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Mesothelial cysts of the diaphragm are uncommon congenital lesions that can be easily misdiagnosed due to their resemblance to other cystic formations, particularly hepatic hydatid cysts. We present the case of a 19-year-old male with no significant past medical history who complained of dull, heavy pain in the right costovertebral region persisting for several weeks. Initial laboratory tests were within normal limits. A contrast-enhanced CT scan revealed a retrohepatic cystic lesion measuring 45 mm, closely associated with the right hemidiaphragm and liver, which was suggestive of a hydatid cyst. However, negative hydatid serology ruled out this diagnosis, leading to the decision for surgical intervention. During surgery via a right subcostal approach, a 4 cm cystic lesion was found tightly adherent to the diaphragm. Complete excision of the cyst along with repair of the diaphragmatic defect was performed without complications. Histopathological examination confirmed the diagnosis of a mesothelial cyst of the diaphragm, a rare benign entity. The patient had an uneventful postoperative course and was discharged on the third day. Follow-up over one year showed no recurrence of symptoms or lesions. This case highlights the diagnostic challenges associated with mesothelial cysts and emphasizes the importance of surgical excision for definitive diagnosis and symptom relief., (© 2025 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Introduction and Importance: Retroperitoneal schwannomas are extremely rare, benign tumors originating from Schwann cells in peripheral nerve sheaths, with few reported cases. Their deep location and nonspecific symptoms make preoperative diagnosis challenging, often requiring imaging and surgical resection for confirmation. This case highlights an uncommon presentation of retroperitoneal schwannoma in a young patient, emphasizing its rarity., Case Presentation: An 18-year-old male presented with a progressively enlarging, non-tender mass in the left flank. Imaging revealed an 8 × 7 cm well-circumscribed, encapsulated mass displacing adjacent major vessels without invasion. The patient underwent successful surgical resection, and histopathology confirmed a benign schwannoma. Immunohistochemistry showed strong S100 protein positivity, with no signs of malignancy. Follow-up was uneventful, with no recurrence at six months., Discussion: Retroperitoneal schwannomas, typically slow-growing and benign, are infrequently encountered. Due to their nonspecific presentation, they often reach considerable size before detection. Imaging may suggest diagnosis but is not definitive, making surgical excision essential for confirmation. Complete resection is generally recommended to reduce recurrence, though partial excision may be appropriate when adjacent critical structures are involved., Conclusion: Retroperitoneal schwannomas are rare and challenging to diagnose preoperatively. Complete surgical resection remains the primary approach, allowing histological confirmation and reducing recurrence risk. This case underscores the importance of considering retroperitoneal schwannomas in young patients presenting with atypical retroperitoneal masses., Competing Interests: Declaration of competing interest No conflicts of interest., (Copyright © 2025. Published by Elsevier Ltd.)

Spontaneous intraperitoneal rupture of hepatic hydatid cysts is a rare but serious complication that can lead to significant morbidity and mortality due to risks such as anaphylactic shock and secondary peritoneal hydatidosis. This report presents the case of a 59-year-old male farmer from a rural area of Tunisia who presented with severe abdominal pain, nausea, and vomiting. Diagnostic imaging revealed a large hepatic cyst with free peritoneal fluid, indicating a ruptured hydatid cyst. Emergency surgery involved cyst evacuation, peritoneal lavage, and drainage. Postoperatively, the patient developed a transient biliary fistula but recovered well with albendazole therapy to prevent recurrence. Six months post-surgery, the patient remains asymptomatic. The case underscores the importance of considering hydatid disease in acute abdomen diagnoses in endemic regions and highlights the critical role of imaging and timely surgical intervention. The literature review indicates variability in the prevalence of cyst rupture and emphasizes the need for a comprehensive approach combining surgery and antiparasitic treatment for effective management and recurrence prevention., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2025 The Authors.)

