Stump appendicitis is a rare complication of appendectomy due to recurrent inflammation of the residual appendix. The diagnosis is often delayed due to low index of suspicious, which may result in serious complications.
We describe a case of stump appendicitis occurred 12 months after appendectomy in 25 years old man. Despite past medical history of appendectomy the diagnosis was made by means of ultrasound scan and an high degree of clinical suspicion.
Stump appendicitis is a rare but important complication of appendectomy, often misdiagnosed. Prompt recognition is important to avoid serious complications. This pathologic entity should always be kept in mind on case of right lower quadrant pain.
Pulmonary alveolar microlithiasis (PAM) is a rare chronic disease with paucity of symptoms in contrast to the imaging findings. We present a case of a 24-year-old Malay man having an incidental abnormal pre-employment chest radiograph of dense micronodular opacities giving the classical "sandstorm" appearance. High-resolution computed tomography of the lungs showed microcalcifications with subpleural cystic changes. Open lung biopsy showed calcospherites within the alveolar spaces. The radiological and histopathological findings were characteristic of PAM.
Pulmonary alveolar microlithiasis; High resolution computed tomography; Calcospherites
Spontaneous perforation of pyometra resulting in generalized diffuse peritonitis is extremely uncommon. Herein, we report the case of a 63-year-old woman who presented to emergency department with a 2-day history of severe diffuse abdominal pain, high-grade fever, nausea, and vomiting. Acute abdomen series was done, and upright plain chest radiograph showed free air under diaphragm. A noncontrast-enhanced computed tomography scan showed a significantly distended fluid-filled uterus measuring 10 × 7.8 × 10 cm, in addition to a single focus of perforation involving the uterine fundus and associated with presence of free air within the nondependant area. No evidence of ascites or pelvi-abdominal lymphadenopathy was identified. A preoperative diagnosis of generalized peritonitis secondary to spontaneous perforation of uterus was established. Subsequently, patient underwent urgent exploratory laparotomy which revealed pus-filled uterus with perforated fundus. Diagnosis of generalized peritonitis secondary to spontaneous perforation of pyometra was established. Consequently, patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy, as well as thorough drainage and irrigation of pelvi-abdominal cavity. Postoperatively, patient was admitted to intensive care unit. Histopathological examination of uterus was negative for malignancy, and surgical culture grew Streptococcus constellatus. Patient had an uneventful recovery. Moreover, a brief literature review on pyometra is presented.
Osteoid osteomas are well-known benign tumors, seen generally in long bones. When seen in phalanxes or toes, they can cause a diagnostic dilemma. A young male presented to us with complaints of enlargement of the great toe and severe pain. He had had an ingrown toe-nail operation before, and this situation caused a diagnostic dilemma. In this case report, we emphasize that osteoid osteomas can cause diagnostic dilemmas and it should be kept in mind as a differential diagnosis.
In this article the authors present a case of pathological neonatal jaundice resistant to phototherapy in a baby with a family history of Gilbert’s syndrome and hereditary spherocytosis. Her presentation was ultimately explained with a diagnosis of both conditions, and required treatment with phenobarbitone. The authors discuss the mechanism by which Gilbert’s syndrome results in hyperbilirubinaemia and its similarities with Crigler–Najjar syndrome. The presentation of hereditary spherocystosis in the neonatal period is also explored, as is the mechanism of exaggerated hyperbilirubinaemia when the two conditions co-exist.
Schwannomas are rarely seen on the sciatic nerve and can cause sciatica. In this case report we aimed to present an unusual location of schwannoma along sciatic nerve that causes sciatica. A 60-years-old-man was admitted to us with complaints of pain on his thigh and paresthesia on his foot. Radiography of the patient revealed a solitary lesion on the sciatic nerve. The lesion was excised and the symptoms resolved after surgery.
A decrease in the anterior capsule opening after cataract surgery has been observed in eyes with weakened lens zonules. It commonly occurs in diabetes mellitus, uveitis, pseudoexfoliation syndrome, high myopia, and elderly patients. Herein, we report the case of a middle-aged man with advanced retinitis pigmentosa who developed a rapid contraction of the anterior capsule after an uneventful phacoemulsification surgery that resulted in severe visual loss during the early postoperative period.
contraction of anterior capsule; early postoperative period; phacoemulsification surgery; retinitis pigmentosa
Urethral stricture is a common urological condition, resulting from trauma or venereal infections. The aim of our study was to report a rare case of squamous cell carcinoma of the penis and pseudoepitheliomatous hyperplasia (PEH) of scrotal skin, on top of repeatedly managed urethral stricture which was of unknown aetiology.
