Delayed Titanium Hypersensitivity and Retained Foreign Body Causing Late Abdominal Complications.

Titanium is a known metal used widely in the medical field and can cause allergic reactions with complications. Our case is about a 28-year-old female presenting with a spectrum of abdominal symptoms with a complicated medical history. The abdominal pain is associated with titanium allergy reaction from previously inserted titanium-based surgical clips. This patient is concurrently found to have a retained pigtail catheter in the cecum discovered incidentally through radiology. We discuss the presentation, investigations, and treatment of this unusual case. The case also unfolds rare differential diagnoses to keep in mind when encountering a patient with abdominal pain and associated nonspecific symptoms.

Cholecystoduodenal Fistula Evading Imaging and Endoscopic Retrograde Cholangiopancreatography: A Case Report.

Cholecystoduodenal fistulas are a type of internal biliary fistula that occur due to chronic inflammation of the gallbladder/biliary tree; if left untreated, perforation and necrosis can occur. Cholecystoduodenal fistulas are often difficult to diagnose due to their non-specific signs and symptoms. Since the widespread use of techniques such as magnetic resonance cholangiopancreatography and imaging modalities such as computed tomography, the frequency of reports describing intraoperative cholecystoduodenal fistula has reduced dramatically. Here, we report the case of a 54-year-old female who presented with a two-day history of non-radiating epigastric abdominal pain, initially diagnosed with acute cholecystitis and choledocholithiasis. Upon undergoing laparoscopic cholecystectomy, she was found to have extensive fibrosis of the gallbladder, adhesions, and an impacted gallstone in the wall of the gallbladder. Imaging and endoscopic retrograde cholangiopancreatography performed prior to surgery did not detect a cholecystoduodenal fistula that was discovered intraoperatively. She was treated successfully with laparoscopic cholecystectomy and repair of the duodenum.

Marchiafava-Bignami disease in a trauma patient.

Marchiafava-Bignami disease (MBD) is a rare pathological condition affecting the corpus callosum (CC), characterized by progressive demyelination and necrosis. While usually found in patients with chronic alcoholism, it has rarely been characterized in non-alcoholics. We describe a trauma patient with an unknown mechanism of injury, who was found to have MBD after remaining comatose for a prolonged period of time. Magnetic resonance imaging (MRI) demonstrated restricted diffusion involving the genu, body, and splenium of the CC. The patient eventually awoke but was non-communicative and uncomprehending prior to discharge to a nursing facility. We reviewed the literature and report here the first case of MBD encountered in a trauma patient. In conclusion, MBD is an extremely rare condition in non-alcoholic patients, and the use of MRI is crucial for its identification.

Laparoscopy to evaluate scrotal edema during peritoneal dialysis.

BACKGROUND: Acute scrotal edema is an infrequent complication in patients who undergo continuous ambulatory peritoneal dialysis (CAPD), occurring in 2% to 4% of patients. Inguinal hernia is usually the cause, but the diagnosis is sometimes confusing. Imaging modalities such as computed tomographic peritoneography are helpful but can be equivocal. We have used diagnostic laparoscopy in conjunction with open unilateral or bilateral hernia repair for diagnosis and treatment of peritoneal dialysis (PD) patients with acute scrotal edema. TECHNIQUE AND CASES: Three patients with acute scrotal edema while receiving CAPD over the span of 7 years had inconclusive results at clinical examination and on diagnostic imaging. All patients underwent diagnostic laparoscopy that revealed indirect inguinal hernia, which was concomitantly repaired using an open-mesh technique. RESULTS: Diagnostic laparoscopy revealed the etiology of the scrotal edema 100% of the time, with no complications, and allowed concomitant repair of the hernia. One patient had postoperative catheter outflow obstruction, which was deemed to be unrelated to the hernia repair. CONCLUSION: Diagnostic laparoscopy is helpful in confirming the source of acute scrotal edema in CAPD patients and can be performed in conjunction with an open-mesh repair with minimal added time or risk.