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INTRODUCTION AND IMPORTANCE: A choledochal cyst is a rare congenital biliary tract pathology. It displays an evident dilation that could arise in any part along the biliary tree. Its incidence rate reflects its rarity when it takes place in 1 per 100,000-to-150,000 newborns. 75 % of them are detected in early childhood, whereas around 20 % are identified and diagnosed in adulthood. The gender-specific predominance favors females over males with an almost 4:1 ratio. Our case is of an adolescent male, and this constitutes a rare variant of the previous criteria. Furthermore, the distal end of the common bile duct could not be identified. CASE PRESENTATION: We present the case of a 15-year-old previously healthy male, who presented to our surgical clinic complaining of chronic dull aching pain in the right hypochondrium. Preoperative radiological analysis revealed a choledochal cyst. CLINICAL DISCUSSION: Surgical intervention was achieved to excise the lesion and comprehensive histopathological analysis was a key element to establish a definitive diagnosis. CONCLUSION: Choledochal cysts are rare biliary anomalies. Its non-specific symptoms lead to misdiagnosis. Consequently, suitable clinical evaluation escorted by comprehensive radiological imaging is essential to suspect this pathology and swiftly treat it. This anomaly predominantly occurs in females and is chiefly discovered during childhood. Our case is a prime exception to this norm. To the best of our knowledge, this is the first documented case from Syria of an adolescent male affected by a Type I choledochal cyst with an ambiguous end of the distal common bile duct.

Introduction and importance Meckel's Diverticulum (MD) is the most occurring congenital anomaly of the gastrointestinal tract. It characterizes a patent remnant of the omphalomesenteric duct. Despite remaining asymptomatic most of the time, the rarity of its occurrence is reflected by the scarcity of data involving it in the literature. Gastrointestinal bleeding, bowel obstruction, and inflammation are the most prevalent complications of MD. Perforation of MD is very rare. Case presentation We present the case of a previously healthy 32-year-old female, who presented to the emergency department with a 2-day-history of generalized abdominal pain. Radiological analysis suggested a perforated viscus and an inflamed Appendix. Clinical discussion Our patient was diagnosed preoperatively with perforated hollow viscus and an exploratory laparotomy was indicated. Intraoperatively, a perforated MD was found and treated by surgical excision of the affected loop of bowel with end-to-end anastomosis and the specimens were sent for histopathological analysis. Histopathology revealed a perforated MD containing gastric mucosa. The patient had successful recovery. Conclusion Early recognition with swift surgical intervention must take place to provide therapeutic outcome for patients and to limit the resulting morbidity. This case highlights the necessity of considering MD as core differential diagnosis in patients with acute abdomen. Due to the scarcity of data on perforated MDs in adult females, it's worthy of studying to highlight its incidence. Due to the rarity of a perforated MD in an adult female, it's worthy to consider such cases to explore preoperative assessment techniques, surgical interventions options, and postoperative complications., Highlights • MD is a rare gastrointestinal anomaly comprising 2% of congenital abnormalities of the GI tract. • Complications of MD range from GI bleeding, diverticulitis, neoplasm, to perforation. • MD mostly remains silent and is rarely complicated in adults, especially in adult females. • Perforation of MD is the rarest of the complications and it would mostly occur in males rather than in females.

Leiomyosarcoma (LMS) is a common form of soft tissue sarcoma. Primary colonic LMS is an extremely rare entity, comprising 1–2% of gastrointestinal malignancies. Primary mesenchymal sarcomas of the gastrointestinal system are rare and constitute just 0.1–3% of all gastrointestinal tumours. LMS is the most common variant of such tumours and represents just 0.12% of colorectal malignancies. We present a case of a 65-year-old female, who presented to the emergency department with 3 days history of obstipation and generalized abdominal pain. Radiology (X-ray and ultrasound) indicated a large pelvic mass compressing the sigmoid colon and its surrounding structures. Histopathological analysis indicated a primary LMS of the sigmoid colon. Diagnosis is established mostly postoperatively after histopathological evaluation. Prognosis and treatment modalities for this aggressive malignancy remain insufficient. LMS is relatively impervious to chemotherapy/radiotherapy. Our patient was treated by surgical excision of the tumour and referred postoperatively for adjuvant chemotherapy.