A Medline search of publications studying the association of urethral stricture with penile cancer was done.
Two case reports were identified that described two occurrences, which were separated by a few months.
Repeated management of urethral stricture with visual urethrotomy or urethral dilation may result in a chronic inflammatory status, predisposing to PEH and squamous cell carcinoma of the genital organs.
urethral stricture; penile cancer; pseudoepitheliomatous hyperplasia
Herein, we report our experience in treating extensive traumatic submacular hemorrhage with a single dose of intravitreal ranibizumab. A 23-year-old healthy Malay man presented with a progressive reduction of central vision in the left eye of 2 days’ duration following a history of blunt trauma. Visual acuity was reduced to counting fingers. Examination revealed infero-temporal subconjunctival hemorrhage, traumatic anterior uveitis, and an extensive sub-macular hemorrhage with suspicion of a choroidal rupture in the affected eye. He was initially treated conservatively with topical prednisolone acetate 1%. The subconjunctival hemorrhage and anterior uveitis resolved but his vision remained poor with minimal resolution of the submacular hemorrhage at 1 week follow-up (day 12 post-trauma). In view of the poor resolution of submacular hemorrhage, he was treated with a single dose of 0.5 mg intravitreal ranibizumab at day 20 post-trauma. At 4 weeks post-intravitreal ranibizumab, there was an improvement in visual acuity (from counting fingers to 6/45) and complete resolution of the submacular hemorrhage with presence of a choroidal rupture scar temporal to the fovea, which was not seen clearly at presentation due to obscuration by blood. His visual acuity further improved to 6/18 at 3 months post-trauma. Although this single case had a favorable outcome, a large population cohort study is needed to establish the effectiveness of intravitreal ranibizumab in treating extensive traumatic submacular hemorrhage.
trauma; choroidal rupture scar; visual acuity; submacular hemorrhage; anterior uveitis
The case of a 32-year-old Malay woman who developed postpartum stroke is reported.
The patient received a series of urut Melayu, the traditional Malay massage, sessions at one of the newly established integrated hospitals in the country.
After 14 urut Melayu sessions, she improved tremendously in her speech and fine motor skills and regained her activities of daily living.
This use of urut Melayu to complement rehabilitation care in patients poststroke is promising.
Self-mutilation acts are known to characterize the borderline personality disorders. However, voluntary cutting of the male genital organ remains extremely rare. The present paper reports a case of a 25-years-old young male with a borderline personality. The patient committed a genital self-mutilation (GSM) targeting suicide during incarceration stage in jail. In addition, a discussion of the epidemiological and psychopathological aspects of the self-mutilation of borderline patients was been conducted. A particular interest is attributed to the genital self-mutilation and a review of the literature is presented.
Borderline; genital self-mutilation; personality disorders
Le syndrome de Fahr est une entité anatomo-clinique rare, caractérisée par des calcifications intracérébrales bilatérales et symétriques, localisées dans les noyaux gris centraux, le plus souvent associées à des troubles du métabolisme phosphocalcique. L'hypoparathyroïdie, primitive ou postopératoire, est l'anomalie la plus classique. L'hyperparathyroïdie est exceptionnellement rapportée comme cause du syndrome de Fahr. Nous rapportons le cas d'une fille de 17 ans suivie depuis l’âge de 12 ans pour une épilepsie avec la notion d'un retard mental depuis l'enfance, qui a présenté un syndrome confusionnel révélant un syndrome de Fahr avec la particularité de l'existence d'une hyperparathyroïdie.
Syndrome confusionnel; syndrome de Fahr; retard mental; épilepsie; hyperparathyroïdie; confusional syndrome; Fahr syndrome; mental retardation; epilepsy; hyperparathyroidism
Coronary Artery Bypass Grafting has not been previously reported in the Nigeria Medical Literature. We report the case performed in our institution of a 56 year old Nigerian female who underwent Off Pump Coronary Artery Bypass Surgery (OPCAB) for an ostial lesion of the Left Anterior Descending Coronary Artery. The Left Internal Mammary Artery was successfully anastomosed to the Left Anterior Descending Coronary Artery. The patient was discharged home after 2 weeks, following correction of problems with glycemic control.
