scholarly journals Rapunzel syndrome: how to orient the diagnosis

2018 ◽  
Vol 10 (2) ◽  
Author(s):  
Enrico Finale ◽  
Piergiorgio Franceschini ◽  
Cesare Danesino ◽  
Michelangelo Barbaglia ◽  
Andrea Guala
Keyword(s):  
Surgical Intervention ◽  
Ectodermal Dysplasia ◽  
Clinical Suspicion ◽  
Clinical Diagnostics ◽  
Surgical Removal ◽  
Rare Form ◽  
Rapunzel Syndrome ◽  
History Of ◽  
Genetic Consultation

Rapunzel syndrome is a rare form of tricobezoar with a tail extending from the stomach into the small bowel; surgical removal is generally required. About 60 cases have been reported and described in the literature since 1968. We present the case of an 8-year-old girl who, during the course of a genetic consultation, was initially assigned with a clinical suspicion of ectodermal dysplasia. Surgical intervention, which resulted in the extraction of a tricobezoar of enormous size and extension, led us to the diagnosis of Rapunzel syndrome. The possibility of a tricobezoar should be considered in all cases of adolescent patients who present signs of intestinal occlusion or sub-occlusion, suffer from psychiatric disorders, and have a history of trichotillomania. Endoscopic methodology, medical imaging and clinical diagnostics are fundamental for a differential diagnosis. Psychiatric follow-up is advised to prevent recurrence.

scholarly journals Urinothorax Caused by Xanthogranulomatous Pyelonephritis

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Waiel Abusnina ◽  
Hazim Bukamur ◽  
Zeynep Koc ◽  
Fauzi Najar ◽  
Nancy Munn ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Obstructive Uropathy ◽  
Xanthogranulomatous Pyelonephritis ◽  
Robot Assisted ◽  
Rare Form ◽  
X Ray ◽  
History Of ◽  
Chest X Ray ◽  
Tract Infections

Xanthogranulomatous pyelonephritis is a rare form of chronic pyelonephritis that generally afflicts middle-aged women with a history of recurrent urinary tract infections. Its pathogenesis generally involves calculus obstructive uropathy and its histopathology is characterized by replacement of the renal parenchyma with lipid filled macrophages. This often manifests as an enlarged, nonfunctioning kidney that may be complicated by abscess or fistula. This case details the first reported case of xanthogranulomatous pyelonephritis complicated by urinothorax, which resolved on follow-up chest X-ray after robot-assisted nephrectomy.

scholarly journals A rare case of pancreaticopleural fistula patient presented in surgery OPD

2020 ◽  
Vol 11 (SPL4) ◽  
pp. 1329-1332
Author(s):  
Sajika Dighe ◽  
Raju Shinde ◽  
Sangita Shinde ◽  
Mohit Gupte
Keyword(s):  
Chronic Pancreatitis ◽  
Pleural Fluid ◽  
Pleural Cavity ◽  
Surgical Intervention ◽  
Fluid Collection ◽  
Clinical Suspicion ◽  
Treatment Modalities ◽  
Chest Drain ◽  
High Level

Pancreatico-pleural fistula is rare and infrequent complication of commonly occurring chronic pancreatitis leading to an extra-peritoneal abnormal connection between the pancreatic system and pleural cavity. Diagnosis needs high-level clinical suspicion to avoid delay in the diagnosis as the patient presents with respiratory distress rather than any abdominal symptom and produces large quantities of pleural fluid intractable of pleural tapping or chest drain. Diagnosis of the fistula is clicked by elevated pleural fluid amylase. Various imaging options are available with their unique importance like CECT, ERCP and MRCP. In a low resource, setup CECT becomes a useful modality to delineate the pancreatic parenchymal changes, pancreatic duct anatomy and fluid collection, thus aid in the diagnosis. Treatment modalities depending on structural anatomy of the duct and parenchymal destruction are either Medical, Conservative and Surgical. Here our patient presented with massive left sided pleural effusion resistant to surgical intervention secondary to chronic pancreatitis in a 28-year man later diagnosed as Pancreatico-pleural fistula on CECT. The patient underwent distal pancreatectomy with splenectomy with decortication of the lung with excision of PPF. The patient now is continuous follow-up for chronic pancreatitis and is symptom-free from last 2 years.

