International Journal of Case Reports

  • Laparoscopic approach for pancreato-splenic abscess from disseminated melioidosis: Surgical outcome and review of literature

    Melioidosis is a severe systemic infection caused by Burkholderia pseudomallei. It commonly affects the lungs, liver and kidneys. Pancreatic and splenic abscess from melioidosis is rare, with few reports in the literature. We present a series of 4 patients with disseminated melioidosis of pancreas and spleen who required surgical intervention. A MEDLINE database review was conducted. Relevant publications were evaluated and demographic data, clinical, radiological findings as well as management options were collected. We found 10 case reports describing this clinical condition. In our series, median age was 57. Median operative time 260 minutes. All four patients failed trial of antibiotic therapy and required surgery. Three underwent distal pancreatosplenectomy and one underwent splenectomy alone. Laparoscopic distal pancreatosplenectomy was successful in two patients. Median length of stay 11.5 days. No post-operative complications and mortality reported. Surgery is indicated in failed medical therapy and laparoscopic approach is safe and feasible.

  • Recognizing Traditional Chinese Medicine Customs during the COVID-19 Pandemic: A Case Report

    Traditional Chinese Medicine (TCM) is based on the belief of vital energy (qi) within the body and attributes disease with imbalance in energies (yin and yang). The COVID-19 pandemic has necessitated unique physical barriers, including increased physical distancing, use of personal protective equipment (PPE), and telehealth services, which complicate existing efforts to understand alternative health practices. This case report highlights the importance of cultural competency training for healthcare providers, as evident in improved patient care when recognizing and acknowledging TCM customs in association with the COVID-19 pandemic.

  • Effect of RevX solution adjunct to standard therapy in a patient with metastatic lung adenocarcinoma: A case report

    RevX solution is a liquid fermented grain extract obtained through a unique extraction technology, and its ingredients contain phytosterols, sulfonamides, organic acids, and anti-inflammatory substances. The adjunct treatment of RevX for lung adenocarcinoma has not yet been surveyed in vitro or in vivo experiments. A 71-year-old woman was diagnosed with lung adenocarcinoma. She underwent the targeted therapy and continually took the RevX solution (3 to 5 ml per day). Sixteen months after diagnosis and targeted therapy, multiple lung metastases appeared. After the second-line targeted therapy and wedge resection for 16 months, the patient was still alive. The distinct improvement of hypodynamia and fewer complication was found during targeted therapy treatment complemented with the RevX solution for longer than 4 years. Thus, the RevX solution might potentially be an adjuvant therapy for patients with metastatic lung adenocarcinoma.

  • Treatment of oversize and recurrent pancreatic pseudocyst after an episode of acute pancreatitis: a case report and review management

    Pancreatic cysts are being diagnosed more frequently because of the increasing usage of multiple noninvasive imaging modalities. Moreover, pancreatic pseudocysts (PPs) present a challenging problem for physicians dealing with pancreatic disorders, especially in cases where their treatment will be required. The diagnosis of a PP needs imaging with ultrasonography, Computed Tomography (CT) scan or Magnetic Resonance Imaging (MRI). In most cases, pancreatic pseudocysts are asymptomatic and resolve spontaneously. [1-3] Asymptomatic PPs up to 6 cm in diameter can be safely observed and monitored with serial imaging.[1] If they evolve and increase in size, they become symptomatic through compression of the adjacent organs and need interven-tion.[1, 4-6] Their management demands the cooperation of surgeons, radiologists and gastroenterolo-gists. The treatment of PPs has evolved considerably over the past decade, moving from what was once open surgical management to increasingly minimally invasive techniques, both by surgery and by endoscopy. Thus, many studies have reported successful drainage through the use of various techniques.[1, 3, 4] However, the absence of a large number of cases as well as guidelines for dealing with them raise even today dilemmas regarding the treatment of choice. Here we present a case of a large pancreatic pseudocyst and a brief review of the literature.

  • Posterolateral uterine rupture in scarred uterus complicated by external iliac vein injury

    Uterine wall rupture is a rare yet catastrophic complication of pregnancy with a high mortality rate of both the mother and the fetus. The condition could be classified according to etiology into primary unscarred uterus, and secondary scarred uterus or according to the site of rupture. Our case presented with scarred uterine rupture through a posterolateral injury. The patient had history of 3 previous CS and a D&C procedure. The rupture was complicated by EIV injury. Uterine rupture does not always present with profound manifestations of shock especially in posterior wall rupture and timely management ensures the best possible outcome. Finally, meticulous examination of the anatomically related structures and vessels, and the repair of any associated injuries, is essential.

