In the emergency department, patients frequently present with abdominal pain, with a variety of different causes ranging from intra-abdominal to extra-abdominal and retroperitoneal pathologies which can affect all age gr...In the emergency department, patients frequently present with abdominal pain, with a variety of different causes ranging from intra-abdominal to extra-abdominal and retroperitoneal pathologies which can affect all age groups. Chronic appendicitis is a rare medical condition characterized by less severe and continuous abdominal pain and a clinical picture lasting longer than 1-2 days and extending over months, even years, and it is not always possible to consider it as a preliminary diagnosis. We represent a case report of chronic appendicitis where the patient's clinical picture led the diagnostics and treatment in different directions and delayed the diagnosis. Namely, our patient was radiologically diagnosed with a collection of denser content retroperitoneally in the right lower quadrant of the abdomen, which in the first place was not related to possible appendicitis, regarding complaints. The existence of chronic appendicitis is a diagnosis unfamiliar to many clinicians and has no official diagnostic criteria. After diagnosis, treatment usually begins with antibiotics, and the next most common step is surgery. The optimal treatment for this condition is unknown. With this case report, we wish to draw attention to chronic appendicitis as a possible differential diagnosis in patients with chronic abdominal pain.
Intussusception is rarely seen in adulthood but is commonly seen in the pediatric age group. Causes of intussusception in adults are commonly due to tumors and inflammatory diseases. Intussusception in adults accounts fo...Intussusception is rarely seen in adulthood but is commonly seen in the pediatric age group. Causes of intussusception in adults are commonly due to tumors and inflammatory diseases. Intussusception in adults accounts for less than 5% of intestinal obstruction. Colonic lipomas are usually asymptomatic and are mostly managed surgically with promising outcomes as seen in our case.
Sclerosing encapsulating peritonitis (SEP) is an unusual fibroinflammatory disease of the peritoneum marked by the development of a fibrous membrane enveloping generally the small intestines. The knowledge around this su...Sclerosing encapsulating peritonitis (SEP) is an unusual fibroinflammatory disease of the peritoneum marked by the development of a fibrous membrane enveloping generally the small intestines. The knowledge around this subject is not completely understood. And the etiology can be either idiopathic or secondary to several diseases, treatments, and/or medications. We present a case of a 52-year-old man suffering from atypical clinical symptoms including recurrent abdominal ascites and intestinal obstruction. An abdominal computed tomography showed findings typical of SEP. Therefore, the patient benefited from exploratory laparotomy, which confirmed the diagnosis of idiopathic SEP. Postoperatively, he again had an episode of bowel obstruction, but this was controlled with steroids. Diagnosis of SEP is a real challenge to surgeons, gastroenterologists, and radiologists. And imagery is very helpful to make the diagnosis. Consequently, it is imperative that all hospital practitioners should distinguish between this lesion and other etiology of acute peritonitis.
Prostate-specific membrane antigen positron emission tomography (PSMA PET) has been approved by the Food and Drug Administration (FDA) to identify prostate cancer in the setting of biochemical recurrence but can also ide...Prostate-specific membrane antigen positron emission tomography (PSMA PET) has been approved by the Food and Drug Administration (FDA) to identify prostate cancer in the setting of biochemical recurrence but can also identify other malignancies. 18F-PSMA PET has not been studied as a potential tool for hepatocellular carcinoma (HCC). We describe the case of a 76-year-old male with a rising prostate-specific antigen (PSA) after definitive prostate cancer treatment and no prior liver pathology who was incidentally found to have HCC on 18F-PSMA PET.
Neonatal testicular torsion (NTT) is a rare but significant condition occurring within the first 30-day postbirth, leading to vascular compromise and potential testicular loss. This paper presents a case of NTT detected...Neonatal testicular torsion (NTT) is a rare but significant condition occurring within the first 30-day postbirth, leading to vascular compromise and potential testicular loss. This paper presents a case of NTT detected incidentally in a neonate with bilateral hydrocele, emphasizing the challenge of early diagnosis and management complexities. The infant underwent surgical intervention involving detorsion and bilateral orchiopexy but eventually required right orchiectomy due to necrosis. The paper highlights the prevalence of NTT in conjunction with hydrocele and stresses the importance of parent education and vigilant follow-up. Various diagnostic methods, primarily ultrasonography, and a range of management strategies are discussed, considering factors such as salvage potential, risk to the contralateral testicle, and surgical intervention's risks and benefits. The paper argues for individualized management, taking into account specific neonate conditions and parental preferences, underlining the essential role of informed and empathetic consultation. The case reinforces the urgent need for increased awareness, early detection, and carefully considered therapeutic approaches to prevent devastating outcomes like infertility and the necessity for lifelong hormone supplementation.
