Atypical enteritis causing life-threatening pneumatosis intestinalis in a dog – radiographic and ultrasonographic findings

A geriatric dog was presented for acute vomiting, anorexia and lethargy. Abdominal ultrasound was suggestive of the presence of gas within the small intestinal walls. Additional abdominal radiographs confirmed the ultrasonographic abnormalities, compatible with pneumatosis intestinalis. Explorative laparotomy revealed hemorrhagic lesions, thickened intestinal walls and serosal discoloration of the jejunum. Partial jejunectomy was performed and histopathology showed findings compatible with atypical bacterial enteritis. The dog recovered completely and did not show any clinical signs during a follow-up period of one year after surgery.

Follicular lymphoma in a patient with splenosis: a case report

Splenosis refers to the seeding of splenic cells associated with surgery or trauma. Splenosis mimicking other diseases has been reported in the literature. To the best of our knowledge, this is the first case of follicular lymphoma in a patient with splenosis whose diagnosis of lymphoma was delayed because of a known history of splenosis. We report a 48-year-old male patient who underwent splenectomy because of injury from a high fall 20 years previously. He had no symptoms other than mild abdominal pain until 2 years previously, which was thought to be associated with splenosis. When his symptoms began to increase, he had explorative laparotomy for diagnosis, which was later confirmed as follicular lymphoma. Splenosis may delay the diagnosis of other conditions that can be underestimated. Clinicians should be aware of unusual symptoms in patients with splenosis.

Outcome of endovascular revascularisation in patients with acute obstructive mesenteric ischaemia - a single-centre experience

Summary: Background: Acute embolic or thrombotic mesenteric ischaemia (AMI) is a rare but life-threatening clinical condition. Despite diagnostic and therapeutic advances, the mortality rate remains high, between 60 % and 90 %. Over the last years revascularisation was increasingly performed by endovascular techniques. The aim of this study was to retrospectively analyse the clinical outcome of catheter-directed thrombolysis (CDT) and aspiration thrombectomy (AT) in patients with AMI with regard to technical success, intervention-related complication rate, need for secondary abdominal surgery, clinical course and 30-day mortality rate. Patients and methods: Thirteen patients (4 men, 9 women; mean age 74.5 ± 17 years) with 12 embolic and one thrombotic occlusion of the superior mesenteric artery (SMA) underwent emergent endovascular revascularisation of SMA. Clinical data including all imaging reports, laboratory analysis and follow-up data were derived from the electronic patient file and images were reviewed on a Picture Archiving and Communication System. Results: Eleven patients (n = 11; 84.6 %) underwent CDT and AT, and two patients (n = 2; 15.4 %) had AT alone. Technical success with complete restoration of SMA perfusion was achieved in 38.5 % (n = 5). Adjunctive angioplasty ± stenting was mandatory in 2 patients. Overall, the intervention-related complication rate was 38.5 %. In total, 46.2 % (n = 6) clinically improved following the intervention, while 38.5 % required explorative laparotomy after the intervention, with 2 colectomies and 2 small bowel resections. Overall, the 30-day mortality rate was 30.8 %. Conclusions: Endovascular revascularisation with CDT in combination with AT is feasible, with a technical success rate of 38.5 % (n = 5). Endovascular revascularisation was beneficial for 46.2 % (n = 6) of the patients, who clinically improved following the intervention. The need for secondary explorative laparotomy was rather low, with 38.5 % (n = 5) of the patients. The 30-day-mortality remains high with 30.8 %.

A rare case of benign omentum teratoma

Introduction. Mature teratomas (benign cystic teratomas or dermoid cysts) are among the most common ovarian tumours; however, teratomas of the omentum and mesentery are extremely rare. Teratoma in the intraperitoneal cavity is uncommon and atypical, and it is even more uncommon in adulthood. Case Outline. An 82-year-old female was admitted to our department with clinical signs of abdominal tumour. The ultrasound scan and preoperative laboratory tests were done. Explorative laparotomy revealed tumour with torsion on its pedicle at the greater omentum. After removal of the mass and the incision a tooth and hair were found, characteristics of teratoma. Conclusion. The excision was very effective and also definitive treatment for this case. The patient recovered well and was discharged 3 days later. The patient probably carried the tumour all her life asymptomatically until admission.

Primary Pancreatic Anaplastic Large Cell Lymphoma, ALK-: A Care Report.

INTRODUCTION: Primary pancreatic lymphomas constitute less than 0.5% of pancreatic malignancies and less than 2% of extranodal lymphomas. Primary pancreatic anaplastic large cell lymphomas (PPALCL) are extremely rare. AIMS-METHODS: To present an extremely rare case of PPALCL RESULTS: An 80-year-old man, who was under evaluation of a fever of unknown origin in a Private Health Center, was admitted to our Clinic for further investigation. He noted anorexia, weight loss and fatigue. On physical examination, he had a leg edema. His blood tests were unremarkable except for normochrome normocyte anaemia (Ht 31%, Hb 9,9 g/dl) and a great elevation of ESR (110 mm), LDH (1880 U/L)and β2-microglobulin (4,19 mg/L). In CT and MRI scan, available from patient’s file, a soft tissue mass located in the pancreas, especially the uncinate process and a slow signal flow of inferior vena cava, due to mass compression, had been observed. He had undergone a normal gastrointestinal endoscopy at that time whereas a new endoscopy, after his admission to us, revealed an ulcerated mass-like deformity of the duodenal bulb with a friable surface. Explorative laparotomy confirmed a diffuse spread of an unresectable malignant mass of the pancreas extending to the adjacent organs. Biopsy specimen was taken from the adhesion of pancreatic surface and gastric serosa, because of the brittle consistency and and necrotic surface of the mass. The duodenal and surgical biopsy results identified an ALCL of T-cell lineage, ALK negative. Bone marrow biopsy showed no evidence of lymphoma involvement. Chemotherapy treatment was not initiated because he died in Intensive Care Unit two days after the explorative laparotomy, due to hemodynamic instability. CONCLUSIONS: Our case supports that primary pancreatic lymphoma should be a high diagnostic possibility in a patient with a pancreatic mass accompanied by elevated LDH and β2-microglobulin. Biopsy specimens’ results, from the mass or the adjacent infiltrated organs, confirm the diagnosis, identify the lymphoma and lead to an appropriate and timeable treatment.

Tertiary blast injury to the intestines

Background. To present the first case of the tertiary blast injury to the intestine, and the tertiary blast injury in general. Case report. A parachutist of the Army of Serbia and Montenegro was injured when descended from the 1 200m height by parachute which did not expand. The force of stroke to the ground, caused the reactive transfer of energy and the subsequent blast injury to the intestine. After 24 hours, the secondary perforation of the small intestine, contusioned by the blast, developed which was the indication of explorative laparotomy. The resectioned small intestine showed the histologic characteristics of a blast injury, so the tertiary blast injury was diagnosed on the basis of these and of the mechanism of the injury. Conclusion. Tertiary blast injuries fall into the group of indirect blast injuries. The only difference between indirect injuries as compared to direct ones, is in the manner of inflicting, otherwise the traumatic mechanisms are alike, and include the transfer of the energy of stroke through the tissue of different density.