Colo-renal fistula following percutaneous radiofrequency ablation of a renal tumor. A case report and review of treatment options
Background: Colo-renal fistula formation is a very rare complication following percutaneous radiofrequency ablation (RFA) in the management of renal cell carcinoma. In this paper we describe the management of a patient with a left colo-renal fistula occurring after renal tumor RFA. Additionally, we present a thorough literature review of reported cases of colo-renal fistulae after percutaneous RFA to further highlight their treatment challenges. Summary: Two weeks after undergoing percutaneous RFA of an incidental 3cm left renal mass, a 67-year-old male was re-admitted to the hospital with a symptomatic colo-renal fistula. Patient ultimately failed conservative management with broad spectrum antibiotics and ureteral stent placements, and subsequently underwent segmental colonic resection and renorrhaphy, with complete renal preservation. Conclusion: Although complications after RFA of renal tumors are rare, iatrogenic colo-renal fistula formation is a significant complication requiring a multi-disciplinary approach with a trial of non-operative management prior to surgical intervention.
Gallbladder torsion is a rare but potentially catastrophic presentation to an acute surgical unit. It was first described by Wendel in 1898 where this presentation was labelled as a ‘floating gallbladder’, with a high propensity for perforation1. Since then approximately 500 cases have been reported in the literature2. Anatomically, gallbladder torsion occurs where the gallbladder rotates along its mesentery causing vascular compromise and obstruction to biliary drainage. This leads to subsequent necrosis and perforation3. Shaikh A. et al have reiterated that the entire aetiological sequence of gallbladder torsion continues to remains a debated topic although, generally, a redundant mesentery is required for torsion to occur4. In most reported cases, the gallbladder has been shown to undergo a clockwise rotation 5. As described later, this presentation has predominantly been reported in elderly females suggesting that age plays a role in anatomically predisposing to torsion. Factors hypothesised for this include decrease in visceral fat and liver atrophy making free movement of the gallbladder and ultimately volvulus more likely to occur6. The symptoms of gallbladder torsion are in keeping with those of cholecystitis, typically presenting with right upper quadrant pain, nausea and vomiting 2. Clinical examinations of previously reported cases have documented abdominal distention, right upper quadrant pain and localised peritonitis2. These non-specific signs can make this specific phenomenon a challenge to diagnose in clinical practice. It has been documented that a partial volvulus can present with intermittent symptoms, similar to those seen in biliary colic, although the majority of cases will present acutely with signs described above 3. Due to the relatively low numbers reported in the literature it is difficult to determine the most appropriate investigations in patients where this is expected. Classically, patients presenting with right upper quadrant pain will likely receive an abdominal ultrasound on admission. From the cases…
Background: Schwannoma is a rare mesenchymal tumor, that arise from the Schwan cells of the nerve sheath. Schwannoma in the gastrointestinal tract is a very uncommon finding, with the stomach being the most common location. Preoperative diagnosis is difficult due to the wide variety of other mesenchymal tumors, definitive diagnosis is after histopathological examination and immunohistochemical staining of the specimen. Case presentation: We are presenting a rare case of stomach schwannoma, in a 50-year-old male who presented with urological complaints. He had a CT scan that incidentally showed a polypoidal gastric mass. Discussion: Schwannomas generally present asymptomatically; however, in some cases they can cause abdominal discomfort, pain or digestive symptoms. The definitive diagnosis of gastric schwannomas is determined by pathological examination of the surgically removed specimen. Conclusion: Schwannoma usually runs a benign course with excellent prognosis, yet there are very few reported cases of Malignant GI schwannoma. Benign or malignant, until now the treatment of choice is surgical excision with free margin.
We present a case of an 81-year-old asthmatic female with a left foot drop and an incidental finding of hypereosinophilia with an initial differential diagnosis of Eosinophilic Granulomatosis with Polyangiitis (EGPA). However, after extensive investigations, all causes of hypereosinophilia were excluded and the left foot drop was secondary to a radiculopathy. This led to a diagnosis of Idiopathic Hypereosinophilic Syndrome (IHES), a diagnosis of exclusion. This is the first case report where hypereosinophilia and a left foot drop where unrelated conditions occurring simultaneously thus posing a diagnostic dilemma. Therefore, this case report aims to highlight the importance of a systematic approach in the investigation of hypereosinophilia, to ascertain the cause and to rule out organ damage as this will affect the management and the outcome.
Recurrences of Graves’ disease (GD) after total thyroidectomy (TT) are uncommon, with few cases reported in literature. This article describes the case of a 58-year-old man who was treated with TT due to GD over 15 years ago. A progressive reduction of levothyroxine treatment was observed due to persistent subclinical hyperthyroidism. Thyroid-stimulating hormone receptor antibodies were detected in blood analysis and in the imaging test, a lesion was identified in the upper left anterolateral cervical region. A histopathological study of the lesion revealed colloid goiter. The patient was diagnosed with GD recurrence in a thyroid remnant and was remitted to an otorhinolaryngologist to remove the lesion. The histopathological study showed diffuse thyroid hyperplasia. The objective of this clinical case report is to highlight this unusual recurrence to better treat and improve long-term outcomes in patients treated with TT.
