Leiomyomas are rare benign esophageal tumors and represent less than 1% of all esophageal neoplasms. Those located at the esophagogastric junction (EGJ) are uncommon and challenging due to their proximity to the lower esophageal sphincter. Most cases are asymptomatic and discovered incidentally, though symptomatic patients may present with dysphagia, heartburn, regurgitation, or chest pain. Diagnosis typically involves barium swallow studies, upper endoscopy, endoscopic ultrasonography, and computed tomography. Surgical treatment is recommended for symptomatic patients or those with tumors larger than 3 cm or showing rapid growth. Traditionally, open enucleation or visceral resection has been used, but recent advances include endoscopic, laparoscopic, and hybrid methods to achieve tumor enucleation. This report demonstrates a laparoscopic transgastric and endoscopically assisted enucleation of a large, horse-shoe shaped EGJ leiomyoma. The patient complained epigastric pain, occasional solid food dysphagia and mild regurgitation. The upper endoscopy revealed a large horseshoe-shaped subcardial mass at the anterior, left-lateral, and posterior aspects of the subcardial junction. Abdominal computed tomography (CT) showed a large hypointense subcardial mass and endoscopic ultrasound identified a 5 cm submucosal hypoechoic lesion from the muscular layer with diagnosis of leiomyoma at fine needle biopsy. A minimally invasive transgastric enucleation was planned and successfully performed. The technique involved a vertical anterior gastrotomy, incision of the overlying mucosa, blunt tumor dissection with enucleation, and mucosal closure with intraoperative endoscopic assistance. The postoperative course was uneventful with no postoperative complication and patient hospital discharge on postoperative day four. Histological examination confirmed the diagnosis of esophageal leiomyoma. This minimally invasive approach offers a safe, effective alternative to EGJ resection, especially for "plongeant" endoluminal leiomyomas involving the posterior aspect of the EGJ.

BackgroundInferior pancreaticoduodenal artery (IPDA) aneurysms are rare visceral artery aneurysms with high rupture rates and significant mortality. Nonspecific clinical presentation frequently leads to diagnostic delay. We conducted a systematic review to characterize clinical features, diagnostic pitfalls, treatment modalities, and outcomes.MethodsA systematic review following PRISMA 2020 guidelines was performed. PubMed, Cochrane Library, and Google Scholar were searched from inception through January 2025. Case reports and series describing adult patients with IPDA aneurysms were included. Fisher exact test was used for categorical comparisons. An illustrative fatal index case is presented.Results113 patients from 81 publications were analyzed. Mean age was 60.3 ± 12.0 years with male predominance (62.3%). Rupture occurred in 70.2% of cases. Overall mortality was 9.6% (10/104). Abdominal pain was the most common presentation (71.7%). Diagnostic pitfall was documented in 47.4% of cases. Celiac axis stenosis was identified in 71.7% of patients. Endovascular treatment was associated with numerically lower mortality than open surgery (3.5% vs 14.3%; OR 0.22; 95% CI: 0.04-1.28; P = 0.08; non-significant). Retroperitoneal hemorrhage predominated among ruptured cases (58.9%).ConclusionsInferior pancreaticoduodenal artery aneurysms present significant diagnostic challenges due to nonspecific symptoms. High clinical suspicion is warranted in patients with unexplained abdominal pain, particularly those with celiac axis stenosis. A stepwise approach-stabilization, endovascular therapy first, and surgical backup-is endorsed by current guidelines. Multidisciplinary team involvement is essential. Mortality is driven primarily by the systemic consequences of hemorrhagic shock rather than by procedural failure; whether earlier recognition reduces mortality cannot be determined from this data set and warrants prospective study.

Superior mesenteric artery syndrome (SMAS) is an uncommon cause of proximal intestinal obstruction caused by compression of the third portion of the duodenum between the SMA and the abdominal aorta. We report the case of a 17-year-old boy with a 2-year history of recurrent nausea, vomiting, epigastric pain, early satiety, postprandial fullness, and progressive abdominal distension, followed by recent clinical deterioration. Despite repeated non-diagnostic investigations and empirical dietary and pharmacological treatment, symptoms persisted. Contrast-enhanced computed tomography established the diagnosis by demonstrating a markedly reduced aortomesenteric angle of approximately 10° and an aortomesenteric distance of 5.5 mm, associated with severe gastric and proximal duodenal dilatation. The patient was treated conservatively with nasogastric decompression and nutritional support. Nasogastric tube placement resulted in marked gastric decompression, with substantial improvement in abdominal distension, epigastric discomfort, early satiety, and vomiting, allowing surgical intervention to be deferred during the acute phase. Follow-up showed no further acute obstructive deterioration; however, the absence of meaningful weight gain over the subsequent six months indicated persistence of the chronic nutritional component of SMAS and the need for continued dietary rehabilitation and close monitoring. This case highlights the diagnostic difficulty of SMAS in adolescents with chronic, treatment-refractory upper gastrointestinal symptoms and emphasizes that resolution of acute obstruction should not be equated with definitive correction of the underlying disease process. Early recognition, conservative stabilization, nutritional optimization, and longitudinal reassessment are essential to prevent delayed diagnosis and guide timely escalation to surgery when conservative treatment is insufficient.

