition to avoid misdiagnosis and optimize the treatment strategies.

Small bowel volvulus secondary to ascariasis in a 7-year-old boy: a case report

Jejunal web as the cause of bowel obstruction in an infant: case report and brief literature review

This was a case of a 65‐year‐old gentleman known to have diabetes mellitus and hypertension since 2012 and post renal transplantation in 2016. He had also been treated for hepatitis C infection in the past. His regular medications included nebivolol 5 mg once a day, tacrolimus 4 mg twice a day, mycophenolate mofetil 500 mg twice a day, prednisolone 5 mg once a day, and insulin–novomix 14 units in the morning and 6 units at night. He presented to a tertiary teaching hospital in Kenya in October 2023 with abdominal pain, vomiting, and constipation on and off for 6 months, worse in the month prior to presentation. His examination was positive for dehydration, abdominal distension, and generalized abdominal tenderness. He had a normal hematological profile and renal function. A CT scan of the abdomen showed features of small bowel obstruction from the distal ileal to distal jejunal bowel loops. The patient underwent an exploratory laparotomy with intraoperative findings of a midjejunal tumor completely obstructing the lumen with proximal dilatation. The tumor was subsequently excised. Histological specimen confirmed diffuse large B‐cell lymphoma (DLBCL) as his final diagnosis.

Patients with concurrent malignancies pose significant diagnostic and therapeutic challenges. We report a rare and fatal case of synchronous ovarian mixed germ cell tumor and mast cell leukemia (MCL) in a 13-year-old female, characterized by a shared clonal origin. The patient initially presented with a large pelvic mass, elevated alpha-fetoprotein(AFP) and human chorionic gonadotropin (β-HCG), anemia, and thrombocytopenia. Exploratory laparotomy confirmed a diagnosis of mixed germ cell tumor, predominantly dysgerminoma with a minor choriocarcinoma component. Despite an initial decrease in serum tumor markers to platinum-based chemotherapy, persistent cytopenias and bone marrow infiltration raised concern for hematologic malignancy. Genomic analyses of both ovarian tumor and bone marrow samples identified identical somatic mutations, including KIT D816V, NRAS G12C and TP53 Y220C, strongly suggesting a common progenitor. Subsequent immunophenotyping, histology, and transcriptome sequencing confirmed the diagnosis of concurrent mast cell leukemia. Targeted therapy with avapritinib and ruxolitinib was initiated but yielded limited response. Further salvage therapy failed due to disease progression and treatment intolerance, and the patient succumbed to multiple organ failure. This case underscores the clinical and genetic overlap between germ cell tumors and hematological malignancies in pediatric patients, highlighting the role of KIT mutations as a potential unifying driver. Given the consistent co-occurrence of KIT mutations in previously reported similar cases, we propose the recognition of a distinct disease entity: ovarian germ cell tumor/mastocytosis with KIT mutations. This report emphasizes the importance of early genetic profiling and multidisciplinary collaboration in diagnosing and managing rare, genetically unified malignancies in pediatric oncology.

The relationship between nutritional status and exploratory laparotomy under general anesthesia postoperative treatment length in pediatric patients

Uterine didelphys, also known as double uterus, is a congenital anomaly of the female reproductive system that can be associated with a significant number of threatening obstetric complications, such as uterine rupture. We report a rare and complex case of an 18-year-old primigravida who presented with uterine rupture due to uterine didelphys at 18 weeks of gestation. Patient had no prior medical or gynecological history. Physical examination revealed a diffusely distended and tender abdomen along with signs of hemodynamic instability. Ultrasound of the abdomen showed hemoperitoneum, with an intrauterine dead fetus. Second trimester intrauterine rupture was considered the initial diagnosis. After successfully resuscitating the patient, exploratory laparotomy was performed. Uterine didelphys with a right-sided uterus ruptured from the fundal region along with a wide-bore intestinal diverticulum was seen. After repairing the uterus in 2 layers and hemodynamically supporting the patient, retained products of conception were removed. Postoperative laboratory investigations were significant for disseminated intravascular coagulation and metabolic acidosis with respiratory compensation. These critical findings necessitated intensive care unit (ICU) admission where the patient received close monitoring, ultimately leading to stabilization of the patient. This case serves as a reminder that adolescents with Mullerian duct anomalies, even without a prior history of uterine scarring, can present with life-threatening obstetric complications such as uterine rupture. Prompt recognition and timely management are essential to prevent fatal outcomes.

Noncommunicating gastric duplication cyst at the pylorus in a 5-year-old child: a case report

Fibrinogen drives neuroinflammation and neuropathology in perioperative neurocognitive disorders.