Ischemic Colitis and Stricture After Hemolytic-Uremic Syndrome

PEDIATRICS ◽  
1978 ◽  
Vol 61 (2) ◽  
pp. 315-317
Author(s):  
Hadi Sawaf ◽  
Marcia J. Sharp ◽  
Kum J. Youn ◽  
Patrick A. Jewell ◽  
Ali Rabbani
Keyword(s):  
Renal Failure ◽  
Hemolytic Uremic Syndrome ◽  
Sudden Onset ◽  
Late Complications ◽  
Surgical Removal ◽  
Review Of The Literature ◽  
Follow Up Studies ◽  
History Of ◽  
Uremic Syndrome

The hemolytic-uremic syndrome (HUS) was first described by Von Gasser et al.1 in 1955 as a syndrome of acute renal failure, hemolytic anemia, and thrombocytopenia in children. Follow-up studies on HUS have emphasized hypertension and uremia as late complications.2,3 A review of the literature has revealed no previously reported cases of persistent colitis and bowel stenosis after HUS. We present a child who continued to have intermittent intestinal obstruction and diarrhea until surgical removal of a segment of colon almost seven months after the onset of HUS. CASE REPORT A 26-month-old white boy who had no history of gastrointestinal disturbance had sudden onset of diarrhea with blood and mucus in the stool.

scholarly journals Paediatric oropharyngeal tularaemia requiring surgical intervention

2019 ◽  
Vol 12 (9) ◽  
pp. e229754
Author(s):  
Amina Nemmour ◽  
Adzreil Bakri ◽  
Claude A Fischer ◽  
Yves Brand
Keyword(s):  
Surgical Intervention ◽  
Cervical Lymphadenopathy ◽  
Who Guidelines ◽  
Clinical Progression ◽  
Delay In Diagnosis ◽  
History Of ◽  
Deep Neck Abscess ◽  
Extended Course ◽  
Specific Symptoms

Tularaemia is a rare infectious disease endemic in most European countries caused by the bacterium Francisella tularensis. 1 Patients often show acute non-specific symptoms, which causes a delay in diagnosis and proper treatment, potentially resulting in significant morbidities such as deep neck abscess, meningitis, endocarditis and septic shock. The authors present a case of a 5-year old boy with a 4-day history of fever, sore throat and painful cervical lymphadenopathy, whose clinical progression worsened despite being treated with recommended antibiotics as per WHO guidelines once the diagnosis of Tularaemia was confirmed by serologic tests. He developed a parapharyngeal abscess and a persistent left necrotic cervical lymph node, which both were surgically drained and excised, respectively, and an extended course of antibiotic was given. Subsequently, the patient fully recovered from the illness and the follow-up was negative for relapse.

scholarly journals Rapunzel syndrome causing partial gastric outlet obstruction requiring emergency laparotomy

2020 ◽  
Vol 13 (1) ◽  
pp. e232904
Author(s):  
Robert Lyons ◽  
Granit Ismaili ◽  
Michael Devine ◽  
Haroon Malik
Keyword(s):  
Ct Scan ◽  
Gastric Outlet Obstruction ◽  
Epigastric Pain ◽  
Outlet Obstruction ◽  
Postoperative Recovery ◽  
Emergency Laparotomy ◽  
Rapunzel Syndrome ◽  
History Of

A 16-year-old girl with a background of childhood trichophagia presented with a 2-day history of epigastric pain and associated anorexia with vomiting. An epigastric mass was palpable on examination. A CT scan revealed an intragastric trichobezoar, extending into the duodenum consistent with Rapunzel syndrome with evidence of partial gastric outlet obstruction and a possible perforation. The patient underwent an urgent laparotomy and extraction of the trichobezoar. The bezoar was removed without complication and no intraoperative evidence of perforation was detected. After an uncomplicated postoperative recovery, she was discharged home with psychiatric follow-up.

