Segmental arterial mediolysis with 5 splenic artery aneurysms. A rare finding of a rare disease: Case report and literature review.

INTRODUCTION: Splenic artery aneurysms (SAA) are uncommon findings. They are usually single and isolated; however they can be multiple; hence vasculopathy and segmental artery mediolysis may be considered. PRESENTATION OF CASE: In our manuscript we present a case of a 54year old multiparous lady who was discovered incidentally to have a diseased splenic artery containing five SSAs. The largest aneurysm was close to the takeoff of the vessel and the smallest was distal embedded in the splenic hilum. Endovascular option was technically not feasible. Therefore the patient underwent a complete splenic artery resection with splenectomy and the histopathologic examination was suggestive of segmental arterial mediolysis (SAM). DISCUSSION AND CONCLUSION: Multiple SAAs remains a rare finding of a rare disease. Complications can be crucial and high index of suspicion is important. Segmental arterial mediolysis can be considered in patients with several aneurysms on one anatomic site; Angiography is the gold standard diagnostic and therapeutic method. Complete splenic artery resection with splenectomy is the best treatment option for solitary vessel involvement.

Gallbladder Mucus Plug Mimicking Ascaris Worm: An Ambiguous Cause of Biliary Colic.

Biliary colic is a visceral pain caused by attempts of the gallbladder or bile duct to overcome the obstruction in the cystic duct or ampulla of Vater. Obstruction can be due to different etiologies such as stone, mass, worm, and rarely by mucus plug. We report the case of a 31-year-old gentleman who presented with recurrent biliary colic and weight loss. Work-up showed linear calcifications in the gallbladder extending to the common bile duct suggesting hepatobiliary ascariasis. Further investigations including stool analysis, upper endoscopy, endoscopic ultrasonography (EUS), and endoscopic retrograde cholangiopancreatography (ERCP) did not support our provisional diagnosis. Laparoscopic cholecystectomy was performed. Histopathological finding was grossly ambiguous; a rope-like mucus plug resembling ascaris worm was noted. The patient's condition improved instantly after the procedure. To our knowledge, we are reporting the first case in the English literature describing this unique entity of symptomatic gallbladder disease to increase awareness and improve its management.

Risk factors for wound complication in pilonidal sinus procedures.

BACKGROUND: Pilonidal disease is a common condition among young people. Complicated pilonidal surgical wounds are associated with considerable morbidity, including chronic sacral wound, loss of work time, and lifestyle limitation. The aim of our study is to report our experience with Karydakis procedure and explore the risk factors associated with infection and poor healing in pilonidal operation. STUDY DESIGN: A 3-year experience of a Joint-Commission International accredited tertiary center in patients with pilonidal sinus operations is reported. We retrospectively reviewed the charts of unselected patients with pilonidal sinus who underwent excision and primary closure on elective basis in terms of wound healing, surgical site infection, and return to work. Variables predictive of surgical site infection and disruption were assessed by multiple logistic analyses. RESULTS: From January 2004 to December 2006, 94 patients with pilonidal disease underwent excision and primary closure on elective basis. Incidence of surgical site infection was 12.8%. No recurrence was observed after median followup of 6 months, with interquartile range of 4 to 9 months. Smoking (p = 0.027) and obesity (p = 0.047) were independent risk factors for wound infections. CONCLUSIONS: Excision and primary closure is an acceptable modality of treatment in nonobese and nonsmoker patients with pilonidal sinus disease. Infection rate in obese patients and smokers is unacceptably high, and active preoperative weight loss and smoking cessation or simple laid open procedure is recommended in these patients.

Cervical radiculopathy secondary to Hodgkin's lymphoma.

BACKGROUND: Spinal cord/root compression is a rare complication of HL and usually seen in the setting of progressive, advanced disease. It is extremely rare to occur as an initial presentation of HL. We report a case of HL presented with bilateral cervical radiculopathy. METHODS: A case report of a 42-year-old woman who presented with C8 cervical radiculopathy and paraspinal mass with extradural extension in C7-T1. Biopsy revealed HL. This case report represents a case of HL presenting with epidural disease, with nerve root compression as the only apparent site of clinical involvement. A review of the literature of patients with HL presenting with spinal cord/root compression is presented. RESULT: Our patient received chemotherapy and external beam radiation therapy. She achieved good recovery of her symptoms and complete response by radiologic criteria. Based on a review of the literature, Hodgkin's disease involving the spinal epidural space is very responsive to chemoradiotherapy with good prognosis for both functional recovery and complete response. CONCLUSION: Chemoradiotherapy is a successful treatment for Hodgkin's disease presenting with spinal root compression. Surgery should be reserved for urgent decompression, if needed; palliation; and maintenance of function and stability.