-
Migration of sclerosant material to the left renal vein following coil embolisation of a varicocele.BMJ Case Reports Jul 2024Percutaneous testicular varicocele embolisation for symptomatic and subfertile males is often preferred over surgical ligation of the gonadal vein due to its minimally...
Percutaneous testicular varicocele embolisation for symptomatic and subfertile males is often preferred over surgical ligation of the gonadal vein due to its minimally invasive approach and reduced complication rate. Glues, coils, vascular plugs, balloons and sclerosants are used in various combinations to achieve sufficient venous occlusion. Here, we report on the first known case of sclerosant material migration beyond the placement of an embolisation coil for treatment of a varicocele, resulting in a left renal vein thrombus. A man in his 20s presented to the emergency department 2 days following uncomplicated left varicocele embolisation with acute left-sided abdominal pain, found to have sclerosant material causing an ipsilateral non-occlusive left renal vein thrombus with extension towards his inferior vena cava on CT. He was treated with 3 months of anticoagulation and follow-up imaging at 3 months showed resolution of this thrombus without renal impairment.
Topics: Humans; Male; Varicocele; Embolization, Therapeutic; Renal Veins; Foreign-Body Migration; Sclerosing Solutions; Adult; Young Adult; Tomography, X-Ray Computed
PubMed: 38955381
DOI: 10.1136/bcr-2023-259262 -
BMJ Case Reports Jul 2024We describe the case of a woman with mild endometriosis and Allen-Masters syndrome after in vitro fertilisation (IVF), presenting at 7 weeks 2 days gestation with...
We describe the case of a woman with mild endometriosis and Allen-Masters syndrome after in vitro fertilisation (IVF), presenting at 7 weeks 2 days gestation with abdominal pain. A transvaginal ultrasound revealed a gestational sac with a non-viable fetus near the right ovary. Laparoscopy was performed due to escalating abdominal pain which revealed a ruptured ectopic pregnancy at the right uterosacral ligament (USL) and blood in the pouch of Douglas. A peritoneal incision along the USL facilitated drainage and removal of the ectopic pregnancy. A pathological investigation described the presence of endometrial tissue directly adjacent to products of conception, which suggested a retroperitoneal implantation that may have been facilitated by the presence of an endometriotic lesion. This case underscores the distinctive clinical trajectory of unconventional ectopic pregnancies, provides novel insights into the pathophysiological mechanism of ectopic implantation and underscores the crucial role of comprehensive patient assessment during IVF and subsequent pregnancy in ensuring effective management.
Topics: Humans; Female; Pregnancy; Fertilization in Vitro; Pregnancy, Ectopic; Adult; Ligaments; Endometriosis; Abdominal Pain; Laparoscopy; Syndrome; Uterus
PubMed: 38955380
DOI: 10.1136/bcr-2024-260553 -
International Journal of Surgery Case... Jun 2024Mantle cell lymphoma is a rare type of non-Hodgkin's lymphoma which accounts for 5 % of all cases. Patients present with an advanced form of the disease. We present...
INTRODUCTION AND IMPORTANCE
Mantle cell lymphoma is a rare type of non-Hodgkin's lymphoma which accounts for 5 % of all cases. Patients present with an advanced form of the disease. We present here a case of ileocolic intussusception secondary to mantle cell lymphoma which was revealed by abdominal pain and vomiting that was treated by surgical resection followed by chemotherapy.
CASE PRESENTATION
This report illustrates the case of a 34-year-old male who presented with abdominal pain and vomiting. Imageology demonstrated an ileocolic intussusception which was treated with hemicolectomy followed by chemotherapy. Histopathology confirmed the diagnosis of Mantle cell lymphoma.
CLINICAL DISCUSSION
Mantel cell lymphoma is a rare type of B-cell cancer. Patients are generally diagnosed with an advanced stage of the disease. Ileocolic intussusception is an uncommon presentation. Surgery is the pillar of the treatment. Resection depends on the extent and location of the lesion. Postoperative chemotherapy is crucial and it increases survival rate.
CONCLUSION
Mantle cell lymphoma is a rare subgroup of B-cell lymphomas. Ileocolic intussusception is a complicated form of the disease. Surgery combined with chemotherapy is the mainstay of the treatment. Diagnosis is confirmed by histological analysis of the surgical specimen.
