BACKGROUND A Spigelian hernia is a ventral hernia that occurs through the Spigelian fascia, formed by the aponeuroses of the transversus abdominis and internal oblique muscles; it may contain peritoneum or abdominal contents. This report describes an older woman who exhibited left leg swelling and intermittent right lower abdominal pain due to compression and thrombosis of the left common iliac vein by an overriding right common iliac artery (May-Thurner syndrome), in conjunction with a right-sided Spigelian hernia. CASE REPORT A 63-year-old woman presented with left leg swelling and intermittent right lower abdominal pain. She initially developed left lower extremity edema, for which percutaneous intervention was performed to treat venous obstruction. During the same admission, she experienced bowel obstruction and right lower quadrant abdominal pain, leading to a diagnosis of incarcerated Spigelian hernia. Computed tomography revealed a non-occlusive thrombus of the left iliac vein consistent with May-Thurner syndrome, as well as a right-sided Spigelian hernia containing obstructed, dilated small bowel loops. The patient underwent endovascular thrombectomy and stenting of the left iliac vein, followed by laparoscopic mesh repair of the Spigelian hernia. Both procedures were completed without complications. CONCLUSIONS This case illustrates the simultaneous occurrence of left common iliac deep vein thrombosis secondary to May-Thurner syndrome and a Spigelian hernia associated with obstructive symptoms. Successful diagnosis and management of these rare conditions were achieved through interdisciplinary collaboration, advanced imaging, and minimally invasive intervention.

A woman in her 20s presented with acute abdomen, manifesting as a palpable abdominal mass, left lower quadrant pain and vomiting. Imaging revealed a large pelvic mass containing multiple linear air pockets, which complicated the differentiation from gastrointestinal tumours (such as gastrointestinal stromal tumour) or abscesses. Emergency surgery revealed a left ovarian tumour with 360-degree torsion and associated congested change. Pathological diagnosis confirmed dysgerminoma, characterised by positive immunohistochemistry for Sal-like protein 4, placental alkaline phosphatase and octamer-binding transcription factor 4 (OCT-4). We hypothesise that the intratumoural gas was intravascular gas associated with the torsion, entrapped within the dysgerminoma's characteristic fibrovascular septa, thereby mimicking an enterogenous mass. This case highlights the importance of considering ovarian torsion as an aetiology of unusual gas images and underscores the challenge in diagnosing rare ovarian malignancies presenting acutely.

Epiploic appendagitis is a rare, self-limiting cause of acute abdominal pain that often mimics more common conditions, such as diverticulitis, leading to frequent misdiagnosis and unnecessary interventions. We report a case of a 46-year-old male who presented with sudden-onset, sharp, localized left lower quadrant pain without systemic symptoms. Physical examination revealed localized tenderness without peritoneal signs, and laboratory tests showed only mild leukocytosis and slight elevation of inflammatory markers. Contrast-enhanced computed tomography demonstrated an oval, fat-density lesion adjacent to the descending colon with a hyperattenuating rim and surrounding fat stranding, consistent with epiploic appendagitis. The patient was managed conservatively with analgesia and supportive care, with rapid symptom resolution within 48 h and complete recovery at two-week follow-up. This case highlights the importance of considering epiploic appendagitis in the differential diagnosis of acute abdominal pain, particularly when systemic signs are minimal, and demonstrates the value of imaging in establishing a definitive diagnosis. Prompt recognition can prevent unnecessary antibiotics, hospitalization, or surgical intervention, allowing for safe and effective conservative management.

Appendicitis is a global disease that affects people of all ages, but occurs most often between ages 5 and 45 years. It is one of the most common causes of acute abdominal surgery and, if left untreated, it is a surgical emergency that requires prompt intervention. Nurses play a vital role in managing patient care by addressing pain, preventing infection, and ensuring patient safety. This article discusses the pathophysiology and typical presentation of appendicitis, followed by an overview of current surgical management, including laparoscopic and minimally invasive techniques. It also explores the critical role of nurses in the care of patients with appendicitis, highlighting the need for accurate assessment, clinical judgment, and patient-centered care to improve patient outcomes. Key nursing responsibilities in the preoperative and postoperative phases include pain management, infection prevention, fluid balance, mobility, emotional support, patient education, and discharge planning. Early recognition of complications through skilled assessment and critical thinking is essential to prevent clinical deterioration. Common nursing diagnoses and measurable outcomes guide care planning and evaluation. Holistic, compassionate nursing care is essential in supporting patients with appendicitis throughout their diagnosis and treatment plan.

