International Journal of Case Reports

PURPOSE: To report case of isolated orbital cysticercosis METHODS: Patients with drooping of eyelid were referred to our hospital. Patients were evaluated and investigated to find the cause of ptosis. RESULTS: Two patients with acute unilateral ptosis were referred to our hospital. Patients were investigated, blood test, stool tests and MRI were done to rule out the causes. In both the patients ptosis was due to involvement of LPS muscle by cysticercus larva. All the patients gave history of excessive consumption of cabbage and pork. The mainstay of treatment included oral albendazole (15 mg/kg/day) and oral prednisolone (1mg/kg/day) for 4 weeks. After 4 weeks, oral albendazole was stopped and oral prednisolone was slowly tapered over the next one month. The effect of above treatment was seen after few days with regression of swelling and improvement of signs and symptoms. CONCLUSION: Orbital cysticercus stands as one of the major causes of ptosis in the lower socioeconomic status people who are consuming mainly unhygienic leafy vegetables such as cabbage, burgers and undercooked pork. Therefore, these patients should be vigorously evaluated on scans (MRI and CT) so that early diagnosis can be made and treatment can be given to prevent the permanent visual loss or dissemination to brain.

The post caesarean fistula and sinus can take place due to tuberculosis , Crohn’s disease , deep pelvic infections or non absorbable sutures and even gauzes. A thirty year old woman ( P1 ,L1 ) who presented with multiple discharging sinuses at left lower abdomen since five months . She underwent lower segment caesarean section 10 months ago. On local examination , there were three linear scars two cm below the previous horizontal scar . The Ultrasound of local site revealed irregular loculated collections of size 3 × 2 cm in subcutaneous plane. We excised the sinus tracts ,but after two month came with reccurence . We did re- exploration and the sinus tract of size 9 cm was excised. Sinuses reccur even without retained foreign body or chronic disease. The management does not differ with the size of sinus.

Objective: To present a case of osseous metaplasia in thyroid nodule. Introduction: Long standing thyroid nodules undergo changes. Sometimes they degenerate, may lead to hemorrhage or fibrosis and sometimes ectopic bone formation. Case report: 41 years old Yemeni married lady, presented to our surgical clinic with left thyroid nodule for 3 years duration. She had right thyroid lobectomy 6 years ago. She presented with left neck swelling and was taken to OR for thyroidectomy. histopathology came as extensive fibrosis and osseous metaplasia with small remnant of thyroid tissue. Discussion; Most thyroid stay longer with no complications but some undergo calcification or hemorrhage, fibrosis and sometimes osseous metaplasia. It may occur in benign or malignant thyroid swellings.

Tracheal rupture is a rare condition associated with high morbidity and mortality. Iatrogenic tracheal injury is also very rare and can occur as a serious complication after endotracheal intubation. We report a case study of tracheal rupture of patient with a history of rheumatoid arthritis and corticosteroid treatment during surgical procedure with orotracheal intubation in a supine position. Lesions were healed after conservative treatment without stenosis, signs of mediastinitis or local infection. Patient was able to undergo three other surgical procedures during the next 8 month without any other complications connected to endotracheal intubation.

Glandular odontogenic cyst (GOC) is an extremely rare cyst of jaw bone with only 182 cases documented so far in the English literature. GOC is considered to be a locally aggressive lesion with high rate of recurrence. Anterior mandible is the most common site of involvement for GOC, involvement of the maxillary bone which is a rare occurrence. The clinical and radiographic finding of GOC are varied & often pathognomic. As clinical & radiographic findings are overlapping with those of other odontogenic cyst, a careful histopathological examination is needed to arrive at a definite diagnosis of GOC. In the present paper we reported a rare case of GOC in a 23yrs old male involving maxillary bone along with a review of literature focussing on clinical & radiological presentation and treatment outcome.

Pneumoperitoneum is often a surgical emergency related to gastrointestinal tract perforation. On rare occasions, free intraperitoneal air can be present without any discernible cause and is considered Idiopathic Spontaneous Pneumoperitoneum (ISP). Deciding which patients with ISP can be managed conservatively would help prevent some patients from undergoing unnecessary surgery. We describe here two cases of successful management of ISP and the review of literature of ISP management for the past 29 years. In the first case, a patient with ISP with no significant abdominal symptoms was successfully managed nonoperatively. In the second case, a patient with ISP and symptoms of small bowel obstruction was successfully treated surgically with exploratory laparotomy and small bowel resection. We recommend conservative management for the subset of ISP patients with no sign of peritonitis or sepsis.