PubMed: 38954973
DOI: 10.1016/j.ijscr.2024.109963 -
International Journal of Surgery Case... Jun 2024Arterial aneurysm is a serious condition caused by weakened arterial walls. Aorto-uni-iliac (AUI) and femorofemoral bypass are safe and effective options for managing...
INTRODUCTION AND IMPORTANCE
Arterial aneurysm is a serious condition caused by weakened arterial walls. Aorto-uni-iliac (AUI) and femorofemoral bypass are safe and effective options for managing abdominal aortic aneurysm (AAA). However, fem-fem bypass leads to longer surgical procedures and introduces additional risks such as graft infection, occlusion, wound complications, and peripheral vascular problems. This report highlights two successful cases of AAA management using the AUI approach without the need for fem-fem bypass.
CASE PRESENTATION
Two male patients, both aged about 70, presented at our medical facility complaining of abdominal pain. Investigations unveiled an approximately 10-cm AAA that was previously undetected. Subsequently, we performed an elective AUI procedure without fem-fem bypass, marking the first instance of this technique being employed in Iran successfully.
CLINICAL DISCUSSION
The placement of an AUI stent graft is generally less technically demanding compared to that of a standard bifurcated graft, especially when anatomical constraints are severe, making the latter difficult or even impossible to deploy. Beside the longer duration of stent deployment, sometimes we encounter contralateral complications to cannulate the main body. The AUI is typically used in emergency situations or when the distal aorta's internal diameter is small. The femoral-femoral bypass is advised in nearly all circumstances.
CONCLUSION
AUI stent grafts are still a viable option for treatments of AAA, especially in cases of severe aortoiliac occlusive disease or comorbidities. AUI without crossover bypass is a viable option in the patients who have stenosis of contralateral iliac artery.
PubMed: 38954972
DOI: 10.1016/j.ijscr.2024.109918 -
International Journal of Surgery Case... Jun 2024The source of abdominal pain in patients with a history of gastric bypass can be difficult to determine. Synchronous disease processes may ultimately be the cause of...
INTRODUCTION
The source of abdominal pain in patients with a history of gastric bypass can be difficult to determine. Synchronous disease processes may ultimately be the cause of their symptoms. Among the etiologies for hematemesis and obstruction in this population are the diagnoses of marginal ulcer and internal hernia. Given the potential complications of bariatric surgery, it is important to maintain a broad differential diagnosis during the workup of these patients.
PRESENTATION
A female with history of laparoscopic Roux-en-Y gastric bypass (RYGB) presented with abdominal pain and hematemesis. Intraoperative findings revealed intussusception of the jejunojejunostomy resulting in obstruction and ischemic bowel. Additionally, a perforated marginal ulcer of the Roux-limb was found to be present. This patient underwent esophagogastroduodenoscopy, bowel resection, jejunojejunostomy revision, and Graham patch repair.
DISCUSSION
This case highlights a patient with history of RYGB presenting with obstruction and gastrointestinal bleeding. Although initially diagnosed with internal hernia and Mallory-Weiss hematemesis, surgical exploration revealed concurrent intussusception and marginal ulceration. While intussusception is a rare complication of bariatric surgery, it can occur secondary to mesenteric thinning and motility dysfunction from significant weight loss. It is imperative to maintain a broad differential diagnosis for the causes of obstruction and GI bleeding that include adhesive disease, abdominal wall hernia, internal hernia, intussusception, and marginal ulcers.
CONCLUSION
Findings of obstruction or GI bleeding after bariatric surgery may represent a surgical emergency. While these symptoms may be attributed to a single diagnosis, clinicians must consider the presence of synchronous pathologies during the workup of patients.
PubMed: 38954971
DOI: 10.1016/j.ijscr.2024.109951 -
International Journal of Surgery Case... Jun 2024Diaphragmatic eventration (DE) associated with gastrointestinal anomalies is rarely reported, and its treatment is not well defined.
INTRODUCTION
Diaphragmatic eventration (DE) associated with gastrointestinal anomalies is rarely reported, and its treatment is not well defined.
