Non-operative management of umbilical pilonidal sinus: One more step towards ideal therapy.

There are controversies regarding the management of umbilical pilonidal sinuses. The current study aims to report on the efficacy of a non-operative, umbilical conserving procedure in the treatment of umbilical pilonidal sinus. This is a prospective, single cohort study. The cases were managed in a single private practice center. Patients were assessed and managed throughout the previous nine years (from January 2013 to June 2022). The required information was obtained from the center's medical database. The current study included 114 patients. There were 82 (71.9%) male patients. The patients' ages varied from 14 to 56 years (mean = 23.24). The umbilicus was retracted under local anesthesia. The sinuses were cleaned with povidone-iodine. Following the drying of the cavity, the mixture was put in the umbilicus, and the area was dressed. The amount of mixture was determined by the size of the cavity. Following treatment, the patients were directly discharged home with instructions to remove all hair from the chest and abdomen and keep the dressing dry for three days. After three days, the patients were advised to use a clean cotton swab to remove the injected mixture. Recurrence was reported in 5 cases (4.4%). The current technique might be used effectively in the treatment of umbilical pilonidal sinus. It is an umbilical preserving technique with a minimal recurrence rate.

Laparoscopic resection of giant adrenal myelolipoma: A case report with review of literature.

Giant adrenal myelolipoma (AML) may cause severe symptoms. In contrast to the previous reports, laparoscopy may play a pivotal role in the management of giant AML. This report aims to discuss a case of giant AML managed successfully by laparoscopy. A 63-year-old male was found to have a giant (12 × 10 × 8 cm) left AML during a workup for left lower chest pain on imaging. laparoscopic excision of a left adrenal gland with the lesion was performed under general anesthesia. The patient was discharged from the hospital after 3 days uneventfully. AML is a benign tumor that is characterized by the presence of adipose tissue and hematopoietic elements. Myelolipomas are typically asymptomatic. AML diagnosis is based on imaging and blood workup. Small asymptomatic AML is usually managed conservatively, while symptomatic AML is managed with surgery. Even though an open approach is the standard option, laparoscopy, as a minimally invasive technique, in some centers may replace laparotomy. Laparoscopy can be a successful method for managing AML, even when they are large in size.

Tuberculous granulomatous inflammation of parathyroid adenoma manifested as primary hyperparathyroidism: A case report and a review of the literature.

Tuberculosis of the thyroid gland is rare, and tuberculous granulomatous inflammation of the parathyroid glands is even rarer. The present study reports a rare case of primary hyperparathyroidism caused by tuberculous granulomatous inflammation. A 58-year-old female patient presented with generalized body pain persisting for 1 year. She had a history of recurrent renal stones (>20 times) and an incidental finding of multinodular goiter involving the parathyroid on neck ultrasound. A blood analysis revealed elevated levels of serum calcium (11.26 mg/dl) and parathyroid hormone (154.7 pg/ml). The patient underwent the resection of the affected left thyroid lobe under general anesthesia. A histopathological examination revealed parathyroid adenoma with caseating granulomatous inflammation involving the adenoma with focal lymphocytic thyroiditis of the left thyroid gland. Although granulomatous parathyroid disease with parathyroid adenoma causing hypercalcemia is an extremely rare event, it can occur. The treatment of choice is surgical resection.

Challenges and successful management of subglottic tracheal stenosis in a 2­year­old child: A case report and a mini­review of the literature.

Tracheal stenosis is a narrowing of the windpipe that can lead to shortness of breath, stridor and even suffocation. The present study reports the clinical course of a patient with this condition in an aim to help clinicians obtain more information about this rare condition and identify potential treatment options. A 2-year-old female child presented with progressive shortness of breath and stridor. She was initially managed with tracheostomy; however, this was unsuccessful in relieving the stenosis. Subsequent interventions, including rigid bronchoscopy and dilatation were successful in relieving the condition. A benign hypertrophy of the bronchial wall was identified through biopsy. The patient was treated with steroids and antibiotics, and she experienced a marked improvement in symptoms and remained asymptomatic after a 1-year follow-up. Tracheal stenosis is a rare, yet serious condition that may be life-threatening. Thus, the early diagnosis and treatment of this condition are essential in order to improve outcomes.

Fibroadenoma in axillary accessory breast mimicking carcinoma of unknown primary; a case report with literature review.

INTRODUCTION: Accessory breast (AB) is extra and ectopic breast tissue. Fibroadenoma (FA) in AB is a rare finding. This study aims to present a case of FA in axillary AB mimicking carcinoma of unknown primary (CUP). CASE REPORT: A 38-year-old female presented with a mass in her right axilla. She had a mass in her right breast for 5 years. She previously had a left breast lumpectomy for a benign condition. The lump in her axilla was palpable and hard. Ultrasound showed an oval lymph node in the level I axilla (12*6mm) with blurred and unclear fatty hilum, suspicious for malignancy. Magnetic resonance imaging revealed an oval lesion (12*7mm) in the level I axilla with no fatty hilum and with heterogeneous enhancements, suggesting abnormal nodes. Fine needle aspiration of the axillary mass suspected CUP. But core biopsy resembled FA. Both masses in the right axilla and breast were surgically excised. Histopathology confirmed FA in both masses. DISCUSSION: Although pathologies in AB are uncommon, it is still susceptible to the same malignant and benign transformations that are found in normal breasts. The axilla is the most frequent location for FA in AB and often affects young women. Imaging techniques can be inconclusive and only histopathology can conclude a definitive diagnosis. CONCLUSION: FA in axillary AB is a rare condition that causes a diagnostic dilemma as it can be mistaken for other benign or malignant pathologies.

Aneurysm of anomalous splenic artery arising from a splenomesenteric trunk: Review of the literature with a report of a new case.

INTRODUCTION: Aneurysm of splenic artery arising from splenomesentric trunk is an extremely rare condition. The aim of this study is to report a new case with literature review. PRESENTATION OF CASE: A 52-year-old housewife presented with mild central abdominal pain for two month duration. Abdomen was soft. Abdominal ultrasound examination showed a focal aneurysmal dilatation in the splenic artery (SA) near the portal vein. Abdominal computed tomographic angiography (CTA) revealed presence of the splenomesentric trunk with fusiform aneurysm (45 × 33 mm) of the proximal part of the SA. In supine position, through upper midline laparotomy incision, exploration of both superior mesenteric artery (SMA) and SA was performed, total excision of the aneurysm was done, the SMA was side-repaired and SA was ligated. The post-operative period was uneventful. DISCUSSION: It is interesting to note that orthotopic SA aneurysms, most commonly present in the distal third of the artery, followed by the middle third, while in cases of splenomesentric trunk, all reported cases of anomalous SA aneurysms including the current one, showed the aneurysms to be located in the proximal portion or root of the SA. CONCLUSION: Splenomesentric trunk is a rare anatomical anomaly, aneurysm of which is even rarer. It can be managed either by endovascular intervention or open surgery.