IJCR (2022), Volume 6

Fournier’s gangrene is a rare and progressive necrotizing infection affecting the perineal, periureteral, perianal, or genital area associated with high mortality rates. A 34-year-old obese man went to the emergency room, complaining of painful perianal and perineal swelling. He was hospitalized and the computed tomography (CT) scan revealed large bilateral anorectal abscesses, anteriorly extended to the base of the scrotum and on the right to the ischiorectal fossa. A diagnosis of Fournier’s gangrene was made and broad-spectrum antibiotic therapy was started. After the abscesses drainage, microbiological examinations were performed. However, the clinical conditions furtherly worsened and the patient was moved to the medical intensive care unit. The microbiological analyses tested positive for Methicillin-resistant Staphylococcus aureus (MRSA) and the antibiotic therapy was modified accordingly. Despite the treatment, the hypotension worsened and the patient died from sepsis and multi-organ failure. Upon autopsy, we observed an external macroscopic picture devoid of the typical destructive lesions that usually characterize Fournier’s gangrene. Therefore, we found ourselves faced with an atypical case which, in the absence of the clinical data, would certainly have been difficult to diagnose based on the autopsy findings only. The presented case is deemed of interest for both clinicians and medical examiners since it is about a highly aggressive and fatal Fournier’s gangrene in the absence of destructive external manifestations. Moreover, this atypical case of Fournier’s gangrene was sustained by an emerging and highly aggressive microbial agent, eventually evolved into sudden death.

Sphenoid wing meningiomas commonly present with headaches and visual changes. Some presentations may vary depending on the meningioma’s site of growth. Here we present a gentleman with no headaches, a very mild proptosis that went unnoticed, together with a rapid visual loss that progressed over 4 months. Prior to presenting at the eye casualty, he has been assessed by other doctors and opticians, who diagnosed his fundal toxoplasmosis scar as the cause of his visual loss. Only through a thorough examination and measurement, did the mild proptosis become a significant part of the investigations and diagnosis. Neuroradiological investigations confirmed a diagnosis of spheno-orbital meningioma, for which he underwent 2 surgeries to achieve satisfactory debulking of the mass. This case report is to highlight the importance of having a systematic approach when reviewing patients with proptosis, and to always explore other potential causes for visual loss. A brief review of literature looking at the various causes of unilateral proptosis and different presentations of spheno-orbital meningiomas is included.

Background: Colorectal cancer (CRC) predominately affects adults over the age of 50, however it occasionally occurs in young patients. Case: This case observes the presentation and management of a 14-year-old African American male (AAM) who presented to the emergency department with a two-week history of insidious onset RLQ abdominal pain. Evaluation of suspected small bowel obstruction with computed tomography raised alarm for a mass lesion causing the obstruction. Subsequent barium enema, colonoscopy, and histological analysis diagnosed colorectal cancer. The patient then underwent surgery, chemotherapy, and radiation for stage IIIc CRC. Conclusion: We use this case to argue for the development of a genetic panel that can screen for high-risk mutations so detected patients can pursue early and frequent screening protocols such as colonoscopy. We demonstrate the importance of early intervention by discussing the prognosis of patients that are discovered after a change in bowel habits.

Calciphylaxis is a rare and serious disorder that presents with skin ischemia and necrosis and is characterized histologically by calcification of dermal arterioles. It is also called “calcific uremic arteriolopathy” (CUA). It has a poor prognosis and often occurs in patients undergoing dialysis. We present six cases of calciphylaxis associated with a wide range of symptoms, including nonhealing thigh, abdominal wall, breast and penile ulcer. We report our experience of a multi-interventional strategy in treating patients with calciphylaxis and nonhealing ulcers.

Background: There is a positive association between various types of cancer and diabetes. Duodenopancreatectomy is the treatment of choice for diabetic patients with duodenal tumors. Pancreatic resections may trigger endocrine insufficiency. There is an association between poor glycemic control and lower survival rates. Low carb diets appears to be an effective approach in the treatment of diabetic patients that require pancreatic resections. Case Presentation: We report the case of a type II diabetic diagnosed with resectable duodenum cancer. At the time of diagnosis he was jaundiced and with decompensated diabetes. The patient was submitted to a low carb diet for three weeks and, having improved its physiological and metabolic parameters, we performed a duodenopancreatectomy. The patient evolved without complications, with easy management of postoperative glycemia. Conclusions: Low carb diets can prove to be a powerful, inexpensive, and safe tool to add to our therapeutic arsenal before pancreatic resections.

