scholarly journals Ascending aorta graft pseudoaneurysm and aortobronchial fistula caused by a fractured sternal wire: a case report

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ahmad Ali Amirghofran ◽  
Elahe Nirooei ◽  
Mohammad Ali Ostovan
Keyword(s):  
Unusual Case ◽  
Preventive Measures ◽  
Prosthetic Graft ◽  
Ascending Aorta ◽  
Dacron Graft ◽  
Thoracoabdominal Aorta ◽  
Case Presentation ◽  
Pseudoaneurysm Formation ◽  
Aortobronchial Fistula ◽  
History Of

Abstract Background Pseudoaneurysm of ascending aorta is a rare but serious complication of cardiovascular surgeries and it infrequently occurs in the normal prosthetic graft materials. We share our experience with an unusual case of ascending aorta Dacron graft pseudoaneurysm caused by a fractured sternal wire. Case presentation A 34-year-old man, known case of Marfan syndrome, with history of two prior aortic surgeries for aneurysm of ascending aorta, arch and thoracoabdominal aorta, presented with hemoptysis. The hemoptysis originated from an aortobronchial fistula secondary to a huge ascending aorta Dacron graft pseudoaneurysm. The graft erosion and subsequent pseudoaneurysm was caused by a fractured sternal wire. Surgical repair of the pseudoaneurysm was performed successfully and a Gore-tex patch was placed behind the sternum over the graft to prevent further direct contact of the wire and the graft. Conclusion Sternal wires can damage the adjacent vascular grafts and lead to fatal complications such as pseudoaneurysm formation. Thus, preventive measures such as using sternal bands and placing a covering layer between the sternal wires and aortic grafts are recommended in patients with dilated or replaced ascending aorta.

563 A Rare Case of Small Bowel Obstruction Secondary to Peritoneal Encapsulation, Congenital Adhesional Band and Gallstone Ileus

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
P Gungadin ◽  
A Taib ◽  
M Ahmed ◽  
A Sultana
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Unusual Case ◽  
Gallstone Ileus ◽  
Gall Stone ◽  
Case Presentation ◽  
Peritoneal Encapsulation ◽  
History Of ◽  
Gall Stone Ileus

Abstract Introduction Small bowel obstruction can be caused by multiple factors. We describe an unusual case of small bowel obstruction secondary to three rare factors: gallstone ileus, peritoneal encapsulation and congenital adhesional band. Case Presentation A seventy-nine-year-old male presented with a four-day history of obstipation and abdominal pain. CT abdomen pelvis revealed small bowel obstruction secondary to gallstone ileus. The patient was managed by laparotomy. The intraoperative findings revealed the presence of a congenital peritoneal encapsulation with an adhesional band and gallstone proximal to the ileo-caecal valve. Although there was some dusky small bowel, this recovered following the release of the band. Discussion Peritoneal Encapsulation is a rare congenital pathology resulting in the formation of an accessory peritoneal membrane around the small bowel. This condition is asymptomatic and rarely presents as small bowel obstruction. The diagnosis is often made at laparotomy. There are less than 60 cases reported in literature. Gallstone ileus is another rare entity caused by an inflamed gallbladder adhering to part of the bowel resulting in a fistula. Conclusions The rarity of these conditions mean that they are poorly understood. A combination of this triad of gall stone ileus in the presence of peritoneal encapsulation and congenital band has not been reported before. Knowledge of this would raise awareness, facilitate diagnosis and management of patients.

scholarly journals Spontaneous Thrombosis of a Middle Meningeal Arteriovenous Fistula With Subsequent Pseudoaneurysm Formation: Case Report and Review of Literature

2020 ◽  
Vol 1 (3) ◽  
Author(s):  
Pouya Nazari ◽  
Pedram Golnari ◽  
Madhav Sukumaran ◽  
Ali Shaibani ◽  
Michael C Hurley ◽  
...  
Keyword(s):  
Unusual Case ◽  
Middle Meningeal Artery ◽  
Complete Healing ◽  
Spontaneous Thrombosis ◽  
Pseudoaneurysm Formation ◽  
Arteriovenous Fistulas ◽  
History Of ◽  
The Right ◽  
Repeat Imaging