INTRODUCTION: Schistosomiasis is a parasitic infection caused by schistosome invasion of blood circulation. Neuroschistosomiasis is a severe cerebral complication that accounts for less than 2.3% of reported cases. Patie...INTRODUCTION: Schistosomiasis is a parasitic infection caused by schistosome invasion of blood circulation. Neuroschistosomiasis is a severe cerebral complication that accounts for less than 2.3% of reported cases. Patients present with progressive encephalitis, seizures, or both. Management includes antiparasitic medications, steroids, and surgical intervention. . We report a case of a 44-year-old female who presented to the ER with a history of transient loss of consciousness (LOC) and seizure. Radiological investigations revealed a right frontal brain lesion. Histopathological results confirmed the diagnosis of schistosomiasis. CONCLUSION: Schistosomiasis is a parasitic infection commonly diagnosed in patients who live in tropical areas. Early diagnosis with radiological and histopathological evaluation is required to identify patients at risk of developing severe neurological complications.
INTRODUCTION: The incidence of colonic diverticulosis has risen significantly. Diverticular disease is the most frequent cause of colovesical fistulas, which are uncommon complications of diverticulitis. Clinical signs,...INTRODUCTION: The incidence of colonic diverticulosis has risen significantly. Diverticular disease is the most frequent cause of colovesical fistulas, which are uncommon complications of diverticulitis. Clinical signs, such as fecaluria and pneumaturia, are typically required to confirm its presence. Finding the cause of the disease so that the proper therapy can be started is the primary goal of a diagnostic workup rather than observing the fistula tract itself. . We present a 43-year-old man complaining of frequent urinary tract infections for six months. On CT abdomen and pelvis, a colovesical fistula was diagnosed. Surgery was performed, and after the division between the sigmoid colon and the bladder, a sigmoidectomy and an end-to-end colorectal anastomosis were performed. During the surgery, the fistula tract was not detected. The patient was discharged in excellent condition on day six, and the catheter was removed on day 10. CONCLUSION: In conclusion, as in our case, any patient with a urinary tract infection should be suspected of having this condition, especially if he has persistent symptoms that have not responded to standard medical care. Patients who present with fecaluria, pneumaturia, and other specific symptoms of a colovesicular fistula do not necessarily need a barium enema or cystography to confirm the presence of the fistula.
BACKGROUND: A gallbladder torsion typically presents as an acute abdomen presentation with nonspecific clinical signs. When not detected by a clinician preoperatively, it can lead to the delay of emergency surgery and po...BACKGROUND: A gallbladder torsion typically presents as an acute abdomen presentation with nonspecific clinical signs. When not detected by a clinician preoperatively, it can lead to the delay of emergency surgery and possible misdiagnosis for other, more common causes of an acute abdomen. . We report the case of acute gallbladder volvulus in an 80-year-old woman complaining of constant pain in the right upper quadrant of the abdomen. CONCLUSIONS: The patient was successfully treated with cholecystectomy. The case highlights the high index of suspicion required to diagnose the condition preoperatively in this population of patients to reduce complications such as biliary peritonitis and death.
Empyema necessitans is a rare complication of pneumonia, which can be seen more frequently with tuberculosis (TB). In this case report, we include a 47-year-old female with empyema necessitans; closed drainage has been s...Empyema necessitans is a rare complication of pneumonia, which can be seen more frequently with tuberculosis (TB). In this case report, we include a 47-year-old female with empyema necessitans; closed drainage has been sought as a sole treatment based on the clinical presentation and radiological findings of an empyema necessitans. Scarce evidence with regard to adult empyema necessitans with Klebsiella was found in the literature where adult cases were managed exclusively using combination of intravenous (IV) antibiotic and closed drainage, reporting such case can help guiding management for similar presentation.
Gallstone ileus is a rare condition. It accounts for approximately 1% of small bowel obstruction and is more prevalent in the elderly population. It is usually present in relatively comorbid patients posing further opera...Gallstone ileus is a rare condition. It accounts for approximately 1% of small bowel obstruction and is more prevalent in the elderly population. It is usually present in relatively comorbid patients posing further operative challenges. The following report investigates the management of two large gallstones resulting in two different points of obstruction. Is double trouble doubly hard to manage?
