A Prospective Multicenter ≥2 Years Clinical Study of the Active Apex Correction (APC) Technique in Early Onset Scoliosis (EOS) Patients.

STUDY DESIGN: prospective multicenter study. OBJECTIVES: Active apex correction (APC) is posterior tethering technique for correction of early onset scoliosis (EOS) via reverse modulation at the apex. Active apex correction has been increasingly used worldwide. This study aimed to assess short-term outcomes of multicenter study with ≥2 years of APC on spine length, curve correction, complications, unplanned surgeries, and proposed low crankshaft phenomena incidence. METHODS: Prospective multicenter study including 24 EOS patients treated by APC; involves inserting and compressing pedicle screws on convex side of apex proximal and distal to most wedged vertebra allowing apex modulation according to Hueter-Volkmann law. Excluded patients with <2 years follow-up whom APC was not primary surgery. RESULTS: Mean age 85.97 ± 32.43 months, 71% congenital scoliosis, mean follow-up 35.54 ± 12.36 months. At final follow-up, statistically significant improvement in Cobbs angle (∆ = 23.96%, P < .0001), spinal length T1-T12 (∆ = 12.83%, P < .0001), T1-L5 (∆ = 13.41%, P < .0001) but not in apical vertebral translation (AVT) albeit clinical improvement (∆ = 7.9%, P = .36) compared to preoperative measurements. Comparing immediate postoperative measurements to >2 years follow-up, statistically significant improvement in spinal length T1-T12 (∆ = 6.03%, P = .0002) and T1-L5 (∆ = 6.26%, P < .0001) but not in Cobbs angle (∆ = 4.93%, P = .3) or AVT (∆ = 14.77%, P = .25). 9 complications requiring 3 unplanned surgeries recorded in all patients including 2 broken rods, 2 adding-on and 4 screw dislodgement. CONCLUSION: Active apex correction is a novel technique that has been incorporated in several countries as treatment modality for EOS. Short-term outcomes are promising in terms of clinical improvement, complication rates and decreased need for multiple operations or unplanned surgeries.

Sigmoid colon cancer presenting as a left inguinal hernia: a case report.

Introduction: Inguinal hernias are common and typically include a portion of abdominal organs. However, there have been reports of additional peculiar content. Case presentation: The authors present the case of a 68-year-old man with sigmoid colon cancer presenting as a left inguinal hernia. Discussion: Colorectal cancer is a unique component that can be identified within inguinal hernias and is a prevalent problem among affected individuals because such a presentation is unusual. Conclusion: Surgeons should be aware of this risk when operating on inguinal hernias in order to prevent ineffective care. The best course of action may be appropriate exploration and oncological excision when underlying colon cancer is suspected after a hernial procedure.

Bilateral renal angiomyolipoma with left renal artery aneurysm in tuberous sclerosis: case report and literature review.

Introduction and importance: Tuberous sclerosis disorder (TSD) is a rare genetic disease that causes abnormal growths or tumors in various organs of the body. They are usually benign and asymptomatic. However, severe, rapidly growing tuberous sclerosis can be fatal. Renal angiomyolipomas are commonly associated with TSD, which can be further worsened by the presence of aneurysms and put the patient at risk for life-threatening hemorrhage. Case presentation: A 29-year-old female presented to the emergency room complaining of right flank pain with an unknown past medical history of tuberous sclerosis. The patient was suspected to have TSD as she fulfilled one of the major features of TSD required to establish a possible diagnosis. On computed tomography scan imaging, bilateral fat-density nodules were revealed in both kidneys. The largest is 7 cm in the left kidney, located at the upper pole, and was associated with a bleeding aneurysm measuring 4 cm in diameter. While the other fatty nodule was recorded at 6 cm in the right kidney at the lower pole. Clinical discussion: After evaluation, the patient was planned for diagnostic catheterization of the left kidney, through which selective angiography of the left kidney was done, and eventually, selective embolization of the branch supplying the left angiomyolipoma was performed. Conclusion: The authors finally conclude that thorough investigations, including systemic manifestations, must be taken into consideration when suspecting tuberous sclerosis, and a conservative approach must always be prioritized before taking any decision toward invasive approaches.