ABSTRACT BACKGROUND AND IMPORTANCE Middle meningeal artery (MMA) pseudoaneurysms and middle meningeal arteriovenous fistulas (MMAVFs) are rarely reported after head injury. We report an unusual case of delayed MMA pseudoaneurysm formation after spontaneous thrombosis of an MMAVF, and review existing literature on MMAVF treatment and results. CLINICAL PRESENTATION A 59-yr-old male presented with a 5-d history of worsening left-sided headaches, followed by nausea, lethargy, and difficulty with speech. Non-contrast computed tomography demonstrated a left temporal intraparenchymal hemorrhage (IPH) and an acute left-sided subdural hematoma (SDH). Cerebral angiography found abnormal shunting between the right MMA and the right sphenoparietal sinus, consistent with an MMAVF. During the course of admission, the patient's neurological condition deteriorated requiring craniotomy for evacuation of SDH and IPH. Given the presumed incidental nature of the contralateral MMAVF, conservative management was recommended. Follow-up imaging 2 mo after surgery revealed spontaneous thrombosis of the right MMAV. Repeat imaging 5 mo later revealed an MMA pseudoaneurysm at the prior fistulous site, which was subsequently embolized with Onyx, occluding the pseudoaneurysm and the MMA both proximal and distal to the pseudoaneurysm. CONCLUSION Spontaneous thrombosis of an MMAVF is rare and only seen in 13.1% of cases. However, subsequent delayed formation of an MMA pseudoaneurysm has not been described. Our case therefore demonstrates that MMAVF thrombosis may not indicate complete healing of the underlying injury to the MMA, and suggests the need for continued follow-up of such lesions despite initial apparent resolution.

scholarly journals Unusual case of classic testicular seminoma in a 90-year-old patient: a case report

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Ahmad Al-Mousa ◽  
Mohammad Nour Shashaa ◽  
Mohamad Shadi Alkarrash ◽  
Mohamad Alkhamis ◽  
Lina Ghabreau ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Elderly Patients ◽  
Unusual Case ◽  
Medical Literature ◽  
Testicular Tumor ◽  
Testicular Seminoma ◽  
Case Presentation ◽  
History Of ◽  
Pure Seminoma

Abstract Background Seminoma is the most common subtype of testicular cancer and occurs most commonly in patients aged 30–49 years, but decreases to a very low level in men in their 60s or older. Case presentation A 90-year-old Syrian man with a 6-year history of an increase in size of his right scrotum, presented to the urological clinic and, on clinical examination, the findings suggested testicular tumor. After orchiectomy and histology results based on microscopic and immunohistochemical examinations, a pure seminoma was diagnosed, so we describe in this case report the second-oldest patient with classical seminoma in the medical literature. Conclusion This case report has been written to focus on the probability of any type of testicular tumor occurring at any age or decade; urologists should consider seminoma as a differential diagnosis with any testicular swelling even in elderly patients.

scholarly journals An uncommon cause of hemoptysis: aortobronchial fistula

2018 ◽  
Vol 13 ◽  
Author(s):  
Roberto Tonelli ◽  
Matteo Fontana ◽  
Filippo Gozzi ◽  
Ivana Castaniere ◽  
Alessandro Marchioni ◽  
...  
Keyword(s):  
Respiratory Diseases ◽  
Aortic Surgery ◽  
Aneurysmal Dilatation ◽  
Case Presentation ◽  
Aortobronchial Fistula ◽  
Contrast Enhanced ◽  
History Of ◽  
Clinical Awareness ◽  
Enhanced Computed Tomography ◽  
Contrast Enhanced Computed Tomography

Background: Hemoptysis is a frequent sign of respiratory and non-respiratory diseases. While in most cases the underlying cause is rapidly identified, sometimes the real etiology might be misdiagnosed with dramatic delay in treatment. Case presentation: A 46-year-old man with hiatal hernia and a history of aortic surgery for aortic coarctation presented with dramatic episodes of hemoptysis and subsequent severe anemia (6,9 g/dl). Digestive and respiratory endoscopy resulted not exhaustive, thus he underwent a contrast-enhanced computed tomography (CT) scan of the chest that showed an aneurysmal dilatation of the descending thoracic aorta with suspected aortobronchial fistula. He underwent cardiac surgery that confirmed the diagnosis and successfully treated the fistula. Conclusion: We briefly review the literature to raise clinical awareness on this uncommon cause of hemoptysis.

scholarly journals An Unusual Case of Asystole Occurring during Deep Brain Stimulation Surgery

2016 ◽  
Vol 2016 ◽  
pp. 1-5
Author(s):  
Ha Son Nguyen ◽  
Harvey Woehlck ◽  
Peter Pahapill
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Unusual Case ◽  
Case Presentation ◽  
Volume State ◽  
Lead Placement ◽  
History Of ◽  
Symptomatic Bradycardia ◽  
Deep Brain Stimulation Surgery ◽  
Deep Brain

