Introduction: Dioctophyma renale, also known as the “giant kidney” worm is the largest nematode that infects mammals. Most commonly, it infects dogs and only a few cases of human infestation have been reported. Case Presentation: In this case, we present a 71-year-old male with a history of right flank pain, painless hematuria, obstructive urinary symptoms and occasional passage of a long red meat-like structure via urethra. Previous ultrasonography revealed a renal mass that was interpreted as renal malignancy. Patient was advised radical nephrectomy with biopsy; however, he was lost to follow up. After 8 years, he again presented with a 2-month history of right flank pain, gross hematuria, unintentional weight loss and obstructive urinary symptoms. He was admitted to our institution and laboratory findings revealed microcytic hypochromic anemia. Ultrasound showed a focal bulge in the superior wall of the urinary bladder and an enlarged right kidney with a large heterogeneous solid structure. Insertion of a foley catheter relieved the urinary obstruction and there was noted passage of a single roundworm measuring 55 cm by 0.32 cm. The specimen was sent for histopathology and microscopic examination revealed a necrotic body of a roundworm consistent with Dioctophyma renale. Case Discussion The clinical manifestations of D. renale infection are non-specific and the diagnosis can be a challenge as it commonly mimics renal malignancy and other intra-abdominal tumors. The diagnosis is often an incidental finding of the parasite on necropsy or by finding ova in the urine. The clinical findings of painless hematuria, unintentional weight loss and an ultrasound finding of renal mass usually point toward the diagnosis of renal cell carcinoma. As we present this case, it will be highlighted that such signs and symptoms, such as painless hematuria, unintentional weight loss and ultrasound finding of a renal mass, can also be found in patients with rare human parasitism from Dioctophyma renale.
Parasites ; Dioctophymatoidea ; Carcinoma ; Kidney

Background: Gastric volvulus is an emergency which warrants immediate correction. It presents clinically with epigastric pain radiating to the back and or left thoracic area or left upper abdominal quadrant, retching and difficulty in passing a nasogastric tube.Case Report: This is a case of a 55-year old male, who had a six-year history of mild, intermittent epigastric pain, bloatedness and occasional retching.Two weeks prior to admission, he had severe, nonradiating epigastric pain accompanied by coffee-ground vomitus, and melena. Chest radiograph revealed an air fluid level in the left lower lungfield. Upper gastrointestinal endoscopy revealed twisting of the rugal folds at a constriction seen at the midportion of the gastric body. Upper gastrointestinal series showed that the stomach was located intraabdominally, but the fundus was seemingly connected to the duodenum, while the distal esophagus was connected to the distal part of the stomach. Exploratory laparotomy was done which revealed a Morgagni hernia with the stomach located in the thorax and rotated along its transverse axis. Reduction and repair of hernia were done.Conclusion: Gastric volvulus mimics many conditions including gastric distention, cardiopulmonary diseases, cholecystitis, gastric and duodenal ulcer andpancreatitis. Therefore, it can be included in the differential diagnosis of chronic abdominal pain.
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