No abstract

Acute perforated duodenal ulcers are considered one of the most encountered emergency surgical conditions leading to mortality. Different approaches have been proposed for management based on the clinical status of the patient. The use of omental patch closure is widely accepted either via an open or laparoscopic approach. However, not all patients are candidates owing to the availability and viability of the greater omentum. In these patients, the falciform ligament can be used as an alternative and efficient method for repair. In this case, we present a male patient with a perforated ulcer in the first part of the duodenum which was managed by falciform ligament patch instead of the usual omental patch. In cases of a deficient or unhealthy greater omentum, or if it cannot be brought in the upper part of the abdominal cavity due to severe adhesions, the falciform ligament can be used efficiently in the closure of perforated duodenal ulcer.

Myasthenia gravis (MG) is an autoimmune disease that occurs as a consequence of anti-acetylcholine (Ach) antibodies specifically targeting postsynaptic Ach receptors (AchR). This leads to the evolution of the classic symptoms of the disease, which range from mild symptoms of diplopia, muscle fatigue with repetitive movement up to severe affection of the respiratory muscle. The disease can occur as an isolated finding or co-exist with a concomitant thymic tumor or hyperplasia. Careful diagnosis is crucial for the development of the management plan. Nearly 10–15% of MG cases coexist with a thymic pathology and in these cases, surgical resection leads to the resolution of symptoms. Although thymomatous MG occurrence is non-heritable, its polygenic nature accounts for its rare familial variant. In this case, we report a family of three brothers with familial thymomatous MG who underwent thymectomy and improved after thymic surgical resection. Myasthenia gravis can occur as an isolated finding or as an association of thymic pathology. Careful discrimination between the two should be made for the elaboration of a management plan. Familial variant thymomatous myasthenia gravis is exceedingly rare. A familial survey is crucial for its management.

Multiple primary tumors' incidence is rare, yet more rare is the incidence of multiple primary malignant tumors. Co-occurring tumors can be divided into synchronous and non-synchronous. Synchronous tumors are those tumors that present within a period not >6 months from each other. To define synchronous malignant tumors: metastasis should not be present, both tumors have to show criteria of malignancy, and they should differ pathologically from each other. Breast cancer is the most common tumor to be associated with other primaries especially; colorectal cancer, endometrial and ovarian cancer, yet the occurrence of invasive ductal carcinoma with clear cell renal cancer is uncommon. In our case, we present a 59-year-old female with invasive ductal carcinoma and clear cell renal carcinoma.

First operated by Claudius Amyand in 1735. Amyand’s hernia is a rare presentation and accounts for only 1% of all inguinal hernias. Amyand’s hernia is described when the appendix is trapped within an inguinal hernia. In most cases, Amyand’s hernia is an incidental finding intra-operatively due to variable clinical manifestations, and features. Amyand’s hernia has variable theories explaining its pathophysiology besides having multiple proposed surgical approaches either via laparoscopic or open repair and with the latter being in a debate of pro and against mesh repair. We present a case of a sliding Amyand’s hernia in which the vermiform appendix and part of the cecum were adherents to the wall of a right inguinal hernial sac. Amyand’s hernia is a rare form of inguinal hernias and its presentation is widely variable. However, in most cases, it is non-complicated and is found as an incidental intraoperative finding. Many studies debate among different diagnostic and management approaches to serve a better outcome with fewer operative complications.