Bipolar fracture of clavicle mimicking fracture dislocation of sternoclavicular joint: A case report.

INTRODUCTION AND IMPORTANCE: Bipolar fractures involving segmental fractures of the lateral and proximal clavicles are exceptionally rare, with only isolated cases documented in the literature. Such fractures may easily be overlooked during the initial presentation. CASE PRESENTATION: We present the case of a 35-year-old male with deformation in the middle segment of the clavicle following a road traffic accident (RTA). On radiography, the injury was initially thought to be a lateral clavicle fracture combined with sternoclavicular joint dislocation but was later changed to a bipolar clavicle fracture intraoperatively. The patient had an uneventful postoperative course with excellent functional outcomes 14 months after surgery. CLINICAL DISCUSSION: A bipolar clavicle fracture is the result of direct trauma to the shoulder region commonly following RTA. Bipolar injuries can be diagnosed based on clinical findings and radiographic evaluation using plain X-rays and aided by computed tomography (CT) scans in doubtful scenarios. With a paucity of guidelines regarding the management of bipolar clavicle fractures most reported cases have been managed operatively with open reduction and internal fixation using locking plates and screws. CONCLUSIONS: Due to its rarity, bipolar clavicle fractures can be easily missed, necessitating a high index of suspicion and detailed evaluation of suspected cases. Appropriate initial and definitive management through operative fixation can lead to optimal outcomes.

Encysted spermatic cord hydrocele: A case series.

INTRODUCTION AND IMPORTANCE: Encysted spermatic cord hydrocele is a rare anomaly characterized by obstruction of processus vaginalis closure. Clinically, it presents as a swelling in the inguinal region extending to the upper scrotum and does not communicate with the peritoneal cavity. It is often mistaken for indirect inguinal hernias, inguinal lymphadenopathy, undescended testis, and primary tumors of the cord in infants and children, making the diagnosis challenging. CASE PRESENTATION: We report the cases of five male patients aged nine months to 12 years who presented with painless swelling on the right side of the scrotal region. Physical examination revealed firm masses in the right inguinal region with positive transillumination, negative cough impulse tests, and irreducibility. Inguinal and scrotal ultrasonography showed an anechoic cystic lesion with thin walls, without any signs suggestive of a hernia. Patients were diagnosed with encysted spermatic cord hydrocele and advised to undergo cyst excision. The postoperative periods were uneventful, and expected recovery was observed at one-week and one-month follow-ups. CLINICAL DISCUSSION: Encysted spermatic cord hydroceles are rare causes of painless inguinal swelling. The medical history and clinical findings can be used to establish a diagnosis, which can be confirmed using ultrasonography. Management depends on differentiating between spermatic cord hydrocele and scrotal hydrocele and involves considering the type. Treatment options range from conservative measures to surgery, particularly for non-communicating hydroceles that persist beyond 12-18 months or enlarge in size. CONCLUSION: Encysted hydrocele of the cord is rare and is often mistaken for indirect inguinal hernias in infants and children. This similarity makes the diagnosis challenging and necessitates vigilance from clinicians. Surgical intervention results in optimal outcomes, especially in cases where the hydrocele persists beyond 12-18 months or with size progression.

Disseminated appendicular lymphoma presenting as acute appendicitis: a case report.

Introduction and importance: Acute appendicitis is a common surgical emergency marked by appendix inflammation, presenting as acute abdominal pain and typically treated with appendectomy. The authors report a rare case of disseminated appendicular lymphoma presenting as acute appendicitis. Acute appendicitis is a common surgical emergency. Case presentation: This case involved a 75-year-old male patient who underwent appendectomy, revealing an enlarged appendix with lymphomatous nodules. Clinical discussion: Lymphoma involvement in the appendix is extremely rare, and lymphomas presenting as acute appendicitis are even more exceptional. Imaging investigations, including ultrasound and CECT scan of the abdomen, are recommended to aid in diagnosis. On computed tomography, appendiceal lymphoma is characterized by markedly diffuse mural soft-tissue thickening with preserved vermiform morphology and occasional aneurysmal dilatation of the lumen. Conclusion: This case underscores the importance of considering unusual etiologies in atypical appendicitis presentations.

Cavernous hemangioma of the breast: a case report.

