International Journal of Case Reports

Facial nerve palsy is a condition with several implications, particularly when occurring in infancy and childhood. It represents a clinical problem with regard to its etiology, treatment options and its outcome, particularly when occurs in infants and children. There are several causes of facial nerve paralysis in children, as it can be congenital (due to delivery traumas and genetic or malformation diseases) or acquired (due to infective, inflammatory, neoplastic, traumatic or iatrogenic causes). Nonetheless, 40-75% of the cases of unilateral facial paralysis remain idiopathic. Unilateral familial congenital facial nerve palsy is an extremely rare condition that is usually syndromic, namely, in Moebius syndrome. The occurrence of isolated familial facial nerve palsy is even rarer, with only a few cases reported in the literature. Here we report a mother and her child both have congenital facial paralysis on the same side.

Introduction: Foreign body (FB) ingestion is frequently observed in surgical and endoscopic practice. They are often removed from the body cavities without causing any severe complications but occasionally they lead to serious damages. We report a case of a rosemary branch ingestion causing a duodenal and Inferior Vena Cava (IVC) perforation. Case Presentation: A 61 year-old man was admitted in ER with abdominal pain, vomiting and with a single episode of melaena. Vital parameters were stable. The abdomen was mildly distended but tender. Computed tomography (CT) scan revealed a foreign body in the second part of duodenum, passing through it, reaching and perforating the Inferior Vena Cava (IVC). An urgent Esophagogastroduodenoscopy (EGDS) confirmed the presence of a rosemary branch passing through the duodenum in correspondence of the lower duodenal knee. An emergency surgery with a median xifopubic laparotomy was performed. The foreign body removed firstly from the duodenum, then from IVC. No complication were observed in the postoperative period. Discussion: This case peculiarity was the paucisymptomatic presentation related to the severe lesion to the vessels and the bowel. Laparotomic approach was chosen to permit a secure and effective bleeding control. Probably the lack of symptoms, was due to the presence of an extended fibrotic reaction around the rosemary branch. Conclusion: Duodenal perforation and large vessels lesions due to foreign body ingestion are rare conditions that can lead to severe complications. Not withstanding the utilization of Computed Tomography (CT) scans and endoscopic procedures, the surgical management of bowel perforation induced by foreign bodies continues to present a formidable challenge. The optimal course of acting to ensure a favorable clinical outcome frequently relies upon the surgical approach adopted by the operating surgeon.

Steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT), also known as Hashimoto’s Encephalopathy (HE), is an immune-mediated condition that may present with a myriad of neuropsychiatric symptoms, making diagnosis a quandary. We report a case of a 70-year-old female who presented with subacute onset of mania and cognitive decline, diagnosed as bipolar disorder. She was treated with valproic acid for mood stabilization with minimal improvement in symptoms and six months later presented with new-onset seizures. Interestingly, her seizures started four days after discontinuing valproic acid. Following her admission to our hospital, a diagnosis of autoimmune epilepsy was suspected. EEG revealed multiple focal onset seizures with secondary generalization originating from the right frontocentral area and/or right temporal lobe. MRI revealed asymmetric cortical thickening along the paramedian right anterior frontal region thought to be nonspecific. She was empirically treated with pulse dose steroids and intravenous immunoglobulins. She underwent an extensive work up including neuroimaging studies that were unremarkable as well as serological testing for autoimmune etiologies. A high titer of anti-thyroid peroxidase (anti-TPO) antibodies was detected. She was clinically and biochemically euthyroid. A diagnosis of SREAT was rendered and the patient had significant clinical improvement in symptoms following administration of corticosteroids. SREAT is a diagnosis of exclusion but is supported by the presence of elevated anti-TPO and steroid responsiveness. Initial presentation may masquerade as a primary mood disorder, as in this case. Prompt diagnosis and treatment fully reverses neurological and psychiatric dysfunction in most cases.

This is an unusual report of a 33-year-old male with retrograde ejaculation as a complication of stand-alone L5-S1 anterior lumbar spinal fusion. This case is discussed in detail, with particular interest directed toward fertility issues and their implications. A plant-based diet was suggested as a treatment option due to the diet’s blood viscosity reduction properties. The patient initially noticed improvement after two months of starting the diet, with complete resolution of his retrograde ejaculation six months after beginning a plant-based diet. He successfully fathered a child a few years afterward.

