Search

In clinical practice, the typical approach to ingested foreign bodies in stable patients involves expectant management, as most materials pass through the gastrointestinal (GI) tract without adverse effects. However, foreign bodies that travel through the appendix's lumen can cause acute appendicitis due to their inability to exit the colon. Rarer causes of appendicitis include parasitic infiltration by Ascaris lumbricoides . The wandering behavior of Ascaris lumbricoides within the GI tract can lead to various surgical complications in the abdomen. Occasionally, these parasites can migrate to the vermiform appendix, where they may either induce pathological changes or remain asymptomatic. We report an unusual case of an eight-year-old Pakistani female patient who presented to the emergency room with pain in the right iliac fossa, associated with anorexia and nausea, for one day. On examination, the patient was found to be vitally stable, with right iliac fossa tenderness noted on palpation. Additionally, the patient exhibited positive pointing, rebound, Rovsing, and psoas signs. Her medical history revealed that she had ingested a metallic needle seven months ago. Blood tests were undertaken, and an abdominal X-ray confirmed the existence of a radiopaque metallic object in the right lower quadrant of the abdomen. The patient underwent an open appendicectomy for acute appendicitis and was discovered to have a metallic needle lodged in the vermiform appendix. Concurrently, she also had ascariasis, as she vomited a 23-cm-long Ascaris lumbricoides worm. It is important to consider both mechanical and parasitic etiologies in diagnosing acute appendicitis; detailed evaluation and management strategies are necessary to address these unique etiologies effectively., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Khan et al.)

One of the most uncommon cystic duct abnormalities is double cystic ducts exiting a single gallbladder. Adequate knowledge of this anomaly should be kept in mind to avoid any surgical complications. We present a case of a 49-year-old Asian Pakistani male patient who had an elective laparoscopic cholecystectomy and was discovered to have two distinct cystic ducts leaving the gallbladder. On examination, there were no other clinically relevant signs except for mild tenderness in the right hypochondrium. Ultrasound of the abdomen and pelvis confirmed the diagnosis of cholelithiasis. Standard four-port laparoscopic cholecystectomy was done via the open Hasson technique under general anesthesia. After meticulous dissection of the Calot's triangle, double cystic ducts were discovered draining a single gallbladder. The gallbladder was retrieved after clipping and cutting the cystic ducts and cystic artery. To minimize the risk of complications, surgeons must be aware of the numerous anatomical variations that may exist., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Khan et al.)

We present a case of subfertility due to isthmocele and cesarean scar endometriosis with a successful pregnancy following laparoscopic repair. This case report is of a 35-year-old female (para 1, living 1) who presented to the gynecological outpatient department with complaints of lower abdominal pain, irregular vaginal bleeding for three months, and subfertility. She was suspected to have isthmocele and endometriosis at the site of the cesarean scar with seroma formation. She underwent a hysteroscopy and laparoscopic excision of the cyst at the site of the cesarean scar with the repair of the cesarean scar defect. Diagnosis of scar endometriosis was confirmed on histopathology. She successfully became pregnant after one year and had a full-term pregnancy and delivered via cesarean section. Cesarean scar defect, also known as isthmocele, emerges as a notable complication following cesarean delivery, often linked with secondary infertility. Other associated complications of scar defect are prolonged menstrual bleeding, dysmenorrhea, dyspareunia, and chronic pelvic pain. The laparoscopic reparation of the uterine scar defect proves to be a successful approach in addressing secondary infertility and subfertility issues. Individuals with a prior cesarean section history, expressing concerns about secondary infertility and distressing complaints, require a thorough examination of the uterine scar before embarking on future pregnancy plans. Scar endometriosis is an uncommon medical condition and can worsen patient symptoms and lead to further complications. Diagnosis is often established following the excision of the lesion and subsequent histopathological examination. Prompt management can relieve patient symptoms and prevent further complications., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Ali et al.)

