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Introduction and importance The gallbladder volvulus is a rare but life-threatening condition characterized by an axial torsion of the gallbladder along the cystic pedicle, causing gallbladder ischemia and necrosis. This paper aims to present and discuss a rare case of gallbladder volvulus. This case report has been reported in line with the SCARE criteria 2020 [1]. Case presentation We report the case of a 90-year-old female patient who presented to the emergency room with sharp right upper abdominal quadrant pain of acute onset associated with vomiting, evolving for the last 12 h. She had no fever nor jaundice. Her body mass index (BMI) was 22. She had kyphosis, and scoliosis. Physical examination found tenderness with a palpable mass in the right upper abdominal quadrant. Laboratory test results showed leukocytosis at 11600 /mL and a high C-reactive protein rate at 40 mg/L revealed acute calculous cholecystitis features. However, emergency laparotomy was performed and discovered a gallbladder volvulus. A detorsion and cholecystectomy were performed with a good outcome. Clinical discussion The preoperative diagnosis of gallbladder volvulus is difficult due to its misleading clinical presentation mimicking acute cholecystitis. The presence of the three highly suggestive triad clinical signs should encourage the radiologist to search for a gallbladder with a horizontal orientation and located outside its anatomical fossa connected to the liver by a conical structure corresponding to the twisted pedicle in ultrasonography. Unlike ordinary acute cholecystitis, which may sometimes tolerate an initial conservative medical treatment, gallbladder volvulus management is always an emergency cholecystectomy. Conclusion Despite the clinical similarities with the classical acute calculous cholecystitis, gallbladder volvulus is more likely to result in fatal outcome. Therefore, a high level of clinical suspicion is necessary to save lives., Highlights • The gallbladder volvulus is a life-threatening condition related to its pedicle strangulation. • When suspected, a complementary Doppler study should be warranted. • It requires urgent cholecystectomy.

Background Management of gastrointestinal perforation by ingested foreign bodies remains a topical subject following technological progress. This work aims to analyze, the epidemiological features, the management in a Tunisian surgical department and to access the most realistic and beneficial management of gastrointestinal perforation by ingested foreign bodies in a low-income country, where there is a paucity of information regarding this subject Methods This is a retrospective review of 24 patients with gastrointestinal perforation by ingested foreign bodies treated in the General Surgery department of Jendouba Hospital in Tunisia from January 2010 to December 2019. Results 24 patients with gastrointestinal tract perforation by an ingested foreign body were managed at our surgical ward. The mean age of patients was 56.58 years with extreme ranging 25-72 years with a male to female ratio 2/1. Three patients (12.5%) had psychiatric disorder, one had myasthenia (4.1%), two patients were alcoholics (8.33%), three patients were toothless (12.5%) and two (8.33%) patients were veiled. According to ASA classification, 6 (25%) patients were ASA I, 15 (62.5%) patients ASA II, 3 (12.5%) ASA III. The mean duration of symptoms was 2.16 days and ranges from 1 to 7 days. All patients (100%) presented to the emergency department with acute abdominal pain. Sixteen patients (66.66%) had a fever, twelve (50%) had vomiting and four (16.66%) had a sub-occlusive syndrome. All patients had performed abdominal x-ray. The foreign bodies were objectified in only six cases (25%). CT scan was performed in 16 (66.66%) patients and the location of ingested foreign bodies was obtained in 9 patients preoperatively (37.5%) and in 4 patients (16.66%) after proofreading. All the 24 patients underwent surgery and they were operated during their initial hospital stay. The most common site of perforation was the terminal ileum (62,5%) followed by the duodenum (12, 5%). Enterectomy was the procedure of choice in 20 patients (16 underwent an enterostomy and 4 patients underwent an enteroanastomosis) and four patients had a simple suture. The foreign body was found in all patients. Two patients developed postoperative complications: one case of intraabdominal abscess and one patient had a wound dehiscence . The median length of hospital stay following surgery was 4.08 days (range 2-7 days). The mortality rate was 4.16 %. All patients managed with enterostomy, had their stoma closed after 3-5 months. Conclusion Open Surgery still remains a management with satisfactory morbidity, mortality and length of hospital stay. However, we estimate that for low/middle-income countries, investing in laparoscopy, for these cases, would be more realistic and more beneficial allowing improving more the outcomes. For this fact, promoting radiologic diagnosis is highly recommended in order to increase prospective identification of the foreign body location and perforation site, allowing a safe laparoscopic approach.

