Extrarenal angiomyolipoma with spontaneous rupture: a case report

We present a very rare case of retroperitoneal extrarenal angiomyolipoma (AML) with spontaneous rupture. A 67-year-old woman without tuberous sclerosis was admitted to our hospital complaining of sudden right flank pain. We suspected right renal AML with rupture by imaging analysis, but the diagnosis was extrarenal AML by surgery and pathological examination.     

Bilateral spontaneous rupture of Achilles tendons: a case report

Spontaneous bilateral rupture of Achilles tendon is rare. Rupture of the Achilles tendon has been described in patients on oral corticosteroid therapy. The sudden dorsiflexion of the plantar-flexed foot is the usual mechanism of injury. Spontaneous bilateral rupture is common in the degenerated tendon, which is often seen in patients with long-term corticosteroid therapy. This case is unusual because the patient has never taken steroids. We discuss the mechanism of injury and other probable causes.     

Atypical presentation of spontaneous discitis: case report

BACKGROUND: Spontaneous discitis is primarily a pediatric illness. Adult patients usually present at an average age of 69 years with a history of diabetes or with a systemic infection. The lumbar spine is the most frequent site of infection (54%), and the cervical is the least at 10%. The causative organisms are most commonly Staphylococcus aureus and beta-hemolytic streptococcus species. Intravenous antibiotics are the mainstays of treatment, and surgical intervention is usually not required. CASE PRESENTATION: A single case observation with an unusual presentation from the statistically typical criterion of discitis is described. CONCLUSIONS: Atypical discitis needs to be considered in the differential diagnoses in the middle-aged and healthy population.     

Recurrent spontaneous rupture of the urinary bladder: a case report

The patient was a 67-year-old woman who had undergone radical hysterectomy and postoperative radiotherapy for cervical cancer at the age of 46 years. Spontaneous rupture of the urinary bladder occurred twice in 1997, and conservative treatment was performed on each occasion. She was admitted to our hospital for the third time of spontaneous rupture of the urinary bladder. She underwent bilateral cutaneous ureterostomy because of panperitonitis and paralytic ileus. A review of 11 cases of recurrent rupture of the urinary bladder reported in Japan including the present case revealed that, patients who had been conservatively treated tended to be subject to recurrence. However, the risk of recurrence remains when a partial cystectomy is performed. Therefore, especially in recurrent cases, augmentation cystoplasty or urinary diversion should be considered as the treatment for spontaneous rupture of the urinary bladder due to radiation cystitis.     

Giant sarcomatoid carcinoma with spontaneous vesical rupture: a case report

A 60-year-old woman has been on steroids under the diagnosis of polymyositis for 25 years. She was referred to our hospital complaining of asymptomatic macroscopic hematuria and lower abdominal pain. Physical examination revealed abdominal tenderness and rigidity. We suspected peritonitis because of free air image on the abdominal roentogenogram. The computed tomographic (CT) scan demonstrated an 8 cm solid mass in the bladder and defect of anterior wall of urinary bladder. Then we performed total cystectomy with cutaneous ureterostomy and partial resection of ileum as an emergency operation. Macroscopically, intra-peritoneal bladder rupture and severe adhesion of necrotic bladder dome wall to ileum were recognized and the tumor 8 cm in diameter existed in posterior wall of urinary bladder. Microscopic examination showed sarcomatoid carcinoma with spindle cell component and no invasion to ileum was recognized. Multiple lung, liver and bone metastasis appeared 6 months after the operation. She died of cancer 11 months after the operation.     

Neglected spontaneous bilateral rupture of the patellar tendon: a case report

A patient taking corticosteroids for rheumatoid arthritis experienced a spontaneous bilateral rupture of the patellar tendon. Initially neglected, the rupture was repaired surgically by tendinoplasty using the semitendinous tendon for the right knee and inversion of the quadriceps tendon for the left. Functional results were similar. On the right knee, the wire cerclage loosened leading to posterior sagittal displacement of the patella, pointing out the difficulties encountered when repairing neglected rupture of the patellar tendon. Due to the small number of cases and difficulties in assessing the techniques proposed, no large-scale series has been reported in the literature.     

