Immune Thrombocytopenia After COVID-19 Vaccine Requiring Splenectomy: A Case Report and Review of the Literature.

Post-vaccination immune thrombocytopenia (ITP) is a rare but recognized adverse event believed to result from an autoimmune reaction triggered by the vaccine. This case report presents the fourth documented instance of severe ITP requiring splenectomy following the administration of a COVID-19 vaccine. The patient, a 54-year-old previously healthy female with no familial history of autoimmune or hematological disorders, developed ITP two weeks after the first dose of the COVID-19 vaccine. While most ITP cases associated with COVID-19 vaccines manifested after the second dose, this unique case demonstrated symptoms following the initial vaccination. Initially responsive to first-line management, the patient experienced a relapse upon receiving the second dose from a different vaccine manufacturer. Despite exhaustive medical interventions, the refractory nature of the condition persisted, ultimately mandating splenectomy for the achievement of complete remission. This case underscores the potential for serious, refractory ITP with the second dose of a COVID-19 vaccine, particularly in patients who initially developed ITP after the first dose, even if they had seemingly achieved complete remission. These findings emphasize the importance of vigilant monitoring and individualized treatment strategies in such cases, contributing valuable insights to the growing body of knowledge surrounding vaccine-induced ITP.

Spontaneous Stoma Closure: A Case Report and Review of the Literature.

Stomas serve various purposes, and surgical closure of temporary stomas is typically performed once the underlying reason for their creation has been resolved. However, spontaneous closure of a stoma without surgical intervention is exceptionally rare. Here, we present a case of spontaneous stoma closure. A 67-year-old female presented with symptoms indicative of partial bowel obstruction. A computed tomography (CT) scan revealed circumferential wall thickening involving the transverse, splenic flexure, and proximal descending colon, along with a dilated proximal colon. Urgent intervention led to a total colectomy with ileorectal anastomosis and the creation of a diverting loop ileostomy. Six months later, she was then booked for stoma closure but found that the stoma was already closed, and the patient reported a history of pushing the stoma inside by herself. Spontaneous closure of a stoma is extremely rare. The mechanism behind spontaneous closure is not fully understood. Stoma retraction or the healing process of an enterocutaneous (EC) fistula can be attributable factors. Only six cases of spontaneous stoma closure have been reported in the literature. The technique that has been described by the patient of pushing the stoma inside has not been discussed before. Gradual retraction of the stoma and the healing process of EC fistula are the most common acceptable factors. The technique of pushing the stoma inside could be a helpful factor in spontaneous stoma closure. Long-term follow-up can help in understanding the unclear mechanism of this condition.

Mammary Myofibroblastoma in a Male: A Case Report and Review of the Literature.

Mammary myofibroblastoma is a rare benign tumor. It is mainly seen in older men and postmenopausal women. These tumors can be presented with a palpable mass or can be discovered incidentally on routine screening. A 76-year-old male presented with a palpable breast mass that was increasing in size. The patient underwent wide local excision with no postoperative complications. The pathology finding was consistent with myofibroblastoma. Myofibroblastoma is a rare tumor and should be considered one of the differential diagnoses in breast lumps.

Changes in Pharyngeal Airway Space and Oxygen Saturation Following Mandibular Setback Surgery: A Narrative Review.

Orthognathic surgery can alter the dental, skeletal, soft tissue, and dimensional changes in the oropharyngeal region. Studies have shown a posterior positioning of the hyoid bone and tongue position after mandibular setback surgery, this in turn can have a negative influence on the upper airway space that could lead to breathing problems such as obstructive sleep apnea. Mandibular setback surgery is commonly used for functional and aesthetic correction in mandibular prognathism patients. There are still some controversial opinions regarding the effect of mandibular setback surgery on the pharyngeal airway space and oxygen saturation. This study aims to review and illustrate the changes in pharyngeal airway space and oxygen saturation following mandibular setback surgery.

Approach for Mandibular Reconstruction Using Vascularized Free Fibula Flap: A Review of the Literature.

Mandible reconstruction is one of the major challenges that face any maxillofacial surgeon worldwide. Different approaches and methods are used for mandible reconstruction, including pedicle flaps, titanium reconstruction plates, and bone grafts. A free fibular flap is used commonly and is considered the gold standard in mandibular reconstruction with a good success rate. Advantages of the free fibula flap include the long pedicle, flexible skin island, good length of dense cortical bone, consistent bone shape, minimal donor site morbidity, superior union rate, anti-collapse effectiveness, segmental blood supply, the potential for two skin paddles, and ease of harvest with a flap survival rate up to 95%. This current review aims to illustrate the approach for mandibular reconstruction using a vascularized free fibula flap.

Fistula between the rectal stump and left iliac artery.

BACKGROUND: Isolated iliac artery aneurysms are rare and difficult to diagnose. It is more common in males. It can be asymptomatic at diagnosis or can present with frank rupture, or symptoms caused by compression on nearby organs. CASE PRESENTATION: A 44 years old male was diagnosed with rectosigmoid adenocarcinoma and underwent low anterior resection. One year after the surgery, he presented with fistula between the rectal stump and left iliac artery that was managed by stenting. CONCLUSION: A fistula between the rectal stump and the left iliac artery is very rare. There are several treatment options for ilio-rectal fistula but no conclusive specific treatment.

Clival simple bone cyst: Rare pathological entity (case report).

BACKGROUND: Clival cystic lesions are not frequently seen in neurosurgery. Cystic lesion in the clivus can be part of a neoplastic process such as chordoma, chondrosarcoma, plasmacytoma, or metastasis. Rare types of pure cystic clival lesions include simple bone cysts and arachnoid cysts, which are asymptomatic most of the time and do not cause symptoms until they reach a large size. CASE DESCRIPTION: This is a case report of a healthy 53-year-old male patient with a clival cystic lesion. The patient underwent surgical drainage and wall resection of the clival lesion with no postoperative complications. Intraoperative finding raised the possibility of the diagnosis of an arachnoid cyst. However, the pathology findings indicated a simple bone cyst. CONCLUSION: Simple bone cyst and arachnoid cyst in the clivus are rare, they should be considered in the diagnosis of clival cystic lesions.