Acute disseminated encephalomyelitis (ADEM) is a rare autoimmune demyelinating disorder that primarily affects the central nervous system (CNS). It is characterized by an acute inflammatory response targeting the myelin sheath surrounding nerve fibers in the brain and spinal cord. The exact mechanism of ADEM is not fully understood, but it is believed to involve an abnormal immune response that leads to the activation of immune cells and subsequent inflammation within the CNS. This immune-mediated attack results in the destruction of myelin, impairing the transmission of nerve signals and causing a wide range of neurological symptoms. This is a case of a six-year-old girl with no notable medical history presented with complaints of a fever and headache for the last month, in addition to difficulty walking for 20 days and speaking for 14 days. On CNS examination, the right upper and lower limbs' power was reduced, and the Babinski sign was seen in both lower limbs. Both sides of the triceps and knee showed increased reflexes, whereas both sides of the ankle showed decreased reflexes. Magnetic resonance imaging (MRI) showed multiple T1 hypointensities and T2-weighted fluid-attenuated inversion recovery (T2-FLAIR) hyperintensities in the subcortical white matter of the bilateral frontal and parietal lobes, bilateral cerebellar peduncles, corpus callosum, pons, and midbrain. Our case report aims to raise awareness and aid in the early recognition of ADEM because prompt recognition, accurate diagnosis, and appropriate management are essential to minimizing neurological damage and promoting favorable outcomes in affected individuals., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Vempati et al.)

Bladder cancers rarely are non-urothelial in origin. We present here, possibly the youngest case of a 35-year-old White female presenting with shortness of breath. She was found to have a malignant pleural effusion with unknown primary, eventually confirmed with genetic testing as metastatic adenocarcinoma of the urinary bladder with brain and lung metastasis. She was scheduled for palliative chemotherapy, however, passed away before it could be started. We highlight this rare case because of its unique presentation. Owing to similarity in receptors between adenocarcinoma and enteric cancer, similar chemotherapy regimens may be used for both. Unfortunately, treatment of metastatic disease remains highly controversial and needs to be studied further if there is an actual survival benefit to this or not., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Ravikumar et al.)

Autoimmune events are rare in multiple myeloma (MM). Herein, we report a rare case of a patient presenting with recurrent gastrointestinal (GI) bleeding of unknown origin, also having pancytopenia eventually diagnosed as MM with Evans syndrome. This is an uncommon disorder presenting as autoimmune hemolytic anemia (AIHA) with immune thrombocytopenia purpura (ITP). A 56-year-old African American male presenting with recurrent GI bleeds and pancytopenia of unknown origin developed acute colonic diverticulitis on recurrent admissions, and sigmoid colectomy with primary anastomosis was performed. Flow cytometry with serum protein electrophoresis eventually revealed IgG MM with elevated Kappa/Lambda ratio. Bone marrow biopsy revealed 80% to 90% Kappa clonal plasma cells confirming MM. Direct antiglobulin test (DAT) was positive with pancytopenia. The patient initially showed a good response to chemotherapy with thrombocytopenia improving with intravenous (I/V) dexamethasone. DAT done after completion of initial chemotherapy was negative. However, his disease relapsed after three months with pancytopenia and DAT becoming positive again. The patient was restarted on chemotherapy for debulking, which resulted in a negative DAT again after two months, but pancytopenia did not improve. The patient eventually passed away due to subarachnoid hemorrhage. We highlight only this fourth reported case because of its unique presentation. In elderly patients with unknown cause of GI bleeding with pancytopenia, blood dyscrasias, especially MM, should be considered. Autoimmune workup if positive might warrant the use of steroids for pancytopenia, which can improve thrombocytopenia in MM with Evans syndrome but not anemia., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2019, Khan et al.)

Vancomycin has been used for a long time to manage resistant gram-positive bacterial infections. Neutropenia is an uncommon and potentially serious adverse effect associated with vancomycin use. Herein we present a case of probable vancomycin induced neutropenia which resolved with discontinuation of the antibiotic. Since blood counts are monitored routinely these days in both outpatient and inpatient setting, due consideration needs to be given to vancomycin induced neutropenia in patients who are on long term antimicrobial therapy., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2019, Kaur et al.)