Coronary artery bypass surgery; off pump; left internal mammary artery; left anterior descending coronary artery; Lagos; Nigeria
We describe here our experience in using sinus microdebrider to rapidly debulk and sculpt the tissues in cases of rhinophyma correction. We utilized the use of the 4 mm M4 Rotatable Cutting Straight Sinus Blade on a straight Straightshot M4 Microdebrider by Medtronic at 800 rpm oscillation which is normally utilised in our sinus surgery practice. The microdebrider is straightforward to use and is already stocked in most ENT departments. It requires no additional training or cost outlay for departments that perform endoscopic sinus surgery with microdebrider. In our experience it affords the surgeon the ability to rapidly and accurately sculpt the nose to an excellent aesthetic result. We feel it is a more precise tool than cold steel or Bovie cautery, quicker than CO2 laser techniques, and avoids the aerosol of dermabrasion. No complications occurred in our series, and all patients rated their cosmetic outcome as good to excellent.
Background. Odontodysplasia is an uncommon condition. It can be localised or generalised, isolated or part of a syndrome. Case Report. We first report the case of an 8.5-year-old boy who presented with abnormally shaped teeth and multiple intraoral abscesses. Findings of clinical and radiographic examinations were consistent with those of generalised odontodysplasia. A 2-step, conservative treatment plan was executed with a 10-year followup. Step 1 was root canal treatment of nonvital teeth. Step 2 was crowning without preparation of new vital, erupted, and malformed teeth. The second case is that of a 12-year-old girl who presented with lack of teeth in the upper-left quadrant. The impacted teeth were exposed surgically, and fixed restoration was performed for temporary aesthetic improvement. Conclusion. Instead of tooth extraction, an approach previously used in similar cases, conservative management is feasible and offers better prosthetic treatment options for the future.
Hereditary multiple intestinal atresia (HMIA), a presumed autosomal recessive disorder, is an unusual and rare form of recurrent intestinal atresia which can be associated with severe combined immunodeficiency (SCID). The combination of HMIA and SCID is invariably lethal. The authors describe this fatal association in two siblings. The parents are consanguineous and have three other normal healthy children. Both index cases had abnormal antenatal ultrasounds and were symptomatic after birth. The final diagnosis of HMIA with SCID was confirmed in both siblings. They were never able to receive enteral feeds, remained totally dependent on parenteral nutrition, had repeated episodes of sepsis and died after a very difficult neonatal intensive care course. In this article we have reviewed the clinical course and outcome of both cases. The existing literature on multiple intestinal atresia, HMIA and HMIA with immunodeficiency is also reviewed.
An unknown number of patients have had male to female gender transformation. Various surgical techniques have been employed to construct the neovagina. The more traditional techniques include inverted penile grafts and vascular pedicle grafts, but also the small bowel and sigmoid colon have been used. In this case, the authors present a patient who previously had a gender transformation from male to female with use of bowel for the neovagina. The patient presented with severe abdominal pain, fever and leukocytosis. A CT scan revealed retroperitoneal free air, and an x-ray examination with contrast through the neovagina showed leakage from the neovaginal top. The patient was treated conservatively with antibiotics and discharged after 7 days.
Solitary metastasis of uveal melanoma to bone is extremely rare and usually associated with other organ involvement. We present a rare case of an ocular melanoma patient presenting with solitary metastasis to the clavicle two years after enucleation, without any other organ involvement. In this report, we tried to present our treatment strategy for the solitary metastasis of bone.
We report on the case of a 68-year-old male patient with the history of right pneumonectomy due to bronchial carcinoma, who was referred for aortic valve replacement due to severe calcified aortic stenosis. Pre-operative chest X-ray and computed tomography (CT) revealed an unusually pronounced mediastinal shift to the right. Despite this unusual anatomy, we decided to perform surgery using the right anterolateral thoracotomy following thorough pre-operative planning using 3D-volume rendering of the CT data-set. This approach yielded excellent exposure of the aortic root and the ascending aorta, respectively. Following an uneventful operative and post-operative course the patient could be discharged on post-OP day 6.
