International Journal of Clinical Research
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A Case Report: Rare Case of Gallbladder Carcinoma Misdiagnosed as Pancreatic Adenocarcinoma in a 5 Week Pregnant Female Patient
No full textBackground: Gallbladder carcinoma is the fifth most common gastrointestinal malignant neoplasm and the most frequent malignant tumor of the biliary tract. It has a poor prognosis, with a 50% 1-year survival rate for patients with stage 1 disease. Unfortunately, this rare disease usually presents at a more advanced stage, with a 5-year survival rate of only 5%.
Case Presentation: The present study describes a case of gallbladder adenocarcinoma presenting in a 34 years old female patient of 5 weeks gestational age in the form of a right upper quadrant pain radiating to the back. The patient had no known history of gallstones, cholecystitis, chronic H. pylori infection or other risk factors. Being 5 weeks pregnant, imaging was first restricted to an abdominopelvic ultrasound and MRI without contrast, which revealed a peri-duodenal-pancreatic mass. There was a high suspicion of pancreatic tumor after an endoscopic ultrasound FNA had revealed an adenocarcinoma, on pathology. It was only after opting for a Whipple procedure that pathology revealed that the primary tumor was a gallbladder adenocarcinoma with an 8 cm peri-pancreatic mass, represented by a poorly-differentiated adenocarcinoma, that probably developed within a lymph node. Fortunately, the patient presented early and resection was successfully performed. She is following-up with oncology for chemotherapy.
Conclusions: The purpose of this report is to highlight a rare disease occurring in a young pregnant patient, and how it was misdiagnosed as a pancreatic adenocarcinoma due to the involvement of the peri-pancreatic lymph node, the results of the EUS guided FNA, and of the preoperative imaging studies
A Case Report: Case of Megacolon due to Bowel Intussusception in an Elderly Patient
Get PDFIntroduction: Intussusception is the telescoping of a proximal segment of the gastrointestinal tract into the lumen of the more distal segment. A rare but still encountered entity, bowel intussusception, is a surgical emergency that should not be taken lightly. Although it is common in those under two years of age, it is one of the less likely diagnoses in adult populations, with only 5% of all cases occurring in adults.
Case Presentation: We report the case of an 86-year-old gentleman who presented to the Emergency Department (ED) complaining of abdominal distension. An abdominopelvic CT scan with IV contrast showed evidence a transition point at the level of the sigmoid, with a small bowel of normal caliber and a homogenously dilated colon reaching 16 cm in its largest diameter. An exploratory laparotomy was opted for during which a colectomy was performed. Pathology results revealed chronic sigmoidal diverticulitis causing severe luminal narrowing with moderate chronic nonspecific inflammatory changes and acting as a lead point for intussusception, thus leading to obstruction, and megacolon.
Conclusion: Intussusception is a challenging entity in terms of diagnosis and treatment when it occurs in adults. Clinical symptoms are usually nonspecific and imaging features are variable, making the preoperative diagnosis often missed or delayed. Up to 20% of cases are idiopathic, with the rest being secondary to an organic cause that must be determined for proper management. Laparotomy remains the best way to diagnose adult intussusception and to determine any underlying pathology for adequate treatment
A Case Report: First Report of a Primary Breast Leiomyosarcoma with Lymph Node Metastasis in Lebanon
Get PDFBackground: Primary leiomyosarcoma (LMS) of the breast is an extremely rare histologic subtype of malignant breast tumors. While breast sarcomas account for 0.0006% of all breast malignancies, primary leiomyosarcoma constitutes only 5-10% of breast sarcomas themselves. To date, the total number of reported cases in the literature is less than 70 cases with the first case reported in 1968. This is, to the best of our knowledge, the first case reported from Lebanon, with only 2 cases previously reported in the Middle East, specifically in Morocco.
Case Report: We report the case of a 48-year-old, white, previously healthy female patient, presenting for a breast mass. She first noticed it three months prior to presentation in her left breast and reports that since then, the lump has been growing and her breast has become more painful and erythematous over time. Physical examination revealed an immobile and tender mass of around 12 cm in diameter. A core biopsy was done followed by a left modified radical mastectomy with lymph node dissection. Pathology of the specimen showed a tumor composed of spindle cells arranged in fascicles invading the dermis, with irregular nuclei and prominent nucleoli. Immunohistochemical staining confirmed the diagnosis of high-grade leiomyosarcoma.
Conclusion: We presented this case of leiomyosarcoma with lymph node metastasis to contribute to the scarce literature regarding this disease. Due to the rarity of this diagnosis, not enough data exists regarding treatment and prognosis. Physicians need to review the literature for relevant cases to achieve the best outcome for their patients.
Keywords: breast mass, leiomyosarcoma, rare, case report, breast sarcomas, lymph nod
A Case Report: Rare Presentation of Intracranial Hemorrhage post Guillain Barré Syndrome
No full textBackground: Guillain Barre Syndrome (GBS) is an autoimmune disease where antibodies attack the myelin sheath of peripheral nerves. The hallmark of the disease includes symmetrical quadriparesis, respiratory distress, and failure with subsequent need for mechanical ventilation. Most cases occur after a viral or bacterial infection. Other causes, such as intracranial hemorrhage, also exist, and several case studies report an association between these two pathologies.