Acquired small intestinal diverticulitis and its complications remain poorly understood due to their rarity and nonspecific presentation. Complications such as abdominal sepsis, bleeding, and perforation can lead to unfavorable outcomes. We report the case of a patient who presented with acute jejunal diverticulitis requiring surgical intervention. A 66-year-old man with a history of endovascular abdominal aortic aneurysm repair presented with acute left lower quadrant abdominal pain and tenderness. Computed tomography (CT) detected intestinal diverticulosis, localized free air, and inflammatory changes associated with the small intestine. Exploratory laparoscopy revealed numerous proximal jejunal diverticula with perforation contained within the mesentery. A 48 cm segment of the jejunum was resected, and a primary anastomosis was performed. Surgical pathology confirmed acute small intestinal diverticulitis and serositis. The patient had an uneventful postoperative course and was discharged home on postoperative day 6. This case highlights the diagnostic challenge in acute small intestinal diverticulitis, which may present with nonspecific signs and inconclusive radiological findings. The location of diverticula along the mesenteric border may contain perforations in the mesentery and obscure peritoneal signs. Although some patients with acute small intestinal diverticulitis may be conservatively managed, surgical intervention remains the standard of care for managing patients with complications. Acute small intestinal diverticulitis, though exceedingly rare, can carry a significant risk of morbidity and mortality. Thus, small intestinal diverticulitis should be considered in the differential diagnosis in older adults who present with acute abdominal pain and tenderness. Surgical management remains the gold standard of treatment of severe acute small intestinal diverticulitis.

Babesiosis is a tick-borne protozoan infection marked by invasion of red blood cells and causing hemolytic anemia. When symptomatic, patients present with symptoms and signs secondary to hemolysis. We report a case of Babesiosis presenting with a rare manifestation of a splenic infarct, emphasizing the importance of early recognition and prompt treatment. A 41-year-old man with no significant past medical history presented to the hospital with fever, chills and sweats for 2 days. He also had left lower quadrant abdominal pain which started 10 days prior to the admission. Initial laboratory results showed mild anemia and thrombocytopenia with a platelet count of 79 K/uL (normal range 150-350), normal creatinine and transaminases. Computerized tomography (CT) of the abdomen showed moderate splenomegaly and 1.2 cm hyperdense focus reflecting an infarct. Peripheral blood smear demonstrated intracellular red cell inclusions suggestive of Babesia spp. Human Babesiosis is an emerging zoonosis with various clinical presentations varying from being asymptomatic to life-threatening conditions. Patients with immunocompromised status, splenectomy, or significant underlying health conditions are particularly susceptible to severe manifestations. Splenic infarcts are reported as a rare complication, found in younger and immunocompetent hosts, and they do not correlate with the level of parasitemia. Our patient was also a young immunocompetent host with a low level of parasitemia presented with abdominal pain; a high level of suspicion is needed to make an early diagnosis. This case is an important reminder of this atypical presentation of Babesia microti infection in an immunocompetent host.

Midgut malrotation is a developmental rotational anomaly of the embryonic bowel. Malrotation can present as either acutely, intermittently, or asymptotically. The diagnosis of malrotation with subsequent volvulus of the intestine represents acute surgical emergencies.  During embryonic development, the small bowel usually rotates in a counterclockwise direction around the superior mesenteric artery (SMA) axis between the fourth to eight weeks of gestation. During this period in embryonic development, the bowel protrudes through the yolk stalk (which will become the future umbilicus). During this process, the digestive tract elongates and undergoes counterclockwise 90 degrees rotation, followed by retraction of the bowel into the abdominal cavity where another 180-degrees counterclockwise rotation occurs.[1] There are different types of Midgut Malrotation: Non-rotation. Incomplete rotation. Reverse rotation. Anomalous fixation of the mesentery[2].

Renal ectopia and malrotation are uncommon congenital anomalies that arise from abnormal kidney ascent and rotation during embryologic development. Although often discovered incidentally, these structural variations may alter venous drainage and predispose to stasis and thrombosis. Renal vein thrombosis (RVT) is rare in adults and usually occurs secondary to nephrotic syndrome, malignancy, dehydration, or hypercoagulable disorders. The coexistence of renal malrotation, ectopia, and spontaneous RVT in an otherwise healthy adult is exceptionally unusual. A 35-year-old woman presented with severe right-lower-quadrant abdominal pain, nausea, and fever, initially raising concern for appendicitis. Laboratory results revealed severe microcytic anemia with reactive thrombocytosis. Contrast-enhanced computed tomography demonstrated a malrotated ectopic left kidney located in the iliac fossa with associated left RVT. Comprehensive evaluation for thrombophilia, autoimmune disease, and malignancy was negative, while iron studies confirmed marked iron-deficiency anemia. The patient was treated with blood transfusion and anticoagulation, resulting in complete clinical and radiologic resolution after one year of follow-up. This case illustrates how congenital renal vascular anomalies and hematologic abnormalities may interact to produce thrombosis. Altered venous outflow from the ectopic kidney likely caused local stasis, while iron-deficiency anemia contributed to a transient hypercoagulable state through reactive thrombocytosis and endothelial dysfunction. Clinicians should consider RVT in the differential diagnosis of atypical abdominal or flank pain when imaging reveals renal positional anomalies. Early recognition and anticoagulation can preserve renal function and prevent unnecessary surgical intervention.