Aortic thrombosis has been studied little in patients with COVID-19 and an association has recently been reported with the vaccine for this disease. The aim of the present study is to report five cases of aortic thrombos...Aortic thrombosis has been studied little in patients with COVID-19 and an association has recently been reported with the vaccine for this disease. The aim of the present study is to report five cases of aortic thrombosis at our institution within a three-month period associated with the COVID-19 vaccine. Five cases of aortic thrombosis were evaluated-three women and two men aged 29, 49, 51, 60, and 79 years. Four thrombi involved the thoracic aortic and one involved the abdominal aorta, with embolisms found in the kidneys, spleen, liver, upper limbs, and lower limbs. Embolectomy was performed on the limbs, and anticoagulant therapy was performed for the abdominal arteries. The patients recovered well and anticoagulant therapy was maintained. Aortic thrombosis is uncommon but was associated with the AstraZeneca vaccine in this case series.
Ondine's curse is a rare condition in which breathing is preserved while awake, but there is absence of autonomic control of ventilation. It is a potentially fatal complication that may result rarely from surgery in post...Ondine's curse is a rare condition in which breathing is preserved while awake, but there is absence of autonomic control of ventilation. It is a potentially fatal complication that may result rarely from surgery in posterior fossa in area close to respiratory centers. We describe a patient with posterior fossa hemangioblastoma who underwent subtotal resection via telovelar approach and developed acquired Ondine's curse postoperatively. The patient's presentation and management are described. Besides that, Ondine's is a great example of how modern medicine is linked to ancient literature, and thus, its anecdotal history is also described.
Lipomas are benign tumors composed of adipose tissue that can occur in various locations throughout the body, including the gastrointestinal (GI) tract. Lipoma of the small bowel is a rare clinical condition. It infreque...Lipomas are benign tumors composed of adipose tissue that can occur in various locations throughout the body, including the gastrointestinal (GI) tract. Lipoma of the small bowel is a rare clinical condition. It infrequently results in small bowel obstruction and volvulus. In most of the patients, it is an incidental diagnosis. However, it may present with abdominal pain, nausea, vomiting, GI bleeding, and constipation. It is commonly diagnosed using imaging studies, such as computerized tomography scan or magnetic resonance imaging. The management of small bowel lipomas depends on the presence of symptoms and the risk of complications. Asymptomatic lipomas can be safely monitored with imaging studies, as the risk of complications is low. However, in symptomatic cases, surgical or endoscopic treatment may be necessary to relieve obstruction and prevent complications. We report a case of volvulus of small bowel in a middle-aged female presenting to our hospital with acute GI symptoms.
A 78-year-old woman presented to the emergency department with mild headaches and a sudden onset of blurred vision. Computerized tomography scan and magnetic resonance imaging showed what was described at first as a meni...A 78-year-old woman presented to the emergency department with mild headaches and a sudden onset of blurred vision. Computerized tomography scan and magnetic resonance imaging showed what was described at first as a meningioma invading and occluding the torcular Herophili, the posterior third of the superior sagittal sinus and the proximal part of the right transverse sinus. Gross total resection of the tumor was performed without reconstructing dural sinuses. The patient was discharged home without new neurological deficit. Histopathology was in favor of a hemangiopericytoma Grade II World Health Organization (WHO). Total body positron emission tomography [F]fluorodeoxyglucose found no secondary location. Radiotherapy was planned post-operatively.
Endometriosis is characterized by endometrial-like glands and stroma outside the uterine cavity, affecting women of reproductive age. Thoracic endometriosis syndrome (TES) is an entity producing a range of clinical and r...Endometriosis is characterized by endometrial-like glands and stroma outside the uterine cavity, affecting women of reproductive age. Thoracic endometriosis syndrome (TES) is an entity producing a range of clinical and radiological manifestations, including catamenial pneumothorax, haemothorax, haemoptysis, and pulmonary nodules within the thoracic cavity or on the diaphragm. TES symptoms are nonspecific, warranting a high degree of clinical suspicion. Management includes hormone replacement therapy, surgical management, or a combination of both. We present a case of a 37-year-old woman who presented with TES and unilateral diaphragmatic palsy, managed with robotic-assisted thoracoscopic surgery and hormone replacement.
