Migration of a bladder diverticulum stone into the rectum revealing an advanced rectal process.

Rectovesical fistulas are rare and typically result from inflammatory or neoplastic conditions in the small pelvis. They occur within a pelvic region that has been altered by local inflammatory or neoplastic processes. This explains the challenges in detecting these fistulas using conventional imaging techniques, despite the effectiveness of CT and MRI. Colonic diverticulosis is the primary cause of colovesical fistulas. To date, there have been no reported cases of a rectovesical fistula associated with a bladder diverticulum in the literature. We present a case of a patient who presented with a large stone within a bladder diverticulum. The migration of this stone into the rectum revealed an advanced rectal tumor. The unique aspect of our case is primarily the presence of a rectovesical fistula arising from a lateral bladder diverticulum. Additionally, we observed the migration of the diverticular calculus from the bladder to the rectum.

Remote bifrontal epidural hematoma following hemispheric glioma resection. A rare life-threatening postoperative complication.

Background: Postoperative acute epidural hematoma (EDH) is a well-known serious complication that usually occurs at the operated site after cranial surgery. However, epidural bleeding, distant from the site of the previous craniotomy, is relatively rare and may sometimes cause significant neurological morbidity or even mortality. We report such a case. Case Description: A 35-year-old woman, previously healthy, was operated on for a left temporo-parieto-fronto-insular anaplastic astrocytoma. Between 2 and 4 h after the surgery, the patient had trouble waking-up following the general anesthesia. Emergent computed tomography (CT) scan revealed an acute bifrontal EDH away from the initial surgical field. The patient underwent an immediate reoperation, a decompressive bifrontal craniotomy, and the evacuation of the hematoma. Despite the neurologic improvement, she died 24 days after the surgery due to severe sepsis caused by pulmonary infection with pseudomonas aeruginosa. Conclusion: The pathophysiology of postoperative remote EDH is poorly understood, although various hypotheses have been suggested including the loss of tamponade effect, the vasomotor mechanisms, and the coagulopathy. As seen in the present case report, we suspected that the intensive use of perioperative mannitol may also promote this complication. In the early postoperative period, every patient with neurological deterioration should have a rapid cranial CT-scan because early detection and removal of postoperative acute EDH can be life-saving.

Acute spinal cord compression caused by atypical vertebral hemangioma.

Vertebral hemangioma is common, benign lesion that occurs mostly in the body of vertebral bones and is mostly asymptomatic although they may occasionally extend into the posterior elements. An isolated location in the neural arch of vertebrae is extremely rare. An acute spinal cord compression by an exceptional hemangioma involving spinous process of the seventh thoracic vertebra and respecting vertebral body in a 40-year-old woman is reported. On magnetic resonance imaging of the spine, the lesion was hypointense on T1-weighted image, hyperintense on T2-weited image, and enhancing avidly, causing compression of spinal cord. Our case is exceptional by the rapidly character of symptom installation and by atypical and elective involvement of spinous process.