CASE PRESENTATION
We present a 24-years-old male admitted for cough, dyspnea, and chest pain, all of gradual onset. Chest computerized tomography (CT) and chest x-ray diagnosed diaphragmatic eventration and colonic distension. He underwent surgery via a posterolateral thoracotomy. We found colonic distension which pushed the left hemidiaphragm under intense pressure further into the chest, making immediate diaphragmatic plication via the chest difficult. We managed this by colonic needle decompression followed by resection and plication of the diaphragm. The patient had a satisfactory postoperative recovery with a good respiratory profile and no constipation. At a follow up visit, barium enema showed megacolon with no apparent etiology. He is to have a long-term outpatient follow up.
DISCUSSION
Diaphragmatic eventration coexisting with megacolon is rare. Data available suggests supplementary abdominal workup is necessary to better plan the surgery. Surgical correction via an abdominal route tends to be more appropriate in these scenarios.
CONCLUSION
In cases of gastrointestinal anomaly associated with diaphragmatic eventration, more careful abdominal consideration is needed to better plan the surgery.
PubMed: 38954969
DOI: 10.1016/j.ijscr.2024.109968 -
International Journal of Surgery Case... Jun 2024Repairing incisional abdominal wall hernia with nonabsorbable meshes is one of the most common procedures in general surgery. Mesh migration into the intestine is rare...
INTRODUCTION AND IMPORTANCE
Repairing incisional abdominal wall hernia with nonabsorbable meshes is one of the most common procedures in general surgery. Mesh migration into the intestine is rare but a serious complication. It can occur months or even years after surgery and often presents with vague abdominal pain, making diagnosis tricky.
CASE PRESENTATION
We report a rare case of a 52-year-old female presenting a small bowel obstruction secondary to mesh migration from the abdominal wall into the intestine, 10 years after repeated surgical repair of a ventral incisional hernia. At surgery, a mesh was migrated into a small bowl. The patient had a small bowel resection. The postoperative course was simple and the patient was discharged after 5 days.
CASE DISCUSSION
Incisional hernia repair with mesh is one of the most commonly performed surgical procedures worldwide. Many complications have been linked to the use of mesh; among the most frequently reported are seromas, hematomas, and infections. Mesh migration remains an uncommon event after incisional hernia repair, and even rarer when considering complete migration within the intestinal lumen. The exact cause of this complication remains unknown. Multiple hypotheses have been proposed for mesh migration. Abdominal pain, intermittent or persistent intestinal obstruction, mass formation, and viscus perforation represent the most common clinical manifestation. Total removal of the mesh via laparoscopy or laparotomy is recommended, along with either partial or entire resection of the organ.
CONCLUSION
Mesh migration is a an uncommon possible complication in case of incisional hernia mesh repair and it requires often surgical intervention.
PubMed: 38954968
DOI: 10.1016/j.ijscr.2024.109976 -
International Journal of Surgery Case... Jun 2024Vaginal agenesis is a rare congenital condition, with an incidence of 1 in 4500 female births.
INTRODUCTION
Vaginal agenesis is a rare congenital condition, with an incidence of 1 in 4500 female births.
CASE REPORT
We present a clinical case of vaginal aplasia with cervical atresia in a 31-year-old woman with primary amenorrhea. We aim to report the diagnostic process and provide a comprehensive outline of different possible treatments.
DISCUSSION
The most common etiology of these agenesis cases is Mayer-Rokitansky-Küster-Hauser syndrome associated with uterine aplasia. However, vaginal aplasia can occur in 9 % of cases where the uterus is present. During embryogenesis, the Müllerian ducts give rise to the fallopian tubes, uterus, and upper two-thirds of the vagina, while the lower portion of the vagina develops from the urogenital sinus. Vaginal aplasia arises from a failure in the development of the terminal portion of the paramesonephric ducts. Abdominal pain, especially periodic pain, is the most common symptom, followed by primary amenorrhea. MRI is considered the gold standard for the diagnosis and precise description of female genital tract anomalies.
CONCLUSION
Total hysterectomy remains a preferred option for cases of complete vaginal atresia to mitigate the risk of cervical or vaginal stenosis, adhesions, and pelvic inflammation resulting from poor menstrual blood drainage.
PubMed: 38954966
DOI: 10.1016/j.ijscr.2024.109957 -
International Journal of Surgery Case... Jun 2024Traumatic pelvic fractures are complex injuries often associated with significant morbidity and mortality. Among the complications of pelvic trauma, rupture of the...