Introduction Crowned dens syndrome (CDS) is a rare clinical presentation of chondrocalcinosis or calcium pyrophosphate crystal deposition (CPPD) disease, characterized by fever, neck pain and stiffness, associated with increased biological markers of inflammation. Diagnosis is made mainly via imaging, and the best modality remains the magnetic resonance imaging (MRI) of the neck showing calcification and calcium pyrophosphate crystals deposition around the odontoid process (1). The aim of this report is to increase awareness of this rare and ill-known clinical tableau and to review its complications and the latest modalities of its diagnosis and treatment. Clinical case: An 83-year-old female patient presented to the emergency department (ED) of the Middle East Institute of Health (MEIH) with severe acute onset neck stiffness and pain of 10/10 intensity, radiating to the submandibular area and reaching the occipital part of the head, associated with nausea and 2 episodes of chills one day prior to presentation. Patient denied any recent history of trauma or surgery of the head and neck. Physical exam at that time was only remarkable for marked limitation of neck motion, and positive Kernig and Brudzinski signs. No skin changes, facial sinuses tenderness, cervical lymphadenopathies or neck swellings were noted. Vital signs at ED were within normal range except for a low grade fever. Laboratory work-up upon presentation showed hyperleukocytosis (WBC = 14000/mm3) with left shift and a C-reactive protein (CRP) of 189 mg/L (0-5 mg/L). Chest X-Ray only showed degenerative osteoarthritis of the thoracic spinal vertebrae. CT-scan of the brain without IV contrast done urgently showed no acute changes. As Clinical and biological features were suggestive of acute meningitis, cultures were taken including blood, urine and CSF fluid from lumbar puncture. The patient was admitted to the hospital for IV antibiotic treatment with a large spectrum carbapenem and close observation. On…

Background: Neuropsychological alterations and decreased hearing, are related to organic solvents (OS) exposure; and if noise is present it potentiates the hearing damage. Aim: to evaluate neuropsychological performance and hearing of a 50 years old worker, occupationally exposed to OS mixtures for 26 years (toluene, ethyl acetate and isopropyl alcohol) and noise > 85 dB (A). Design of study: Report of a case assessed by Neuropsychological tests, CT and SPECT studies of hearing and clinic-occupational history. Results: He presented, loss between 35 to > 55 dB HL of his hearing in both ears, both in low frequencies (125 Hz-2 kHz) as well as the treble ones (3-8 kHz), in relation to his age. There was an otoacoustic emissions absence at the same frequencies. He showed cerebellar atrophy, cognitive, motor and emotional disorders. Conclusions: We Integrated diagnosis of: moderate to severe hearing loss, mental and behaviour disorders due to the simultaneous exposure to noise and an OS mixture, mainly toluene. It should fully evaluate workers exposed to noise and OS.

During routine educational dissection of the upper part of the abdominal cavity in a female cadaver (67 years old, Netherlands) a unique association of two rare biliary and vascular patterns was discovered. The gastroduodenal artery originated from the celiac trunk along with the right hepatic, gastric and splenic arteries, and gave origin to the accessory right and left hepatic vessels. The right hepatic artery took the course typical for the common hepatic artery; however, as a component of the portal triad, the artery was located behind the bile duct and portal vein. Next to the hilum of the liver, it branched off the cystic artery to the gallbladder and bifurcated into two segmental hepatic branches. The described hepatic vascular pattern was associated with the presence of an accessory aberrant cystic duct connecting the body of the gallbladder with the right anterior inferior segmental bile duct. The case is reported to emphasize the importance of a detailed preoperative investigation of the patients considered for open and laparoscopic procedures on the liver and gallbladder documenting the variability of both the biliary and vascular patterns.

Fracture of the penis is a misnomer, the cause being rupture of one or both of the tunica albuginea that covers the corpora cavernosa. It usually occurs following sexual intercourse or masturbation. Here we report 2 cases of penile fracture in our institution. Ultrasonography was done which confirmed the diagnosis. In both the cases, the urethra was intact. Exploration with evacuation of the hematoma and repair of the tunica albuginea was done.