Meckel's diverticulum, a congenital anomaly of the omphalomesenteric duct, is a rare cause of acute abdomen and poses significant diagnostic challenges due to its variable presentation and complications such as perforation. We present the case of a 19-year-old male with a 24-hour history of right iliac fossa pain progressing to generalized abdominal tenderness. Laboratory results showed leukocytosis and elevated C-reactive protein, while CT imaging suggested pneumoperitoneum and an inflamed Meckel diverticulum. Laparoscopic exploration, followed by conversion to laparotomy, confirmed a perforated Meckel diverticulum, which was resected with an uneventful recovery. This case highlights the importance of including Meckel's diverticulum in the differential diagnosis of acute abdomen in young patients, emphasizing the utility of CT imaging and the need for prompt surgical intervention to achieve favorable outcomes., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Introduction: Intestinal tuberculosis (ITB), a rare yet severe manifestation of Mycobacterium tuberculosis infection, poses significant diagnostic and therapeutic challenges due to its nonspecific clinical presentation. Perforation, a life-threatening complication, necessitates prompt surgical intervention and effective antituberculous therapy., Case Presentation: This case study highlights a 41-year-old immunocompetent male who presented with fever, abdominal pain, vomiting, and significant weight loss. A computed tomography scan revealed minimal pneumoperitoneum, intestinal wall thickening, mesenteric fat stranding, lymphadenopathy, and an intra-abdominal abscess. Exploratory laparotomy identified a perforation at the terminal ileum, leading to ileocaecal resection and stoma formation. Histopathological examination confirmed ITB, and a nine-month regimen of antituberculous medication was initiated., Discussion: ITB, more common in immunocompromised individuals, can also affect immunocompetent patients, often mimicking other gastrointestinal conditions and delaying diagnosis. This case underscores the importance of considering ITB in differential diagnoses for patients with vague gastrointestinal symptoms. Diagnostic confirmation typically requires a combination of clinical, radiological, and microbiological assessments, with histopathology playing a crucial role. Factors such as age and comorbidities can increase the risk of severe complications like perforation. Surgical resection with anastomosis tends to yield better outcomes than direct closure, and comprehensive antituberculous therapy is essential for successful treatment., Conclusion: The complexity of diagnosing and managing ITB, compounded by its severe complications, necessitates heightened awareness among healthcare providers. Accurate diagnosis, timely surgical intervention, and rigorous antituberculous therapy are vital for improving patient outcomes, especially in high-risk populations or regions with prevalent TB., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Introduction: Stercoral perforation of the colon is a rare and life-threatening condition caused by pressure necrosis due to fecal impaction. It is commonly associated with chronic constipation, particularly in patients with neurogenic bowel disorders or prolonged opioid use. However, its occurrence in the context of chronic heroin use is rarely reported., Case Presentation: We report the case of a 40-year-old male with a 5-year history of heroin abuse who presented with diffuse abdominal pain, vomiting, and cessation of gas and stool passage for 10 days. Physical examination revealed a distended abdomen with generalized tenderness, guarding, and a rectal examination confirmed fecal impaction. Computed tomography (CT) showed massive fecal impaction in the sigmoid colon with pneumoperitoneum, indicating perforation. The patient underwent urgent exploratory laparotomy, revealing two perforations in the sigmoid colon with extensive fecal peritonitis. A segmental resection of the sigmoid colon with colostomy was performed. Postoperatively, the patient required intensive care for septic shock but eventually recovered and was referred to an addiction treatment program., Discussion: This case highlights the serious gastrointestinal complications associated with chronic opioid use, particularly heroin. The pathophysiology involves opioid-induced inhibition of gastrointestinal motility, leading to chronic constipation, fecaloma formation, and subsequent perforation. Early recognition and prompt surgical intervention are crucial in managing stercoral perforation, which carries a high mortality rate if delayed., Conclusion: This case underscores the importance of recognizing gastrointestinal risks in chronic opioid users, especially heroin, and the need for integrated care strategies to prevent severe complications like stercoral perforation., Competing Interests: Conflict of interest statement Authors declare no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Total hip arthroplasty (THA) is commonly performed to alleviate hip pain and restore function. While generally safe, complications such as prosthesis migration can occur. Intrapelvic migration of hip prostheses, leading to bowel perforation and fistula formation, is a rare but severe complication requiring prompt diagnosis and management. This case report, presented in line with the SCARE criteria, highlights a case of caecal perforation due to hip prosthesis migration., Case Presentation: A 78-year-old female with a history of right THA presented with severe hip pain, loss of function, and a persistent fistula exuding fecaloid fluid. Examination revealed fever, rigidity, and limited hip motion. CT scans showed intrapelvic protrusion of the prosthetic components and a colo-cutaneous fistula. Emergency laparotomy revealed caecal perforation by a screw from the acetabular component, necessitating resection of the perforated caecum. A subsequent surgery addressed the hip prosthesis. The patient recovered uneventfully and was discharged on day 7., Discussion: Prosthesis migration into the pelvis is a serious complication of THA. Risk factors include implant loosening, acetabular bone loss, surgical technique issues, and patient factors like obesity and osteoporosis. Diagnosis relies on imaging