Taking the Road Less Travelled: A Case Report of Distal Splenic Artery Embolisation via the Pancreaticoduodenal Arcade in Splenic Trauma With Celiac Artery Stenosis.

Celiac axis stenosis (CAS) is one of the most prevalent splanchnic arterial pathologies. It seldom results in clinically severe ischemic bowel disease because of the rich collateral circulation from the superior mesenteric artery. Knowledge about the collaterals in celiac artery stenosis guides various interventional procedures. Here, we describe a case of a 19-year-old female with American Association for the Surgery of Trauma (AAST) grade IV splenic injury found to have CAS. Distal splenic artery embolisation was performed via the collateral pathway through the pancreaticoduodenal arcade.

Prevalence of Anterior Inferior Cerebellar Artery Vascular Loop in Cerebellopontine Angle With Three-Dimensional Constructive Interference in Steady State (CISS) Sequence MRI.

Background The cerebellopontine angle (CPA) cistern houses vital neurovascular structures such as cranial nerves V, VII, and VIII and the anterior inferior cerebellar artery (AICA), often leading to neurovascular compression syndromes due to its complex anatomy. Although vascular compression is a recognized cause of certain neuralgias, its association with otologic symptoms such as tinnitus, hearing loss, and dizziness remains uncertain. Hence, this study aims to determine the prevalence of the AICA vascular loop in the CPA cistern on MRI in patients with asymptomatic audiovestibular symptoms. Methodology Adult patients who underwent MRI, including the posterior fossa's high-resolution volumetric T2 sequence (three-dimensional constructive interference in steady state (3D-CISS)), were assessed. Patients with a history of audiovestibular symptoms (tinnitus/dizziness/vertigo/sensorineural hearing loss), intracranial tumor, vascular lesions, intracranial surgery, brain radiation therapy, traumatic brain injury, poor image quality, and MRI scans without 3D-CISS sequences were excluded. Two radiologists independently reviewed 114 (228 sides) MRI studies for the vascular loop of AICA in the CPA cistern and the extension of the AICA loop into the ipsilateral internal acoustic meatus which was graded by Chavda's classification. Results The prevalence of vascular loop of AICA in the CPA cistern was as high as 47.6% in asymptomatic patients. Grade I Chavda vascular loop was the most common type followed by type II, with type III being the least common type. Conclusions Knowledge regarding the high prevalence of the AICA loop in the asymptomatic population and the lack of significant correlation between the presence of the AICA loop and otovestibular symptoms should be considered in preoperative planning for decompression procedures.

When the Gut Took a Wrong Turn to the Right: A Case Report of a Rare Complication of Closed Loop Small Bowel Obstruction With Small Bowel Volvulus in a Right Paraduodenal Hernia With Midgut Malrotation.

Internal hernias constitute 5.8% of all small bowel obstructions. The right paraduodenal hernia is a less common subtype of the paraduodenal hernia. Lack of specific signs and symptoms precludes its clinical diagnosis, which emphasizes the need for computed tomography in diagnosis. We present a case of a 24-year-old male patient with a right paraduodenal hernia and midgut malrotation causing closed loop small bowel obstruction and small bowel volvulus within the hernial sac who underwent laparoscopy-assisted reduction of hernia and adhesiolysis with closure of the peritoneal defect. Since the right paraduodenal hernia is associated with gut malrotation, risk of strangulation, closed-loop obstruction, and rarely volvulus, these patients need prompt radiological diagnosis and surgical intervention.