INTRODUCTION AND IMPORTANCE
Traumatic pelvic fractures are complex injuries often associated with significant morbidity and mortality. Among the complications of pelvic trauma, rupture of the ovarian vein represents a rare yet potentially life-threatening event. Prompt recognition and appropriate management are essential to mitigate the risk of hemorrhage and associated complications.
CASE PRESENTATION
We present a case of a 70-year-old woman who sustained a traumatic pelvic fracture following a skiing accident, resulting in rupture of the left ovarian vein. The patient came with the ambulance in the emergency room with lower abdominal tenderness, pelvic pain, but no signs of hemorrhagic shock. Imaging studies confirmed the diagnosis of a pelvic fracture with venous leakage of the left ovarian vein.
CLINICAL DISCUSSION
This review synthesizes recent insights into the diagnosis, management, and complications associated with pelvic fractures, with an emphasis on optimizing patient outcomes through a multidisciplinary approach. The analysis incorporates findings from key studies, including those by Wong and Bucknill, Ma Y et al., and Tullington and Blecker, which advocate for the use of advanced diagnostic tools like CT scans and systematic evaluation processes. These studies underline the necessity of precise classification systems such as the Tile classification to guide treatment and predict outcomes.
CONCLUSION
Management of traumatic pelvic fractures with associated vascular injuries requires a multidisciplinary approach involving trauma surgeons, interventional radiologists, and critical care specialists. Early recognition, accurate diagnosis, and timely intervention are paramount in optimizing outcomes and reducing the risk of mortality. This case underscores the importance of prompt intervention and highlights the challenges associated with traumatic pelvic fractures and rupture of the ovarian vein. Further research is warranted to enhance our understanding of optimal management strategies and improve outcomes for patients with these complex injuries.
PubMed: 38954965
DOI: 10.1016/j.ijscr.2024.109894 -
European Journal of Pain (London,... Jul 2024Visceral hypersensitivity is considered the core pathophysiological mechanism that causes abdominal pain in patients with irritable bowel syndrome (IBS). Fungal...
BACKGROUND
Visceral hypersensitivity is considered the core pathophysiological mechanism that causes abdominal pain in patients with irritable bowel syndrome (IBS). Fungal dysbiosis has been proved to contribute to visceral hypersensitivity in IBS patients. However, the underlying mechanisms for Dectin-1, a major fungal recognition receptor, in visceral hypersensitivity are poorly understood. This study aimed to explore the role of Dectin-1 in visceral hypersensitivity and elucidate the impact of Dectin-1 activity on the function of transient receptor potential vanilloid type 1 (TRPV1).
METHODS
Visceral hypersensitivity model was established by the intracolonic administration of 0.1 mL TNBS (130 μg/mL in 30% ethanol) in the male mice. Fluconazole and nystatin were used as fungicides. Laminarin, a Dectin-1 antagonist and gene knockout (Clec7a) mice were used to interrupt the function of Dectin-1. Colorectal distension-electromyogram recording was performed to assess visceral sensitivity. Immunostaining experiment was performed to determine the localization of Dectin-1 in dorsal root ganglion (DRG) neurons. Calcium imaging study was performed to assay TRPV1-mediated calcium influx in acutely dissociated DRG neurons.
RESULTS
Pretreatment with fungicides, administration of laminarin or genetic deletion of Clec7a alleviated TNBS-induced visceral hypersensitivity in male mice. The expression of Dectin-1 was upregulated in the DRG and colon of TNBS-treated mice. Colocalization of Dectin-1 and TRPV1 was observed in DRG neurons. Importantly, pretreatment with curdlan, a Dectin-1 agonist, increased TRPV1-mediated calcium influx.
CONCLUSIONS
Dectin-1 contributes to visceral hypersensitivity in IBS or in inflammatory bowel disease in remission and activation of Dectin-1 induces TRPV1 sensitization.
SIGNIFICANCE STATEMENT
This work provides direct evidence for the functional regulation of TRPV1 channel by Dectin-1 activity, proposing a new mechanism underlying TRPV1 sensitization. Control of intestinal fungi might be beneficial for the treatment of refractory abdominal pain in patients with IBS or IBD in remission.
PubMed: 38953581
DOI: 10.1002/ejp.2311