BackgroundHydatid cyst is an infectious disease caused mainly by E. Granulosus, which is generally considered benign, however, the rupture of the hepatic Hydatid Cyst to the abdominal cavity is a life-threatening incident that requires urgent and multidisciplinary management (emergency physician, radiologists, aneasthetists and surgeons). This study aims to describe the various clinical and paraclinical features of ruptured liver hydatid cyst in the peritoneal cavity, and to detail the appropriate treatment.Materials and MethodsFifteen cases of ruptured liver hydatid cyst into the abdominal cavity that underwent urgent surgery were collected over a period of eight years. Results There were nine men and six women. The average age was 38 years. Two patients were admitted with abdominal trauma. All patients presented with acute abdominal pain. Only one patient had anaphylactic shock. Abdominal ultrasound showed discontinuous cyst wall and intraperitoneal fluid in 100% of cases. Abdominal computed tomography (CT) showed discontinuous cyst wall with intraperitoneal fluid in 100% of cases. Intraoperatively, the intraperitoneal fluid was clear in thirteen cases and purulent in two. All patients underwent unroofing procedure associated with intra-operative peritoneal lavage and external drainage. The mean hospital stay was 6.11 days and the mean follow-up was 19 months. No case of recurrence was reported among the patients.ConclusionRupture of a hydatid cyst in the abdominal cavity should be considered as a differential diagnosis in every case of an acute abdominal pain, especially in endemic areas and in presence of an allergic reaction or signs of anaphylactic shock. Combined medical and surgical care starting in the emergency room is the only guarantee of a good outcome.

Introduction and importance Hydatid cyst of liver is a disease usually seen in endemic regions. Fistulization into duodenum is one of the most exceptional complications of the hydatid cyst commonly discovered during surgery. This paper aims to present and discuss a rare case of cyst ruptured into the duodenum. This case report has been reported in line with the SCARE criteria 2020. Case presentation A 44-year-old female patient, previously diagnosed with hydatid cyst of liver with deferred care due to the period of COVID 19 containment, presented with the complaints of abdominal pain and fever. Abdominal CT scan showed up a 2 cm multiseptal hydatid cyst in the segment III of the liver with an exovesiculation of 20 cm, communicating with the first duodenum. The patient underwent antrectomy involving the first duodenum and removing the cystoduodenal fistula with a Roux-en-Y anastomosis. She was discharged with full recovery on the postoperative 5th day. Clinical discussion Clinical features of hydatid cyst fistulized into the duodenum are non-specific. There are two pathognomonic symptoms, hydatidemesis and hydatidenteria.Typically, cysto-duodenal fistula is intra-operatively discovered. The CT scan is the most used morphological examination. The presence of air in the cyst should alert for the gastrointestinal fistula formation. Surgical strategies to perform should be tailored to every patient and to intra operative findings. The post-operative morbidity and mortality are underestimated in the literature. Conclusion The fistulization of Hydatid cyst into the duodenum should be evoked in front of any acute abdominal pain whether or not associated with hydatidemesis or hydatidenteria., Highlights • Hepatic hydatid cyst fistulized in the duodenum is a potentially fatal condition with non-specific clinical features. • Hydatidemesis and hydatidosis are the two pathognomonic symptoms. • Fistulized hydatid cyst in the duodenum is often infected and requires urgent surgical management.

Introduction Gallbladder adenomyomatosis is a benign acquired gallbladder disease. It can mimic cancer on radiological findings, leading to a diagnostic dilemma. The management and prognosis of these two gallbladder anomalies are entirely different. Therefore, it is essential to recognize the pathognomonic features of gallbladder adenomyomatosis is in order to accurately diagnose this pathology. This paper presents two encountered cases of gallbladder adenomyomatosis is, their diagnostic modalities as well as the algorithmic approach of their management. These two-case reports have been reported in line with the SCARE Criteria 2020 [1]. Presentation of case Patient-1 was symptomatic. He was explored by an abdominal ultrasound picturing gallbladder wall thickening while the biopsy showed pleomorphic proliferation of inflammatory cells. An examination of the liver with MRI was indicated, showing diffuse parietal thickening with multiple cystic pockets. He underwent laparoscopic cholecystectomy with simple operative follow-up. Patient 2 was asymptomatic, a staging CT scan of acute pancreatitis revealed focal mural thinking of the gallbladder wall. A liver MRI showed an intramural cystic formation in the vesicular fundus. Given the inconclusive imaging results, laparoscopic cholecystectomy was performed. Histological examination confirmed the diagnosis of GA. Discussion Adenomyomatosis is usually asymptomatic. Imaging can confirm the diagnosis of gallbladder adenomyomatosis without the need for invasive procedures such as vesicular biopsy. Histologic examination can also confirm the diagnosis when cholecystectomy is done. High resolution ultra-sound is the most efficient radiological examination. Laparoscopic cholecystectomy is the gold standard for symptomatic GA or radiological suspicion of a gallbladder cancer. Conclusion The practitioner should always consider gallbladder carcinoma before confirming the GA, as they share the same features but with a far worse prognosis. The likelihood of malignancy depends on radiological characteristics. In the case of inconclusive findings, cholecystectomy is justified., Highlights • Gallbladder adenomyomatosis is a frequent but underestimated pathology as it is usually asymptomatic. • The diagnosis is most commonly made post-operatively on histological examination of a cholecystectomy specimen. • Gallbladder adenomyomatosis may mimic cancerous lesions on radiological findings, which leads to a diagnostic dilemma. • Clinical symptomatology as well as the reliability of the radiological diagnosis guide therapeutic management.