Hemorrhagic Shock Revealing Rupture of Splenic Artery Pseudoaneurysm Three Years After Post-Traumatic Pancreatitis.

Splenic artery pseudoaneurysm (SAP) is an uncommon entity but extremely serious, given the high mortality rate if untreated. Only a limited literature reports association with post-traumatic pancreatitis. We report the case of a 30-year-old man, who was brought to the emergency department (ED) for acute confusion. His past medical history includes trauma of right hypochondriac and epigastric regions, three years ago. Three days before his admission to the hospital, he experienced abdominal pain with nausea and vomiting, without transit disorders or fever. When examined, the patient was disoriented, pale with profuse sweating, cold extremities, and a temperature of 36.3°C. Blood pressure was 75/51 mmHg, heart rate was 126 beats per minute, and oxygen saturation was 96% on room air. The abdominal exam detected generalized abdominal sensitivity. A CT angiography of the abdomen revealed hemoperitoneum of medium abundance, with extravasation of the contrast product from the splenic artery. The size of the spleen was normal with a lower polar hypodense area. In addition, a pancreas of normal size, steady outlinings, seat of bilobed cystic formation suggested a pancreatic pseudocyst. This led us to suspect a rupture of a pseudoaneurysm of the splenic artery. A laparotomy was performed and showed an estimated 2 L hemoperitoneum. Active bleeding was noted from an SAP in the mid-portion of the splenic artery, next to the pancreatic pseudocyst. Ligation of the splenic artery and splenectomy was carried out. The patient was discharged home on the 10th post-operative day. Our case highlights an uncommon cause of hemorrhagic shock, but critical to recognize. Indeed, ruptured SAP needs to be promptly detected and managed, to avoid fatal complications if left untreated.

Acute Bilateral Renal Infarction: An Unusual Complication After Mitral Valve Replacement Surgery.

Bilateral renal infarction is an uncommon clinical condition that is frequently misdiagnosed. Its various mechanisms mainly include thrombotic and embolic. We report the case of a 51-year-old Moroccan woman, who presented with acute bilateral renal infarction three days following mitral valve replacement surgery of probable embolic origin despite curative heparin. Her renal function did not improve, and the patient developed chronic renal failure. Diagnosing bilateral renal infarction is challenging, especially in the postoperative period of mechanical mitral valve replacement surgery. Curative heparin therapy does not totally protect (100%) against this serious complication. This case study aimed to raise awareness of this rare clinical condition after cardiac surgery.

Acute Hepatitis and Pancytopenia in a Child With Chronic Abuse of Senna.

Long-term use of Senna and its anthraquinone glycosides has been associated with the development of hepatotoxicity in both children and adults. Our case study aims to present, for the first time, acute hepatitis associated with pancytopenia in relation probably to liver and bone marrow toxicity in a three-year-old child suffering from chronic abuse of Senna. We report the case of a three-year-old girl with a history of chronic constipation regularly treated with drinkable preparations made from the Senna plant and hospitalized eight months ago with an almost similar and reversible clinical presentation, probably of toxic origin. She was admitted to a pediatric intensive care unit with severe acute hepatitis and profound pancytopenia. Her first physical examination revealed an unconscious child with a Glasgow score of 11/15, generalized hypotonia, bleeding from the gum lining, facial erythrosis with peeling cheeks, hair loss (telogen effluvium), erythematous lesions ulcers of the anal margin, and fever. The myelogram performed two days after admission revealed a rich regenerative bone marrow with signs of inflammation. Besides, she developed deep vein thrombosis three days after placing her femoral catheter. Pancytopenia in hospitalized children is a rare but alarming situation. In our case, malignancy was excluded, as well as a severe infection. The cause of pancytopenia could be related to the toxic effects of Senna. Chronic use of Senna may be associated with bone marrow and liver toxicity and lead to deep vein thrombosis.

Hybrid open and endovascular treatment of an aortic arch pseudoaneurysm in a patient with human immunodeficiency virus infection.

We describe an hybrid approach for aortic pseudoaneurysm with open and endovascular treatment as an alternative treatment for a high-risk patient infected with human immunodeficiency virus. A 42-year-old man, serum positive for human immunodeficiency virus, presented, with a large pseudoaneurysm of the arch aorta measuring 61 × 70 mm. An aortic arch debranching was performed, completed by thoracic endovascular aneurysm repair. A control computed tomography scan performed 3 months later showed a complete thrombosis of the pseudoaneurysm. The outcome of this treatment, particularly regarding the rate of infection, is yet to be determined, Longer follow-up is needed with a greater of patients.