Case Report: In this report, we present the case of an elderly male patient with intracranial (IC) bleeding post-GBS. The patient was admitted to the hospital for dyspnea and diagnosed with pneumonia. When he started complaining of progressive bilateral ascending paralysis of his lower extremities, we performed a lumbar puncture, and he was diagnosed with GBS. We started him on intravenous immune globulins (IVIGs) immediately, but his weakness progressed to include his respiratory muscles, and he required mechanical ventilatory support with Intensive Care Unit (ICU) admission. We extubated him after two weeks, but he needed to be reintubated 24 hours later for a severely decreased level of consciousness. An urgent computed tomography scan of the brain showed IC bleeding. The patient developed a septic shock due to his pneumonia, which was refractory to antibiotics and vasopressors. He passed away a few weeks after that.
Conclusion: Our case represents a unique type of association between IC hemorrhages and GBS, where the bleeding occurred several days after, as opposed to before GBS. It also reinforces the correlation between GBS and Intracranial bleeding and stresses the importance of having a high index of suspicion when facing either pathology since both have similar symptoms that may overlap or mask each other
A Case Report and Literature Review: Grape Seeds Causing Meckel’s Diverticulitis, Perforation and Small Bowel Obstruction in a Young Adult Patient
No full textBackground: Meckel’s diverticulum is a true diverticulum consisting of a 3-layered outpouching of the bowel wall along the antimesenteric border. It is a remnant of the omphalomesenteric duct and the most common congenital gastrointestinal disorder. It has a male predilection and remains asymptomatic in the majority of cases. It constitutes a diagnostic challenge to physicians, as it can present with gastrointestinal bleeding in the pediatric population, and as an intestinal obstruction in adults. While the management of an asymptomatic Meckel’s diverticulum is on a case-by-case basis, when symptomatic, prompt surgical intervention is necessary, and a laparoscopic approach allows both in-situ diagnosis and treatment.
Case Report: A 23-year-old previously healthy female patient, presented with diffuse abdominal pain, vomiting, and obstipation. Abdominal X-Ray and abdominopelvic Computed Tomography showed an intra-abdominal inflammatory process and evidence of bowel obstruction but were not conclusive. The patient was admitted to the hospital for management, and on the third day of hospitalization physical examination showed abdominal guarding suggestive of peritonitis. An urgent exploratory laparotomy identified a Meckel’s Diverticulum obstructed with phytobezoar grape seeds, and an inflamed and perforated bowel wall, with adhesive bands to proximal small bowel loops, necrosis, and resultant small bowel obstruction. We resected the Meckel’s diverticulum and the necrotic bowel and performed an end-to-end primary anastomosis of the small bowel. The postoperative course was uneventful, and the patient was discharged on the fourth postoperative day.
Conclusion: The diagnosis of Meckel’s diverticulum remains a challenge as it has a myriad of clinical presentation and radiological imaging sometimes fails to provide a definite diagnosis. It must be systematically included in the differential diagnosis of small bowel obstruction in adult patients, as it requires prompt surgical intervention for both diagnosis and treatment
A Case Report: Wandering Spleen in a Young Primiparous Woman Treated by Laparoscopic Splenectomy
No full textBackground: Wandering spleen (WS) is an uncommon splenic disorder defined as the displacement of the spleen from its usual anatomical position. It is most prevalent in females in their reproductive age. It can be encountered incidentally or may present with symptoms. Risks of complications exist and vary with the presentation. Several imaging techniques are able to define it clearly preoperatively. Laparoscopic surgery is the definitive diagnostic and therapeutic method.
Case Report: A 24-year-old pregnant female patient presented to the Emergency Department complaining of intermittent dull abdominal pain and pelvic heaviness for 9 days. Contrast- Enhanced Computed Tomography and a color Doppler sonography of the abdomen and pelvis showed a large-sized spleen in the pelvis corresponding to a diagnosis of WS, without ischemic signs. The patient underwent a laparoscopic splenectomy and was vaccinated for Haemophilus influenza, meningococcus, and pneumococcus postoperatively. The post-operative period was uneventful, and the patient later delivered a full-term baby girl by a Cesarean section.
Conclusion: This is, to the best of our knowledge, the second reported case of laparoscopic splenectomy in a pregnant patient with WS. While splenopexy is associated with better outcomes, splenectomy seems to be preferred in pregnant patients, who may undergo a vaginal delivery, but guidelines and data are still scarce regarding the management of WS in pregnancy. Vaccination against encapsulated bacteria is required in case of splenectom
A Case Report: Fatal Case of Disseminated Tuberculosis in a 24-year-old Male Patient with Crohn’s Disease
Get PDFIntroduction: Cohn’s disease (CD) is an idiopathic disorder involving the GI tract. The differential diagnosis of CD is broad and includes infectious colitis, ulcerative colitis intestinal TB (iTB), etc. Due to the lack of standards in a definitive diagnosis, discrimination between iTB and CD has long been a diagnostic challenge.
