Conservative management of fish bone-induced large bowel perforation: Case report.

INTRODUCTION: Fish bone ingestion is one of the common medical complaint. Most foreign bodies passed safely through gastrointestinal tract (GIT) without any complications. The clinical presentation of foreign body ingestion is similar to other conditions such as diverticulitis. Most literatures focus on the surgical management of complications secondary to fish bone ingestion. In this case we report a case of an elder patient with complain of progressive abdominal pain. PRESENTATION OF CASE: 71-year-old female, admitted to surgical ward with the complain of progressive abdominal pain. Physical examination revealed right upper quadrant tenderness with normal digital rectal examination. An abdominal X-ray was obtained and was not remarkable. Computed tomography (CT) chest, abdomen, and pelvis with contrast revealed proximal transverse colon wall thickening with reginal soft tissue thickening, inflammation and a radiopaque foreign body. Patient was managed conservatively by bowel rest, and antibiotics. DISCUSSION: Fish bone swallowing account for two third of these foreign bodies. Most of the foreign bodies pass through the gastrointestinal tract (GIT)without any significant harm or complications. The clinical presentation of perforation secondary to fish bone is nonspecific which may delay the diagnosis. The management can be either medical or surgical depend on many factors. CONCLUSION: Although, foreign body ingestion is one of the common complaints in the medical practice, its complications is extremely uncommon. However, improvement of medical imaging increased sensitivity and specify in detecting fish bone.

Unusual collision tumor with infiltrating ductal carcinoma and breast skin squamous cell carcinoma: A case report and literature review.

INTRODUCTION: Breast cancer is the most common diagnosed cancer among women worldwide. Invasive ductal carcinoma (IDC) is the most common type, on the other hand, squamous cell carcinoma of the skin (SCC) overlying the breast is a rare tumor. The co-presence of two tumor types in one organ is even a rarer entity, termed as collision tumor. Only 3 known cases of collision tumor with breast invasive ductal and skin squamous carcinoma were reported in the literature. CASE PRESENTATION: An otherwise medically free 91-year-old, postmenopausal, female presented with left breast fungating mass for four months. Pre-operative core tissue biopsy and incisional skin biopsy revealed two distinct tumor subtypes of invasive ductal carcinoma, positive for progesterone, estrogen receptors and negative for human epidermal growth factor receptor 2, as well as skin squamous cell carcinoma, and axillary lymph node metastasis. Patient underwent left breast modified radical mastectomy and split skin grafting for wound closure. The final histopathology was consistent with grade 2 IDC. The nipple and areola complex were involved by moderately differentiated squamous cell carcinoma. Currently patient on adjuvant hormonal treatment. Follow up showed no local recurrence or distal metastasis. CONCLUSION: Collision tumors of the breast with IDC and SCC of the overlying skin is very rare. The surgeon has to be aware of of such entity as the proper peri-operative management should be tailored to target the most aggressive histologic subtype.

First tracheal ring fracture in a complex thyroid surgery.

INTRODUCTION: Tracheal injury is a rare complication of thyroidectomy that endocrine surgeons might face during or after the surgery. It accounts for less than 1 % of all thyroidectomy complications. CASE PRESENTATION: A 48-year-old who presented with hyperthyroidism signs and symptoms, diagnosed with Graves' disease. Patient underwent total thyroidectomy after failure of the medical management that ended in first tracheal ring laceration. Tracheal laceration discovered intraoperatively and repaired with primary closure. DISCUSSION: Tracheal injury is one of the rare complications of thyroidectomy. It can be discovered intraoperative or postoperative. Tracheal injury can be managed conservatively or surgically depending on the size of the injury. But, the early diagnosis of it can lead to better outcome and decrease the mortality and morbidity. CONCLUSION: Tracheal injury can be prevented by increasing the awareness of its presentation and its risk factors.

A Cecal Mucormycosis Mass Mimicking Colon Cancer in a Patient with Renal Transplant: A Case Report and Literature Review.

