Hung-Hua Liang

Endometriosis-induced appendiceal intussusception

Appendiceal intussusception is a rare entity that is difficult to diagnosis before surgery both clinically and radiologically. We report here a case of a 55-year-old woman with a 6-month history of right lower abdominal pain caused by appendiceal intussusception. Laparoscopic appendectomy was performed. Endometriosis foci were identified in the appendix tip and became the leading point of the appendiceal intussusception. The appendix was removed laparoscopically, which is the optimal treatment for such patients.

Sausage-Like Mass in Lower Abdomen

C uestion: A 25-year-old woman presented with indolent bdominal pain and loss of appetite for 5 years. She ame to our emergency department with severe abdomial distension and intermittent cramping pain. She had o vomiting, but still had flatus and stool passage. A sausage-like mass with rebound tenderness was oted in the lower abdomen. The abdominal pain proressed and auscultation revealed a metallic sound. Abominal ultrasonography revealed a mass lesion with a arget sign in the lower abdomen. Abdominal computed omography (CT) showed a soft tissue mass with a target ign and suspected intussusception of the small intestine Figure A, arrow). A laparotomy was performed immeditely and showed a jejunojejunal intussusception involvng approximately 30 cm of the jejunum (Figure B). ultiple tumors on the surface of the mesentery and urface of the small bowel were noted. One tumor on the ntestinal wall formed the leading point of the intussuseption (Figure C). She underwent segmental resection of he small bowel with end-to-end anastomosis. Some arger tumors were resected, but most of the other tuors were left in situ because they were small and nuerous. Her postoperative recovery was uneventful and he has enjoyed good health for 2 years. What is the likely diagnosis? Look on page 2561 for the answer and see the ASTROENTEROLOGY web site (www.gastrojournal.org) or more information on submitting your favorite mage to Clinical Challenges and Images in GI. HUNG-HUA LIANG, MD WEU WANG, MD PO-LI WEI, MD Department of Surgery Taipei Medical University Hospital Taipei, Taiwan

Difficulty in swallowing

A 34-year-old man underwent gastroscopy to evaluate episodes of difficulty in swallowing. Gastroscopy revealed suspected extraluminal compression in the oesophageal–cardiac junction (fig 1). History of epigastric fullness was also noted. Abdominal ultrasonography revealed a cystic lesion between the left lobe of the liver and the oesophagus. Abdominal CT showed a 3 cm thoracoabdominal cystic mass that appeared to be contiguous with the diaphragmatic crura (fig 2). Laparoscopic exploration and resection of the cystic lesion were performed (fig 3). Removal …

A rare cause of duodenal obstruction

A 35-year-old woman presented with bloating and vomiting. She had a 2 month history of occasional abdominal pain and had been vomiting for …

Phrenic Nerve Schwannoma-presenting a Cystic Tumor of the Anterior Mediastinum: Report of a Case

Benign neurogenic tumors originating from the peripheral nervous system usually appear as schwannomas or neurofibromas. They represent one of the common causes of a posterior mediastinal mass and are usually found incidentally. However, tumors originating from the intrathoracic phrenic nerve are rare. We therefore report a case of schwannoma of the left phrenic nerve presenting as a lobulated mass causing hoarseness.