Use of Accessible Blood Filter for Post-operative Cell Salvage in Cardiac Surgery

The availability of centrifugal cell savers supports intraoperative cell salvage and thereby reduces the need for allogeneic red blood cell transfusion. Use of these devices, however, is limited to the operating room, forcing a switch to allogeneic products in the post-operative setting. Here we present a case of massive post-operative bleeding due to severe coagulopathy following CABG. Due to the lack of availability of donor blood products a novel blood filter (HemoClear BV, Zwolle, the Netherlands) was used for post-operative salvage. Because of its accessible use, we believe this salvage device has great clinical value in the poor-resource setting.

Review of Management of Ileosigmoid Knotting

Ileosigmoid knotting (ISK) is a rare type of intestinal obstruction caused by knotting of the mesentery of the ileum or sigmoid colon that rapidly progresses to gangrene with a high risk of mortality and high morbidity. The incidence of ISK is not well established, but it is higher in regions with high rates of sigmoid volvulus and in countries along the sigmoid belt. Clinical presentation is that of both small-bowel and large bowel obstruction and includes vomiting and nausea, abdominal pain, tenderness, and distention, with constipation. A contrast-enhanced computer tomography (CT) scan is the preferred modality for imaging. Management involves hemodynamic stabilisation with correction of shock using aggressive fluid resuscitation, electrolyte balance and commencement of antibiotics. Principles of surgery include resection of the knot, resection of the gangrenous bowel and establishing intestinal continuity. The outcome is generally complicated by peritonitis and sepsis that lead to mortality.

Intra-Abdominal Malignant Solitary Fibrous Tumor with Peritoneal Dissemination: A Case Report

Solitary fibrous tumor (SFT) is a rare mesenchymal tumor primarily found in the pleura, with occasional presentations in extra-pleural locations. SFTs are typically diagnosed based on compressive symptoms due to their large size. Most SFTs are benign with a low recurrence rate, with an overall good prognosis with an overall 5-year survival of over 90%. Approximately 12-22% of SFTs are malignant and are associated with a higher recurrence rate of up to 78%. Given the low incidence and sparse case series literature, no adjuvant therapies have demonstrated a survival benefit. We present the first case of abdominal malignant SFTs with peritoneal dissemination, describing the presentation, histopathology, treatment planning and surveillance.

A Case of Pericardial Tamponade Caused by Abdominal Knife Stab Injury

This paper reported a case of pericardial tamponade, caused by the blood from abdominal organ injury, which flowed through the diaphragm and pericardial holes into the pericardium. Liver injury, gastric injury, pancreatic injury, diaphragmatic break were found by the following laparotomy exploration.

A Case Report on a Pancreatic Enigma: Metastatic Solid Pseudopapillary Neoplasm

Introduction: Solid pseudopapillary neoplasm is a unique enigmatic disease typically affecting young females. Being a low-grade neoplasm surgical resection is often curative. Rare cases (5-15%) present with distant metastasis. Only 2% has lymph nodal metastasis. This is a case report of metastatic SPN with both visceral and lymph nodal involvement. The work has been reported in line with the SCARE criteria. Case Presentation: The authors present a case of metastatic SPN in an 18-year-old female who came with an abdominal lump. Contrast enhanced CT abdomen findings were in favour of huge SPN arising from pancreatic tail. The prime concern was the coexistence of bilobar liver metastasis predominantly involving right lobe. The complexity of surgical resection along with metastatectomy in a young female was herculean. This clinical dilemma was tackled with staged resection. Conclusion: Even in metastatic SPN a reasonable survival can be achieved by surgical debulking. We emphasize the importance of aggressive approach in operable metastatic SPN.

Acute Lumbar Paraspinal Compartment Syndrome after a Tug of War: A Case Report and Review of the Literature

Compartment syndrome of the upper and the lower extremities is a well-known entity in emergency medicine and traumatology. However, compartment syndrome of the paraspinal musculature is a very rare cause of acute back pain and may be missed at presentation despite its clinical importance. Therefore, we present a case of paraspinal compartment syndrome embedded in an overview of the actual literature. A 21- year-old woman presented with acute back pain refractory to analgesia with opiates after a tug of war match. A CT-scan of the abdomen demonstrated paraspinal swelling and an MRI ruled out intra-spinal pathologies. A compartment measurement yielded a pressure of 135mmHg. Even though conservative treatment attempts are often described, an emergency fasciotomy was carried out. Further rehabilitation was uneventful. Nevertheless, the timing of fasciotomy in the paraspinal region is under discussion, especially due to very rare experiences. Even if surgery is delayed by more than 24 hours following symptom onset, favourable postoperative outcomes have been observed.