Case presentation: A 24-year-old male patient, known to have Crohn’s disease, treated with daily prednisone 60 mg and mesalamine since 1 week (due to a flare-up), presented for 2 days history of severe exacerbating diffuse abdominal pain, along with generalized weakness, weight loss, watery diarrhea, vomiting, decreased oral intake, and high-grade fever (39 °C). An urgent abdominopelvic CT scan with IV contrast showed significant pneumo-peritoneum and minimal fluid distributed inside the abdomen, denoting bowel perforation. The patient underwent an urgent laparotomy. Intraoperative findings were an abdominal cavity full of fecal material, multiple small bowel perforations, and entero- enteric fistulas. 1.5 meters of the small intestine was resected. Pathology showed iTB. TB PCR of deep tracheal aspirate was positive as well. The patient was started on anti-TB treatment for disseminated tuberculosis affecting the lungs and GI tract. Unfortunately, the patient developed a septic pulmonary embolism on day 7 post-op and was announced dead on day 9.
Conclusion: Our case emphasizes that the two chronic granulomatous diseases (CD and iTB) have similarities that make the distinction between them difficult and yet crucial because of possible repercussions of a misdiagnosis. It also highlights the importance of latent TB screening before starting the confirmed CD immunosuppressive treatment especially in underdeveloped countries, as the patient could have a reactivation of latent TB upon initiation of immunosuppressive therapy
A Case Report: An Unusual Presentation of Purple Urinary Bag Syndrome
No full textBackground: The Purple Urinary Bag Syndrome (PUBS) is an uncommon and under-reported syndrome. It results from the purple discoloration of urine by tryptophan-oxidizing bacteria in a favorable alkaline milieu and usually affects patients with indwelling catheters. Other risk factors include female gender, chronic constipation, tryptophan-rich diet, and cognitive impairment. Although asymptomatic in the majority of cases, PUBS may be the sole and earliest sign of an aggressive urinary tract infection, especially in elderly patients where the presentation may be atypical and associated with resistant organisms, such as Pseudomonas aeruginosa and Vancomycin-resistant Enterococci (VRE). Proper treatment consists of catheter replacement and antibiotic therapy, which is indicated only in the setting of symptomatic infections.
Case Presentation: We report an unusual presentation of PUBS in a 79-year-old male patient with no classical risk factors. The patient had a supra-pubic catheter for urinary retention secondary to urethral strictures. Every month, by the time of catheter exchange, the patient developed an asymptomatic purple discoloration of the urinary bag, which was not investigated until he presented at our facility. Urine analysis revealed acidic urine. Appropriate antibiotic therapy was initiated after the development of urinary symptoms, and the catheter was replaced. No recurrent urine discoloration occurred.
Conclusion: This case represents the rare occurrence of PUBS in the setting of a suprapubic catheter in a male patient. It also highlights that even in atypical presentations, antibiotic therapy should be tailored to the clinical status of the patient and not the mere presence of bacteriuria. Raising awareness about this “esoteric” syndrome is essential for early diagnosis and proper management
DOs and DON’Ts in Ophthalmology during the COVID-19 Pandemic: Editorial
No full textThe recent pandemic caused by SARS-CoV-2 has spanned continents, races, and social constructs. It has caused mortality and morbidity around the world and left those unaffected, or unknowingly so, with constant anxiety from contracting the virus by one means or another. As such, habits have changed, roads have emptied, and hospitals have been overwhelmed. One of the first whistleblowers who tried to alert the medical community to a possible new outbreak was a young ophthalmologist in Wuhan, China, who unfortunately contracted the disease and died in February 2020. The following editorial aims to improve care in ophthalmology during the pandemic
Displaced Femoral Neck Stress Fracture in a 7-year-old Child: A Case Report
Get PDFBackground: Stress fracture of the femoral neck is rare in children. Its differential diagnosis includes muscle strain, synovitis, infection, dysplasia, etc. Since physicians rarely see this type of fracture in children, they often overlook it or misdiagnose it.
Case Report: A seven-year-old girl presented to our service with right groin pain following a fall on her right hip 15 days ago. Pelvic and knee radiographs of her right limb showed a fracture line with sclerosis at the femoral neck. Magnetic-resonance imaging (MRI) confirmed the diagnosis of a stress fracture of the femoral neck. We opted for conservative management and gave the patient analgesics and limited weight-bearing with the help of crutches for eight weeks. Three weeks after her first visit, the patient presented with severe limping and inability to bear weight on her right leg. Right hip radiographic imaging showed a varus displaced fracture of the femoral neck, which we managed surgically with an open reduction and internal fixation using plate and screws, followed by immobilization of the right hip with a hip spica cast. Six weeks following the surgery, the patient had no complaints, and the radiographic images showed an appropriate reduction and signs of union. The patient was allowed to start partial weight-bearing for a further six weeks before proceeding to full weight-bearing.
Conclusion: Our case emphasizes the importance of considering femoral neck stress fracture in children, through a thorough clinical evaluation and imaging analysis, especially for those carrying classical risk factors. Failure to do so can complicate the disease course and may lead to a displaced fracture requiring more invasive and timely management