This case study presents a patient with massive ureterolithiasis in a duplicated ureter. A 31-year-old female patient underwent two dual-energy X-ray absorptiometry (DEXA) scans, which incidentally revealed an ossific pelvic mass identified by a chiropractor. Pelvic X-ray and CT confirmed ureterolithiasis measuring 6.08 cm x 1.92 cm. Two months later, she developed left-sided lumbar pain radiating to the lower extremity, left lower quadrant abdominal pain, urinary urgency, and persistent fever requiring hospitalization. Clinical investigations, including urinalysis, blood work, and CT, confirmed a urinary tract infection secondary to ureterolithiasis. A follow-up CT scan revealed a completely duplicated ureter on the left side that had been missed on prior studies. The patient was treated with multiple courses of antibiotics over six weeks with limited clinical improvement; subsequently, a ureteral stent was placed. Approximately one month later, the calculus spontaneously passed into the bladder, resulting in significant symptomatic relief. A follow-up CT scan revealed a completely duplicated ureter on the left side that had been missed on prior studies and revealed that the previously placed ureteral stent had been inadvertently inserted into the unobstructed ureter. This case highlights the importance of thorough imaging review, as the urological pathology was initially detected on a DEXA scan. Timely recognition and referral are essential to optimizing patient outcomes in atypical presentations.

Foreign body ingestion can lead to life-threatening complications, including colonic perforation, especially with sharp-pointed objects. We detail an unusual case of a male patient in his seventies who presented with left lower quadrant abdominal pain and diarrhea, found to be secondary to a sharp foreign body ingestion, a wishbone. This finding led to a diagnosis of sigmoid adenocarcinoma, followed by colonic perforation weeks after an unsuccessful endoscopic removal attempt and prior to planned surgical intervention. He underwent exploratory laparotomy with wishbone removal, sigmoid colectomy, and diverting loop ileostomy. He was discharged to a skilled nursing facility for postoperative recovery with vacuum-assisted midline incision therapy. Our case is one of the few to detail a malignant mass causing colonic foreign body impaction with attempted endoscopic intervention, highlighting the intricacies of managing foreign body ingestion with endoscopic versus surgical intervention.

Mixed Neuroendocrine-NonNeuroendocrine Neoplasms (MiNENs) are rare and aggressive entities, with scarce reports worldwide, especially from Latin America. We describe the first documented case of sigmoid MiNEN in Perú in a 77-year-old woman with a history of hypertension, diabetes, and osteoporosis who presented with left lower quadrant pain and abdominal distension. Colonoscopy revealed polyps, one of which was histologically consistent with a large-cell neuroendocrine carcinoma (NEC) and a high-grade tubular adenoma, each accounting for ≥30% of the lesion, fulfilling MiNEN criteria. Immunohistochemistry confirmed the diagnosis with an Antigen Kiel 67 [Ki-67] index of 70%. Positron Emission Computed Tomography (PET/CT) demonstrated focal uptake without nodal involvement. The patient underwent laparoscopic radical sigmoidectomy with colorectal anastomosis; histopathology confirmed submucosal invasion and metastasis in 5/14 lymph nodes. She was subsequently started on adjuvant carboplatin/etoposide chemotherapy and remains under oncological follow-up. This case underscores the diagnostic and therapeutic challenges of colorectal MiNENs, highlights the role of PET/CT as well as multidisciplinary management, and emphasizes the importance of considering radical resection even after endoscopic removal, given the high risk of recurrence and aggressive biological behavior.

We present a case of symptomatic colonic strongyloidiasis diagnosed in an immunocompetent patient with chronic peripheral eosinophilia, with an absolute eosinophil count ranging from 0.71-1.47 × 10^3/µL since 2013. Initial evaluation for persistent eosinophilia, including random colon biopsies, demonstrated increased eosinophils and mast cells within the biopsy fragments. The patient was subsequently lost to follow-up. In December 2025, the patient presented to the emergency department with left lower quadrant abdominal pain and loose bowel movements. Computed tomography demonstrated diffuse bowel wall thickening. Follow-up colonoscopy performed approximately three months later revealed diverticulosis and flat polyps. Random biopsies obtained from the left colon demonstrated focal Strongyloides stercoralis larvae within eosinophilic abscesses in the lamina propria. The patient received treatment with ivermectin and albendazole, with subsequent resolution of symptoms. This case highlights S. stercoralis infection as a potential consideration in patients with persistent unexplained eosinophilia and illustrates the role of histopathologic evaluation in establishing the diagnosis.