Duodenal Hemangioma as a Rare Cause of Gastrointestinal Bleeding: A Case Report and Literature Review.

Duodenal hemangiomas are benign vascular tumors caused by haphazard vascular proliferation within the duodenal wall. Although rare, duodenal hemangiomas could lead to rapidly progressive life-threatening gastrointestinal (GI) bleeding that requires urgent intervention. The diagnosis of duodenal hemangioma often requires direct visualization of the lesion either endoscopically or surgically, as well as histopathological examination. Treatment options include endoscopic resection, laser coagulation, sclerotherapy, or in a specific subset of patients, open or laparoscopic surgical intervention. We herein report a case of a 46-year-old female presenting with signs and symptoms of chronic GI bleeding. The patient underwent upper endoscopy and was found to have an ulcerated mass in the proximal duodenum consistent with the diagnosis of duodenal hemangioma. This case highlights the importance of including duodenal hemangioma in the differential of upper GI bleeding. It also underscores the significance of surgical intervention in treating duodenal hemangioma, as well as the crucial role of employing endoscopy in the diagnostic and therapeutic management of this condition.

Mesenteric and portal vein thrombosis, a rare complication in a patient with polycystic ovary syndrome: A case report and review of literature.

INTRODUCTION AND IMPORTANCE: One of the rare complications of polycystic ovarian syndrome (PCOS) treated with combination contraceptives is venous thrombosis. However, there is currently no information on intestinal necrosis and portal venous thrombosis in polycystic ovary syndrome patients, and diagnosis is frequently delayed in these situations. CLINICAL PRESENTATION: We report a case of a 30-year old female patient who experienced a sudden onset of rectal bleeding and severe abdominal pain. Superior mesenteric vein thrombosis was detected with Doppler ultrasonography. Right portal vein thrombosis was discovered on contrast-enhanced tomography of the abdomen; it was treated with enoxaparin sodium without improvement. A colonoscopy was then conducted; it revealed a distal descending colon with proximal sigmoid colon ischemia alterations. During a laparoscopic, ischemic portion were removed. On follow-up after two weeks, the patient was still on enoxaparin sodium (80 mg twice daily) in good general condition. CLINICAL DISCUSSION: Portal vein thrombosis (PVT) and Superior mesenteric venous thrombosis (MVT) are rare forms of venous thrombosis and unusual conditions. Superior MVT related to hormonal contraception and PCOS is uncommon. To best of our knowledge, here we report the first case of PCOS presented with acute intestinal ischemia related to MVT. CONCLUSION: Except for the correlation between PCOS and the use of combination contraceptives, no predisposing factor for portal vein thrombosis was found. Our case report indicates the need for clinicians to consider acute intestinal ischemia in patients with polycystic ovarian disease who have acute abdominal pain and atypical site of thrombosis.

Digestive hemorrhage and fever as a result of a double secondary aortoenteric fistula following the repair of a juxtarenal abdominal aortic aneurysm and an infection of the aortobifemoral bypass graft: a case report.

A double secondary aortoenteric fistula (AEF) occurs in a patient who has had significant aortic surgery and is characterized by a direct connection between the gastrointestinal (GI) tract and the aorta at two separate sites. Importance: During aortoc reconstructive surgery, the patient may present with a variety of unusual complaints, including fever and GI bleeding. These symptoms are indicative of problems, including the development of an aortoentric fistula, particularly when there is a double secondary fistula. Case presentation: The patient was admitted to the hospital due to hematemesis, melena, and high-grade fever after undergoing synthetic grafting aortobifemoral bypass (anatomical reconstruction) and partial resection of the juxtarenal abdominal aortic aneurysm. Pus discharge and a double aortoenteric fistula in unusual sites such as the second-third portion of the duodenum and caecum are visible in upper GI endoscopy and computed tomography angiography. The patient underwent a two-stage open surgery, the first stage involving aortic limb graft exclusion and extra anatomical reconstruction, and the second stage involving graft removal, fistula management, and bowel repair. Then the patient spent a few days in the surgical intensive care unit before being discharged. Clinical discussion: Primary and secondary AEF are the two categories of AEF. In patients who underwent aortic reconstruction surgery, the frequency of secondary AEF ranges from 0.36 to 1.6%. Due to the 8:1 injury ratio in the secondery AEF, men suffer more injuries than women.There are two types of fistula depending on whether or not the suture line is involved. The first form is graft enteric erosion, which excludes the suture line, while the second type is entric graft fistula, where the suture line is included. Most common site fistula is third and fourth part of duodenum and least common site is fistula formation in large bowel. Conclusions: An uncommon complication is double secondary AEF following aortic reconstruction surgery. Since one of the most significant presentations an AEF patient can present with is major GI bleeding and sepsis, A delay in seeking immediate medical treatment could result in the patient's death. It should be emphasized that one of the mechanisms for AEF formation and a frequent cause of sepsis in patients is recurrent aortic graft infection following aortic reconstruction surgery.