studies. Management typically involves surgical removal of the migrated prosthesis and repair of the perforation, necessitating a multidisciplinary approach., Conclusion: Caecal perforation due to intrapelvic migration of a hip prosthesis is rare but potentially life-threatening. Prompt diagnosis and appropriate management are crucial. Further research is needed to better understand risk factors and prevention strategies., Competing Interests: Declaration of competing interest Authors declare no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Spontaneous splenic rupture (SSR) is a rare but potentially fatal condition. It is commonly linked to underlying conditions such as infections, neoplasms, or hematologic diseases. SSR can also occur in a healthy spleen without any associated pathology, termed idiopathic splenic rupture. Symptoms range from non-specific abdominal pain to hemodynamic instability, often requiring emergency splenectomy. Early recognition using CT is crucial for improving outcomes., Case Presentation: A 32-year-old male presented with severe abdominal pain for 24 h. Examination showed stable hemodynamics but tenderness in the left upper quadrant. CT revealed a subcapsular hematoma and moderate hemoperitoneum, leading to a diagnosis of SSR. Initially managed conservatively, the patient developed hemorrhagic shock 24 h later, with hemoglobin decreasing to 6.2 g/dL. An exploratory laparotomy confirmed a superior pole splenic fracture with significant hemoperitoneum, necessitating a total splenectomy. Postoperative recovery was uneventful, and the patient was discharged on postoperative day 6 with prophylactic vaccinations and lifelong penicillin., Discussion: SSR in a normal spleen is extremely rare and poses significant diagnostic and therapeutic challenges. The exact mechanisms are unclear, with theories including vascular anomalies, microtrauma, increased splenic pressure, and idiopathic factors. SSR symptoms are often non-specific, leading to misdiagnosis. Timely diagnosis using imaging, particularly contrast-enhanced CT, is essential. Management varies from conservative approaches to splenectomy, based on hemodynamic stability and splenic damage., Conclusion: Spontaneous rupture of a normal spleen is a critical condition requiring high clinical suspicion for timely diagnosis and management. Further research is needed to understand its pathophysiology and risk factors., Competing Interests: Conflict of interest statement Authors declare no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Splenic artery pseudoaneurysms (SAP) are uncommon but significant vascular complications frequently associated with pancreatitis. These lesions carry a substantial risk of rupture and subsequent life-threatening hemorrhage. Standard treatment typically involves surgical or endovascular intervention to prevent such catastrophic outcomes. However, this case report documents a rare instance of spontaneous regression of a SAP following severe pancreatitis, challenging the established treatment protocols and highlighting the potential for conservative management under specific conditions., Case Presentation: A 65-year-old male with a past history of acute biliary pancreatitis secondary to gallstones, which was treated with laparoscopic cholecystectomy, presented with severe abdominal pain and a significant drop in hemoglobin levels. Imaging revealed acute pancreatitis with multiple pseudocysts and a newly identified 10 mm splenic artery pseudoaneurysm exhibiting recent bleeding. Although arterial embolization was recommended, the patient opted for non-invasive management. Intensive monitoring and conservative treatment were initiated. Over several days, his symptoms improved, and follow-up imaging showed spontaneous thrombosis of the SAP. One month later, a CT scan confirmed the complete resolution of the pseudoaneurysm., Discussion: SAPs are serious complications of pancreatitis, often necessitating urgent intervention due to high rupture risk. This case of spontaneous regression underscores the importance of individualized management strategies. It suggests that conservative treatment may be a viable option for stable patients with resolving pancreatitis, although such cases are rare and require careful monitoring., Conclusion: While the primary approach to managing SAP remains interventional due to the high risk of rupture, this case highlights the potential for spontaneous regression in select circumstances. It underscores the need for personalized treatment plans., Competing Interests: Conflict of interest statement Authors declare no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Psammocarcinoma is an uncommon subtype of low-grade serous carcinoma. It is characterized by the presence of extensive psammoma bodies and can have either an ovarian or peritoneal origin. To our knowledge fewer than 30 cases of primary peritoneal psammocarcinoma (PPP) have been reported in the English literature. We report a rare case of  PPP in a 74-year-old female, discovered fortuitously within a laparotomy for gallbladder lithiasis. At laparotomy, multiple nodular implants involving the omentum, the peritoneum and a magma of intestinal loops in the right iliac fossa were noted. A biopsy from nodules was performed. Gross examination showed multiple nodules of different sizes in the fat tissue. Pathologic examination showed massive psammoma bodies representing more than 75% of the tumor. The final diagnosis was psammocarcinoma. Our patient was referred to the gynecologic department for further investigation and to ascertain whether the tumor arose from the ovaries or peritoneum. Hysterectomy, bilateral adnexectomy and omentectomy were performed. Macroscopic examination showed that both ovaries were intact having a normal size. No invasion of ovarian stroma was shown in microscopic examination. The patient died of SARS-CoV-2 (COVID-19) six days after the surgery. PPP is a rare type of  low-grade serous carcinoma. The behavior of this tumor is unclear, and the treatment is not standardized because of its rarity and lack of long-term follow-up. More cases need to be studied for better understanding and improvement of the management protocols., Competing Interests: No competing interests were disclosed., (Copyright: © 2023 Helal I et al.)