A 10-year-old male with a prior history of right epididymitis presented to the emergency department with a one-day history of right lower quadrant abdominal and right testicular pain. His initial examination was notable for café-au-lait macules and axillary freckling. An evaluation with renal ultrasound demonstrated mild left hydronephrosis, and subsequent testicular ultrasound was concerning for right epididymo-orchitis. A right lower quadrant abdominal ultrasound revealed a heterogeneous mass, and a CT of the abdomen and pelvis with and without contrast confirmed a large 14 cm × 16 cm × 16 cm hypoenhancing mass extending through the right lower mesentery and enveloping mesenteric vessels. An abdominal mass biopsy revealed a plexiform neurofibroma, and the patient met the criteria for neurofibromatosis type 1. He underwent resection of the plexiform neurofibroma, and further imaging revealed other neurofibromas. This case report highlights the importance of considering anatomic explanations for recurrent epididymitis in sexually naïve males and the importance of visual awareness during the physical examination, as neurocutaneous findings can influence the final diagnosis.

Peutz-Jeghers Syndrome (PJS) is a rare inherited autosomal dominant condition characterized by hamartomatous polyps in the gastrointestinal (GI) tract and mucocutaneous hyperpigmentation involving the lips, oral mucosa, and hands. Patients with PJS are at an increased risk for intussusception, causing small bowel obstruction (SBO), a surgical emergency. A 29-year-old female presented to the emergency department (ED) with stabbing left lower back pain that began the previous night and progressively worsened, accompanied by nausea. Her medical history was significant for PJS, von Hippel-Lindau (VHL) mutation carrier status, prior SBO requiring surgical resection at 14 years of age, recurrent left lower quadrant (LLQ) intussusception, and rectal bleeding. On physical examination, the patient had LLQ abdominal tenderness and left costovertebral angle tenderness. CT imaging of the abdomen revealed findings concerning for residual or recurrent LLQ intussusception. An exploratory laparotomy was recommended with resection of approximately 20 cm of the jejunum, followed by reconstruction with a stapled side-to-side anti-peristaltic anastomosis. Pathology demonstrated a tubular adenomatous polyp associated with intussusception and ischemic injury with no evidence of malignancy or high-grade dysplasia. This case highlights a unique presentation of a jejunal adenomatous polyp causing intussusception in a patient with PJS. Awareness of this atypical polyp location in a patient with PJS is essential, given its potential for malignancy and implications for management and surveillance. Furthermore, the patient's known status as a VHL mutation carrier emphasizes the importance of comprehensive assessment in patients with overlapping tumor syndromes.

Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract and is often asymptomatic. Unusual complications such as enterolith formation or foreign body impaction are rare, particularly in pediatric patients, and may produce atypical imaging findings that mimic other intra-abdominal pathologies. We report a case of a previously healthy 4-year-old boy who presented with intermittent colicky abdominal pain and non-bilious vomiting. Contrast-enhanced CT demonstrated a cystic lesion in the left paracolic gutter containing multiple internal rounded low-attenuation structures, initially suspicious for hydatid daughter cysts. Follow-up MRI revealed interval migration of the lesion to the right lower quadrant with peripheral rim enhancement and internal floating components, raising suspicion for a mobile bowel-related process. The patient underwent surgical exploration, which confirmed an inflamed Meckel's diverticulum arising from the ileum. Histopathology demonstrated an intraluminal foreign body (watermelon seed) with surrounding enterolith formation, corresponding to the presumed daughter cysts on imaging. Complicated Meckel's diverticulum may closely mimic hydatid disease on cross-sectional imaging, particularly when enteroliths and inflammatory debris simulate daughter cysts. Recognition of lesion mobility and careful clinicoradiologic correlation are critical to avoid misdiagnosis and unnecessary antiparasitic therapy. This case highlights an important diagnostic pitfall in pediatric abdominal imaging.

Abdominal pain in adolescents often prompts imaging that may reveal incidental findings unrelated to the presenting symptoms, and anchoring on such findings can delay recognition of the true diagnosis. A 17-year-old girl with no significant past medical or surgical history presented to the emergency department with acute right lower quadrant pain of approximately 12 hours' duration. The pain was sharp, nonradiating, exacerbated by movement, and unrelated to meals. Contrast-enhanced computed tomography performed to evaluate for appendicitis revealed left lower quadrant epiploic appendagitis, anatomically discordant with her symptoms. The anatomic mismatch prompted a focused abdominal wall examination, which demonstrated a discrete right-sided trigger point with positive Carnett sign and altered cutaneous sensation, findings most consistent with anterior cutaneous nerve entrapment syndrome. Ultrasound-guided rectus sheath nerve block provided partial relief, and the patient was managed conservatively without surgery. Over subsequent months of multidisciplinary follow-up, her intermittent pain has been controlled with supportive care, with no new hospital admissions and no gynecologic pathology identified. This case highlights anterior cutaneous nerve entrapment syndrome as an underrecognized cause of focal abdominal pain in adolescents and illustrates the importance of anatomic correlation between imaging findings and clinical symptoms.

