Complicated small bowel diverticulosis--a case report and literature review

We report herein the case of a small bowel diverticulum perforation which has caused peritonitis and consequently has led to operation. The patient, a 79-year old woman, was hospitalized due to etiological clarifying and specifying of a newly diagnosed diffuse liver pathology. During the hospital stay, she has received severe abdominal pain with features of peritonitis. Suspecting perforated appendicitis she has undergone an operation. The explorative laparotomy has identified a purulent exudation in the abdominal cavity, resulting from a perforated inflammatory jejunal diverticulum and multiple middle-size diverticula all along the small bowel and the colon. The reported case as well as the review of the literature have shown that various and sometimes potentially fatal complications could occur even for such a relatively banal insignificant entity as is diverticular disease in elderly patients.     

Bare metal stent infections: case report and review of the literature

Infection of bare metal stents in the vasculature is rare, but associated with significant morbidity and mortality. We report two cases of bare metal stent infections and review the literature regarding infected bare metal stents with respect to risk factors, pathophysiology, diagnosis, treatment, and prevention. Overall, this article highlights the need to have a high index of suspicion of bare metal stent infection, since prompt diagnosis and treatment can ultimately decrease the morbidity and mortality associated with this devastating problem.     

Posttraumatic cerebrovascular narrowing. A case report and review of the literature

We, neurosurgeons have sometimes confronted with the case of posttraumatic cerebrovascular narrowing or spasm. However, there have been few reports on the pathophysiology of the posttraumatic narrowing or spasm in comparison with those the spasm following the subarachnoid hemorrhage caused by the rupture of the aneurysm. The authors report here a case of temporal lobe contusion who demonstrated cerebrovascular narrowing angiographically at the 21st days after head injury. This 53-years-old male was examined again by angiography one week after the above-described angiography and the narrowing disappeared. The authors reviewed the literature on the posttraumatic cerebrovascular narrowing or spasm. Thirty seven cases have been reported in detail. Under the conditions of these 38 cases including the present case, the pathophysiology of the posttraumatic cerebrovascular narrowing or spasm was discussed. Two theories had been suggested for a long time: one was vasospasm caused by the traumatic subarachnoid hemorrhage and the other by direct mechanical irritation of cerebral artery. Recently, neurogenic factor is thought to take a part of this to a great extent such as hypothalamic dysfunction or dysfunctioning fragile autoregulation mechanism. It is seemed to be that such spasm caused by these mechanism will exist sure. However, in the posttraumatic cerebrovascular vasospasm, there are other accompanying intracranial lesions such as cerebral swelling, cerebral contusion, fracture of the base of the skull and so on. It is not assumed to be so simple environment as the spasm following the rupture of the aneurysm, and also the mechanism of genesis of the posttraumatic cerebrovascular spasm is not to be so simple. Several factors and their duplication will play a role in the mechanism. Further investigation is necessary for the clearness of the problem.     

Complicated duodeno-biliary fistula in bleeding duodenal ulcer: case report an literature review

Upper gastrointestinal tract bleedings may represent the first clinical evidence of peptic ulcer and the related surgical emergency is still characterized by a high mortality rate. The presence of multiple complications, rare but possible in case of duodenal ulcer, such as the fistulization in the common bile duct alone or associated to others, can significantly increase the difficulty in the treatment. The Authors report a particularly complex case of a 77 years old male diabetic patient, with chronic bronchopaty, urgently admitted to our department for hematemesis. Soon after his hemodynamic stabilization, the patient was submitted to surgery which showed a duodenal ulcer with penetration/fistulization in the common bile duct associated to a perforation of the gallbladder with intra-hepatic abscess and erosion of the gastro-duodenal artery. Despite unfavourable outcome the case gave us the starting point for a review of the literature primarily related to the rarer biliary complications of duodenal ulcer. Bleeding ulcers today are usually treated by an interdisciplinary approach comprehensive of endoscopy, interventional radiology and, only rarely, surgery. The choice among the available options depends on the clinical presentation of the patient. Despite diagnostic and therapeutic progresses, peptic ulcer may still rarely have a dramatic presentation and be associated to uncommon and difficult anatomical aspects whose diagnosis and treatment may be not easy at all. The knowledge of all the aspects of peptic ulcer pathophysiology is therefore essential for the treatment of these patients.     