Competing Interests: Declaration of Competing Interest The authors have no competing interests to declare.

Introduction: Fistulization or rupture of hydatid liver cysts to the inferior vena cava (IVC) is an extremely rare and life-threatening condition., Presentation of Case: We report the case of a 70-year-old patient who presented with right-upper-quadrant pain and fullness evolving for 03 months. Physical examination showed dilated veins over the anterior abdominal wall and the flanks associated with lower-extremity swelling. Computed tomograph of the abdomen showed a hydatid cyst invading segments VI and VII of the liver fistulized into the inferior vena cava. The IVC was partially trombosed. The diagnosis of a possibly ruptured hydatid cyst in the inferior vena cava was then made. The patient underwent surgical management. Per-operatively the cystic cavity had bloody content but the cysto-vascular communication was not identified. Partial cystectomy was performed leaving a fairly extensive contact between the calcified pericyst and the IVC. The postoperative course was uneventful., Discussion: Rupture of the hepatic hydatid cyst into the IVC is very rare and may lead to fatal pulmonary embolism secondary to the migration of vesicles in the pulmonary artery or haemorrhagic shock. CT scan remains the best investigation method to assess the vascular links of the hepatic hydatid cyst especially with the IVC. Surgical treatment of the hepatic hydatid cyst ruptured into the IVC mandates vascular control before the hydatid cyst is punctured or removed., Conclusion: Fistulized hydatid cysts into the IVC should be operated on in centres equipped for extracorporeal bypass techniques, and experienced in the surgery of hepatic echinococcosis., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: The ectopic gallbladder is an uncommonly encountered anomaly that surgeons should be aware of. Its diagnosis is difficult but can be elucidated with the use of computed tomography and MRCP., Presentation of Case: We present a case of a 64-year-old patient who presented with abdominal pain, inflammatory epigastric mass and fever. Computed tomography (CT) revealed the presence of a para-umbilical gallbladder with signs of acute cholecystitis. Laparoscopic exploration revealed that the gall bladder was not present in its usual fossa but was seen attached to the midline anterior abdominal wall with extensive adhesion between it and the omentum. Given the complexity of the cholecystectomy via the laparoscopic approach, a conversion to a midline incision was performed. The IOC confirmed the absence of anatomical variants of the biliary tree., Discussion: An ectopic gallbladder is a difficult entity to diagnose as it can create clinical confusion by tampering with the common clinical presentation of cholecystitis. MRCP is currently one of the most effective preoperative examination methods as it detects the coexistence of biliary tract variation. Laparoscopic surgery is a safe procedure to be performed in the ectopic gallbladder., Conclusion: Ectopy of the gallbladder is a rare congenital abnormality that should be kept in mind to avoid errors or delays in management., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

We described two cases of acute pancreatitis secondary to ansa pancreatica. The first patient was diagnosed on MRCP and improved after standard treatment of AP. In the second case, ansa pancreatica was diagnosed on IOP. At the second episode of AP, sphincterotomy of the minor papilla was performed., Competing Interests: Authors declare no conflict of interest., (© 2022 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)