BackgroundApproximately 20% of the U.S. population resides in rural areas where health care access is limited by physician shortages. This presents a disparity in emergency general surgery where timely intervention is essential. This study aims to evaluate the impact of rurality on outcomes of emergency general surgery patients transferred to a metropolitan center.MethodsA retrospective single-center cohort study of 1189 patients who underwent non-traumatic emergent exploratory laparotomies. Patient rurality was determined by Rural-Urban Commuting Area (RUCA) codes which categorize patients as metropolitan, micropolitan, small town, or rural. The primary outcome was in-hospital mortality.ResultsRural (n = 369) and small-town (n = 135) patients had similar preoperative comorbidities, Physiological Emergency Surgery Acuity Scores (PESAS), utilization of damage control laparotomies, ICU metrics, and outcomes compared to those that presented to a metropolitan center (n = 508). In contrast, micropolitan (n = 177) patients had higher PESAS scores (5 vs 3, P < 0.0001) and underwent more damage control laparotomies (62% vs 40%-49%, P < 0.0001) with higher use of intraoperative vasopressors (57% vs 37%-39%, P < 0.001) and higher overall mortality (23% vs 13%-15%, P = 0.027).DiscussionOur findings suggest that a mature and centralized transfer system promotes equity of outcomes between rural and metropolitan emergency general surgery patients. Micropolitan patients were more acuity ill than patients of other degrees of rurality, which suggests that low acuity micropolitan patients were more likely to be managed within their own communities.

Starvation and nutritional support clinically influence horses, particularly during the treatment of gastrointestinal diseases and post-surgical recovery. In this study, we aimed to evaluate the effects of different nutritional strategies on the endocrine response of horses subjected to exploratory laparotomy followed by food deprivation. Sixteen healthy adult horses were randomly allocated into four groups (n=4) based on treatments: enteral fluid therapy without (ENTFL) or with glutamine (ENTGL), and parenteral fluid therapy with glucose (PARFL) or total parenteral nutrition with glutamine (PARGL). Treatments were administered for 144 hours of starvation followed by 144 hours of refeeding. Blood samples were collected at five time points for hormonal (leptin, ghrelin, adiponectin, cortisol, insulin, free T3, and free T4) analyses. Serum insulin and glucose significantly varied across all groups, with the PARGL group exhibiting hyperinsulinemia and persistent hyperglycemia during starvation. No significant alterations in free T3 or T4 concentrations were observed, which is potentially attributed to elevated serum glucose levels maintaining thyroid hormone stability. Notably, cortisol levels increased in the ENTGL group 72 hours after the onset of starvation. Ghrelin significantly increased only in the PARGL group during starvation, and it decreased after refeeding. Adiponectin levels were enhanced in the PARFL group during deprivation, which dropped after refeeding. Starvation reduced leptin levels in the ENTGL and PARGL groups, which were increased after refeeding. Despite hormonal changes, enteral nutrition maintained glycemic control, indicating stable intestinal absorptive function. These findings highlight the influence of nutritional route and composition, especially glutamine and glucose, on endocrine adaptation during starvation and refeeding. However, limitations such as the small sample size and absence of an absolute fasting group constrain the interpretations. Future studies involving broader hormonal panels and longer follow-up can better clarify neuroendocrine regulation during nutritional stress in horses.

Fibroids are the most common pelvic tumors in women; serious complications are very rare but can be life threatening also. This case report highlights the atypical presentation of spontaneous hemorrhage and gangrene from a uterine myoma that clinicians should consider as a differentials diagnosis of haemoperitonium. It adds to the existing literature in discussing the investigations and management of these rare fibroid complications. We present a case of an atypical presentation of spontaneous hemorrhage from a uterine fibroid with gangrene with no precipitating factors. A 36-year-old lady who was diagnosed as a case of sub serous pedunculated fibroids presented to us with acute abdominal pain and high fever in an unstable condition who required 2 units of blood transfusion. Her ultrasound examination revealed abdominopelvic ascites, two solid pelvic mass most likely right adnexal origin, her vital signs revealed tachycardia with raised temperature, her abdomen was soft but tender with mild distension. Her tumor marker was raised CA-125 (137μ/ml), there was neutrophilic leucocytosis, negative urine pregnancy test-all together made a diagnostic dilemma, so plan for exploratory laparotomy was done with frozen section biopsy facility. After laparotomy a huge hemoperitonium was found. Hemorrhagic fluid was sent for cytology. Two large twisted gangrenous fiboids were found, there was bleeding from surface vein overlying uterine myoma. Gangrenous myoma was sent for frozen section biopsy. After frozen section biopsy report definitive surgery was done with preservation of one ovary. Patient was discharged on 4th post-operative day with no complaints. Haemorrhage and gangrene secondary to a uterine fibroid are a rare complication of uterine fibroids that clinicians must consider. Initial rapid imaging can be used to narrow down the diagnosis. Prompt resuscitation, definitive surgical management in a multidisciplinary team approach will aid in management and improve outcomes.

