International Journal of Case Reports

This case report could be considered very useful to show to the surgical residents how to obtain a correct diagnosis utilizing logically both clinical signs and diagnostic tools. Twenty days after a right hemicolectomy for colon cancer this patient presented a right sided colic pain in the lumbar region with irradiation to the groin and a CT showing a dilated right ureter. The anamnesis of the recent surgery was suggestive for iatrogenic ureteral lesion. Through the comparison of pre-operative and postoperative CT, however, it has been realized that a stone present in the right pelvis before surgery had been gone down to the ureter just immediately after surgery. Iatrogenic ureteral lesions after colorectal surgery are rare but should be considered a potential event during colorectal surgery. However, the correct and complete evaluation of anamnesis, clinical history, and diagnostic tools should be always done in order to reach a correct diagnosis. During the surgical residency, the residents should be encouraged to reason and think carefully, without any haste, to obtain a valid diagnostic solution.

Background: Enteric duplication cysts are rare congenital malformations. Cases in adults are rare, often asymptomatic and diagnosed incidentally. Enteric duplication cysts in adults could present abdominal pain, distention, mass and dysphagia. The preoperative diagnosis is difficult, radiological images, even an abdominal Computed Tomography scan could not show a bowel duplication. Malignant transformation is rare. Case presentation: We present a case of a 67 year-old man admitted in Our Surgery Unit for several episodes of bowel obstruction. After an ileal resection the anatomopathological exam diagnosed an Enteric duplication cysts. Conclusion: A diagnosis before surgery is difficult. Only surgery and a precise anatomopathological exam can discover this malformation.

Reversible cerebral vasoconstriction syndrome (RCVS) is a coined term to express conditions that manifest narrowing of the cerebral arteries. The most common manifestation of a patient with RVCS is severe headache that is thunderclap in presentation, however, some may present with focal neurologic deficits related to the site of edema or vascular occlusion and even cortical manifestation such as seizure. The current treatment for RCVS is still observational, which includes use of calcium channel blockers and intra-arterial vasodilation. In this case report, Cilostazol, a phosphodiesterase 3 inhibitor with a myosin light chain kinase enzyme inhibitor, can be used as a treatment for recanalization of constricted cerebral arteries.

Background: The purpose of this case report is to illustrate the clinical course of an extremely rare case of Congenital Pulmonary Lymphangiectasia (CPL) presenting as an early pulmonary interstitial emphysema (PIE) complicating respiratory distress syndrome, in an extremely low gestational age neonate (ELGAN) along with a short review of the literature. Case presentation: This 24 weeks ELGAN male with radiologic changes consistent with pulmonary interstitial emphysema (PIE) complicating respiratory distress syndrome which later progressed to bilateral cystic lung changes, expired at 23 days of age. Maternal history was complicated by E. coli urinary tract infection and Group-B Strep chorioamnionitis. The infant remained intubated throughout the hospital course and received antibiotics initially and terminally. His tracheal aspirate cultures also grew Mycoplasma hominis, and Ureaplasma urealyticum, treated with azithromycin. An autopsy revealed diffuse bilateral congenital lymphangiectasia. Postmortem blood and lung tissue cultures were positive for methicillin-resistant Staphylococcus aureus (MRSA). Conclusion: Despite its extreme rarity, the authors recommend considering congenital pulmonary lymphangiectasia in the differential diagnosis, in an extremely preterm neonate, presenting with early pulmonary interstitial emphysema (PIE), and respiratory failure refractory to surfactant, antibiotic therapy, and complex ventilator management.

Bockdalek hernia is a rare type of congenital diaphragmatic hernia which was firstly described by Vincent Alexander Bockdalek in 1848.[1] The hernia sac is more commonly located on the left due to protection of the right side of the diaphragm by the liver, and contents can include spleen, small bowel, liver, colon or kidney.[1] Bockdalek hernia with intra-thoracic kidney is extremely rare and the reported incidence is less than 0.25%.[2] During embryogenesis the developing kidney which is located in the pelvis migrates upwards to fuse with the adrenal glands. Sometimes, this upward migration of the developing kidney does not stop at its designated point and thus the kidney reaches into the thorax. [3] Treatment options for Bockdalek hernia may include open or laparoscopic surgical repair, which involve the reduction of the herniated organs and closure of diaphragmatic defect with or without prosthetic mesh.[4] Herein we report a rare case of recurrent Bockdalek hernia including an intra-thoracic left kidney in a 59 year old lady with a past history of a Bockdalek hernia that was repaired at the age of 3, who presented to our hospital with severe lower abdominal pain and vomiting.

Few cases of ankle tuberculosis have been reported in the literature. We describe two cases of tuberculosis of ankle presented to Orthopaedics OPD at Rajindra Hospital, Patiala. Case one was a 34 year male with complain of swelling of the left ankle since 3 years and a discharging sinus at the tip of the old healed scar on the left ankle for 6 months. The patient was an old case of Pulmonary Tuberculosis treated with anti-tubercular therapy 6 years back. On laboratory evaluation, CBC, ESR and CRP were normal. Ankle X-Ray showed a lytic lesion in both malleoli. The patient was admitted and debridement of the left ankle was done, and the tissue specimen CB-NAAT was positive. The patient was subsequently put on anti-tubercular therapy for 11 months. His follow-up visits were uneventful. Case two was a 31 old year female presented to us with complaint of pain at right ankle since 5 months. Pain was followed by swelling which progressed over a period of time of one month. MRI was done which showed bone defect with erosions Tissue sample were sent for histopathological examination and CBNAAT.CBNAAT result came to be positive. Patient was put on ATT. Patient improved after ATT. Ankle TB is a rare entity ,must be considered in the differential diagnosis of a swelling of the foot and ankle., requiring a high index of suspicion. As the disease is progressive and promotes degenerative changes of the articular cartilage, early identification is critical for successful treatment and to avoid permanent functional disability.

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.