It is imperative for surgeons to have a heightened awareness of complications of jejunal diverticular disease so that they can act quickly and contribute to a successful clinical outcome for their patients., Competing Interests: The authors declare no conflict of interest., (© 2021 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)

Focal nodular hyperplasia (FNH) is a common asymptomatic benign hepatic tumor encountered in middle-aged women. However, pedunculated FNH is exceedingly rare and more frequently associated with complications. That is why surgical management is mandatory in this form., Competing Interests: Authors declare no conflict of interest., (© 2021 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)

We wish to highlight that on encountering a suspicious hepatic and a colonic lesion, the possibility of TB should also be kept in mind apart from the obvious possibility of metastasis of a colonic cancer especially in an endemic country like Tunisia., Competing Interests: Authors declare no conflict of interest., (© 2021 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)

Gallbladder agenesis (GA) is a rare congenital malformation characterized by the absence of the gallbladder and cystic duct due to an anomaly in the embryonic development. It is commonly associated with other congenital abnormalities, and the isolated form is extremely rare. Its clinical presentation is variable. Actually, GA is more often incidentally diagnosed. Magnetic resonance cholangiopancreatography (MRCP) is considered to be the diagnosis method of choice since it avoids unnecessary and risky surgery in symptomatic patients. Here we report the case of a radiologically incidentally discovered gallbladder agenesis in a 68-year-old patient., Competing Interests: The authors declare no competing interests., (Copyright: Imen Ben Ismail et al.)

Competing Interests: There are no conflicts of interest.

Chilaiditi sign is a rare condition typically mistaken for pneumoperitoneum. CT scan can confirm the diagnosis. Its management is conservative that is why it should be well known by surgeons to avoid unnecessary exploratory laparotomies., Competing Interests: None declared., (© 2020 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)

Colo-rectal intussusception is rare in adults and is often secondary to malignant lesions, rarely benign lesions such as colonic lipomas can also be the cause. We present the case a 60-year-old man who presented to the emergency department with acute abdominal pain. On physical examination, the abdomen was distended with diffuse tenderness. CT scan of the abdomen revealed a colo-rectal intussusception secondary to a rectal lipoma with parietal pneumatosis of the invaginated loop. An emergency laparotomy was performed. Intraoperatively the radiological findings were confirmed. A rectosigmoid resection (Hartmann's procedure) taking off the lipoma and the invaginated segment of the colon was performed and the patient had an unevent full recovery. Histopathology confirmed a 6cm sub-mucosal lipoma without evidence of malignancy. As the diagnosis of a benign disease in patients presenting with colonic intussusception can only be made on pathological examination, this entity should be managed as a malignant lesion due to the high incidence of malignancy., Competing Interests: The authors declare no competing interests., (Copyright: Hakim Zenaidi et al.)

Groove pancreatitis (GP) is a rare form of chronic pancreatitis involving the groove area bound by the pancreatic head, the duodenum, and the common bile duct. The diagnosis of this entity is challenging since it can mimic pancreatic carcinoma. We herein report the case of groove pancreatitis diagnosed in a 37 year old men, with a past history of chronic alcohol consumption. The patient was admitted for several times over the past three years because of recurrent alcohol-induced pancreatitis. The diagnosis of groove pancreatitis was made on the basis of CT, MRI and EUS findings. A medical treatment was initially attempted. In the absence of improvement in clinical symptoms, a pancreatico-duodenectomy was performed with satisfying results at 24 months follow up. Pancreatico-duodenectomy is the treatment of choice in groove pancreatitis since it leads to total resolution of clinical symptoms., Competing Interests: The authors declare no competing interests., (© Hakim Zenaidi et al.)

Hydatid disease is endemic in Tunisia. The involvement of the female genital tract is uncommon, and the occurrence in the fallopian tube is exceptional. We present a case of a 42-year-old woman who had complained of a 4-month history of lower abdominal pain. The abdominal ultrasonography and CT scan showed a multiloculated cystic lesion in the left adnexa. The exploratory laparotomy found a cystic mass developing in the left fallopian tube. Left salpingectomy was performed. The pathological examination confirmed the diagnosis of hydatid cyst disease. No recurrence was detected at the 2-year follow-up. Tubal hydatid cyst is an extremely rare condition that should be considered in the differential diagnosis of any cystic lesion in patients from endemic areas., Competing Interests: There are no conflicts of interest to declare., (© 2020 The Author(s).)