Hydatid hepatopleural fistula causing biliothorax: minimally invasive approach with ERCP stent placement and chest tube drainage: a case report.

Introduction and importance: Biliothorax and hydatid bilio-bronchial fistula (HBBF) are rare complications of hydatid cysts of the liver with high perioperative mortality. Case presentation and clinical discussion: The authors here report the case of a patient with a right massive pleural effusion with evidence of HBBF in imaging studies, who underwent surgical resection of a hydatid cyst of the liver 8 years ago. The patient was managed with intercostal chest tube drainage for biliothorax and endoscopic sphincterotomy with biliary stent placement for the re-establishment of internal biliary drainage, which ultimately allowed the fistulous tract to heal without any major surgical intervention. Conclusion: This article focuses on the successful management of the HBBF at our institution. Our findings emphasize the significance of early diagnosis and the criticality of implementing aggressive and early interventions to minimize complications and fatalities. By examining this specific case and reviewing existing literature, the authors have determined that endoscopic treatment appears to be a viable, secure, and efficacious option for addressing postoperative HBBF.

Esophageal variceal bleeding: portal hypertension and portal vein thrombosis secondary to protein S deficiency - a case report.

Introduction: Proteins C and S play a key role in the inhibition of the coagulation cascade. Deficiencies of proteins C and S deficiency are rare conditions that lead to abnormal activation of the coagulation cascade, resulting in a prothrombotic state and an increased risk of venous thromboembolism. These deficiencies also pose a risk factor for the development of portal vein thrombosis (PVT). PVT secondary to these deficiencies in the acute phase is usually asymptomatic, but the disease in chronic cases may present with features suggestive of portal hypertension, usually hepatosplenomegaly, variceal bleeding. However, cavernous transformation of the portal vein due to proteins C and S is usually rare. Introduction and Importance: Proteins C and S are rare thrombophilic disorders that may present even with PVT, resulting in esophageal bleeding as an uncommon presentation. Hence, protein S and protein C deficiency should also be considered a cause of noncirrhotic portal hypertension with esophageal bleeding. Case Presentation: The authors hereby present you with the case of a 22-year-old female who presented with complaints of abdominal pain and black-colored stool in the emergency department. Clinical Discussion: Relevant investigations were sent, and she was treated in line with esophageal variceal bleeding with the cavernous transformation of a thrombosed portal vein secondary to noncirrhotic portal hypertension due to protein C and S deficiency. Esophageal varices were managed with rubber band ligation. An oral anticoagulant was started for the thrombophilic disorder. The patient was also advised for splenectomy for splenomegaly and ongoing anemia and thrombocytopenia. Conclusion: The main aim of the article is to highlight a rare case of protein S deficiency that has led to upper GI bleeding due to esophageal varices secondary to portal hypertension secondary to PVT. Esophageal variceal bleeding secondary to PVT is an uncommon presentation of protein S deficiency. PVT without liver cirrhosis is also uncommon. Protein S and C deficiency is a rare clotting disorder that may cause clots in vessels and ultimately dislodgement of clots that can result in life-threatening complications. Hence, timely diagnosis, treatment, and prophylaxis can prevent life-threatening complications.

Percutaneous management of complicated empyema thoracis using pigtail, report of a case from University Hospital of Nepal: a case report.

Empyema thoracis is a condition characterized by the accumulation of pus in the pleural cavity of the lungs. Empyema thoracis is a cause of high mortality in man and its occurrence is increasing in both children and adults. Traditionally, chest tube drainage has been a preferred method of treatment, but recent studies have shown that pigtail catheter drainage is a more effective and less invasive alternative. Image-guided drainage is also preferred over blind drainage, and alternative drainage sites are being explored. These management changes have improved patient outcomes and reduced the risk of complications. Case presentation and clinical discussion: A 66-year-old female presented with complaints of cough, fever, and chest pain. A clinical examination was done and relevant investigations were sent. She was then treated in the line of left-sided empyema thoracis. A pigtail catheter was inserted into the loculated empyema via the left 9th intercostal space through a posterolateral approach with ultrasonography guidance. Conclusion: The main aim of this article is to provide an overview of a rare management approach for empyema, a condition characterized by the accumulation of pus in the pleural cavity of the lungs. In this case report, the authors have focused on pigtail catheter drainage over traditionally performed chest tube drainage, and image-guided drainage has been performed over blind drainage ensuring accurate placement and reducing the risk of damage to surrounding tissues. Another notable change in empyema management is the shift in drainage sites from the safety triangle to other sites based on the site of loculations under ultrasonography guidance.

A rare case of pediatric orbital rhabdomyosarcoma in Nepal: a case report.

Orbital rhabdomyosarcoma (RMS) is a highly malignant, mesenchymal orbital tumor of childhood with a predilection in children less than 20 years of age. It presents as a space-occupying lesion in the orbit, most commonly over the superior nasal quadrant of the orbit. The patient usually presents with rapid onset unilateral proptosis and eyelid edema. Case Ppresentation: In this article, a 14-year-old male presented with rapidly progressive swelling of the right orbit. On ocular examination, there was nonaxial inferolateral proptosis of the right eye. Computed tomography revealed a large soft tissue density tissue lesion in the right nasal cavity and meati measuring at least 3.2×2.7×5.4 cm in size with the erosion of the right orbit along with extension of the lesion in the extraconal compartment of the orbit. An MRI of the brain with contrast showed a heterogeneously enhancing altered signal intensity lesion. Debulking was planned, and a biopsy of the mass was sent that gave an impression of alveolar RMS. He also received radiotherapy and chemotherapy at one of the cancer hospitals in Nepal. Postsurgical follow-up showed gradual improvement in the visual acuity of the right eye. No evidence of metastasis and recurrence was found upon subsequent follow-up. Conclusion: Thus, early diagnosis and prompt treatment is most for a favorable prognosis in the case of RMS. The main aim of this article was to briefly overview a rare case of RMS, its clinical presentation, diagnosis, treatment modalities, and its prognosis.