Mastoiditis and Tegmen Tympani Defect Leading to Intracranial Abscess with Actinomyces odontolyticus

Introduction: Central nervous system (CNS) actinomycosis typically presents from the local spread of infection via the ear, sinus, or cervicofacial region, resulting most commonly in abscesses. Only one other case report reports on cerebral abscess with Actinomyces odontolyticus. Presentation of Case: A 60-year-old male presented with cognitive impairment and speech difficulties. Imaging revealed a cerebral abscess in the left temporal lobe causing significant mass effect and uncal herniation. Bony erosion was noted along the middle cranial fossa with fluid attenuation of the middle ear and mastoid. An emergent surgery was performed with neurosurgery and otolaryngology. Initially, a left craniotomy was performed in order to obtain access to the left temporal lobe. A vascularized flap was harvested from the fascia of the temporalis in order to repair any defects along the middle cranial fossa. The abscess was drained using ultrasound guidance. A mastoidectomy was then performed for source control. Cultures revealed Actinomyces odontolyticus for which intravenous antibiotics were administered. The patient developed postoperative seizures requiring monitoring and anti-epileptic medication. Follow-up revealed continued improvement in the patient’s cognition. Discussion: Cerebral abscess in the temporal lobe along the floor of the middle cranial fossa can be due to direct extension of infection from the middle ear or mastoid which requires a multidisciplinary approach to surgical treatment. Actinomycosis is a rare pathogen for CNS infection with only one other case report of CNS Actinomyces odontolyticus. Postoperative care in regards to antibiotic treatment and follow-up are also reviewed. Conclusion: The case highlights the urgency of treatment and surgical decision making made intraoperatively by both neurosurgery and otolaryngology in regards to drainage, repair of the defect, and treatment of infectious source.

Perineal Ectopia of Male Genitalia

The authors present a case of Perineal Ectopia of Male External Genitalia with successful surgical treatment.

Uvula Strangulation: A Rare Case of Hair Thread Tourniquet Syndrome

Hair thread tourniquet syndrome is a rare but previously well-documented presentation. It is described as circumferential strangulation of distal or multiple distal appendages, which can lead to tissue ischaemia and eventually necrosis without prompt treatment. Despite the characteristic presentation and potential for serious complications, many healthcare professionals remain unaware of hair tourniquet syndrome and the need for urgent management. We present the case of a 9-month-old infant who presented to the emergency department. The parent noted a long hair emanating from the mouth but on attempts to remove it was unable to do so. The child was otherwise stable. Examination on the oral cavity revealed the hair strand tightly wrapped around an oedematous and congested uvula. Attempts to remove the ligature in the emergency department were unsuccessful and a subsequent referral to otolaryngology was made. A decision was made to take the child to the operating theatre, where the ligature was successfully removed with the distal uvula remaining viable.

How to Suspect and Manage an Hypoplasic Gallbladder: A Case Report and Review of Literature

Background: Malformations related to the gallbladder are uncommon, with an incidence lower than 0,1%. The majority of them are asymptomatic, however when symptoms appear are non-specific with a similar presentation to biliary colic. Methods: We report a case of a 29-year-old woman with persistent upper right abdominal pain and no visualization of the gallbladder in the ultrasound (US), CT scan or in the magnetic resonance cholangiopancreatography (MRCP). Results: A laparoscopic exploration was performed due to persistent abdominal pain which confirmed an hypoplasic gallbladder. After cholecystectomy, symptoms were relieved. Herein we propose a decisional algorithm when suspecting a gallbladder with agenesis or hypoplasia. Conclusion: Surgeons need to take into consideration congenital anomalies of the gallbladder. Performing imaging techniques is important in order not to misdiagnose hypoplasia.