Recurrent spontaneous bladder rupture cured by conservative therapy: a case report

The patient was a 44-year-old woman, who had undergone radical hysterectomy and postoperative radiation therapy for cervical cancer at the age of 34 years old. In 1998, she was admitted to our hospital with chief complaints of acute abdominal pain and high fever. We made a diagnosis of spontaneous bladder rupture associated with neurogenic bladder dysfunction and radiation cystitis, based on findings of cystoscopy and cystography. She was cured by conservative therapy, including catheter drainage and antibacterial chemotherapy. Thereafter, she was managed with intermittent self-catheterization. In 2000, spontaneous bladder rupture recurred, but conservative therapy was effective again. A review of 12 cases of recurrent spontaneous bladder rupture in Japan, including the present case, suggests that proper management of urination for neurogenic bladder dysfunction may be necessary for prevention of recurrent rupture, when the impaired bladder is left after either successful conservative or surgical treatment of bladder rupture. Urinary diversion and augmentation cystoplasty should be considered for repeated rupture of the bladder.     

Choriocarcinoma presenting as a spontaneous rupture of an adrenal metastasis: a case report

A 20-year-old woman, who had a history of childbirth, was admitted to the emergency room with an acute abdomen. An abdominal enhanced computed tomography (CT) revealed retroperitoneal hemorrhage, leading to life-threatening, and multiple tumors in the liver. Additionally, chest CT also revealed multiple coin lesions in the lung. These findings strongly indicated a spontaneous rupture of adrenal tumor. We performed exploratory laparotomy. An examination during surgery showed a rupture of adrenal tumor. En bloc resection of adrenal gland, tumor, and the kidney was performed. Pathological finding revealed the adrenal tumor was choriocarcinoma.     

Recurrent spontaneous bladder rupture. A case report

Spontaneous (non-traumatic) intraperitoneal rupture of the bladder in a 37-year-old pregnant woman was repaired at laparotomy. Nine months later she again presented with an intraperitoneal bladder rupture during pregnancy and fatal sepsis. Histological examination of the resected bladder wall showed acute ulcerative and necrotising cystitis. All patients with apparently spontaneous bladder rupture should undergo full urological evaluation to identify possible disease which might lead to recurrent rupture.     

Bilateral spontaneous rupture of achilles tendon secondary to limb ischemia: a case report.

A rare case of spontaneous bilateral rupture of the Achilles tendon of nontraumatic origin is described. The poor arterial circulatory status of both lower limbs of the patient was the only factor found to be a possible cause of this rupture.     

Rare presentation of a gastrointestinal stromal tumor with spontaneous esophageal perforation: A case report

INTRODUCTIONGastrointestinal stromal tumors (GISTs) of the alimentary canal are malignant tumors with <1% of cases diagnosed in esophagus. These cases require special consideration given their close proximity to vital structures and propensity to be highly aggressive. Management of patients with GISTs has been transformed since the introduction of tyrosine kinase inhibitors. In this report, we present an unusual case of GIST with spontaneous esophageal perforation.PRESENTATION OF CASEA 39-year-old Caucasian male presented to our hospital with complaints of severe chest and abdominal pain. A diagnostic chest radiograph revealed a moderate right-sided pleural effusion. Subsequently, an esophagram demonstrated a perforation proximal to an elongated stricture in the distal esophagus. A left thoracotomy was performed whereby a large mediastinal mass firmly attached to the esophagus and gastroesophageal junction was encountered. The neoplasm involved proximal one-third of the stomach and perforated into the right hemithorax. Histopathological evaluation of the tumor led to a diagnosis of GIST.DISCUSSIONGISTs of the gastroesophageal junction are uncommon and may rarely present with esophageal perforation. The standard of care for treating GIST at present includes tyrosine kinase inhibitors. This pharmacologic agent, along with improved surgical techniques and understanding of molecular markers for accurate diagnosis, will assuredly continue to improve overall survival of patients with GISTs.CONCLUSIONWhen stricture or achalasia is detected on imaging, GIST should be considered in the differential diagnosis for individual patients. Additionally, chest and abdomen CT scans of may be performed to confirm presence of a tumor mass, thereby ruling out achalasia.     

Case report of a young female with early presentation of spontaneous splenic rupture in infectious mononucleosis

Spontaneous splenic rupture is a well known, yet very rare complication of infectious mononucleosis with an estimated incidence of 0.06% to 0.5%. It primarily affects teenagers and young adults and is the leading cause of death in infectious mononucleosis. There is a 9% mortality rate associated with spontaneous splenic ruptures; in all lethal cases a rupture occurs within the first 10 days of symptoms onset from infectious mononucleosis. The present case report concerns a young female, who presented with abdominal pain, vomiting and positive Kehr’s sign two days after the onset of infectious mononucleosis symptoms. The patient was diagnosed with a spontaneous splenic rupture due to infectious mononucleosis and was treated operatively by laparotomy and splenectomy. The patient was successfully treated, and had no post operative complications.     

