A rare case of extra-digital glomus tumor of the thigh.

INTRODUCTION: Glomus tumors are rare benign tumors arising from glomus bodies that are responsible for thermoregulatory control. Their typical location is the subungual area of the digits, and extra-digital glomus tumors are very rare, leading to misdiagnosis and delayed treatment due to the absence of typical symptoms. CASE: Here, we report the case of a 49 years old male patient with a long history of localized right thigh pain who was found to have an extra-digital glomus tumor of the thigh after surgical excision. DISCUSSION: A comprehensive physical examination, detailed medical history, in depth imaging and early surgical excision upon clinical suspicion may prevent delayed or incorrect diagnosis. The treatment of glomus tumor is surgical excision providing immediate relief from pain, however if the lesion is not palpable, it can be easily missed or confusing with other diagnoses such as schwannoma, neuroma or arteriovenous malformation. CONCLUSION: Glomus tumors of the thigh represent an exceptional location for extra digital glomus tumors. The aim of this report was to make the surgical community more aware of this entity to prevent delayed treatment and misdiagnosis. Glomus tumor should be kept in mind in the differential diagnosis of all painful subcutaneous lesions.

Adenoma Detection before and after the age of 50: a retrospective analysis of Lebanese outpatients.

BACKGROUND AND AIM: Colorectal cancer (CRC) has an increased impact on the Lebanese population's morbidity and mortality. This study evaluated the situation of adenoma detection in an outpatient clinic in Lebanon. PATIENTS AND METHODS: 918 patients underwent colonoscopy over a period of 24 months by a qualified physician. Biopsy results were divided into normal versus abnormal colonic tissue, which was further subdivided into number of polyps and cancer. RESULTS: Out of 918 individuals included, 82 cases of Crohn's colitis (8.93%) and 22 cases of ulcerative colitis (2.39%) were identified. A total of 42 cases of CRC (4.58%) and 188 cases of adenomatous polyps (20.48%) were identified. The data show that age >50 years and male gender significantly correlate with increased incidence of precancerous and cancerous polyps. Further exploring the results by age groups and gender, detection of adenomatous polyps in women aged 40-49 (8.33%) was significantly different from their female counterparts aged ≥50 years old (25.26%) (p<0.01). However, no statistical difference between detection of adenomas was found between men aged 40-49 (33.33%) and their male counterparts aged ≥50 years old (37.5%) (p=0.6). CONCLUSION: Within the limitations of this study, the incidence of CRC and adenomatous polyps falls in the high range compared with international studies. Furthermore, symptomatic male patients aged 40-49 appear to exhibit detection rates of adenomas similar to their counterparts aged ≥50 years old. Subjects younger than 50 years underwent diagnostic rather than screening colonoscopy, which introduces some selection bias. Nevertheless, these findings can serve as a basis for further studies.

Toothpick ingestion and migration into the liver through the colonic hepatic flexure: case presentation, management, and literature review.

The approach to toothpick ingestion and its complications should not be underestimated. The surgeon should be prepared for life-threatening situations such as major vascular involvement, as well as highly specialized and technically challenging procedures, when the hepatic hilum is involved for instance. Referral to tertiary centers is sometimes mandatory.

Results from a retrospective analysis of colonoscopies for Inflammatory bowel disease and colorectal cancer in a Lebanese tertiary care centre.

BACKGROUND AND AIMS: Inflammatory bowel diseases (IBDs) and colorectal cancer have an increased impact on the Lebanese population's morbidity and mortality. This study evaluated the situation of IBD and colorectal cancer at a tertiary hospital centre in Lebanon. METHODS: 1007 patients underwent colonoscopy over a period of 12 months by qualified physicians. 91 patients were excluded from the study. Biopsy results were divided into normal versus abnormal colonic tissue. The abnormal section was further subdivided into number of polyps, IBD, dysplasia and cancer. RESULTS: Out of 916 individuals included, 61 cases of Crohn's colitis (CC) (6.7%) and 24 cases of ulcerative colitis (UC) (2.7%) were identified. A total of 92 cases of colorectal cancer (10.04%) were also identified. There was a slight male predominance in both groups of IBD without any statistical significance. One statistical significance was reported in favour to age<50 years in both IBD groups with a mean age of 37.9±9.7 years and 34.4±6.4 years for CC and UC, respectively. The incidence of granuloma in the CC group was 8.9% without any correlation compared with age or gender. No correlation was made between colorectal cancer and the existence of any IBD type. The data showed that age >50 years and male gender significantly correlate with an increased incidence of precancerous and cancerous polyps in the colon. They significantly correlate with adenocarcinoma. The estimated incidence of colorectal cancer, CC and UC was 54.1, 35.8 and 14.1 per 100 000, respectively, with a denominator of 169 959 patients per year. CONCLUSION: Within the limitations of this study, the incidence of colorectal cancer and IBD falls in the high range compared with similar European and American studies. Our data are biased because of the tertiary centre setting but they can be considered as base for further investigations.

Liver hydatid cyst with cutaneous fistulization to the right breast: a case report, management, and literature review.

Echinococcus granulosus is the most common tapeworm causing hydatid disease in humans. Its least-encountered complication is cutaneous fistulization. Omentoplasty, cyst, and fistulous tract drainage revealed successful in the management of this complication. Such intervention can be an alternative when conservative management fails, and a minimally aggressive procedure is required.

A case of reversible hyperoxaluria nephropathy early after roux-en-y-gastric bypass induced by vitamin C intake.

Roux-en-y-gastric bypass (RYGB) is the most commonly performed bariatric procedure worldwide which is taking the lead in resolving of comorbid conditions. Short- and long-term complications of RYGB procedure have been recognized, including osteopenia, osteomalacia and more rarely neurological disorders. Oxalate nephropathy is a complication of RYGB that has been described earlier in the literature and may end with renal failure and dialysis if not recognized and treated early. The etiology of this phenomenon is still unclear, but the length of common limb remains the theory that mostly contributed to its development. We believe that this limb should be more than 100 cm to prevent severe malabsorption. Here, we report a reversible case of oxalate nephropathy 3 months after RYGB in a 51-year-old patient.

Wernicke's encephalopathy three weeks after sleeve gastrectomy.

Following bariatric surgeries for management of morbid obesity, less nutrients are absorbed, giving rise to complications due to vitamin deficiencies with frequently dramatic consequences. Neurologic complications resulting from folate, vitamin B12, and thiamine deficiencies have been estimated to occur in up to 16% of cases and present within weeks to months following bariatric surgery. Among bariatric surgeries, Roux-en-Y gastric bypass has been the most associated with such deficiencies due to both restrictive and malabsorptive components. Complications are less seen with restrictive surgeries. We report a case of rapid Wernicke's encephalopathy due to a thiamine deficiency in a young female patient following Sleeve gastrectomy (SG).