Background. Symptomatic bradycardia and hypotension in neurosurgery can produce severe consequences if not managed appropriately. The literature is scarce regarding its occurrence during deep brain stimulation (DBS) surgery.Case Presentation. A 67-year-old female presented for left DBS lead placement for essential tremors. During lead implantation, heart rate and blood pressure dropped rapidly; the patient became unresponsive and asystolic. Chest compressions were initiated and epinephrine was given. Within 30 seconds, the patient became hemodynamically stable and conscious. A head CT demonstrated no acute findings. After deliberation, a decision was made to complete the procedure. Assuming the etiology of the episode was the Bezold-Jarisch reflex (BJR), appropriate accommodations were made. The procedure was completed uneventfully.Conclusion. The episode was consistent with a manifestation of the BJR. The patient had a history of neurocardiogenic syncope and a relatively low-volume state, factors prone to the BJR. Overall, lead implantation can still occur safely if preventive measures are employed.

scholarly journals Gossypiboma with perforation of the umbilicus mimicking a complicated urachal cyst: a case report

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Mustapha S. Kabba ◽  
Martha Y. Forde ◽  
Kevin S. Beckley ◽  
Bernadette Johnny ◽  
Ann-Marie B. M. Jah-Kabba ◽  
...  
Keyword(s):  
Unusual Case ◽  
Open Appendectomy ◽  
Exploratory Laparotomy ◽  
Urachal Cyst ◽  
History Of Surgery ◽  
Surgical Sponge ◽  
Case Presentation ◽  
Retained Surgical Sponge ◽  
Peripheral Hospital ◽  
History Of

Abstract Background A retained surgical sponge, also known as a gossypiboma, is a rare cause of serious postoperative complications. Diverse retained surgical materials including instruments such as clamps and sutures have been reported, but surgical sponges are the most common material. We report an unusual case of a gossypiboma mimicking a complicated urachal cyst that led to perforation of the umbilicus. Case presentation A 38-year-old female patient presented in our facility with a palpable periumbilical mass and discharge of pus from the umbilicus for 7 months after an open appendectomy. Since the onset of symptoms, the patient had been treated conservatively in a peripheral hospital where she had been operated on. As no improvement was seen, an ultrasound scan was performed that suggested an intraperitoneal abscess adjacent to the umbilicus. Consequently, the patient was referred to our specialist outpatient department for surgical intervention. Suspecting a complicated urachal cyst, an exploratory laparotomy was performed but revealed a retained surgical sponge as the underlying cause. The gossypiboma was resected, and the postoperative period was unremarkable. Conclusion This case demonstrates that gossypibomas, even though rare, continue to occur. They may clinically and radiologically mimic other pathologies, especially abscesses and tumors. Preventive measures as well as the inclusion of gossypibomas in the differential diagnosis of intraabdominal masses or fistulation detected in patients with a history of surgery are of utmost importance to minimize morbidity, mortality, and potential medicolegal implications.

scholarly journals Corneal Epithelial Hyperplasia after 5-Fluorouracil Injection

2018 ◽  
Vol 9 (1) ◽  
pp. 254-256 ◽  
Author(s):  
Dania A. Bukhari ◽  
Sarah K. Alessa ◽  
Safaa I. Beheiri
Keyword(s):  
Rna Synthesis ◽  
Unusual Case ◽  
Epithelial Hyperplasia ◽  
Progressive Decrease ◽  
Case Presentation ◽  
Corneal Epithelial ◽  
Corneal Scarring ◽  
Lens Implantation ◽  
Pyrimidine Analogue ◽  
History Of

Background: 5-Fluorouracil (5-FU) is a pyrimidine analogue which selectively inhibits DNA synthesis, RNA synthesis, and VEGF antibodies. 5-FU is widely used in ophthalmology for inhibition of postoperative corneal scarring and scleral bleb fibrosis. Case Presentation: In this case report, we describe an unusual case of a 65-year-old male who presented to the clinic with progressive decrease of vision after he underwent a revision of scleral bleb with the administration of 0.05 mL 5-FU (2.5 mg) injection and was diagnosed with corneal epithelial hyperplasia. The patient had a history of glaucoma managed by deep sclerotomy and phacoemulsification with intraocular lens implantation. Conclusion: Our case demonstrates an unusual consequence of corneal epithelial hyperplasia developed after 5-FU injection.