scholarly journals Clinical features and surgical outcome of patients with indolent brain tumors and epilepsy

2007 ◽  
Vol 13 (2) ◽  
pp. 65-69
Author(s):  
Julieta G. S. P. Melo ◽  
Ricardo S. Centeno ◽  
Suzana M. F. Malheiros ◽  
Fernando A. P. Ferraz ◽  
João N. Stávale ◽  
...  
Keyword(s):  
Brain Tumors ◽  
Seizure Frequency ◽  
Seizure Control ◽  
Slow Growth ◽  
Young Patients ◽  
Biological Behavior ◽  
Surgical Removal ◽  
Cortical Gray Matter ◽  
History Of

INTRODUCTION: In this study the authors review the outcomes of 22 patients with medically refractory epilepsy and slow growth brain tumors. OBJECTIVES: Evaluate the clinical, electrophysiological, operative, and histopathological features. PATIENTS AND RESULTS: The majority of the tumors were located in the temporal lobe (n = 20) and involved the cortical gray matter. The most frequent tumors were gangliogliomas (n = 9), astrocytomas grade I and II (n = 6), dysembryoplastic neuroepithelial tumors (n = 5) and ganglioneuroma (n = 2). The biological behavior of the tumors was strikingly indolent, as indicated by a long preoperative history of chronic seizures (mean, 14 years). Mean follow-up time after resection was 27 months, and according to Engel’s classification, 85% were seizure-free, 10% showed a reduction of seizure frequency of at least 90%, and 5% had reduction in seizure frequency at least 75%. CONCLUSION: The data indicate that neoplasms associated with pharmacoresistent epilepsy constitute a distinct clinicopathological group of tumors that arise in young patients, involve the cortex, and exhibit indolent biological behavior for many years. Complete surgical removal of these tumors, including the epileptogenic area, can achieve excellent seizure control.

scholarly journals Non-operative Management of Posterior Shoulder Instability: An Assessment of Survival and Predictors for Conversion to Surgery at 1 to 13 Years After Diagnosis

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0009
Author(s):  
Jarret Murray Woodmass ◽  
Julia Lee ◽  
Nick R. Johnson ◽  
Christopher L. Camp ◽  
Diane L. Dahm ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Radiographic Progression ◽  
Surgical Intervention ◽  
Cox Proportional Hazards ◽  
Posterior Shoulder Instability ◽  
Late Failure ◽  
Posterior Shoulder ◽  
Increased Risk ◽  
History Of

Objectives: Among patients treated non-operatively for 1 year following a diagnosis of posterior shoulder instability (PSI), little is known about the the incidence of surgery between 1-13 years after injury. The purpose of this study is to define the frequency and evaluate the factors predictive for late surgical intervention of symptomatic PSI. Methods: This study included a population-based cohort of 115 patients (14 females, 101 males) diagnosed with PSI between January 1994 and July 2012 with a minimum 5-years follow-up (mean:13.9 years; range: 5-23 years). Landmark survival analysis was performed to evaluate incidence of surgery after 1 year. Survival was estimated using Kaplan Meier method and predictors of late surgical intervention were analyzed using Cox proportional hazards regression. Results: A total of 61/115 (53%) patients were treated non-operatively for 1 year following diagnosis of PSI. Of these, 24/61 (39%) converted to surgery for symptomatic PSI. The overall survival free of surgery at 1 and 5 years was 53.0% (95% CI 434.7-63.0) and 37.1% (95% CI 29.1-47.1), respectively. BMI >35 (p=0.04, HR 3.3) was predictive for late conversion to surgery. Age, gender, occupation, or history of glenohumeral dislocation were not significant. Assessing surgery as a time dependent covariate, a patient undergoing surgery was at an increased risk for radiographic progression of osteoarthritis (p=0.02, HR=4.0, 95% CI 1.2-13.2). Conclusion: Conservative management was performed for at least one year in over half of patients diagnosed with PSI. However, long-term follow-up demonstrates that nearly 40% of these patients eventually require surgery. Increased BMI was predictive for late failure of while age, gender, history of dislocation and occupation did not show an effect. Patients who underwent surgery were at an increased risk of radiographic progression of arthritis.

