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The echocardiography revealed that the left ventricular keratosis had been surgically removed through ventriculotomy. The patient experienced mesenteric ischemia during hospitalization, and due to the initial presentation of severe abdominal pain, it is not uncommon for the patient to be diagnosed with mesenteric ischemia before referral. The patient had the following vital signs SPO
, 98%; BP, 96/63; PR, 91; RR, 19; and GCS, 10/15 and was treated in the intensive care unit.
Our case highlights the importance of diagnosis and on-time treatment of post-large left ventricular fibroid thrombosis complications.
Our case highlights the importance of diagnosis and on-time treatment of post-large left ventricular fibroid thrombosis complications.
Mediastinal mature teratomas are often benign, asymptomatic, and incidentally detected during routine chest roentgenography. Enzymes secreted by intestinal or pancreatic tissue in teratomas may lead to mediastinitis or the rupture of adjacent tissues. Herein, we present a case of a patient who experienced sudden onset of chest pain followed by the perforation of a mediastinal teratoma.
A 10-year-old boy presented with chest pain 2 days before admittance to the hospital. Chest radiography showed an anomalous mass shadow, and computed tomography showed an anterior mediastinal mass. Radiography revealed an increase in the mass shadow size and dullness of the left costal phrenic angle. Magnetic resonance imaging revealed pleural effusion and intratumoral haemorrhage, indicating perforation of the tumour. Emergency excision and thymectomy via sternotomy were performed. Pathology confirmed that the mediastinal tumour presented no immature or malignant elements.
In the present case, the onset of chest pain occurred 2 days before admission, and the initial computed tomography did not reveal tumour perforation. Subsequent chest radiography and magnetic resonance imaging indicated that the tumour had perforated. selleck kinase inhibitor Surgical tumour excision was planned at the time of admission; however, once perforation was confirmed, emergency surgery was performed. The pleural effusion had high cancer antigen 19-9 levels, and this was expected as the pleural effusion contained pancreatic digestive enzymes.
The perforation of a mediastinal mature teratoma cannot be predicted based on the symptoms, tumour size, or onset of pain alone. Once perforation is confirmed, surgical excision should be performed immediately.
The perforation of a mediastinal mature teratoma cannot be predicted based on the symptoms, tumour size, or onset of pain alone. Once perforation is confirmed, surgical excision should be performed immediately.
30 year old male with no significant past medical history presenting to the hospital with significant left-sided abdominal pain.
Patient was found to have a thrombus within the celiac artery for which he underwent a catheter assisted thrombolysis procedure. Hypercoagulable work-up revealed evidence of a JAK 2 V617F mutation which is indicative of Polycythemia Vera. The patient returned the following day with considerable left-sided flank pain associated with shortness of breath, nausea, and vomiting. CT performed showed evidence of an expanding left renal subcapsular hematoma. Patient was treated conservatively with IV fluids and pain medication before he was discharged hemodynamically stable after a few days.
Accessory renal vessels can be a rare finding coming of the celiac artery and so, care must be taken to evaluate vascular anatomy to avoid iatrogenic injuries; a bleed from one of these vessels could lead to the development of a hematomas, as seen with this patient.
Accessory renal vessels can be a rare finding coming of the celiac artery and so, care must be taken to evaluate vascular anatomy to avoid iatrogenic injuries; a bleed from one of these vessels could lead to the development of a hematomas, as seen with this patient.
Median arcuate ligament syndrome (MALS) is a rare condition in which the median arcuate ligament (MAL) causes compression of the celiac artery (CA) and plexus. Although 13-50 % of healthy population exhibit radiologic evidence of the CA compression, the majority remains asymptomatic. With or without symptoms, MALS have a risk of developing collateral circulation that leads to pancreaticoduodenal artery (PDA) aneurysms that have high risk of rupture. The treatment of MALS is the surgical release of the MAL. However, the necessity of ganglionectomy of the celiac plexus is still unclear.
A 60-year-old man with a ruptured PDA aneurysm caused by MALS was admitted to our hospital for an emergency. After treatment for the ruptured PDA aneurysm by transcatheter arterial coil embolization, he underwent elective laparoscopic MAL release in the hybrid operation room to check blood flow of the CA intraoperatively. The angiography of the CA immediately after MAL release without ganglionectomy of the celiac plexus showed the antegrade blood flow to the proper hepatic artery instead of the retrograde flow via the pancreaticoduodenal arcade. The postoperative course was uneventful and the follow-up computed tomography revealed no residual CA stenosis.
Unlike symptomatic MALS, it might be enough to just release the MAL without ganglionectomy of the celiac plexus for asymptomatic MALS, especially that with the treated PDA aneurysm.
Laparoscopic treatment of MALS in hybrid operating room could allow for adequate MAL release without ganglionectomy of the celiac plexus using the intraoperative angiography of the CA.
Laparoscopic treatment of MALS in hybrid operating room could allow for adequate MAL release without ganglionectomy of the celiac plexus using the intraoperative angiography of the CA.
Pericecal hernia is a rare type of internal hernia and may present with unspecific signs and symptoms. Thus, preoperative recognition of pericecal hernias can be challenging and difficult.
We present a case of pericecal hernia in a rare location that was managed laparoscopically. A 63-year-old medically free gentleman presented to the emergency room with clinical and radiographic evidence of small bowel obstruction. An abdominal computed tomographic scan showed diffuse small bowel dilation and a transitional zone at the distal illeal loop near the ileocecal junction. The patient was admitted and started on conservative management. Two days later, there was no improvement in the patient's situation, and the patient underwent laparoscopic exploration where part of the distal ileum was seen going through a mesenteric defect superior to the ileocecal valve. The herniated bowel was reduced, and the hernia orifice was closed with sutures. The patient was discharged at day 9 postoperatively with excellent clinical and radiographic findings during the postoperative period.