  • Bilateral acute renal infarction treated by endovascular therapy: A case report and literature review

    Renal infarction is a rare emergency and the estimated incidence is extremely low according to the literature. In addition, simultaneous bilateral renal infarction was only about 20% in these rare cases. Herein we reported a case of acute renal failure related to bilateral renal infarction and successfully treated by endovascular therapy including angioplasty and catheter-directed thrombolysis. His renal function also significantly improved after the intervention. This rare case reminds physician that early endovascular therapy might improve renal function and result in better renal outcome for patients with simultaneous bilateral renal infarction.

  • Cardiogenic Shock Due to Acute Myocarditis Following AZD1222 Vaccine Administration: a Case Report

    Aim: A number of cases of SARS-CoV-2-related myocarditis have been reported since the outbreak of the Covid-19 pandemia, with autoimmune-mediated damage due to molecular mimicry proposed as the virus’ direct mechanism of injury. After commencing with a worldwide mass vaccination program, there have also been reports of myocarditis in the context of Covid-19 immunization. However, myocarditis is still not recognized as a potential side effect of the AZD1222 (ChAdOx1-S recombinant) vaccine administration by the health authorities. Methods: In this article we report a case of myocarditis and further complications after vaccination for Covid-19 using the AZD1222 vaccine. Conclusion: Even though it is hard to demonstrate the etiology of acute myocarditis, considering the cases reported around the world, the temporal association, the absence of other plausible causes, and the serological pattern described, it seems reasonable to assume that there is a genuine possibility of myocarditis being a side effect of AZD1222 vaccine administration.

  • Spontaneous Oculomotor and Abducens Nerve Palsy as Initial Presentation of Lymphoma of the Cavernous Sinus: Case Report

    Primary lymphomas of the skull base are rare (1% of lymphomas in adults); they can originate from the cavernous sinus and the parasellar region. Diffuse large B-cell lymphoma is the most common histologic subtype. Currently, the origin of these lymphomas is controversial, and their clinical characteristics are not very specific. There are various treatments for these lesions with a variable response; therefore, the prognosis of these lesions is variable. Clinical case: We present the case of a 52-year-old man who spontaneously presented with diplopia. Physical examination revealed a limitation in adduction of the right eye, right palpebral ptosis, and limitation in the abduction of the left eye. Brain magnetic resonance imaging revealed a well-defined and homogeneous extra-axial lesion at the cavernous sinus level. The patient was biopsied and diagnosed with B-cell lymphoma; received chemotherapy and radiotherapy. In this article, we present a clinical case that considers the characteristics of the diagnosis and is the first B-cell lymphoma at the cavernous sinus level reported in Mexico. Conclusion: Skull base lymphomas have a broad clinical spectrum. Minimally invasive surgery for biopsy purposes is the gold standard for diagnosis, and the treatment with the best results is chemotherapy.

  • Non-resolving acute sinusitis due to nasal hamartoma: a case report

    The paranasal sinuses are closely related to vital structures, and therefore, rhinosinusitis may lead to various dangerous complications. Nasal chondromesenchymal hamartoma is a rare benign lesion of the sinonasal tract in children and adolescents. We report the case of a 15-year-old patient with antibiotic-refractory acute sinusitis in whom a nasal tumor was identified and histopathologically diagnosed as a hamartoma. Therefore, the tumor was removed surgically to alleviate the patient’s symptoms. This case highlights the necessity of investigating the underlying cause if conventional treatment fails to resolve a mild disease like acute sinusitis. To the best of our knowledge, this is the first reported case of a chondro-osseous respiratory epithelial adenomatoid hamartoma presenting with acute sinusitis.

  • Gas in the Inferior Mesenteric Vein – successful non operative management of a rare complication of diverticulitis

    Septic phlebitis (also known as pyelephlebitis) because of diverticulitis is a rare but important complication. Many previous cases have mandated urgent surgical management for fear of further deterioration. This case report details one of the first cases where septic phlebitis was successfully managed conservatively, and details important clinical lessons clinicians should be aware of.