Background: Hemangioma is a common benign tumor resulting from abnormal blood vessel growth but is infrequent in the breast. Preoperatively, it is challenging to diagnose breast hemangioma using clinical and conventional imaging modalities because of their lack of pathognomonic characteristics. An excisional biopsy can be used for tissue diagnosis in cases of diagnostic uncertainty. Case presentation: The authors report a case of cavernous hemangioma of the breast in a 15-year-old adolescent female complaining of a rapidly enlarging firm and mobile lump in the right breast. Breast ultrasonography revealed a well-circumscribed, encapsulated, heteroechoic mass with smooth margins in the retroareolar region of the right breast. Subsequent excision of the lump revealed features of a cavernous hemangioma, and the follow-up was uneventful. Discussion: Cavernous hemangioma of the breast is a rare entity, and its diagnosis poses a significant challenge for clinicians, as the lump may not be noticeable. The clinical diagnosis is challenging; therefore, imaging is required. Breast ultrasonography typically shows a hypoechoic lobulated mass with clear borders, although isoechoic and hyperechoic appearances are also possible. Breast mammography revealed a well-defined mass with areas of calcification. Surgical excision is often necessary when there is a discordance between imaging and histopathological findings, lesions greater than 2 cm, and atypical/malignant features. Conclusion: Breast hemangiomas are rare benign tumors with nonspecific imaging features that require tissue sampling for diagnosis. Clinicians should be familiar with these characteristics to ensure proper management.

Isolated pancreatic injury following blunt trauma in a seven-year-old girl: A case report.

INTRODUCTION AND IMPORTANCE: Isolated pancreatic injury following blunt abdominal trauma is rare, and the absence of definite clinical signs and symptoms may delay diagnosis and management. CASE PRESENTATION: We present the case of a seven-year-old girl with a history of progressive, periumbilical abdominal pain and multiple episodes of non-bilious, non-blood mixed vomiting following a road traffic accident. Computed tomography (CT) imaging revealed an isolated grade three pancreatic injury managed conservatively. CLINICAL DISCUSSION: The patient usually presents with epigastric tenderness with or without a rise in pancreatic enzyme levels. CT grading of injury correlates with and guides the management approach, and CT abdomen with contrast is the preferred investigation for diagnosis. Management depends on the grade of injury, the hemodynamic status of the children, and the co-existence of other injuries. CONCLUSION: Isolated pancreatic injury, although rare, can go undiagnosed due to a lack of suspicion from the treating surgeon and may have dire consequences. Conservative management can be a suitable strategy for children with stable hemodynamic status.

A solitary osteochondroma of the sixth cervical spine: A case report.

INTRODUCTION AND IMPORTANCE: Osteochondromas, the most common benign tumors of the appendicular skeleton, are uncommonly found in the spine. Although the cervical spine is the most frequent location of spinal osteochondromas, the lower cervical spine is less commonly affected. CASE PRESENTATION: We present the case of a 16-year-old female adolescent who presented with a hard palpable mass over the nape of the neck more toward the right side associated with non-radiating pain for 3 years. Radiography and computed tomography (CT) revealed an expansile bone lesion arising from the sixth cervical spinous process (C6). En-bloc resection of the tumor was performed, which alleviated her symptoms. A histopathological examination revealed the presence of an osteochondroma without any features suggestive of malignancy. CLINICAL DISCUSSION: Osteochondroma is a common benign bone tumor, mainly found in the appendicular skeleton, with rare occurrences in the spine. It can be solitary or associated with multiple hereditary exostoses (MHE). The cervical spine is the most affected area, and its symptoms vary depending on its location. Diagnosis involves imaging, and surgical excision is recommended for symptomatic cases to prevent neurological compromise, and recurrence, and to confirm the diagnosis by histopathology. CONCLUSION: Diagnosing rare conditions such as cervical osteochondroma requires a high level of clinical suspicion and the assistance of imaging techniques in patients exhibiting relevant symptoms. Optimal outcomes were achieved using en bloc resection.

Bilateral hydrocele of the canal of Nuck: A case report.

