Babesiosis Presenting as Splenic Rupture in the Midwest: A Case Report.

Babesia microti is a parasite that invades erythrocytes inducing hemolysis. It presents with a variety of non-specific symptoms that can be mistaken for other illnesses. A rare manifestation of babesiosis is splenic rupture, generally seen in a younger, healthier population with low parasitemia, which can be treated conservatively depending on the grade and clinical condition. This case describes an elderly male with multiple comorbidities who is an avid hiker in the Northern Ohio and Western Pennsylvania areas presenting with a spontaneous American Association for the Surgery of Trauma (AAST) grade V splenic rupture requiring emergent splenectomy. Subsequent re-admission was required to diagnose babesiosis, which was managed with pharmacotherapy and plasmapheresis. In lieu of other identifiable etiologies, patients with atraumatic splenic rupture in an endemic area should be screened for possible parasitic infections.

Primary small lymphocytic lymphoma of the breast: a rare presentation of non-Hodgkin's lymphoma.

Primary Small Lymphocytic Lymphoma of the breast is a rare presentation of Non-Hodgkin's lymphoma. In this report, we present the case of primary small lymphocytic lymphoma of the breast in a 65-year-old female who presented with an abnormal breast ultrasound significant for a nodule of the right breast consistent with BI-RADS 4, indicating follow-up with ultrasound-guided biopsy for further diagnostic evaluation. The patient had no prior history of extramammary lymphoma or widespread disease. A sample of the breast mass was obtained via ultrasound-guided core needle biopsy and the pathology report revealed low-grade B-cell Lymphoma. After discussion with medical oncology and the explanation of risks, benefits and alternatives to surgery, a lumpectomy was performed, and the final pathology report of the mass revealed primary low-grade B-cell lymphocytic lymphoma of the breast. On follow up, the PET scan was unremarkable and showed no evidence of abnormal glucose metabolism or adenopathy.

Ogilvie's Syndrome Secondary to Narcotics Complicated by Colonic Perforation.

Ogilvie's syndrome is a condition characterized by colonic dilation in the absence of mechanical obstruction. This case report presents a patient who was immobile and hospitalized for several months following a motor vehicle accident that left the patient paralyzed, who subsequently developed Ogilvie's syndrome. The aim of this study is to briefly discuss the clinical presentation, diagnostic workup, and management of Ogilvie's syndrome. This article also discusses the impact of narcotics and the possible association with Ogilvie's syndrome in this patient.

Mantle Cell Lymphoma With Non-traumatic Splenic Rupture Requiring Emergency Splenectomy.

Mantle cell lymphoma (MCL) is a type of non-Hodgkin (B-cell) lymphoma (NHL) with manifestations ranging from indolent to aggressive disease. This type of NHL is predominately found in western countries and affects men more often than women (M:F 2:1). The median age of diagnosis with the disease is around 60 years of age. In this report, the patient is a 68-year-old female who had an atraumatic splenic rupture with no past medical history of trauma. She presented to the emergency department with severe abdominal pain in her left upper quadrant. An emergency splenectomy was executed successfully, and the patient was stabilized. In this case report, we will discuss the pathogenesis, clinical presentation, known clinical treatment, diagnostic testing, and atraumatic splenic rupture.

Adult Hirschsprung's disease: A case report and literature review.

INTRODUCTION & IMPORTANCE: Adult Hirschsprung's disease (AHD) is a difficult diagnosis to make due to its rarity, frequently after emergency interventions have been conducted. We present a case of possible AHD and sketch a classic presentation of Adult Hirschsprung's Disease. This would help recognize and include AHD in the differential diagnoses of chronic constipation where appropriate. CASE PRESENTATION: The case involved a 41-year-old male with a history of multiple abdominal surgeries for volvuli and a ventral hernia repair complicated by post-operative SBO. Presenting symptoms were chronic constipation, abdominal colic, and dilation. SBO secondary to volvulus was discovered, decompressed, and emptied of 3000cc fecal material in the OR. His case was again complicated twice by SBO which led to the suspicion of AHD and instigated this systematic review. Papers were extracted from the EBSCO and PubMed databases. Papers were excluded if patients were younger than 10 years old. CLINICAL DISCUSSION: The classic patient will be a male over the age of 10 years old with an average age of 30 years old and a long history of chronic constipation, often complicated by an acute symptomatic obstruction. Patients may have had a history of multiple surgical or non-surgical interventions to relieve their constipation. CONCLUSION: AHD is being seen more frequently with the increasing availability of healthcare in underserved areas of the world. Duhamel's procedure is the most effective procedure after diagnosis has been made. Barium enema and a biopsy show hypo- or a-ganglionic segments that are to be resected for curative purposes.