Osteoarticular tuberculosis (TB) is a form of extrapulmonary TB that affects bones and joints, with the spine being the most common site of involvement. Spinal TB, also known as Pott's disease, is therefore the most frequent manifestation of osteoarticular TB. Historically, Pott's disease has been more prevalent in developing countries; however, its incidence is increasing in developed nations, driven by global migration and a growing population of immunocompromised individuals. We report the case of a woman in her 50s who presented with a one- to two-month history of intermittent lower abdominal pain, radiating to the back and associated with fever, nausea, and recent weight loss. Initial examination suggested acute appendicitis, with tenderness localised to the right lower quadrant and McBurney's point. Laboratory investigations revealed mild anaemia (haemoglobin, or Hb 95 g/L) and elevated C-reactive protein (CRP) (49 mg/L), while other parameters were normal. Computed tomography (CT) imaging revealed a large left psoas collection with vertebral destruction at L4, suggestive of discitis/osteomyelitis. Magnetic resonance imaging (MRI) confirmed a multiloculated left psoas abscess with extensive involvement of the L4/L5 vertebrae, paravertebral tissues, and epidural space. CT-guided aspiration obtained approximately 90 mL of pus, which tested positive for Mycobacterium tuberculosis without rifampicin resistance. Initial empiric therapy with flucloxacillin was discontinued, and antitubercular therapy was commenced. Subsequent drug susceptibility testing revealed isoniazid resistance, prompting regimen modification to include rifampicin, pyrazinamide, ethambutol, and levofloxacin. The patient improved clinically, with gradual resolution of symptoms and reduction in abscess size on follow-up imaging. Multidisciplinary management, involving general surgery, radiology, microbiology, and infectious disease teams, was critical for timely diagnosis and tailored therapy. This case highlights the atypical presentation of spinal TB with a left-sided psoas abscess mimicking acute appendicitis. It also shows the importance of a multidisciplinary approach, early imaging, CT-guided aspiration for microbiological confirmation, and culture-guided therapy, especially in the context of drug-resistant TB. Awareness of such presentations can prevent diagnostic delays, reduce morbidity, and optimise outcomes.

Mechanical bowel obstruction due to a giant colonic calculus is an exceedingly rare clinical entity, typically associated with gallstone ileus or migration through a cholecystocolonic fistula. This case report describes the clinical presentation, diagnostic process, and treatment of an 81-year-old male with a history of cholelithiasis who developed acute mechanical large bowel obstruction due to a 5 cm sigmoid colon calculus. The patient, with comorbidities including diabetes mellitus, hypertension, chronic renal failure, prior prostatectomy, and appendectomy, presented with abdominal pain, nausea, and vomiting. Physical examination revealed tenderness in the left lower quadrant without rebound or guarding, indicating no evidence of perforation. Laboratory findings showed leukocytosis (white blood cell count [WBC]: 12,000/μL, neutrophil percentage: 85.2%) and elevated C-reactive protein [CRP] (33 mg/L). Non-contrast abdominal computed tomography (CT) revealed a 5 cm calculus in the sigmoid colon, with proximal dilatation, air-fluid levels, and pneumobilia. A prior hepatobiliary ultrasound had documented a 49 mm gallstone, suggesting migration via a cholecystocolonic fistula. Sigmoidoscopy, performed using an Olympus CF-HQ190 colonoscope with tripod grasping forceps, successfully extracted the calculus. Due to the patient's advanced age and significant comorbidities, surgical repair of the cholecystocolonic fistula was not pursued. A follow-up hepatobiliary ultrasound one month post-procedure revealed no residual gallstones. The patient achieved rapid recovery and was discharged the following day. This case is notable for the exceptionally large 5 cm calculus, which is rare compared to the 2-3 cm stones typically reported, and highlights the efficacy of sigmoidoscopy in managing such cases in elderly patients with significant comorbidities.