A giant low-grade appendiceal mucinous neoplasm (LAMN) presenting as ileocecal intussusception: a case report.

We report the rare case of a giant low-grade appendiceal mucinous neoplasm (LAMN), presenting as ileocecal intussusception. An 80-year-old woman presented in the emergency department of our institution with progressively worsening diffuse abdominal pain during the last 24 h. A CT scan revealed a giant abdominal mass (98.7 × 127.3 × 107.6 mm) with air-fluid level and imaging characteristics of ileocecal intussusception. An emergency exploratory laparotomy was performed, and a well-circumscribed cystic mass deriving from the appendix was found. A right hemicolectomy was performed, and the histopathological examination confirmed the diagnosis of LAMN. This report aims to raise awareness among surgeons and radiologists, about LAMNs as a differential diagnosis of right iliac fossa masses presenting as acute abdomen.

Lasting bilateral mydriasis after traumatic brain injury may not always be a lost case.

BACKGROUND: Lasting bilateral mydriasis and absence of pupillary light reflex following severe traumatic brain injury (TBI) are considered signs of irreversible brainstem damage and have been strongly associated with poor outcome. CASE DESCRIPTION: A young female patient presented with severe TBI, contusions, and diffuse brain edema. She was initially treated medically, but developed delayed secondary refractory intracranial hypertension and bilaterally dilated, non-reactive pupils for 12 h. Wide decompressive craniectomy and dural incisions were performed. The patient presented gradual improvement in her clinical condition [Glasgow Coma Scale (GCS) 13/15]. Delayed recurring infections lead to the patient's death due to sepsis after 3 months. CONCLUSION: In light of recent studies, lasting bilateral mydriasis may not always be considered a decisive factor for non-escalation of treatment, as variability among TBI patients and outcomes has been demonstrated. Wide decompressive craniectomy is viable for controlling refractory intracranial hypertension in hemodynamically stable patients.

Cervical epidural plasmacytoma presenting as ascending paraparesis.

BACKGROUND CONTEXT: Spinal epidural plasmacytomas are very rare and are usually localized in the cervicothoracic and lumbar spines. PURPOSE: To present the first case of cervical dural plasmacytoma and discuss the treatment options for this entity. STUDY DESIGN: Case report and review of the literature. METHODS: A 45-year-old man presented with gradually progressive legs to arms numbness preceded by upper respiratory tract infection and followed by rapid flaccid quadriparesis over 1 week. Because of the above symptoms, he was initially thought to have Guillain-Barré syndrome, but this diagnosis was ruled out by an emergency normal nerve conduction studies and needle electromyography. Cervical magnetic resonance imaging revealed an enhancing epidural mass at the C4-C7 level on T1-weighted images and increased signal on T2, causing spinal cord compression. Complete surgical evacuation was performed. Subsequent histology revealed plasmacytoma associated with anaplastic multiple myeloma, and the patient was referred to the hematology department for further treatment. RESULTS: Follow-up at 9 and 13 months after surgery revealed complete remission of the primary disease (multiple myeloma). The patient was neurologically improved and ambulatory with unilateral support. CONCLUSION: The reported case describes the first epidural extramedullary plasmacytoma isolated in the cervical spine in the English literature. Emergent neuroimaging and surgery can dramatically affect prognosis of this rare spinal neoplasm.

Spontaneous spinal cord herniation: recurrence after 10 years.

BACKGROUND CONTEXT: Transdural spontaneous spinal cord herniation is a very rare nosological entity, which despite recent reports in the medical literature remains often misdiagnosed preoperatively. Usually it affects the thoracic segment, protrudes ventrally, presents clinically as a progressive Brown-Séquard syndrome and carries a favorable surgical outcome. PURPOSE: To describe a rare case of delayed recurrence of spontaneous spinal cord herniation despite excellent outcome for 10 years, and discussion of management and observation issues. STUDY DESIGN/SETTING: Case report/University Hospital. METHODS: We describe the management of a patient with spontaneous spinal cord herniation that presented initially with a Brown-Séquard syndrome and has been treated successfully with surgery. After 10 years free of symptoms, the patient developed progressive paraparesis and urinary incontinence because of recurrence of the herniation at the same level. RESULTS: Despite technical challenges, during the second operation the enlarged ventral dural defect was meticulously closed and the patient's neurological condition presents 9-month postsurgery considerable improvement. To our best knowledge, recurrences of spontaneous spinal cord herniation are extremely rare. CONCLUSIONS: The reported case underlines the necessity to be aware of this rare but treatable spinal disease, notify the possibility of late recurrences and the need of long-term follow-up even if initial outcome is favorable.

Modification of end-loop ileostomy for the treatment of ischemic or radiation enteritis.

AIM: To evaluate a new technique of temporary ileal anastomotic stoma, following small bowel resection, in patients where the anastomosis is anticipated to have borderline margins with dubious viability. METHODS: Five patients underwent enterectomy and partially anastomosed end-loop ileostomy at the University Hospital of Larissa between 2000 and 2006. Enterectomy was performed because of conditions such as mesenteric vascular occlusive disease, radiation entritis and small bowel injury. RESULTS: Postoperatively, none of the patients developed any stoma-related or anastomotic complications. There were no major complications. All patients were discharged between the 8th and 15th day after the procedure, and the stoma was closed 3 wk to 4 wk later. CONCLUSION: We believe that our proposed modification of end-loop ileostomy is a simple, quick and safe technique with minimal stoma-related morbidity, and with simple and safe reversion. This technique can be considered as a useful option in the treatment of ischemic or radiation-induced enteritis, and in the management of severe intestinal trauma.