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Hepatocellular carcinoma (HCC) is the most common primary tumor of the liver. HCC usually develops in cirrhotic liver but cases arising in a healthy liver are rare and its etiology remains uncertain. The treatment of choice of hepatocellular carcinoma is surgical resection. Centrally located liver tumors were traditionally treated by extensive liver resection. With recent improvements in surgical techniques, centrally hepatectomy became an alternative approach for parenchymal preservation. We report here, the case of a 68-year-old male patient with an incidental finding of a 9 cm hepatic mass in segment IV of a non-cirrhotic liver found to be a hepatocellular carcinoma successfully treated by central hepatectomy. Although technically challenging, improvements in the understanding of liver structure, based on functional segmental anatomy, together with advances in imaging technology have contributed to the development of segment-oriented liver surgery making central hepatectomy an acceptable procedure for centrally located malignancies and allowing parenchyma preservation.

Conventionally, patients with recurrent cholangiocarcinoma have been treated palliatively, most often with supportive care only. Since intrahepatic cholangiocarcinoma (I-CCA) is an uncommon malignancy, treatment guidelines for I-CCA therapy have a low level of support, and guidelines for the treatment of recurrence are particularly challenging to establish. While a surgical approach is not clearly recommended for recurrent I-CCA in current guidelines, this approach has been reported as reasonable in a particular patient demographic and should be considered [1-3]. Herein we present to you a case of a 56-year-old female patient who presented with local recurrence 1.5 years post resection and was treated surgically.

Hepatic cavernous hemangiomas are the most common benign tumors of the liver. They can be found incidentally in the general population in up to 20% of the cases. On the other hand, gastric hemangioma is a very rare entity. These tumors account for only 0.05% of all gastrointestinal (GI) neoplasms. Hemangiomas have no malignant transformation potential. They are detected using CT-scan or MRI. Endoscopy can play a role in the differentiation of gastric from hepatic hemangiomas. Hepatic hemangioma can be associated with portal vein thrombosis as a mass effect resultant. Surgery is recommended for the treatment of symptomatic hemangiomas or giant ones (above 10cm). Laparoscopy is recommended for symptomatic hemangiomas less than 4cm or those who harbor a vascular pedicle. Here we present a case of a 50-year-old male presenting with a history of 1 month duration of epigastric pain and 5 kilograms of weight loss diagnosed on imaging studies with gastric hemangioma and partial portal vein thrombosis. Laparoscopic approach was adopted to deal with his condition. Intra-operatively, he was found to have hepatic hemangioma of around 10cm associated with complete atrophy of the left liver lobe. Decision was taken intra-operatively to carry a laparoscopic left hepatectomy regardless of all the challenges that pose laparoscopy in general for any hepatectomy. This decision was taken due to the presence of a vascular pedicle, which was clipped for hemostatic control.

Highlights • The spleen is normally located in the left hypochondriac region just underneath the 9th to 11th intercostal spaces. • Splenoptosis, wandering spleen or floating spleen, is a rare entity in which the spleen migrates from its normal position. • The diagnosis is confirmed by imaging modalities. • The only definitive treatment is surgical intervention., Background Splenoptosis is an uncommon disorder defined as the dislodgment of the spleen from its anatomical location in the left hypochondrium to another location in the intraabdominal cavity. This migration is the result of laxity or absence of the ligaments that fix the spleen to surrounding structures. Splenoptosis is either diagnosed after it causes symptoms, or incidentally using different imaging modalities. Surgery is the definite treatment either by splenopexy or splenectomy. Case presentation In the case presented here, we discuss a 17 years old female patient who presented to our institution for acute onset of abdominal pain, mainly suprapubic, occurring for 4 days. Ultrasound showed a suspicious right pelvic mass, which was found to be a wandering spleen with pedicle torsion. The patient was treated surgically by splenectomy. Conclusion We report this rare case to encourage physicians to keep this etiology in mind as part of the differential diagnosis of unspecific abdominal pain.