Duodenal perforation secondary to biliary stent dislocation: a case report and review of the literature

Gut perforation secondary to the insertion of a biliary stent is an uncommon but potentially life-threatening complication. Duodenal perforation has to be taken into consideration whenever the patient starts to suffer severe abdominal pain after the stenting procedure. An early diagnosis is fundamental in order to avoid further complications. Timely conservative treatment with nasogastric suction, nothing by mouth, antibiotics and stent replacement could prevent infection and consequent development of an abscess. We report a case of duodenal perforation secondary to biliary endoprosthesis dislocation in which, in spite of prompt diagnosis and treatment, a large retroperitoneal abscess developed and a CT-guided drainage proved necessary followed later by a surgical operation.     

Self-expanding stent (Wallstent) supported angioplasty for carotid artery stenosis]

We reported the preliminary results of percutaneous transluminal angioplasty (PTA) supported with a self-expanding stent (Wallstent) for the cervical internal carotid artery (i.c.) stenosis in 6 patients (7 lesions). All were male aged from 60 to 79 (mean 70.8). Three patients were symptomatic and 3 were asymptomatic. The procedure was attempted in patients with severe i.c. stenosis according to criteria of NASCET, ECST or ACAS studies and with high risk if carotid endarterectomy (CEA) were performed. In all cases, vascular access was from the femoral artery and angioplasty was performed without cerebral protection. Successful angioplasty was obtained in all cases with no mortality. Stenosis was improved from 82.7% (74-90%) to 17.4% (10-33%). Perioperative complications were seen in only one case with TIA during the postdilatation period, which was supposed to be due to a distal embolism. The preliminary results of PTA supported with self-expanding stent for severe i.c. stenosis were excellent. These results suggested that some patients with severe i.c. stenosis can be treated safely and effectively by stent-supported PTA. However, it is necessary to mark the indications clear and strict, and to follow up these lesions after the procedure, because of the possibility of perioperative ischemic complications and restenosis.     

Complicated Littre's umbilical hernia with normal Meckel's diverticulum: A case report and review of the literature

Introduction and importanceA Littre's hernia (LH) is defined by the presence of Meckel's diverticulum (MD) in any kind of hernia sac. Preoperative diagnosis of LH is a challenge because of its rarity and the absence of specific radiological findings and clinical presentation. Surgery is the appropriate treatment of complicated LH that is an extremely rare condition with approximately 50 cases reported in the literature over the past 300 years.Case presentationA 46-year-old Caucasian female was admitted to the Emergency Department with a two-day history of abdominal pain. Physical examination revealed an irreducible and painfull mass in umbilical region. Abdominal computed tomography scan showed the protrusion of greater omentum and small bowel loop through the umbilical ring. Laboratory tests were unremarkable. After diagnosis of strangulated umbilical hernia, the patient underwent exploratory laparotomy: the irreducible umbilical hernial sac was opened with presence of incarcerated and strangulated omentum and uncomplicated MD. Resection of incarcerated and ischemic greater omentum alone was performed. The postoperative course of patient was uneventful.Clinical discussionMeckel's diverticulum (MD) is a vestigial remnant of the omphalomesenteric duct, representing the most common congenital malformation of the gastrointestinal tract. Preoperative diagnosis of LH is very difficult and surgery represents the correct treatment of complicated LH.ConclusionLH represents an extremely rare complication of MD difficult to diagnose and suspect because of the lack of specific radiological findings and clinical presentation. Surgery represents the appropriate treatment of abdominal wall hernias and complicated MD.     

Endoscopic management of pancreatic duct injury by endoscopic stent placement: a case report and literature review

ABSTRACT: Recently, the diagnostic evaluation of pancreatic injury has improved dramatically. On the other hand, it is occasionally difficult to diagnose pancreatic injury, because there are no specific signs, symptoms, or laboratory findings. Radiological imaging also often fails to identify pancreatic injury in the acute phase. Delayed diagnosis results in significant morbidity and mortality. Most cases of pancreatic injury with suspicion or pancreatic duct disruption require surgery. Endoscopic retrograde cholangiopancreatography is one of the most accurate modalities for ductal evaluation and therapy and might enable one to avoid unnecessary surgery. We describe endoscopic management of pancreatic duct injury by endoscopic stent placement. A 45-year-old woman was admitted after a traffic accident. A computed tomography scan showed pancreatic parenchyma disruption at the pancreatic head. Endoscopic retrograde cholangiopancreatography demonstrated disruption of the pancreatic duct with extravasation into the peripancreatic fluid collection. A 5-French endoscopic nasopancreatic drainage (ENPD) tube was placed. Her symptoms dramatically improved. ENPD tube was exchanged for a 5-French 5-cm pancreatic stent. Subsequent follow-up CT revealed remarkable improvement. On the 26th day, the patient was discharged from the hospital without symptoms or complications. In this report, a pancreatic stent may lead to rapid clinical improvement and enable surgery to be avoided. On the other hand, the reported complications of long-term follow-up make the role of stenting uncertain. Thus, close attention should be paid to stenting management in the follow-up period. A pancreatic stent is useful for pancreatic ductal injury. If pancreatic ductal injury is managed appropriately, a pancreatic stent may improve the clinical condition, and also prevent unnecessary surgery.     