IgG-4 related disease (IgG4-RD) is a chronic inflammatory condition characterized by tissues infiltration with lymphocytes and IgG4 secreting plasma cells, significant fibrosis and response well to steroids. It is typically a systemic disease that involves various organs. We are presenting a 57-year-old female who was found to have elevated serum creatinine, Proteinuria. An ultrasound scan revealed bilateral hydronephrosis and an abdominal computed tomography (CT) scan illustrated a large retroperitoneal mass. Further evaluation of the mass with whole-body positron emission tomography (PET CT) scan was suggestive of retroperitoneal fibrosis or lymphoma. A CT guided biopsy was done, and results were consistent with fibrosis in the context of IgG-4 related disease. IgG-4 serum levels were elevated. The patient was treated with oral steroids. Azathioprine and Rituximab. Renal function improved significantly and was stable upon 3 months follow up with a decrease in IgG-4 levels and with a significant reduction in the mass lesion.

Pneumoperitoneum is mainly caused by viscus perforation, in most cases by ulcer. However, it may be caused by non-surgical causes in 10 % of the cases, such as patients on respiratory support, renal dialysis, paracentesis, and anaerobic bacterial infections. In addition, there are some sporadic causes of pneumoperitoneum; one of them is wisdom tooth extraction, which is described in our case. In the literature review, there were many documented cases of subcutaneous emphysema, pneumothorax, and pneumomediastinum caused by wisdom tooth extraction. However, there was only one case that represented pneumoperitoneum after that procedure. In this case report, We are reporting a case of a 50-year-old male patient who presented one-week status post wisdom tooth extraction, with significant subcutaneous emphysema involving the face, neck, and upper chest; further workup and assessment showed that the patient has considerable pneumoperitoneum, pneumomediastinum, mild pneumothorax bilaterally, and extensive subcutaneous emphysema on computerized tomography. The patient was managed conservatively, with no need for any surgical intervention, and he was discharged home in a good general condition.

Calcium polystyrene sulfonate (CPS), also known as Kalimate, is a cationexchange resin (CER), commonly used to treat hyperkalemia. A case of a patient with chronic kidney disease (CKD) who underwent right hemicolectomy for colonic perforation due to intestinal necrosis secondary to oral CPS administration is presented. The histopathological findings confirmed the colonic ischemia and perforation and showed a luminal deposition of crystals with a fish scale pattern, compatible with CER (Kalimate). This report aims to present and discuss this unusual case considering the most updated scientific evidence.

Methicillin-Resistant Staphylococcus Aureus (MRSA) bacteraemia is associated with high morbidity and mortality. Early identification of a source of infection is critical for appropriate management. MRSA infection can affect any organ system, however infection of the biliary tract is a rare phenomenon. We report on a 67-year-old male who presented with atypical cholecystitis, intra-hepatic collections and MRSA bacteraemia. The patient was managed on a long course of antibiotics following cholecystectomy and surgical drainage of the collections. Our case highlights the importance of considering biliary sepsis as a potential source for MRSA bacteraemia, in order to expedite source control and prevent intra-hepatic abscess formation.

Introduction: Intrahepatic cholangiocarcinoma (ICC) is rare and often diagnosed in an advanced stage. Neoadjuvant therapy is not established and data on its value are in palliative intention. In the case of a recurrence patients often are offered systemic chemotherapy as the only treatment option. We report on a patient with advanced intrahepatic cholangiocarcinoma who underwent multimodal treatment leading to a long-term survival. Case report: A 61-year-old woman presented with an advanced intrahepatic cholangiocarcinoma of the right liver lobe without evidence of metastatic spread. She had already completed two cycles of chemotherapy of Cisplatin and Gemcitabine resulting in stable disease. An extended hemihepatectomy of the right lobe including segments I, IVa and partially IVb was performed. The TNM status (8th edition) was pT2b (3), pN0 (0/6), M0, V1, G2 and R0. Ten months later recurrence was diagnosed and treated with microwave ablation. Recurrence occurred again and the patient underwent repeated resection 22 months after primary resection. After detection of repeated recurrence once more, repeated resection was performed 46 months after initial resection. The patient is still alive and tumor-free 7 years after primary resection. Conclusion: Multimodal treatment including preoperative chemotherapy, complete resection and repeated resection of recurrence as well as microwave ablation led to long-term survival in a case of advanced intrahepatic cholangiocarcinoma. Close follow-ups were crucial to offer the best treatment options.