Highlights • There’s no consensus on definitions & types of intrabiliary hydatid rupture. • Original classification included either frank or occult rupture. • Hydatid cyst rupture should always be ruled out as a cause of biliary obstruction. • MRI may miss the diagnosis, and ERCP is valuable in diagnosis and treatment. • Surgical removal of the mother cyst is essential for treatment., Introduction A 64-year-old lady was diagnosed with having a klatskin type 3A tumor based on imaging, however, an alternative diagnosis was achieved during surgery. Presentation of case We present a case of a 64-year-old lady who presented for new-onset jaundice and was diagnosed with type 3A klatskin tumor based on MRCP findings. During surgery, it was revealed that the obstruction was caused by a frank intrabiliary hydatid cyst perforation. Choledocoscopy with irrigation, cholangiography, and removal of the mother cyst were performed, and an end-to-end biliary anastomosis over a t-tube was then done. The patient tolerated the intervention and recovered well. Discussion Hydatid cyst disease of the liver usually follows a benign course, however, intrabiliary rupture is one of the common complications associated with this disease. Intrabiliary rupture is classified into either frank or occult. Frank perforation, which is more common, is when hydatid material passes into the biliary ducts, and it may cause biliary obstruction and cholangitis with a high mortality rate. Occult perforation is when the hydatid cyst becomes infected itself, which usually leads to a silent presentation, and may only cause signs of suppuration. Diagnosis is usually achieved by imaging and relevant history. Treatment consists of medical and surgical intervention. Intraoperative cholangiography, choledocoscopy, and t-tube drainage are recommended during surgery for frank rupture. Conclusion Intrabiliary hydatid cyst perforation can mimic cholangiocarcinoma and must be considered as an alternative diagnosis in these patients prior to surgery.

Patient: Male, 68 Final Diagnosis: Ruptured metastatic hepatic lesion from a jejunal GIST Symptoms: Abdominal discomfort • hypotension Medication: — Clinical Procedure: — Specialty: Gastroenterology and Hepatology Objective: Rare disease Background: Gastrointestinal stromal tumors (GISTs) are rare gastrointestinal neoplasms. The spontaneous rupture of a jejunal GIST is very rare and spontaneous rupture of liver metastasis from an intestinal GIST is even rarer with only a few cases reported in the literature. Case Report: In this article, we reported a case of spontaneous rupture of a liver metastasis from a malignant jejunal GIST that presented with active tumoral bleeding, hypovolemic shock, and hemoperitoneum. The patient was successfully treated with arterial embolization of the tumor. Conclusions: In appropriately selected patients, arterial embolization appears to be an effective safe treatment for a GIST metastasis rupture.

Introduction In patients who underwent pancreatoduodenectomy for management of Chronic pancreatitis, early and late anastomotic failure can occur [1]. Nevertheless, taking into consideration that most pancreatic head resections are performed for malignant disease with poor prognosis, long term pancreatico-jejunal anastomotic durability has not been well examined; similarly, the management of its stenosis has not been well assessed [1]. Case Here we present a case of a 69 years old male patient with history of chronic alcoholic pancreatitis and ampullary fibrosis managed by pancreatico-duodenectomy presenting for 10 years delayed onset of recurrent acute pancreatitis with signs of pancreatico-jejunal anastomotic stenosis, managed surgically with revision of pancreatico-jejunal anastomosis. Conclusion Our case report might hold strongly for bringing up a purposeful approach, and be an insight to take into consideration in approaching pancreatic anastomosis, especially when pancreatic resections are utilized for treating benign pathologies., Highlights • Long term recurrent acute pancreatitis post pancreatic resections for benign pathologies are more and more emerging. • Recurrent acute pancreatitis post pancreatic resections manifest as debilitating entities that urges interventions for relief of symptoms, after failure of conservative management. • Strictures of pancreatico-jejunostomy, one of the common causes for recurrent acute pancreatitis post pancreatic resections. • Revision of anastomosis for relief of symptoms and preservation of gland function shall gain more publicity compared to radical interventions.