Massive non-aneurysmal subarachnoid hemorrhage after cervical carotid angioplasty and stenting: A case report and review of the literature

IntroductionCarotid angioplasty and stenting (CAS) of the cervical segment is a safe and effective procedure for the treatment of carotid artery disease. In rare cases, this procedure causes intracranial hemorrhage (ICH), which is described most often as an ipsilateral intra-parenchymal hematoma. This ICH is the result of a cerebral hyperperfusion syndrome (CHS). Isolated subarachnoid hemorrhage may occur exceptionally, with only 9 cases that have been reported in the literature.ObservationWe reported a case of a 71-year-old man who presented a massive non-aneurysmal subarachnoid hemorrhage one hour after angioplasty and stenting of the cervical segment of the left internal carotid artery. Medical and surgical management included external ventricular drain placement. Rebleeding occurred two days later, worsening the patient's clinical condition. Finally, the patient died 2 weeks later.CommentsThis rare presentation of ICH following CAS allows us to discuss the risk factors, complications and management of CHS.     

长期滞留双J管的临床处理并文献复习

目的:探讨长期滞留双J管的处理方法。方法:对11例长期滞留双J管患者分别采用或联合应用ESWL、输尿管镜(URS)、经皮肾镜(PCN)等方法进行处理。结果:11例患者均顺利拔除滞留的双J管。结论:术前完善影像学检查,明确双J管的位置及有无其他复杂情况,灵活应用ESWL、URS及PCN等多种内镜方法,多可顺利拔除滞留的双J管。     

Melorheostosis: a case review and review of literature]

The authors present a review of the literature and the diagnostic difficulties in a case of melorheostosis in a 6 year old boy. Melorheostosis is characterized by longitudinal foci of subcutaneous sclerosis, limitation of motion in the joints and swelling of the knee and ankle joints. Radiologically numerous foci of hyperostosis similar to wax flowing down a burning candle have been noted.     

Polyorchidism: case report and review of literature

Polyorchidism is a rare anomaly with approximately 70 cases reported in the literature. It may result from transverse division of the urogenital ridge, a hypothesis that best explains the anatomical features of the supernumerary testicle. The primary accompanying disorders and anomalies include maldescended testis, inguinal hernia and torsion. Malignancy has been reported in 3 cases. In the absence of any concomitant disorder and if testicular tumor can be ruled out by magnetic resonance imaging and ultrasonography, surgical exploration with biopsy is unnecessary.     

Traumatic hemipelvectomy: case report and literature review

Traumatic hemipelvectomy is a rare but devastating injury involving complete disruption of the hemipelvis from the pubic symphysis to the sacroiliac joints and often results in death. We present an interesting case of traumatic hemipelvectomy caused by a previously undescribed mechanism of injury in which judicious angiography and aggressive surgical treatment contributed to patient survival.     

Spinal angiolipoma: case report and literature review

BACKGROUND/OBJECTIVE: Spinal angiolipoma (SAL) is an uncommon clinico-pathological entity. DESIGN: Single case report. METHODS: Retrospective data analysis. FINDINGS: An obese woman with a 1-year history of progressive spastic paraparesis and acute deterioration underwent magnetic resonance imaging of the thoracic spine, the results of which suggested a tumor compressing the thoracic spinal cord. The histopathological examination of the completely resected tumor revealed an epidural angiolipoma. CONCLUSIONS: This case report offers a reminder that SAL should be considered in the differential diagnosis of long-standing, slowly progressive paraparesis. It remains unclear whether an increased body mass index might be a contributing factor to the development of SAL.