Neuroendocrine tumors (NET) are rare neoplasms that can originate throughout the human body. An initial treatment option includes upfront surgical resection of the primary tumor (pT) if the tumor can be localized. Curren...Neuroendocrine tumors (NET) are rare neoplasms that can originate throughout the human body. An initial treatment option includes upfront surgical resection of the primary tumor (pT) if the tumor can be localized. Current systemic therapy options following resection of the pT or with evidence of metastatic disease include somatostatin analogs, evorlimus, peptide receptor radionuclide therapy, cytotoxic chemotherapy, and interferon alpha among other less common therapy options. We present a case of a patient with a NET that originated in the ileocecal region. The patient underwent upfront surgical resection with a right hemicolectomy due to the location of the tumor. The pT was notable for extensive invasion into the visceral peritoneum and metastasis to nearby lymph nodes. However, despite being diagnosed as a stage IV NET, the Ki67 index was less than 1%, categorizing it as a low-grade well-differentiated tumor. Following resection of the tumor, there was no evidence of metastasis to the liver on the follow-up magnetic resonance imaging and recurrent somatostatin receptor overexpressing neoplasm on the Gallium-68 DOTATE PET/CT scan. Due to the juxtaposition of the low grade of the tumor and the high staging, several different treatment options were discussed with the main distinction being whether to base these options off of the stage or the grade of the tumor in the case. Low-grade well-differentiated NET have a good prognosis. On the other hand, stage IV NET and tumors that have metastasized to nearby lymph nodes and organs have an increased likelihood to reoccur and worse outcomes. Recommendations for NET based on current evidence have a lack of clarity in terms of when to undergo observation versus systemic therapy.
Gastrointestinal stromal tumors (GIST) account for the majority of non-epithelial, mesenchymal tumors occurring in the gastrointestinal tract. Usually, the tumor measures a few centimeters, and cases larger than 15 cm ar...Gastrointestinal stromal tumors (GIST) account for the majority of non-epithelial, mesenchymal tumors occurring in the gastrointestinal tract. Usually, the tumor measures a few centimeters, and cases larger than 15 cm are rare. Here, we report a rare case of a previously healthy 50-year-old woman, with generalized abdominal pain and increased abdominal girth for over nine months. Imaging showed a very large cystic lesion (21 cm × 15 cm × 24 cm) arising from the greater curvature of the stomach with rupture of the lesion into the intraperitoneal space. The patient was taken for exploratory laparotomy, which revealed a ruptured large cystic mass (21 cm × 15 cm × 24 cm) occupying the upper abdomen and encompassing the greater curvature of the stomach, body, and tail of the pancreas, as well as part of the spleen.
Endoscopic retrograde cholangiopancreatography (ERCP) is a non-surgical method utilized to manage biliary tract obstruction, but the complication of biliary stent migration occurs in 5-10% of patients. Though migrated st...Endoscopic retrograde cholangiopancreatography (ERCP) is a non-surgical method utilized to manage biliary tract obstruction, but the complication of biliary stent migration occurs in 5-10% of patients. Though migrated stents are commonly passed through the gastrointestinal tract without harm, intestinal perforation is a rare but severe complication, affecting less than 1% of cases. We report a case of a 65-year-old woman who presented to the emergency department with symptoms of abdominal pain, nausea, and loss of appetite. According to clinical examination and evidence, the patient underwent surgery with high suspicion of appendicitis, which unexpectedly uncovered a perforated cecum with a protruding biliary stent. Our report describes a unique and unexpected finding of cecal perforation caused by a migrated biliary stent in a patient. We also conducted a review of current literature on ERCP complications, including risk factors for stent migration, relevant statistics, and appropriate interventions. Surgeons should be aware of the risk of stent migration and complications in patients with a history of ERCP. Removal of migrated biliary stents is recommended, regardless of the presence of complications. Additional assessments for alternative diagnoses are recommended for older patients with abdominal pain complaints. Flexible plastic stents should be used for patients at risk of stent passage.
Isolated fallopian tube torsion (IFTT) is a rare pathology that causes acute abdomen in women, it is even less common in pediatric patients. We present a case of an 11-year-old girl who presented with abdominal pain 24 h...Isolated fallopian tube torsion (IFTT) is a rare pathology that causes acute abdomen in women, it is even less common in pediatric patients. We present a case of an 11-year-old girl who presented with abdominal pain 24 hours of evolution, the diagnosis could not be specified with cabinet methods, so the definitive diagnosis was made using a diagnostic laparoscopy. A necrotic hemorrhagic tubal cyst was found. A left salpingectomy had to be performed due to necrosis. Early diagnosis can have a positive impact on the fertility of these patients.
Necrotizing soft tissue infection (NSTI) of the breast is an extremely rare event in surgical practice. It is considered the most aggressive form of soft tissue infection and a true surgical emergency. It is also associa...Necrotizing soft tissue infection (NSTI) of the breast is an extremely rare event in surgical practice. It is considered the most aggressive form of soft tissue infection and a true surgical emergency. It is also associated with a high risk of mortality if not diagnosed promptly. Few cases have been documented in the literature; the exact etiology and risk factors vary from those involving the limbs, trunk, and perineum. Early recognition, prompt surgical treatment, and broad-spectrum antibiotic therapy are crucial for reducing morbidity and mortality. These reports present cases of NSTIs in breasts with unique etiologies and challenges in their management.