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.

Stage II Medullary Carcinoma of the Colon: A Surgery Case Report.

Medullary carcinoma (MC) is a rare subtype of colorectal cancer, which presents with poorly differentiated histology and is often confused with conventional adenocarcinoma of the colon. While this form of colorectal cancer is rare, it often does not meet the high-risk criteria to qualify for adjuvant chemotherapy even with a favorable prognosis. Diagnosis of MC is a proven difficulty because of the lack of immunohistochemical stains on pathology seen in adenocarcinoma of the colon. Unlike adenocarcinoma of the colon, distant metastasis is rare. Patients diagnosed with MC have one- and two-year survival rates of 93% and 74%, respectively. The patient was a 75-year-old female diagnosed with MC of the sigmoid colon and a large uterine fibroid. In this case report, we discuss the high-risk indications of colorectal cancer and the recommended treatment of patients with stage II MC of the colon.

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.

Acute Large Bowel Obstruction Caused by Endometriosis Requiring Sigmoidectomy.

Large bowel obstruction (LBO) accounts for nearly 25% of all bowel occlusions. LBO is managed as a surgical emergency due to its increased risk of bowel perforation. Nearly, 2% to 4% of all surgical admissions are a result of LBO. The most common pathological development of LBO remains colonic malignancy, representing approximately 60% of cases. Other etiology includes abdominal adhesions, diverticulosis, hernia, inflammatory bowel disease (IBD), and in rare cases endometriosis. In this report, the patient is a 36-year-old female with an LBO, originally thought to be a complication of diverticulitis. However, it was confirmed that the obstruction was a result of endometriosis tissue adherence to the colonic wall narrowing the intestinal lumen. The patient presented to the emergency department (ED) with nausea, vomiting, and abdominal pain that started six weeks prior. In this case report, we will discuss the rare complication of endometriosis causing LBO, clinical presentation, diagnosis, and management.

A case of simultaneous abdominal wall reconstruction and creation of diverting ostomy in a ventral hernia with loss of domain.

INTRODUCTION: Diverting ostomies are traditionally used as a bridge to primary resection in patients with an obstructing mass, or severe inflammatory bowel disease [1]. In some cases, severe infections or non-healing wounds can be better managed after the diversion of fecal material away from the area [2]. In this case report, we discuss a patient who underwent a diverting loop colostomy placement through a ventral hernia defect with primary repair of the hernia in one procedure. PRESENTATION OF CASE: A 67-year-old female presented with a large, stage four sacral decubitus ulcer and an incarcerated ventral hernia. She was taken to the operating room for a transverse loop diverting colostomy through a large, pre-existing ventral hernia. The ostomy site was passed through the ventral defect at the midline. The remainder of the ventral hernia was closed primarily, and the initial incision was stapled closed. At post-operative day 11, the ostomy remained functional and intact, with no hernia recurrence, and significantly improved healing of the ulcer was seen. DISCUSSION: The large ventral hernia presented a significant obstacle during pre-operative planning. It was decided that a midline stoma was to be created simultaneously with an abdominal wall reconstruction, as any other site to bring up the ostomy would have been too far laterally. CONCLUSION: The patient was discharged in stable condition. This case presents a novel and viable method for the creation of an ostomy in patients with large ventral hernias. Further study regarding long-term outcomes may be beneficial in establishing utility.