Gallbladder lymphangioma simulating liver hydatid cyst: A case report.

INTRODUCTION AND IMPORTANCE: Gallbladder lymphangiomas are very-rare, yet benign tumors that start developing in early life. Those tumors often go unnoticed until adulthood as they grow into a larger size or a complication happens. Despite its rarity, suspicion for the diagnosis should be maintained by the physicians. CASE PRESENTATION: A 14-year-old female patient presented to the hospital complaining of right upper quadrant abdominal pain of one month duration. Physical examination showed mild upper quadrant tenderness. Serology testing for the patient only showed eosinophilia. Computed tomography showed a large non-enhancing cystic lesion attached to the gallbladder. Presumptive diagnosis of hydatid cyst was made, and the patient was treated accordingly. Histological analysis of mass showed dilated lymphatic vessels, hence the shift in diagnosis towards a lymphangioma was made. CLINICAL DISCUSSION: Gallbladder lymphangioma are usually asymptomatic, but they can present with pain, nausea and vomiting. Multiple complications had been reported including compression of the nearby structures, intra-abdominal infection, rupture, torsion or hemorrhagic transformation. Surgical removal of the mass is the treatment of choice. CONCLUSIONS: Right upper quadrant pain can be the presenting symptom of liver pathology. Histological assessment is needed to confirm the diagnosis which will show dilated lymphatic vessels.

Eosinophilic granuloma affecting the parietal bone of the skull: A case report and literature review.

BACKGROUND: The rare form and mildest variant of Langerhans cell histiocytosis is eosinophilic granuloma (EG). In the clinical presentation, EG can be monostotic, polyostotic, or can encompass many organs. The parietal bone is the most common location of the skull bones that are affected by EG. So far, there have been no reported cases of EG with skull odor as an unexplained presentation. CASE PRESENTATION: An 8-year-old girl presented with a 4 months history of a right parietal bone swelling of the skull with an offensive odor. There was no discharge and no history of vomiting or trauma. An MRI scan of the brain showed swelling with a bone lesion of the right parietal bone. Infection was the source of the swelling and the bad odor. Treatment was done by surgical excision of the lesion. CONCLUSION: EG has a variety of presentations and should be suspected when tenderness and local swelling are present. Radiography was found to be helpful in the diagnosis and surgical treatment was done to manage the case.

Double-Expressor Appendiceal Burkitt's Lymphoma: A Case Report and Literature Review.

Background: Appendiceal lymphoma is a very rare entity accounting for 0.015% of all gastrointestinal lymphoma cases. Acute appendicitis is the most common presentation of primary appendix neoplasms. Burkitt's lymphoma presenting as an acute appendicitis is a rare entity with around 21% of the cases presenting as a lower iliac fossa mass. Case Presentation. A 23-year-old male was admitted to the surgical ward as a case of acute appendicitis with localized tenderness in the right iliac fossa, positive rebound tenderness, a positive Rovsing's sign, and ultrasound findings of suspected complicated appendicitis. Appendectomy was performed. Histopathological examination of the appendectomy specimen revealed a double-expressor non-Hodgkin diffuse large cell lymphoma with Burkitt's-like morphology. He was sent for chemotherapy treatment. Conclusion: Only 34 cases of Burkitt's lymphoma have been reported to present as acute appendicitis. Histological examination following appendectomy for an apparent appendicitis is essential. Furthermore, complete blood count and a computed tomography scan aid the diagnosis of lymphoma. Double-expressor lymphoma has been shown to have poor outcomes. Therefore, prompt and aggressive treatment is vital.