Torsion of the vermiform appendix is rare. When torsion involves an appendiceal mucocele, timely surgical management, and avoidance of rupture are essential to prevent intraperitoneal mucin spillage. A 68-year-old woman presented with 12 h history of severe lower abdominal pain. Examination revealed marked lower abdomen rebound tenderness and her laboratory tests showed leukocytosis and elevated C-reactive protein. Urgent computed tomography demonstrated a 9 × 3.4 cm predominantly cystic mass posterior to the uterus with mural calcifications, consistent with an appendiceal mucocele. Emergency laparotomy revealed a necrotic appendiceal mucocele with complete torsion. The lesion was resected intact. Histopathology confirmed an appendiceal mucocele. The patient had an uncomplicated recovery and remains in excellent condition 3 months postoperatively. Appendiceal mucocele torsion should be considered in acute abdomen with a cystic pelvic mass on computed tomography. Intact resection is a key operative principle.

Angiotensin-converting enzyme inhibitors (ACEIs) are widely prescribed for managing hypertension and improving cardiovascular and renal health while being relatively low-cost and generally well-tolerated. ACEI-induced angioedema is an uncommon but potentially serious adverse effect that may present with swelling of the face, lips, tongue, and pharynx, raising concern for possible airway obstruction, hypoxia, and even death. Other presentations have been documented, including small bowel angioedema (SBAE). SBAE is diagnostically challenging due to its nonspecific gastrointestinal symptoms. This report highlights a middle-aged woman who experienced ACEI-induced SBAE for nearly seven years alongside comorbid conditions. Despite extensive evaluations for gastrointestinal pathologies, her condition remained unresolved until a multidisciplinary team attributed her symptoms to ACEI therapy. Upon discontinuing lisinopril, her symptoms resolved, emphasizing the importance of recognizing drug-induced causes in patients with unexplained, persistent symptoms. This case underscores the critical role of the healthcare team in identifying and managing adverse drug reactions (ADRs), especially with common medications like ACEIs. Clinicians may utilize readily available assessment tools to help identify possible ADRs. A multidisciplinary approach is essential, as physicians across specialties are uniquely positioned to recognize potential ADRs and communicate concerns collaboratively. Early detection can reduce unnecessary hospitalizations and interventions and improve patient outcomes.

Anterior cutaneous nerve entrapment syndrome (ACNES) is an important cause of focal abdominal wall pain and may be missed when routine imaging and laboratory findings are normal. We report an eight-year-old girl who developed sharp, well-localized right lower abdominal pain six months after bilateral laparoscopic percutaneous extraperitoneal closure (LPEC) for inguinal hernia. She was initially evaluated at a university hospital and diagnosed with irritable bowel syndrome; however, the pain progressed and prevented school attendance. On presentation to our department, she had a clear focal tender point to the right of the umbilicus with a positive Carnett sign, consistent with ACNES. One day before surgery, she additionally reported new localized pain at a pigmented lesion in the right groin, and a neurectomy was performed at two sites. At the periumbilical site, a cutaneous nerve was identified immediately beneath the skin incision and excised with the fascia. Pathology demonstrated fibrosis around the neurovascular bundle, thickened nerve fascicles, and close apposition of the nerve fascicles to an artery. At the right groin site, no cutaneous nerve was found directly beneath the skin; a cutaneous nerve branch extending cranially was identified on deeper exploration and excised with the fascia. Pathology demonstrated adipose scar formation and a perineural/fascial neuroma with whorled nerve fascicles intertwined with collagen fibers. Postoperatively, pain at both sites resolved promptly without recurrence. This case illustrates that distinct mechanisms of abdominal wall neuropathic pain, including ACNES and traumatic neuroma, may coexist after LPEC.