Metastatic cancer to the female genital organs is a very rare clinical presentation. The myometrium is more frequently affected than the endometrium. Prolonged use of tamoxifen has been found to be associated with endometrial hyperplasia, endometrial polyp formation, and the development of endometrial adenocarcinoma in some cases. A 55-year-old lady with a history of invasive lobular carcinoma of the breast that had been operated upon with left mastectomy 7 years previously & who had also been treated with tamoxifen for 5 years presented with irregular vaginal bleeding and lower abdominal pain. The patient had a three cm uterine fibroid with an endometrial polyp. She had anemia with hemoglobin level 8 mg/dl. Laparoscopic hysterectomy with bilateral oophorectomy was performed for a polyp in the endometrium which proved to be a metastasis from her lobular carcinoma of the breast. Patients with breast cancer who present with abnormal vaginal bleeding should alert the physicians about the possibility of metastatic breast cancer to the uterus regardless the use of the hormonal therapy such as tamoxifen. The pathologists also should be aware of this possibility and they should examine the polyps very carefully to detect any metastatic foci especially if the patient has been treated with tamoxifen.

Hydatid disease is a zoonotic condition caused by the adult or the larval stages of tapeworms belonging to the species Echinococcus granulosus or less commonly Echinococcus multilocularis. The presentation depends on the site of involvement. Many cases are not symptomatic and may be discovered accidentally. Hydatid cyst of the ovary is an extremely rare presentation and accounts for 0.2–1% of the diagnosed cases. It may be mistaken for ovarian cysts or cystic tumors of the ovary. An 18-year-old woman complained of episodes of lower abdominal pain and frequent urination for the last 3 months. During abdominal examination, there was deep tenderness in the supra-pubic region with no palpable organs or masses. Ultrasound of the abdomen showed evidence of cystic left adnexal lesions. A computerized tomography scan of the abdomen revealed evidence of cystic left adnexal lesion with no enhancement after contrast injection. Laparoscopy was performed and there was evidence of a hydatid cyst of the left ovary. The cyst was extracted from the cavity using a retrieval bag. Anthelmintic medications were prescribed for 3 months, and follow-up ultrasound after 6 months was normal. A high index of suspicion is required for the diagnosis, particularly in the presence of any cystic lesion, in any part of the world. The enzyme-linked immunosorbent assay test may be informative in the active stages of the disease. Laparoscopic management involves cyst excision. Anthelmintic drugs are required after surgery to decrease the recurrence rate.

A 35-year-old man presented with poorly localised lower abdominal pain for 3 months. Abdominal examination revealed lower abdominal tenderness, with normal other parts of examination. CT scan of the abdomen showed irregular multiloculated mass related to the upper part of the urinary bladder with mild rim enhancement in the postcontrast study with no areas of calcifications. During laparotomy, we found a mass attached to the superior part of the urinary bladder and arising from its wall. Complete excision was done without opening the cavity of the bladder. The mass was opened and was a hydatid cyst of the bladder containing multiple daughter cysts.

Gall bladder anomalies varies from variations in the size, site, duct systems, and shape. Abnormal location comprises the commonest one.The presence of an ectopic gall bladder is estimated to occur in around 0.1-0.7% of individuals, it can be truly ectopic locating under the left lobe of the liver or just to the left of falciform ligament.Gall stones are common disorder that may mandate cholecystectomy especially in symptomatic patients, surgery can be done laparoscopically safely in cases of abnormal anatomical position, but such cases may be at higher rate of complications especially if associated with other biliary tract anomalies. Six cases of symptomatic gall stones who underwent laparoscopic cholecystectomy included in this case series. During insertion of the telescope through the umbilical port, we found midline gallbladder under the falciform ligament instead being under right lobe of the liver. We did modification of the port sites by placing epigastric port in the left hypochonrdium. In all the six cases the surgery had been done successfully laparoscopically without conversion to open technique. Follow up of the patients done for 2 months with no post-operative sequelae. Laparoscopic cholecystectomy for midline gall bladder is technically difficult. Modifying the port sites make the surgery easier. MRCP preoperatively, intraoperative cholangiography, or fluorescent cholangiography may be needed if there is any concern about biliary anomalies or for real time detection of biliary injuries.

Introduction: Ingestion of foreign bodies and their impaction at the lumen of the appendix is a very rare finding and only few cases have been reported all over the world. A variety of metallic foreign bodies when ingested may be lodged in the lumen of the appendix such as screws, bird shots, and needles. This is called in most literatures as foreign body appendicitis. Case presentation: A 4-year-old boy with history of an accidental ingestion of a metallic nail presented to the emergency department one week later with right iliac fossa pain and one attack of vomiting. During abdominal examination there was tenderness and rebound tenderness at the right iliac fossa. Plain abdominal X-ray showed the metallic nail in the region of the right iliac fossa. Ultrasound examination was normal apart from tenderness of putting the probe on the right lilac fossa. The white blood cell counts were 14,000 cell per microliter. During surgery the nail was found to be impacted inside the lumen of the vermiform appendix causing inflammation of the appendix. Appendicectomy done and the patient discharged on the third day in a good general condition. Conclusion: Acute appendicitis may be caused by a variety of causes including ingested foreign bodies if impacted in its lumen. When the patient has signs of generalized peritonitis it is important to exclude bowel perforation. The surgery can be done by the open surgery or laparoscopically. Highlights:

Situs inversus is a condition in which the anatomical viscera are placed in a reverse anatomical location, it may be partial affecting the thoracic organs or the abdominal organs, or total affecting both. A 28-year-old man who was a known case of situs inversus totalis presented with epigastric pain and left hypochondrial pain. ultrasound revealed multiple gall stones in a left-sided gall bladder, laparoscopic cholecystectomy was done successfully for him with no complications. Patient position during surgery and the sites of the laparoscopic ports greatly affect the performance during surgery. Identification of the anatomical structures which are arranged in a mirror image pattern is the key for successful surgery. The critical view of safety should be identified before any structure is clipped or divided. A right-handed surgeon will feel more impairment during surgery for a left-sided gall bladder, while a left-handed surgeon will do it with better comfort. Surgeries for such cases are better to be performed by a surgeon with massive experience in laparoscopy or by a hepatobiliary surgeon, it may not be suitable for surgeons in training. MRCP will show the biliary anatomy prior to surgery and CT-scan with dual phase contrast will help to show any associated vascular abnormalities.