Right hepatectomy after spontaneous hepatic rupture in a patient with preeclampsia: A case report

IntroductionSpontaneous hepatic rupture associated with preecalmpsia or HELLP syndrome is a rare and life threatining event, only 200 cases have been reported in the literature.Presentation of caseWe present a case of a 31 year old female with 28 weeks of gestation that presented with acute abdominal pain, elevated blood pressure and altered liver enzymes an abdominal ultrasound that showed a subcapsular hematoma occupying the whole right lobe and free abdominal fluid, she required emergent laparotomy, C-section, hepatic packing, followed by angioembolization and finally right hepatectomy.Discussion and conslusionSpontaneous hepatic rupture due to preeclampsia or HELLP syndrome is a medical emergency, it requires a prompt and decisive treatment. Multiple treatment modalities are available, from simple hepatic packing to endovascular embolization, but in extreme situations a formal hepatectomy might be required.     

Spontaneous tracheal rupture: a case report

We report the case of a spontaneous posterior tracheal wall rupture following a cough. A 67-year-old woman with a history of longstanding treatment with corticosteroids (8 years) for Giant Cell Arteritis had general anesthesia for cataract removal. Surgery and anesthesia were uneventful. In the recovery room, the patient coughed and soon after developed subcutaneous emphysema of the neck. Chest radiography confirmed the clinical diagnosis of marked subcutaneous emphysema and showed huge pneumomediastinum and minor right pneumothorax. A thoracic CT scan revealed a large laceration of the posterior tracheal wall (a 4 cm longitudinal tear), extending from the middle of the trachea to the level of the carina. Surgical repair consisted in closure of the dilaceration using an autologous pericardial patch. It seems reasonable to suspect the facilitating role of connective tissue fragility due to chronic corticosteroid administration in the development of this tracheal rupture following cough. Tracheal rupture is a potentially lethal injury, which can be repaired successfully if the diagnosis is made early. Risk factors, diagnosis and principles of treatment of this lesion are discussed.     

Successful primary repair of late diagnosed spontaneous esophageal rupture: A case report

IntroductionSpontaneous esophageal rupture is rare, roughly 300 cases reported annually. Diagnosis is often delayed or missed. Overall mortality is about 20%. This feared high mortality rate has led to the misconception that primary esophageal repair should be avoided in late diagnosed patients. We report a successful primary repair of spontaneous esophageal rupture which was delayed for more than two weeks.MethodsA 53 year-old male presented to our medical service after falsely having been treated for pneumonia at an outside hospital. He was subsequently diagnosed with spontaneous esophageal rupture and treated with over the scope clips followed by stenting. Persistent leak into mediastinum made surgical exploration necessary. At exploration a primary repair could be performed successfully.ResultsUnsuccessful endoscopic management of esophageal perforation that was delayed for two weeks underwent primary surgical repair without complications.ConclusionPrimary closure of late diagnosed spontaneous esophageal rupture can be successful, even when it is complicated by a prolonged delay in treatment and failed endoscopic procedures. We conclude that primary surgical repair should be attempted in patients with spontaneous esophageal rupture if tissues are viable.     

Intraperitoneal spontaneous rupture of the bladder subsequent to irradiation of the uterus: a case report

We report a case of spontaneous intraperitoneal rupture of the bladder. A 54-year-old woman was admitted to our hospital with the chief complaints of severe lower abdominal pain, dysuria and macroscopic hematuria in October, 1985. In 1969, she had had a radical hysterectomy and postoperative irradiation for cancer of the uterus. Two years later she had undergone additional irradiation. On physical examination, the abdomen was tender with guarding and signs of peritonitis. Laboratory data revealed a blood urea nitrogen of 32.8 mg/dl and all electrolytes were normal. Excretory urogram showed normal upper urinary tract but irregularity of the bladder dome. Cystoscopy revealed acute inflammation of the bladder mucosa. Consequently, we made a presumptive diagnosis of radiation cystitis and she was treated with antibiotics and drip infusion. Within a week her general condition was improved and she had discharged. In June, 1986 she was admitted again with the same chief complaints as at her first admission. Cystoscopic findings showed a hole on the postero-superior wall and retrograde cystogram revealed an intraperitoneal rupture of the bladder. At exploration a necrotic bladder wall was resected and closed in 3 layers. The post operative course was uneventful.     

Hemorrhagic shock secondary to spontaneous rupture of a non-secretory adrenal cortical tumour: A case report

A 21-year-old female presented with left-sided loin pain and profound circulatory shock. After emergency laparotomy, angiography, embolisation and histological investigation, a diagnosis of spontaneous rupture of a benign non-secretory adrenal cortical tumour was made. To our knowledge, this is the only reported case of this diagnosis.