Case series Patients: Male, 33 • Male, 18 • Male, 19 Final Diagnosis: Congenital band causing a small bowel obstruction Symptoms: Progressive abdominal pain that eventually becomes excessive Medication: — Clinical Procedure: Laparoscopic band removal Specialty: Surgery Objective: Rare disease Background: Among the causes of constipation are bands and adhesions that lead to obstructions at different points in the intestinal tract. These can occur as a consequence of healing following surgery or trauma. However, an entity known as congenital band exists where a band is present from birth. Here we report three such cases of adults with symptoms of intestinal obstruction, in whom a congenital band was discovered through exploratory laparoscopy. Case Reports: All three of these patients presented lacking a history of any abdominal trauma or previous abdominal surgeries, a fact that is often used to exclude an adhesion as a differential. All three recovered quickly and had relief of their symptoms following surgical intervention. Conclusions: Bands and adhesions are common surgical causes of small bowel obstruction, leading to symptoms such as nausea, vomiting, constipation, and obstipation. These bands almost always result from a prior abdominal surgery or from a recent abdominal trauma. The three cases presented here show a far more unusual picture of a band, one that is congenitally present, as there was an absence of such a history. This is significant because clinical suspicion of a band is often very low due to a lack of distinguishing clinical and diagnostic features, and when the past history is negative.

BACKGROUND Duodenal and ampullary carcinoids are very rare tumors accounting respectively for 2% and 0.03% of all carcinoid tumors. Clinical findings vary according to the location of the tumor within the periampullary region; with epigastric pain being the most common presenting symptom in duodenal carcinoids and jaundice the most common clinical finding in ampullary carcinoids. Treatment options include pancreaticoduodenectomy, local excision, and endoscopic excision. CASE REPORT In this case report, we present a 60-year-old male who presented with a one-week history of intractable epigastric pain. He was diagnosed with duodenal periampullary carcinoid tumor and treated with local excision. CONCLUSIONS Although duodenal and ampullary carcinoid tumors may have different clinical presentations, as well as histochemistry characteristics and metastatic potential, they appear to benefit from the same surgical treatment.

Background Laparoscopic sleeve gastrectomy (LSG) is thought to be a simpler and safer operation compared with malabsorptive operations that include an enteric anastomosis. Leakage along the staple line at the gastroesophageal junction (GEJ) is difficult to treat and is a known complication of sleeve gastrectomy. Nonsurgical treatment methods often fail to heal the leaks and patients often require conversion to other procedures for definitive treatment. We report our experience with conversion to Roux-en-Y anastomosis over the leak site as a treatment option, comparing patients who had early treatment to late intervention. The purpose of the study is to stress the medical and social benefits of early surgical reintervention with conversion to Roux-en-Y anastomosis over the leak site. Methods Six patients underwent Roux limb placement over the leak site. Four of the patients had delayed surgery (group A), and the other 2 had early intervention (group B). Results Patients in group A had a median increase of all medical cost by 500%, whereas the 2 patients who underwent early intervention (group B) had an increase by 200%. The mean time until complete recovery (removal of all drains, adequate oral intake, and return to normal daily activity) in group A was 131.25 days (range 99–165) versus 38 days (range 28–48) in group B. Conclusions Roux-en-Y gastrojejunostomy over the leak site is an effective technique to treat refractory staple line leakage and can be adopted as early treatment in selected patients after stabilization, thereby reducing the cost and length of hospital stays.

Patient: Male, 45 Final Diagnosis: Mesenteric fibromatosis Symptoms: — Medication: — Clinical Procedure: Surgical removal of the mesenteric fibromatosis Specialty: Surgery Objective: Rare disease Background: Mesenteric fibromatosis, also known as mesenteric desmoids, is part of the clinical-pathologic spectrum of deep fibromatosis, which encompasses a group of benign fibro-proliferative processes that are locally aggressive and have the capacity to infiltrate or recur without metastasis. Case Report: Case of a 45-year-old man, with a history of hypertension and lung fibrosis, presenting for a left abdominal mass, which was found incidentally during his lung fibrosis imaging. He complained of constipation due to pressure upon his bowel leading to difficulty in defecation. Conclusions: Although there are many overlapping criteria between gastrointestinal stromal tumors and mesenteric fibromatosis, making it difficult to discriminate between the two, there are differences that are unique to mesenteric fibromatosis that should be noticed during the diagnosis. In this case, mesenteric fibromatosis was unusual as it is not associated with Gardner’s syndrome, desmoid tumors, nor familial adenomatous polyposis, but was an incidental finding.