Talar Extrusion, A Very Rare Sequela of Trauma: A Case Report.

BACKGROUND Extrusion of the talus is a very rare sequela of high energy trauma. There is limited information on these cases, given the rarity, with no consensus on treatment. Our case report demonstrates the radiographic and computed tomography (CT) findings in this injury. CASE REPORT We report the case of a 38-year-old female patient who was involved in a high energy trauma secondary to a motor vehicle accident. Lower extremity CT revealed talar extrusion with posteriorly displaced residual small fracture fragments and large pockets of emphysema in its expected location. Orthopedic management consisted of open reduction, debridement, and external fixation of the ankle, with an internal fixation placed afterwards. CONCLUSIONS Talar extrusion is a very rare entity with few cases reported in the literature. Prompt identification of extrusion of the talus is key given that treatment is time sensitive and surgical management is needed.

Non-Surgical Management of Colo-Colonic Intussusception in Patients with Hereditary Angioedema.

BACKGROUND Hereditary angioedema (HAE) is an autosomal disease caused either by deficiency or presence of a non-functioning C1 inhibitor. The lack or non-functionality of said inhibitors leads to activation of an inflammatory cascade, which result in cutaneous and mucosal edema. Most patients with HAE present with either cutaneous, laryngeal/pharyngeal, or gastrointestinal exacerbations. An uncommon gastrointestinal manifestation of HAE is an intussusception, which in most cases require invasive/surgical management. CASE REPORT A 17-year-old Hispanic female patient with past medical history of HAE, presented with a 4-day history of episodic abdominal pain, worsening during the last 2 days with associated nausea, vomiting, and bright red blood per rectum. The abdominal ultrasound performed at our institution showed an elongated region of hypoechoic and hyperechoic concentric rings, raising suspicion of an intussusception. The patient was treated conservatively, with 30 mg of ecallantide and a unit of fresh frozen plasma (FFP). Follow-up abdominopelvic computed tomography scan was performed approximately 20 hours after the administration of fresh frozen plasma revealing complete interval resolution of the colo-colonic intussusception. Subsequently, the patient was kept under hospital care for the next 4 days with adequate progression of diet and without recurrence of intussusception. CONCLUSIONS To the best of our knowledge, most cases of patient with HAE presenting with intussusception have been treated with invasive/surgical procedures. In our case, conservative management has proven successful to reduce edema with subsequent non-surgical reduction of the intussusception. By directly targeting the pathophysiologic aspects of HAE, an unnecessary invasive procedure, as well as its potential complications, were avoided.