INTRODUCTION: The hydrocele of the canal of Nuck is a rare cause of bilateral inguino-labial swelling. Due to its rarity, lack of clinician knowledge regarding this entity, and paucity of relevant literature, it can be misdiagnosed and often mistreated. CASE PRESENTATION: We present a case of a two-year-old female with bilateral inguino-labial swelling who was diagnosed with a hydrocele of the canal of Nuck based on history and clinical examination. The patient underwent bilateral hydrocele excision with high pouch ligation, and she experienced an uneventful recovery. DISCUSSION: Bilateral hydrocele of the canal of Nuck is rare in females. Diagnosis can be made based on history and clinical findings. In cases of diagnostic uncertainty, preoperative ultrasonography may aid in diagnosis. Management of hydrocele of the canal of Nuck involves surgical intervention, which is necessary for both definitive diagnosis and treatment. CONCLUSIONS: Although rare, hydrocele of the canal of Nuck must be suspected in cases with inguino-labial swelling, properly diagnosed, and surgically excised. It can be misdiagnosed; therefore, clinicians need to have a high index of suspicion to reach a provisional diagnosis and prevent morbidity and further complications.

Imidacloprid poisoning in a young female: a case report.

BACKGROUND: Imidacloprid, a neonicotinoid insecticide, is widely used in agricultural settings. Consequently, cases of accidental and suicidal poisoning are increasingly seen in clinical practice. Although cases with varied clinical presentations and toxicological profiles have been reported, standard management principles are lacking. CASE PRESENTATION: We present a case of Imidacloprid poisoning in a 25-year-old previously healthy indigenous Tamang female without a classic toxidrome requiring ventilatory support, complicated by a prolonged neuropsychiatric sequela. CONCLUSIONS: Although uncommonly reported, imidacloprid toxicity may lead to life-threatening complications and hence should be suspected in cases of unidentified poisoning with a relevant toxidrome. Vigilance on the part of treating physicians plays a crucial role in appropriate management.

An unusual case of intestinal obstruction due to abdominal cocoon: A case report.

INTRODUCTION AND IMPORTANCE: Abdominal cocoon (AC) or Encapsulating Peritoneal Sclerosis (EPS) is a rare cause of bowel obstruction and due to non-specific presentation, it can be misdiagnosed and often mistreated. CASE PRESENTATION: We present the case of 42 years male with a history suggestive of complete small bowel obstruction (SBO) without a history of pulmonary tuberculosis (TB) or peritoneal dialysis. CT imaging as well as the intraoperative finding of a cocoon membrane encasing the small bowel led to the diagnosis of abdominal cocoon. CLINICAL DISCUSSION: Abdominal cocoon can be idiopathic or secondary to peritoneal dialysis, tuberculosis, or other rare causes. Patients usually present with features of SBO with varying severity. Diagnosis is aided by imaging investigations mainly CT scan and management is primarily surgical and usually involves adhesiolysis, total removal of the membrane with or without bowel loop resection. CONCLUSION: Diagnosis of abdominal cocoon warrants awareness of the disease and a high index of suspicion of the treating clinician in patients with intestinal obstruction and an abdominal lump without a history of previous abdominal surgery. CT can guide diagnosis and early operative management seems to bear the best outcomes.

Symptomatic familial adenomatous polyposis in an adolescent: A case report.

INTRODUCTION: Familial adenomatous polyposis (FAP) is an inherited colorectal cancer syndrome characterized by several adenomatous polyps of the gastrointestinal mucosa with a universal risk of colorectal cancer in a lifetime. FAP is usually asymptomatic in the first decade of life. CASE PRESENTATION: We report a case of a 13-year-old girl diagnosed with FAP who presented in our center with symptoms of hematochezia along with a positive history of the untimely demise of her father and elder sister with similar symptoms. DISCUSSION: FAP is an autosomal dominant disease affecting both male and female equally with variable penetrance. Diagnosis is made by finding hundreds to thousands of adenomatous polyps in the colon and rectum, and molecular analysis of the APC gene which forms the definitive diagnosis. Prophylactic laparoscopic total proctocolectomy with ileorectal anastomosis is a safe and feasible surgical option with a low risk of complications among adolescents. An endoscopic/colonoscopic procedure is recommended every 6 to 12 months after surgery to assess the anastomosis site, pouch, and residual rectum. CONCLUSION: FAP, a rare disease entity in adolescents should be managed by appropriate diagnostic procedures, early prophylactic surgery, and regular lifelong follow-up.