BACKGROUND Mucormycosis is a rare, invasive, and opportunistic fungal infection that occurs in the setting of neutropenia, immune deficiency, solid-organ transplant, and iron overload. The gastrointestinal system is a rare site of mucormycosis, and gastrointestinal mucormycosis is associated with high mortality and accounts for 4-7% of all cases. CASE REPORT We present the case of a 64-year-old hypertensive man with transfusion-dependent myelodysplastic syndrome who underwent renal transplant surgery 11 years ago. He also was taking maintenance Deferasirox for iron overload. He presented with a 2-day history of right lower-quadrant abdominal pain, nausea, vomiting, and non-bloody diarrhea. An abdominal examination revealed guarding and a 5×6 cm mass in the right iliac fossa. A CT scan of the abdomen showed signs of perforation of a cecal mass. As the patient was unstable, emergency right hemicolectomy and end ileostomy were performed. After the surgery, the patient was moved to the Intensive Care Unit (ICU) and a broad-spectrum antibiotic was administered. Histopathological examination results received on postoperative day 5 showed broad pauciseptate hyphae with substantial blood-vessel infiltration, suggestive of mucormycosis. Amphotericin B was started; however, on the same day, his condition deteriorated and he was moved back to the ICU. Despite maximum cardiorespiratory support, he had multiorgan failure and died. CONCLUSIONS Gastrointestinal mucormycosis presentation is non-specific, the diagnosis is often made late or is missed, and mortality remains high. High clinical suspicion, early diagnosis, and combined antifungal and surgical treatment is the best way to reduce mortality and improve survival.

A Diagnostic Dilemma of a Subcutaneous Hibernoma: Case Report.

BACKGROUND Subcutaneous lipomatous lesions are commonly encountered in clinical practice. Hibernoma is a rare subtype of the benign lipomatous tumor, representing 1% of all types. It poses a challenge due to the difficulty of differentiating it from atypical lipomatous lesions and liposarcomas, which may lead to possible inappropriate diagnosis and management. CASE REPORT We report a case of a 33-year-old male who presented with a right upper thigh swelling noticed some time prior to presentation that had started increasing in size prior to his presentation. The magnetic resonance imaging (MRI) was unable to rule out atypical lipomatous tumor and liposarcoma. An ultrasound-guided biopsy gave a diagnosis of hibernoma. The patient underwent a wide local excision, which confirmed the diagnosis of hibernoma. At the 3-year follow-up, there was no evidence of local recurrence. CONCLUSIONS Hibernoma has been reported in the literature to be discovered incidentally by radiological imaging done for other causes. However, hibernomas raise a diagnostic challenge because in most imaging modalities they are indistinguishable from other malignant tumors. A wide local excision with negative margins is key to resolving the diagnostic dilemma that a hibernoma presents, as it will provide a definitive diagnosis differentiating it from other lipomatous lesions and prevent any future recurrence. Caution is advised when dealing with lipomatous lesions, as they often overlap with malignancy. Furthermore, an MRI should be done for any subcutaneous lesion that is larger than 5 cm or shows recent growth. A biopsy can resolve the diagnostic dilemma with caution to the hypervascularity of such tumors.

Cutaneous Erythema at Scar Site of Modified Radical Mastectomy: An Unexpected Manifestation of Recurrent Carcinoma.

A 44-year-old woman presented with marked erythema over right mastectomy scar, while on Herceptin therapy. She had neoadjuvant chemotherapy, modified radical mastectomy, and radiotherapy less than one year earlier for the treatment of invasive ductal carcinoma. On physical examination, no palpable masses were detected in the erythematous skin. A biopsy revealed permeation of the skin lymphatics by emboli of metastatic ductal carcinoma, similar to what is seen in inflammatory carcinoma. The involved skin was excised, followed by immediate reconstruction with transverse rectus abdominis muscle (TRAM) flap. On follow-up, the wound was healing well, with no signs of inflammation.