Patient: Female, 66Final Diagnosis: Extraovarian primary peritoneal carcinomatosisSymptoms: Abdominal distension with constipation of 3 days, while still passing flatus. She further complained of mild postprandial epigastric pain, but denied nausea or vomiting as well as feverMedication: —Clinical Procedure: —Specialty: SurgeryObjective:Rare diseaseBackground:Extraovarian primary peritoneal carcinoma (EOPPC) is a rare malignant epithelial tumor with an age-adjusted incidence rate of 6.78 per million, which arises from the peritoneal lining with minimal or no ovarian involvement. EOPPC is a diagnosis of exclusion with the absence of other identifiable primary sites and after surgical assessment and consideration of the histological report to evaluate the extent of ovarian invasion.Case Report:A 66-year-old woman complained of mild postprandial epigastric pain. Physical exam revealed positive bowel sounds over all 4 quadrants, with a soft, non-tender abdomen. Distension and dullness to percussion were noted. A CT scan revealed peritoneal fluid, and evaluation of the peritoneal fluid showed an elevated white blood cell count, while fulfilling criteria for exudate. There was no bacterial growth from the peritoneal fluid. Serum tumor markers CEA were significantly elevated, suggestive of an underlying malignancy. An exploratory laparoscopy confirmed diffuse carcinomatosis in the omentum, the coloparietal region bilaterally, as well as surrounding small bowel loops, the transverse and sigmoid colon, and the rectum. A bilateral oophorectomy was performed and 2 biopsies from the thickened peritoneum were taken. The histomorphological features from the pathology examination concluded the patient had peritoneal serous carcinoma with uninvolved ovaries.Conclusions:EOPPC may be misdiagnosed as epithelial ovarian cancer, and should be considered in patients with peritoneal carcinomatosis, normal-sized ovaries, and no identifiable primary lesion. Since the common therapeutic strategies achieve comparable survival rates, failed recognition may be without consequences. However, to further improve survival, optimal cytoreductive surgery is essential and should be made a priority in disease management.

Introduction and objectives Since the outbreak of the COVID-19 pandemic, increasing evidence suggests that infected patients present a high incidence of venous thromboembolic (VTE) events and elevated aminotransferases (AT).The objective of this work was to evaluate the incidence of aminotransferases disorders in patients infected with COVID-19 and to manage the VTE events associated with elevated AT. Patients or Materials and methods We report a retrospective study of 46 patients admitted for COVID-19 infection. Venous duplex ultrasound of lower limbs was performed in all patients at Day 0 and Day 5. All patients had antithrombotic-prophylaxis upon admission using low molecular weight heparin with Enoxaparin. Demographics, comorbidities and laboratory parameters were collected and analyzed. Results Elevated AT were reported in 28 patients (61%). 10 had acute VTE events of which eight (17.4%) had aminotransferases disorders. They had been treated with curative Enoxaparin. After a follow-up of 15 and/or 30 days, six of them were controlled, and treated with direct oral anticoagulant (DOACs) after normalization of aminotransferases. Conclusions The incidence of aminotransferases disorders associated with acute VTE events in patients infected with COVID-19 is significant. The use of DOACs appear pertinent in these patients. Monitoring of the liver balance should therefore be considered at a distance from the acute episode in the perspective of DOACs relay.

Patient: Male, 68Final Diagnosis: Ruptured metastatic hepatic lesion from a jejunal GISTSymptoms: Abdominal discomfort • hypotensionMedication: —Clinical Procedure: —Specialty: Gastroenterology and HepatologyObjective:Rare diseaseBackground:Gastrointestinal stromal tumors (GISTs) are rare gastrointestinal neoplasms. The spontaneous rupture of a jejunal GIST is very rare and spontaneous rupture of liver metastasis from an intestinal GIST is even rarer with only a few cases reported in the literature.Case Report:In this article, we reported a case of spontaneous rupture of a liver metastasis from a malignant jejunal GIST that presented with active tumoral bleeding, hypovolemic shock, and hemoperitoneum. The patient was successfully treated with arterial embolization of the tumor.Conclusions:In appropriately selected patients, arterial embolization appears to be an effective safe treatment for a GIST metastasis rupture.

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