Giant Meckel diverticulum with enteroliths: a case report of a patient presenting with low back and episodic right lower quadrant pain.

OBJECTIVES: The purpose of this case report is to describe a patient who presented with low back pain and episodic right lower quadrant pain who had a long-standing giant Meckel diverticulum with enteroliths. CLINICAL FEATURES: A 49-year-old woman presented to a chiropractic clinic with low back pain and history of intermittent right lower quadrant pain. Lumbar radiography demonstrated calcifications in the pelvic basin that changed position with changes in patient posture. The patient was referred to an abdominal surgeon for consultation and management. INTERVENTION AND OUTCOME: Computed tomography identified calcifications in the small bowel in the region of the ileocecal valve. The patient underwent prophylactic diverticulectomy with no complications. Gross pathology revealed a giant Meckel diverticulum measuring 24 inches (60.9 cm) containing 6 enteroliths. CONCLUSIONS: A timely diagnosis resulted in a favorable surgical outcome for this patient with long-standing giant Meckel diverticulum and enteroliths.

A rare presentation of cervical osteochondroma arising in a spinous process.

STUDY DESIGN: The case of a 21-year-old woman with a palpable neck mass is reported. OBJECTIVE: To describe the rare presentation of an osteochondroma arising in the right bifid tip of the C5 spinous process presenting as a palpable neck mass. Emphasis will be placed on the pathophysiology, symptomatology, complications, imaging, and surgical management. SUMMARY OF BACKGROUND DATA: Osteochondromas rarely occur in the cervical spine and lesions arising from the neural arch may present as a palpable neck mass. METHODS: The patient's medical and imaging history and medical literature were reviewed. RESULTS: A 21-year-old woman presented with a hard palpable mass in her lower cervical spine. Review of radiography, CT, MRI, and skeletal scintigraphy demonstrated an expansile bone lesion arising in the right bifid tip of the C5 spinous process with dense chondroosseous matrix in the distal tip of the lesion. Wide C5 laminectomy with en bloc resection of the tumor alleviated her symptoms. Biopsy revealed osteochondroma without malignant degeneration. CONCLUSIONS: Patients with cervical spine osteochondromas may present with a multitude of symptoms and complications depending on the size and location of the lesion. These may include pathologic fracture, spinal stenosis, nerve root compression, cranial nerve deficits, myelomalacia, and malignant degeneration to chondrosarcoma. Advanced imaging modalities are required for characterization, diagnosis, surgical planning, and management of these rare spinal lesions.

Brain stem compression and atlantoaxial instability secondary to chronic rheumatoid arthritis in a 67-year-old female.

OBJECTIVE: This case study describes a patient with long-standing rheumatoid arthritis of the cervical spine who presented with significant bone destruction, gross joint derangement, and a potentially life-threatening complication, basilar invagination with brain stem compression. The pathophysiology, clinical presentation, imaging, and surgical management are discussed. CLINICAL FEATURES: A 67-year-old female presented to a chiropractic clinic with chronic neck pain of 30 years of duration complicated by rheumatoid arthritis. Her neck pain had recently exacerbated and was radiating into her trapezius muscle and shoulders. She also reported a recent onset of mild dysphagia. The patient was referred to a neurosurgeon for consultation and management. INTERVENTION AND OUTCOME: Computed tomography and magnetic resonance imaging of the cervical spine demonstrated significant bone destruction, gross joint derangement, and basilar invagination. There was moderate stenosis of the foramen magnum secondary to basilar invagination with significant brain stem compression. The patient underwent surgical stabilization fusion from the occiput to T2 using a posterior approach. Her pain severity was lessened after surgery, and the dysphagia had not progressed suggesting stabilization of brain stem compression. CONCLUSION: Patients with long-standing rheumatoid arthritis of the cervical spine often present with chronic neck pain. Cervical spine instability may arise from rheumatoid osteolysis and is also secondary to horizontal or vertical subluxation of the atlantoaxial and occipitoatlantal regions, respectively. High-velocity, low-amplitude manipulation of the upper cervical spine is an absolute contraindication in cases of atlantoaxial instability. A timely diagnosis and favorable surgical outcome provided relief from a potentially life-threatening disorder. This case exemplifies the clinical caution necessary for managing patients with chronic cervical spine pain complicated by rheumatoid arthritis.

Total situs inversus: a rare anomaly presenting to a chiropractic teaching clinic.

OBJECTIVE: The purpose of this article is to describe a patient with a previously undiagnosed rare anomaly, total situs inversus (TSI), and discuss the range of clinical presentations and complications associated with this and other situs anomalies. An emphasis is directed toward educating the clinician concerning the potential diagnostic challenges posed by patients with TSI and the need for patient education. CLINICAL FEATURES: The patient was a 26-year-old white woman who presented to a chiropractic teaching clinic for a scoliosis evaluation and underwent full-spine radiography. The cardiac silhouette and gastric air bubble were evident on the right side. INTERVENTION AND OUTCOME: Radiography including a 2-view chest and 1-view abdomen series was performed. Examination showed a complete mirror image presentation of the cardiothoracic and visceral organs. The patient was informed of her diagnosis and associated complications and counseled concerning how typical health complaints may present atypically in patients with situs anomalies. The patient has not experienced complications associated with the TSI. CONCLUSION: Total situs inversus is a rare autosomal recessive anomaly. This article highlights the classification and nomenclature of situs anomalies and their clinical presentations and complications. In addition, the importance of thorough patient education and counseling in those with situs anomalies is emphasized.