Background: The migration of surgical clips after laparoscopic cholecystectomy is rare and can lead to complications such as clip-related biliary stones and intra-abdominal abscesses. In this article, we report a case of a retained dropped metal clip after a laparoscopic cholecystectomy resulting in an abscess that necessitated through the right abdominal wall and into the subcutaneous tissues 13 months later. Summary: Our patient is a 79-year-old male, with multiple comorbidities who underwent a laparoscopic cholecystectomy for acute cholecystitis. The cystic duct and artery were divided in-between 10-mm metallic clips. After 13 months, patient presented with a perihepatic abscess and a retained metallic clip necessitating through the right abdominal wall into the subcutaneous tissues. Patient was taken to the operating room and underwent an incision and drainage of the right abdominal wall abscess and retrieval of the migrating cholecystectomy clip. Conclusion: To avoid complications related to dropped cholecystectomy clips, it is important to use the correct technique for applying clips and attempt to retrieve any noticeably dropped clips intraoperatively.

Acquired diverticula of the small intestine are formed by a herniation of mucosa and submucosa through the muscular layer of the intestinal wall. These diverticula remain asymptomatic in 60 to 70% of cases. Symptoms, when present, are not very specific and may imitate other acute intra-abdominal conditions. The etiological diagnosis is often difficult to make after initial assessment. In most cases, an exploratory laparoscopy is necessary to make an accurate diagnosis. We report the case of a giant perforated and abscessed jejunal diverticulum. A review of the literature about this pathology is carried out.

People with intellectual disabilities (ID) are living longer, bringing into focus the need to better understand the cognitive trajectories associated with normal and abnormal aging in this population. ….

Aim: Graves’ disease or endocrine orbitopathy (EO) is an immune system disorder that results in the overproduction of thyroid hormones (hyperthyroidism). EO is characterized by the symptomatic triad of hyperthyroid goiter, orbitopathy, and dermatopathy. The surgical techniques used to correct EO can be fat decompression by using the Olivari technique, 3-wall bony decompression, or the combination of these surgical strategies. Fat decompression is indicated when the intraconal and extraconal fat tissue is increased, whereas bony decompression is used when there is extraocular muscle involvement associated with a normal quantity of intraconal-extraconal fat. Surgical techniques include the transconjunctival approach and ostectomy of the medial wall (when possible, through endoscopy), orbital floor, and lateral wall of the orbit. Complications of bony decompression are often represented by sensitivity disorders of the second branch of the trigeminal nerve, compressed by the intraorbital contents when they prolapse into the sinus. Possible sensitivity disorders are paresthesia, anesthesia, hypoesthesia, dysesthesia, and hyperesthesia. Methods: The technique consists of performing a mini-osteotomy around the infraorbital foramen with removal of a small bony fragment. This causes the nerve to relax and makes it easier for the descent of periorbital tissue into the maxillary sinus, allowing a larger expansion of the orbit contents. The absence of compression significantly reduces sensitive complications. Conclusion: The use of the mini osteotomy of the infraorbital foramen combined with a 3-wall bony expansion leads to a significant reduction of sensitive complications that otherwise often cause patient discomfort.

Any organ of the body can be affected in systemic lupus erythematosus (SLE) which is an auto immune. Patients can present with clinical features of mild joint and skin involvement to life-threatening kidney, hematologic, or central nervous system involvement. Peripheral neuropathies in SLE is not an uncommon presentation but Guillain–Barré syndrome (GBS) is considered as an unusual and one of the least neuropsychiatric syndromes in SLE. In this case report we are aiming to report a rare association of GBS as an initial presentation for an SLE in a male patient. A 46-year-old male patient present with overlapping symptoms and required admission to intensive care unit. He was diagnosed initially as case of GBS treated with Intravenous immunoglobulin (IVIG) for five days with improvement. Patient developed overlapping symptoms of fever, palindromic polyarthralgia with active urine sediment, and proteinuria lead to diagnosis of class V lupus nephritis. Prednisolone and Mycophenolate mofetil given and he received rituximab injection for extra renal manifestation of SLE.

Esophageal perforations (Boerhaave’s syndrome) are uncommon and potentially life-threatening conditions, while recurrent esophageal perforations are extremely rare. Esophageal perforations are generally managed surgically with Kehr’s T-tube and drains or primary surgical repair. We present a patient with recurrent esophageal perforation due to Barrett’s esophageal ulcer. He was successfully managed with an endoluminal vacuum suction drain without a sponge.