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Mucinous cell neoplasia are rare and conceivably fatal causes of surgical abdomen. Adult manifestations can be obscure and ill-defined, yielding misdiagnoses and wasting precious time and effort to reach the correct one. Clinical awareness ought to be present once presented with a surgical abdomen in such a patient because this neoplasm may present with misleading presentations which mask the actual diagnosis and masquerade as a different one, and in turn, may result in performing a dissimilar treatment intervention. Rapid learnt surgical judgments must be taken and put into action to diminish the morbidity and mortality consequential to this pathology.Our case is of a 46-year-old female, who was admitted into our hospital with a 2-month-history of general fatigue. Colicky abdominal pain and discomfort developed shortly prior to admission. Multi-Slice Computed Tomography (MSCT) scan exposed cystic formation in the terminal ileum. Exploratory laparotomy was warranted, in addition to performing a right hemicolectomy.We treated our patient via open surgery and performing an appendectomy with right hemicolectomy in addition to the excision of several surrounding lymph nodes. Diagnosis is traditionally reached intraoperatively relying on gross morphology and postoperatively through histopathological analysis of the excised specimens.Low Grade Appendiceal Mucinous Neoplasm is a scarce entity and varies critically in its manifestations, hence, it is existential to thoroughly study this kind of neoplasia, document it, and consider it, so that we can construct precise decisions to reach ideal results for patients who suffer from this neoplasm.

Introduction and importance The gastrointestinal system is the most common site for extra-nodal NHL. Adolescent population are among the rarest of compromised groups, especially males. The gastrointestinal system is more involved by secondary metastasis rather than by primary lymphomas. Cardinal B-Symptoms and obstipation constituted the presentation of our patient who was diagnosed postoperatively as a case primary non-metastatic NHL. NHL can have misleading presentations which result in the implementation of different treatment modalities. We ought to have high clinical suspicion when presented with a patient suffering from B-Symptoms and obstipation to make timely judgements which help in performing effective therapeutic interventions to limit the morbidity and mortality which result from this pathology. Case presentation We present the case of a 19-year-old male, who presented with obstipation and B-Symptoms. CT scan indicated loop dilation, a lobulated mass, and what radiologically seemed to be intussusception. Surgery was done and the resected specimens were DLBCL. Clinical discussion We treated him by surgical excision of the affected ileal segments. Histopathology indicated a primary Non-Hodgkin's DLBCL of the ileum. Afterwards, we referred him for adjuvant chemotherapy. Treatment modalities for this malignancy are mainly surgical in addition to Chemotherapy. Conclusion Intestinal extranodal NHL presents with an array of vague symptoms. As a result, this type of tumors can be clinically indistinguishable from other gastrointestinal malignancies. It is vital to keep this type of malignancy in mind as a differential diagnosis when presented with a surgical abdomen in a patient with B-Symptoms., Highlights • The gastrointestinal system is the most common occurrence site for extra-nodal Non-Hodgkin's Lymphoma. • Cardinal B-Symptoms can mislead the diagnosis as the incidence rate in such a patient demographic is undocumented. • The most frequently compromised site in the small intestine is the ileum followed by the jejunum, and the duodenum. • Primary non-metastatic NH-DLBCL is so rare in adolescent males that it warrants documentation and follow-up. • It's vital to consider this pathology when presented with obstipation and B-Symptoms in an adolescent male.

Introduction and importance Midgut Malrotation (MM) is a potentially fatal and rare congenital anomaly that results from an incomplete rotation of the bowel 270 degrees around the Superior Mesenteric Axis. Newborns are the most affected age group, nevertheless, adult malrotation can manifest, but in a much rarer incidence rate. Clinical awareness must be present when faced with a surgical abdomen in an adolescent patient because this pathology can have several misleading signs and symptoms which may eclipse the true preoperative diagnosis and masquerade as another, and this could result in implementing a different therapeutic approach. Swift clinical informed judgments must be made and acted upon to limit the morbidity and mortality resultant from this pathology. Case presentation We present the case of a 15-year-old female, who was brought to our Emergency Department (ED) with a 5-day-history of biliary emesis which evolved into obstipation with continuous and excruciating abdominal pain. Computed Tomography (CT) scan indicated gastric and duodenal dilation in addition to a “Whirlpool sign”. Exploratory laparotomy was done, and a Ladd's procedure was performed. Clinical discussion We treated our patient by performing Ladd's procedure and adhesiolysis. Diagnosis is conventionally established pre-/intraoperatively based on radiological imaging and clinical suspicion. Therapeutic methods for this pathology are primarily surgical in nature. Conclusion Midgut Malrotation is a rare entity, thus, it is crucial to further study this type of clinical presentation and keep it in mind to be able to make an accurate diagnosis to reach the optimal outcome for patients who present with acute surgical abdomen., Highlights • MM is a potentially fatal and rare congenital anomaly of the Gastrointestinal tract comprising 0.2% of live births. • Most cases are diagnosed within the first year of neonatal life. Rarely, a case is diagnosed in the adolescent population. • Symptoms are non-specific and this warrants high clinical suspicion when presented with a case of acute surgical abdomen. • There are three major types of Midgut Malrotation according to the established Stringer classification. • Surgery is the mainstream treatment modality and Ladd's procedure and remains the gold standard for treatment of MM.