Chigger Mite Infestation

2003 ◽  
Vol 93 (5) ◽  
pp. 399-401 ◽  
Author(s):  
Wayne R. Axman ◽  
John J. Brummer
Keyword(s):  
Physical Examination ◽  
Unusual Case ◽  
Rare Condition ◽  
Mite Infestation ◽  
Chigger Mite ◽  
Case Presentation ◽  
History Of ◽  
The Right ◽  
Comprehensive History

This article reports on a 45-year-old woman who presented with pruritus and was diagnosed as having chigger mite infestation, a rare condition. The chigger mite larvae were encountered while the patient was traveling in South America. A small erythematous area with a well-circumscribed papule in the sulcus of the second digit of the right foot was incised and drained. Follow-up examination showed relief of all symptoms, including pain and pruritus. This unusual case presentation underscores the need for all podiatric physicians to obtain a comprehensive history, including history of travel, along with performing a thorough physical examination. (J Am Podiatr Med Assoc 93(5): 399-401, 2003)

scholarly journals An Unusual Case of Anti-GBM Antibody Elevation in HIV-Associated Nephropathy

2014 ◽  
Vol 2014 ◽  
pp. 1-6
Author(s):  
Vinay Minocha ◽  
Raafat Makary ◽  
Andreea Poenariu
Keyword(s):  
Hiv Infection ◽  
Unusual Case ◽  
Elevated Serum ◽  
Kidney Injury ◽  
African American Female ◽  
Case Presentation ◽  
A Value ◽  
Biopsy Confirmation ◽  
History Of ◽  
Nephrotic Range Proteinuria

Introduction.The most commonly seen glomerular disease in HIV infected patients is HIV-associated nephropathy (HIVAN); however, a multitude of other nephropathies can occur in HIV infection with an almost equal cumulative frequency. We report an unusual case of a patient with clinical and histological evidence of HIVAN in which the diagnosis was initially confounded by the finding of an elevated serum anti-glomerular basement membrane (anti-GBM) antibody.Case Presentation.We present a case of a 27-year-old African American female with a history of schizophrenia, cocaine abuse, and HIV infection who upon admission to our hospital was found to have severe acute kidney injury requiring hemodialysis. Urine studies revealed nephrotic range proteinuria and a serological workup was positive for anti-GBM antibody elevation with a value of 91 units (normal: 0–20 units). A renal biopsy revealed HIVAN with no evidence of crescentic glomerulonephritis or anti-GBM disease.Conclusion.This case highlights the need for careful interpretation of anti-GBM antibody tests in HIV infected patients with kidney disease and, in particular, the need for biopsy confirmation of the diagnosis prior to starting therapy. More research is needed to study the prognostic correlation between the degree of anti-GBM antibody elevation in HIVAN and disease severity.

scholarly journals Extraction of intra-biliary hepatocellular carcinoma by endoscopic retrograde cholangiopancreatography

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Chieh Sian Koo ◽  
Khek Yu Ho ◽  
Yin Huei Pang ◽  
Daniel Q. Huang
Keyword(s):  
Hepatocellular Carcinoma ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Unusual Case ◽  
Biliary Tree ◽  
Endoscopic Retrograde ◽  
Quadrant Pain ◽  
Case Presentation ◽  
Lower Survival Rate ◽  
Uncommon Presentation ◽  
History Of

Abstract Background Hepatocellular carcinoma with biliary ductal invasion is rare and associated with a significantly lower survival rate. Case presentation We present an unusual case of a patient with hepatocellular carcinoma and biliary invasion, who had his diagnosis confirmed by histological analysis from tissue extracted by endoscopic retrograde cholangiopancreatography. An 87-year-old male presented with a 1-day history of right upper quadrant pain and jaundice. His past medical history included recurrent gallstone cholangitis and a previous cholecystectomy. An abdominal CT demonstrated a dilated intrahepatic biliary tree with left proximal intrahepatic hyperdensities, as well as a 3 cm hepatocellular carcinoma. He was initially suspected to have concurrent gallstone cholangitis and a newly diagnosed hepatocellular carcinoma. Endoscopic retrograde cholangiopancreatography and balloon trawling of the intraductal lesions extracted necrotic tumour-like tissue which was histologically consistent with hepatocellular carcinoma. The extraction of the intra-biliary portion of HCC resulted in complete resolution of his jaundice, enabling further treatment with nivolumab, which would not have been possible if the obstruction was not cleared. The patient is currently well and has completed his 6th cycle of nivolumab. Conclusion Obstructive jaundice is an uncommon presentation for patients with HCC. it is key for clinicians to be aware of the possibility of intrabiliary invasion in order obtain an early diagnosis and to reduce any delay in treatment.

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