Endodontic Therapy and Surgical Excision of a Chronic Suppurative Osteomyelitic Lesion in a Horse: A Case Report

1996 ◽  
Vol 13 (4) ◽  
pp. 145-148 ◽  
Author(s):  
Steven D. Baerg ◽  
David A. Russell ◽  
Laura M. LeVan ◽  
Carl A. Kirker-Head
Keyword(s):  
Eating Habits ◽  
Surgical Excision ◽  
Maxillary Incisor ◽  
Surgical Removal ◽  
Mandibular Incisor ◽  
Surgical Extraction ◽  
History Of ◽  
Functional Position

A 22 year old thoroughbred gelding was presented for evaluation and treatment of chronic dental disease. The horse had a history of quidding and abnormal bit behavior. Intraoral examination revealed signs of chronic generalized gingival inflammation and severe dental caries affecting the maxillary and mandibular incisor teeth. Treatment was provided on two separate visits over an interval of four months. The first visit consisted of the surgical extraction of three unrestorable incisor teeth and restoration of six carious maxillary incisor teeth. The second visit consisted of conventional endodontic therapy on the remaining mandibular incisor teeth and the surgical removal of a chronic suppurative osteomyelitic lesion. Immediate and long term improvements in eating habits were noted. Three month follow-up examinations following completion of treatment have shown the teeth to be in functional position, the restorations intact, and the surgical site well healed.

scholarly journals Rapunzel syndrome resulting in gastric perforation

2016 ◽  
Vol 98 (1) ◽  
pp. e6-e7 ◽  
Author(s):  
JS Parakh ◽  
A McAvoy ◽  
DJ Corless
Keyword(s):  
Gastric Perforation ◽  
Postoperative Recovery ◽  
Patch Repair ◽  
Free Fluid ◽  
Proximal Jejunum ◽  
Rapunzel Syndrome ◽  
Omental Patch ◽  
History Of ◽  
Entire Stomach

We report the case of an 18-year-old female patient with no past medical history who presented to the emergency department with acute abdominal pain and vomiting on the background of a long history of ingesting hair (trichophagia). Computed tomography revealed pneumoperitoneum and free fluid in keeping with visceral perforation. In addition, a large hair bolus was seen extending in contiguity from the stomach to the jejunum. A laparotomy was performed, revealing an anterior gastric perforation secondary to a 120cm long trichobezoar, which had formed a cast of the entire stomach, duodenum and proximal jejunum. The bezoar was removed and an omental patch repair to the anterior ulcer was performed. The patient made an excellent postoperative recovery and was discharged home with psychiatric follow-up review.

scholarly journals Cervical Spine Myelopathy from Metalloma Association with Chronic Retention of a Bullet

2021 ◽  
Author(s):  
Piyawat Bintachitt ◽  
Ratanaphorn Chamnan ◽  
Weera Chaiyamongkol ◽  
Wongthawat Liawrungrueawng
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Gunshot Wound ◽  
Foreign Bodies ◽  
Surgical Removal ◽  
History Of ◽  
Spine Fixation ◽  
Cervical Spine Fixation ◽  
Cervical Spine Myelopathy

     A Civilian gunshot wound associated with metallosis in the cervical spine region was an extremely rare case; hence, the clinician had difficulty with diagnosis and surgical treatment.      A 57–year-old gentleman had a history of a gunshot wound injury going back 30 years. He presented with neck pain, progress of paresthesia of upper extremities and progressively difficult ambulation for 3 months. Radiographic and pathological diagnosis from tissue of the 7th paravertebral of the cervical spine showed foreign bodies consistent with metallosis. The patient showed improvement of symptoms after posterior cervical spine fixation and decompression. He had full recovery at 1 year follow up.      Metallosis can occur in cases of chronic exposure to lead and metals. The results of this chronic process of metallosis will develop to metalloma, which then compresses the spinal cord and develops into myelopathy. The patient had a bullet, or piece of metal at the cervical spine, so surgical removal was performed to prevent further compression of the spinal cord from metalloma.

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