Cholangitis caused by surgical clip migration into the common bile duct: a rare complication of a daily practice.

A 54-year-old female patient complained of right upper quadrant abdominal pain 11 years following a laparoscopic cholecystectomy. A CT scan demonstrated a collection in the surgical bed and a surgical clip in the proximal bile duct. Cholangitis developed a few days later. Another CT showed that the surgical clip migrated to the distal common bile duct. The clip was removed by endoscopic retrograde cholangiography and the cholangitis was resolved.

Wandering spleen: a rare complication of sleeve gastrectomy.

The spleen is an intraperitoneal organ typically located in the left upper quadrant. Ectopic ('wandering') spleen refers to the displacement of the spleen from its normal anatomical location to another region in the abdominal cavity or pelvis. It's a relatively rare condition with no clear aetiology. We present, here, a case of a wandering spleen following sleeve gastrectomy in a 23-year-old female patient, whose spleen, prior to this event, was demonstrated by imaging in a normal anatomical position. A splenectomy was performed, and after an uneventful postoperative period, the patient was discharged. No similar case description was found in the relevant medical literature. Possible causes and decision-making process are discussed. We conclude that the wandering spleen phenomenon should be considered in the differential diagnosis of patients presenting with abdominal pain and new abdominal mass following sleeve gastrectomy.

A rare case of adult colocolonic intussusception of the descending colon.

A 28-year-old woman approached the emergency department because of recent diffuse abdominal pain and diarrhoea. Peritoneal signs on physical exam led to abdominal CT scan which demonstrated colonic obstruction, resulting from colocolonic intussusception of the descending colon. An exploratory laparotomy confirmed the diagnosis as well as the aetiology of a 4 cm intraluminal polyp. Left hemicolectomy with primary anastomosis was performed. The final pathology revealed a tubulovillous adenoma with multiple foci of high-grade dysplasia. Intussusception is a rare cause for colonic obstruction, and ~90% of cases in adults are secondary to an anatomical or pathological condition. Therefore, we recommend oncological resection of the affected part.

Inter-operator Reliability of Magnetic Resonance Image-Based Computational Fluid Dynamics Prediction of Cerebrospinal Fluid Motion in the Cervical Spine.

For the first time, inter-operator dependence of MRI based computational fluid dynamics (CFD) modeling of cerebrospinal fluid (CSF) in the cervical spinal subarachnoid space (SSS) is evaluated. In vivo MRI flow measurements and anatomy MRI images were obtained at the cervico-medullary junction of a healthy subject and a Chiari I malformation patient. 3D anatomies of the SSS were reconstructed by manual segmentation by four independent operators for both cases. CFD results were compared at nine axial locations along the SSS in terms of hydrodynamic and geometric parameters. Intraclass correlation (ICC) assessed the inter-operator agreement for each parameter over the axial locations and coefficient of variance (CV) compared the percentage of variance for each parameter between the operators. Greater operator dependence was found for the patient (0.19 < ICC < 0.99) near the craniovertebral junction compared to the healthy subject (ICC > 0.78). For the healthy subject, hydraulic diameter and Womersley number had the least variance (CV = ~2%). For the patient, peak diastolic velocity and Reynolds number had the smallest variance (CV = ~3%). These results show a high degree of inter-operator reliability for MRI-based CFD simulations of CSF flow in the cervical spine for healthy subjects and a lower degree of reliability for patients with Type I Chiari malformation.