A Spigelian hernia (SH) is an uncommon abdominal wall hernia occurring along the semilunar line and is often difficult to diagnose due to its intermuscular location. The presence of an epiploic appendage within the hernial sac is extremely rare and may further complicate diagnosis, especially when associated with inflammation or strangulation. We report a case of a 37-year-old female presenting with persistent left lower quadrant abdominal pain, fever, and nausea. Clinical examination revealed localized tenderness, while laboratory findings demonstrated leukocytosis and elevated inflammatory markers. Ultrasound of the abdomen was inconclusive. Computed tomography (CT) demonstrated a fat-attenuating lesion with a hyperattenuating rim and surrounding inflammatory changes, herniating through the semilunar line, consistent with the diagnosis of epiploic appendagitis (EA) within an SH, which is a rare condition with an incidence of 8.8 per million patients. The patient underwent successful laparoscopic reduction and repair with an uneventful recovery.

The canal of Nuck cyst is a rare pathology seen in women in the inguinal canal. It is often mistaken for a hernia or a lipoma; however, diagnosis is confirmed on surgical exploration and histopathological examination. We present a case of a 38-year-old woman, gravida 2 para 2, with progressively worsening left lower quadrant abdominal and groin pain over two months. Imaging identified a small cystic structure in the canal of Nuck that had increased in size and demonstrated surrounding inflammatory changes. She underwent a laparoscopic transabdominal preperitoneal exploration; the canal lesion was excised, and the associated inguinal hernia was repaired. Histopathological findings were consistent with leiomyomatous proliferation. We report a rare case of severe groin pain in a childbearing-age woman to highlight the differential diagnosis and describe this unusual finding. Documenting such cases is important for improving our understanding of canal of Nuck cysts and their pathogenesis.

Isolated fallopian tube torsion (IFTT) is a rare cause of acute abdominal pain in adolescents. Its preoperative diagnosis is often challenging because imaging findings are usually nonspecific. Here we report the case of a 16-year-old girl with IFTT that closely mimicked a functional ovarian cyst. The patient, who had no history of abdominal surgery or pelvic infection, presented with persistent left lower quadrant pain. Initial computed tomography and ultrasonography showed a 30-mm simple cyst without signs of a twisted vascular pedicle, and a functional ovarian cyst was suspected. Her pain persisted, and on day 5 repeat ultrasonography again demonstrated the same simple cyst as at the initial visit, but the left ovary was clearly visualized separately, raising suspicion of a tubal origin. Diagnostic laparoscopy was performed, revealing a 1080° counterclockwise torsion of the left fallopian tube with necrosis, while the ovary appeared normal. As detorsion failed to restore color, a left salpingectomy was performed. Histopathology confirmed torsion secondary to hydrosalpinx. The postoperative course was uneventful, and the patient has remained symptom-free for one year. This case demonstrates that IFTT can occur even in adolescents without risk factors. Identifying a normal ovary on ultrasonography is crucial for suspecting IFTT, and early diagnostic laparoscopy is essential for confirming the diagnosis and preserving future fertility.

Colo-colic intussusception secondary to a submucosal lipoma is exceedingly rare, particularly in adolescents, and presents significant diagnostic and management challenges. A 16-year-old male presented with a 5-day history of left lower quadrant pain, nausea, vomiting, and currant jelly stool. Abdominal ultrasound identified a left iliac fossa mass, and contrast-enhanced computed tomography confirmed a submucosal lipoma with a 10 cm colo-colic intussusception and pelvic free fluid. Conservative management via contrast enema and sigmoidoscopy failed due to mucosal oedema and ulceration, and open sigmoid colectomy was performed. Histopathology confirmed a 32 mm mature lipoma as the lead point with no evidence of malignancy. The patient recovered well and was discharged on postoperative day ten. This case highlights that colo-colic intussusception in adolescents should not be presumed idiopathic. A pathological lead point must always be excluded, and when conservative measures fail, timely surgical resection ensures definitive treatment and favourable outcomes.

Left-sided acute appendicitis is an exceptionally uncommon presentation, most often associated with congenital anomalies such as situs inversus totalis (SIT), and may contribute to diagnostic delays. A 31-year-old man presented with a two-day history of migratory abdominal pain localized to the left lower quadrant, with nausea, vomiting, and anorexia. He was hemodynamically stable without leukocytosis. Contrast-enhanced CT demonstrated SIT and an inflamed appendix in the left lower quadrant (approximately 11 mm), with periappendiceal fat stranding and a small volume of free fluid, without pneumoperitoneum. Laparoscopic appendectomy was performed using modified team positioning and port placement to accommodate the mirrored anatomy. Recovery was uncomplicated, and histopathology confirmed acute appendicitis with periappendicitis and no malignancy. Appendicitis should be considered in the differential diagnosis of left lower-quadrant pain; CT supports timely diagnosis in SIT, and laparoscopy is safe and effective when anatomic and ergonomic factors are anticipated.