Acute abdomen requires urgent intervention for potentially life-threatening conditions. We report the case of a 59-year-old male with acute abdominal pain and bloody stools treated at the Regional Hospital of Pilar, Paraguay. Exploratory laparotomy revealed intestinal ischemia with necrosis, congestive appendicitis, inguinal hernia, colocolic intussusception, and diverticulosis. A comprehensive surgical approach resulted in favorable postoperative recovery. This case highlights the critical role of timely diagnosis and multidisciplinary management in optimizing outcomes for complex acute abdomen presentations.

Hernia development is a common abdominal wall condition observed in calves, frequently manifesting in the umbilical region. This innovative biological dermoid scaffold is considered superior because of their inherent ability to combat infections through the release of antimicrobial peptides and non-complement fixing antibodies. The Division of Surgery at ICAR-IVRI, Izatnagar, has pioneered the development of bioinspired-bioactive dermoid scaffolds, as an initiative aimed at addressing hernias in large animals. The in vitro evaluation of the scaffold included crucial parameters such as H and E staining, SEM evaluation, and scaffold-cell interaction. Histocompatibility, cyto-toxicity, cell attachment, and proliferation of the seeded scaffolds were assessed using DAPI staining, along with an examination of porosity and density. All cases share a common history of a large swelling in the abdominal region. Physical examination, palpable hernial ring was identified followed by USG examination leading to the diagnosis of a large ventral hernia. Hematobiochemical analysis indicated a slight metabolic alkalosis, along with mild anaemia and azotaemia. Subsequent exploratory laparotomy was performed, to address the large abdominal defect, we decided to repair it using an allogenic dermoid graft in an overlaid fashion. Postoperative care included a 7-day course of antibiotics, analgesics, and antihistamines. All buffaloes in the study exhibited uneventful recovery, with no recurrence observed during the 5-month follow-up period. No reports on treatment of large abdominal wall defects with dermoid graft reported, which prevent reoccurrence of hernia. This study marks for the first time, where we outline the successful closure of a hernia in clinical cases.

BackgroundCrohn’s disease, a chronic inflammatory bowel disease, commonly presents with abdominal pain, diarrhea, and weight loss, typically leading to diagnosis through endoscopic or imaging studies. Its incidental discovery during emergent trauma surgery is rare.Case PresentationWe report the case of a 25‐year‐old male who sustained blunt abdominal trauma in a dirt‐bike accident, presenting to the emergency department the same day with progressive abdominal pain. Emergent exploratory laparotomy for a suspected bowel perforation revealed characteristic “creeping fat,” inflammatory adhesions, and an enterocolonic fistula, suggesting undiagnosed Crohn’s disease. The presence of acute inflammation necessitated extended small bowel resection and precluded primary anastomosis. Postoperatively, the patient developed recurrent intra‐abdominal abscesses, including a subhepatic collection measuring 5.7 × 2.6 × 5 cm, as well as pleural effusions, necessitating multiple drainage procedures, targeted antibiotics, and nutritional optimization. A multidisciplinary team—including trauma surgeons, gastroenterologists, infectious disease specialists, and interventional radiologists—collaborated to manage both acute injuries and the newly recognized chronic inflammatory condition. Final pathology revealed multifocal colonic mucosal ulceration with acute inflammation, ileocolic fistula formation, and colonic perforation, consistent with a penetrating (fistulizing) phenotype, ileocolonic Crohn’s disease.ConclusionThis case illustrates the importance of maintaining a broad diagnostic perspective during trauma surgery and highlights how an unrecognized inflammatory bowel disease can complicate postoperative recovery. Early suspicion and tailored interventions are crucial for mitigating complications such as abscess formation and sepsis. A prompt gastroenterology consult and confirmatory investigations are recommended to guide long‐term management of Crohn’s disease. Ultimately, this report underscores that vigilance for atypical findings in emergent settings can significantly improve patient outcomes.

Schistosomiasis is a chronic enteropathogenic disease assignable to blood flukes of the genus Schistosoma. The illness afflicts roughly 240 million human beings globally. The chronic state attributed to the infection arise because of granuloma creation either in the intestine, liver or the bladder. This is a case report based on a patient who presented with an acute abdomen in need of an emergency surgery. The diagnosis could only be made after the Pathology report on the surgical specimen. This is a case report of a 53-year-old-female with no past medical history, presented to the emergency department with an abdominal pain, hematochezia, diarrhea and weight loss. The blood work revealed elevation of inflammatory parameters and the computed tomography (CT) scan suggested a complicated acute appendicitis versus a complicated either cecum or a redundant sigmoid colon neoplasm. The patient underwent an exploratory laparotomy followed by a right colectomy with primary anastomosis, right salpingectomy and a sigmoidectomy with a terminal colostomy. It is essential to emphasize the significance of early identification, diagnosis and treatment of schistosome illness to impede or defer the succession to advanced stage, although occasionally can be an obscure malady, with a delayed arrival of diagnostic features, whomever the diagnosis is incredibly difficult on imaging, being most of the times made by a pathologist, as so, it can mimic several other surgical problems.