Diverticulae are uncommonly encountered in the stomach. They can be congenital or acquired- the latter variety being the less frequent of the two. This article details one such rare case from Lagos, Nigeria and discusses certain aspects of its clinical and endoscopic presentation. We present a 59-year old with a background history of non-steroidal anti-inflammatory drugs abuse presented with hematemesis and melena and was in hemorrhagic shock. After stabilization, the gastroscopy findings were of a gastric diverticulum (GD) in the anterior prepyloric wall. There was a Forrest IIb ulcer in the GD’s wall with surrounding erythema and edema. The patient was successfully managed medically and conservatively and with good long term results.
Background: Homocystinuira is a rare autosomal recessive disorder in the metabolism of sulfur-containing amino acid caused by mutations in the cystathionine beta-synthase gene which encodes the pyridoxine (Vitamin B6) dependent enzyme cystathionine beta-synthase. It is characterized by significant elevations in plasma and urine homocysteine concentrations, which could be associated with increased risk of fracture. Methods: We describe a case of Homocystinuria who suffered from a low impact patellar fracture with a literature review to highlight the critical relationship between homocysteine level and bone health. Results: We reported a 36-year-old female with a diagnosis of Homocystinuria due to pyridoxine (B6) unresponsive severe Cystathionine Beta-Synthase deficiency. After a minor knee injury she developed a right patellar fracture and her X-ray revealed osteopenia. On examination, she has severe scoliosis in the spine with bilateral aphakia (absence of the lens of the eye). Her labs showed, persistent high Homocysteine above 100 umol/L, Methionine: 383 umol/L (10-42), Vitamin D 12 ng/ml. Her spine X-ray revealed very severe scoliosis with osteopenia but no vertebra fracture. Her DXA scan showed her Z-Score was within the expected range for her age in hip, spine and 1/3 radius areas, however her ultra-distal radius Z-Score was -4.0. Her Homocystine level was mostly higher than 100 due to non-compliance with dietary advice and treatment. High homocysteine levels in Homocystinuric patients impair the function of bone cells that regulate bone remodeling as well as bone material properties such as collagen cross-linking. This imbalance between bone formation and resorption may lead to a low BMD and fracture in patients with homocystinuria. Interestingly, even in general population hyperhomocystinemia with a plasma level of more than > 13 nmol/ml has been found to be associated with low BMD and an increased risk of fractures that is independent of BMD. Deficiencies in vitamin B6, B12, or…
Solitary extramedullary plasmacytoma of prostate on the background of treated prostate adenocarcinoma
Solitary Plasmacytoma is a rare entity which accounts for < 5% of all plasma cell dyscrasias. Most commonly involved sites for solitary extramedullary plasmacytoma are head and neck (90 %) especially upper respiratory tract, followed by Gastrointestinal tract. Rarely it can involve testes, bladder and orbit. PET/CT provides an invaluable imaging support for initial evaluation of additional plasmacytomas and response to treatment. There are no randomized trials regarding the best treatment approach. Generally, radiotherapy remains treatment of choice of solitary plasmacytoma. Our case, with its rare site of occurrence along with patient’s history of radiotherapy treated prostate malignancy and significant history of radiation cystitis provides a unique diagnostic and therapeutic challenge. Treatment can be personalised in cases such as this, where patients can be treated with chemotherapy in contrary to radiotherapy as further exposure to the radiations could exacerbate the bleeding risks.
Background: Although mucinous carcinoma or mucoepidermoid carcinoma of the thyroid gland are an extremely rare but an established entity, papillary thyroidal carcinoma (PTC) with mucin production is also exceedingly rare. Case report: We reported one rare case of mucin producing PTC with unusual histology. The patient was 71 years-old Japanese man. The hemi-thyroidectomy was performed. Histologically, the tumor cells harbored the similar features with conventional PTC, but this case indicated extracellular and intracellular mucin. On the other hand, the tumor showed cystic-papillary or cribriform growth of the columnar tumor cells. Conclusions: We diagnosed it as mucin-producing PTC with columnar cell variant (CCV). We examined it immunohistochemically, and this case expressed TTF-1, thyroglobulin, and cytokeratin (CK)7, but was negative for HBME-1. We discuss on the differential diagnosis.
Iron deficiency anemia (IDA) is a common but underdiagnosed cause of morbidity in adolescent females. Associated thrombocytopenia is rare, but resolves when the anemia is treated with iron supplementation. Menorrhagia is an important cause in the multifactorial etiology and may be familial. This article presents a case of severe anemia and thrombocytopenia in the presence of iron deficiency due to menorrhagia. A holistic approach to IDA is discussed with an approach to the management thereof in adolescent females.