Left Hemicolectomy for Intussusception of the Transverse Colon Caused by a Giant Benign Lipoma

Colocolonic intussusception, caused by submucosal lipomas, is extremely rare. These benign soft tissue tumours comprise mature adipocytes of mesenchymal origin. While the majority of patients with lipomas remain asymptomatic, large or giant size lipomas (>4 cm) have been shown to cause debilitating abdominal pain, alternating bowel pattern, and anaemia secondary to gastrointestinal blood loss. This necessitates intervention in the form of surgical resection or endoscopic removal. However, once lipomas increase beyond 2 cm in size there is a significant risk of complications with an endoscopic approach, and open surgery or laparoscopic resection with bowel re-anastomosis is warranted. In this case put forth, the patient underwent a successful transverse colectomy and primary anastomosis.

A Rare Case of Primary Aortoduodenal Fistula

Aortoduodenal fistula is a rare but life-threatening condition that can cause gastrointestinal bleeding. Due to its rarity, it is often overlooked as a cause of gastrointestinal blood loss. Notably, the mortality rate of aortoduodenal fistula is nearly 100% in undiagnosed and untreated cases. We report a case of aortoduodenal fistula, which resulted in the patient’s death. This report highlights the importance of considering even extremely rare causes of gastrointestinal bleeding in the differential diagnosis in patients with such a presentation.

Successful Management of Blue Rubber Bleb Nevus Syndrome (BRBNS) with Sirolimus

Blue rubber bleb nevus syndrome (BRBNS) is a rare disease with vascular malformations in several systems of the body, most commonly the skin and gastrointestinal tract. Bleeding from the gastrointestinal (GI) tract is a major complication, which may lead to chronic iron deficiency anemia and the need for frequent blood transfusions due to ongoing gastrointestinal blood loss. In this case report, we describe a now 19-year-old female with BRBNS who required six blood transfusions per year and after starting sirolimus is symptom- and transfusion-free.

A 21-Year-Old Returned Traveller with Typhoid Fever Complicated By a Multifactorial Anemia and Splenic Infarction

Typhoid fever is a rare disease in North America. We present the case of a 21-year-old female who developed invasive Salmonella typhi infection after returning from rural Pakistan. The patient presented with classic signs of enteric infection including high fever, diarrhea, and a tongue coated in white patches. The patient developed hematologic complications of anemia and splenic infarction. Investigations, imaging studies and treatment are discussed. The case outlines both common and uncommon complications of typhoid fever and reminds the clinician of its importance in the differential of fever in the returning traveller. Four key point to consider are:1. Fever in a returning traveler has a broad differential diagnosis, but concurrent abdominal symptoms should result in blood cultures to assess for gram-negative bacteria. 2. Ceftriaxone, azithromycin, or fluoroquinolones are the treatments of choice for Salmonella typhi, although clinicians should be aware of increasing resistance to the latter and base treatment on sensitivity testing. 3. Anemia during typhoid fever can be multifactorial and include elements of gastrointestinal blood loss, hemolysis and transient marrow suppression. 4. Spleen involvement can lead to complications such as splenic infarction or abscess formation.