Meckel’s diverticulum is a congenital anomaly that is often clinically silent but can present with life-threatening complications. In adolescents, its presentation as acute intestinal obstruction due to a closed loop is extremely rare and diagnostically challenging. We report a case of a 15-year-old male who presented with acute abdominal pain, vomiting, and distension. Clinical and imaging features suggested closed-loop small bowel obstruction. Emergency exploratory laparotomy revealed a gangrenous segment of the distal ileum and a Meckel’s diverticulum associated with dense adhesions. The patient underwent resection of the gangrenous ileum and cecum with end ileostomy. Postoperative recovery was uneventful, histological examination revealed coagulative necrosis with ectopic pancreatic tissue in Meckel’s diverticulum and he was discharged in a stable condition. This case emphasizes the importance of considering Meckel’s diverticulum in the differential diagnosis of intestinal obstruction in adolescents, especially in the absence of previous abdominal surgeries. Early surgical intervention is essential to prevent ischemic complications and optimize outcomes.

Abstract Introduction Symptomatic patients post abdominal surgery may be referred for hydrogen breath test (BT) to screen for small intestinal bacterial overgrowth (SIBO). This study reviews the complex nature of the outcomes. Method BTs were performed in accordance to Bedfont Scientific guidelines (20g Lactulose was used and Gastrolyzer analysed the breath samples). Patient undergoing BT post abdominal surgery between January to June 2025 were reviewed. Results 51 patients (18.8%)(female:male=37:14) had abdominal surgery (surgery of foregut 14, midgut 18, hindgut 11, gynaecological surgery 7, exploratory laparotomy 3 and nephrectomy 1. 15 patients had multiple surgeries form the list). 39 patients (76.5%) produced exceptional end-tidal breath samples from average oxygen concentration found &amp;lt;15%. SIBO was unequivocally positive in 11 patients (21.6%) with maximum hydrogen rise from baseline by 109PPM [95%CI: 38.5-80.7PPM], which was captured within 90-minutes. 2/11 patients (18.2%) had SIBO co-existing with gastrointestinal methanogenic archaea (MA). In total, 12 patients had MA (23.5%) which oxidise ambient hydrogen as fuel source for energy and produce methane. Thereby reducing the hydrogen production expelled in BT and producing false-negative detection for SIBO. Furthermore, 19 patients (37.3%) in the absence of MA demonstrated no evidence of colonic fermentation of the indigestible lactulose by 180-minutes (hydrogen rise &amp;lt;20PPM). This is suggestive of a slow gut transit which can also falsify negative for SIBO. Conclusions Half of the patients with past abdominal surgery may have false-negatives for SIBO and require repeat testing after treating other causes.

Introduction: Spirochetes of Leptospira spp. are responsible for leptospirosis, a zoonotic bacterial infection that affects various animal species, particularly canines. The present study aimed to report the detailed clinical presentation, management, post-mortem examinations, and histopathological findings of a 5-year-old male Boerboel dog displaying signs of acute illness, including anorexia, constipation, and emesis. Case report: The dog was presented to the small animal clinic, Department of Veterinary Services, Ministry of Agriculture and Food Systems, Ikeja, Lagos State, Nigeria. Initial physical examinations revealed lethargy, pale mucous membranes, and constipation; laxatives and enemas were administered. The dog’s condition worsened, and then an exploratory laparotomy was performed, revealing a distended, obstructed intestine. Post-surgical care included antimicrobial and fluid therapy; however, the dog died a few days after the surgery. Necropsy revealed significant findings, including fatty liver, haemorrhagic enteritis, and lymphadenomegaly. Histopathological findings of the liver exhibited moderate hepatic lipidosis, inflammatory cell infiltration, and cholestasis. Renal samples exhibited interstitial nephritis and tubular degeneration. Reactive changes in gut-associated lymphoid tissues were observed in the intestinal samples. The polymerase chain reaction result for the Leptospira 16S rRNA gene was positive in the liver, confirming the diagnosis of canine leptospirosis.Conclusion: The present study highlighted the importance of timely diagnosis and intervention in suspected cases of leptospirosis. The combination of clinical assessment, post-mortem findings, histopathological evaluation, and molecular diagnostics provided a comprehensive understanding of the disease process and emphasized the need for increased awareness and improved management strategies for canine leptospirosis in veterinary practice.