Although only occasionally described for aortic valve replacement a right anterolateral thoracotomy may represent a valuable surgical approach, particular in patients with unusual anatomy, e.g. a mediastinal right-shift. However, thorough pre-operative planning, i.e. using visualization and planning techniques such as 3D-volume rendering should be mandatory as it provides information crucial to facilitate surgical steps and thus, may help avoid severe surgical complications.
Pneumonectomy; Aortic valve; Thoracotomy; Minimally invasive surgical procedures
Situs inversus totalis is a rare condition, which presents difficulties in diagnosis and treatment of gallstones due to the reversal location of abdominal organs. In this article we present 2 cases of women in age of 51 and 55 years with situs inversus totalis and gallstones. There are described the clinical and imaging features, also the laparoscopic surgery with the difficulties encountered by right handed surgeon. In patients with situs inversus totalis, laparoscopic surgery may be performed safely by a surgeon with experience.
Situs Inversus Totalis; Laparoscopy; Cholecystectomy
Hypermature cataracts are commonly seen in developing countries. Spontaneous rupture of the anterior capsule, resulting in dislocation of the lens nucleus into the anterior chamber, presents rarely in hypermature cataracts. We describe a middle-aged woman who presented with spontaneous anterior dislocation of the nucleus in both eyes. The presence of calcification spots in the posterior capsule at the pupillary edge strongly suggested that our patient had hypermature cataracts. It is important to highlight this uncommon cause of nucleus dislocation in a patient with no previous history of ocular trauma.
dislocation of the nucleus; anterior chamber; hypermature cataract
Hydatid cysts are rarely asymptomatic depending on their location. Complaints may be only relevant due to secondary problems. This paper presents a case report of a myocardial hydatid cyst which was totally excised under cardiopulmonary bypass operation with median sternotomy. Patient was admitted to the hospital with complaint of atypical chest pain in pungent manner together with shortness of breath. Various methods are used for diagnosis. However, echocardiography and computerized tomography with contrast are usually enough for definitive diagnosis and for deciding the strategy of operation. Curative excision must be performed. Extra care should be provided during the operation in order to prevent contamination. Postoperative appropriate antibiotherapy must be administered. Environment should be changed, and infrastructure must be improved in order to prevent further recurrences.
Hydatid cyst disease is a common worldwide zoonosis. Most of the cysts are located in the liver. Abscess formation due to infection of the cyst is an important complication. M. morganii, a Gram-negative Bacillus, is a quite rare cause of liver abscess. A 77-year-old woman was admitted to hospital with complaints of fever, chills, nausea, vomiting, loss of appetite, and abdominal pain located in the right-upper quadrant. Her history was positive for hepatic hydatid cyst disease ten years ago. Physical examination revealed a painful mass filling the right-upper quadrant and extending down to umbilicus. Indirect hemagglutinin test for hydatid cyst was positive at a titer of 1/320. Giant liver abscess due to infected hydatid cyst was found in computed tomography scan. Surgeons performed cystectomy and cholecystectomy. Cefazoline, cefuroxime, and metronidazole were administered empirically, but all the three agents were replaced with intravenous ceftriaxone after M. morganii was isolated from the cultures of the abscess material. Clinical signs of the patient resolved at the second week of treatment, and she was discharged.
Segmental testicular infarction (STI) is a rare cause of acute scrotum. The spectrum of findings on gray-scale and color Doppler ultrasonography differ depending on the time between the onset of testicular pain and the ultrasonography examination. We are not aware of the usefulness of shear-wave elastography for the diagnosis of STI. We report the shear-wave elastography features in a case of STI and discuss the role of this diagnostic modality in the differential diagnosis.
Testis; Infarction; Ultrasonography; Sonoelastography; Doppler ultrasonography
Mycetoma is a disfiguring, chronic granulomatous infection which affects the skin and the underlying subcutaneous tissue. We present an atypical case of recurrent mycetoma without ulceration, in a 35-year-old immunocompetent male caused by Scedosporium apiospermum sensu stricto and Madurella grisea, occurring at two separate anatomical sites.