搜索结果：Pain medicine case reports

Craniocervical instability (CCI) is a disorder caused by weakness of the stabilizing ligaments of the craniocervical junction, leading to abnormal motion between the skull and upper cervical spine. CCI can present with any combination of the following symptoms: cervical neck pain, dizziness, autonomic dysfunction, migraines, and radiculopathy/myelopathy. CCI is often associated with connective tissue disorders. We present the case of a 51-year-old woman with a history of rheumatoid arthritis and chronic neck pain, migraines, vertigo, and autonomic dysfunction who underwent a series of regenerative injection treatments alongside postural and chiropractic therapy. Symptomatic and structural improvement was achieved, suggesting a possible role for regenerative therapies in the treatment of CCI. However, further studies are needed to investigate the effects of regenerative therapies on CCI severity. Our primary objective in presenting this case is to continue the conversation regarding the treatment of CCI with regenerative therapies and to spur further research on the topic.

The lateral transpoas approach has become increasingly utilized in the treatment of thoracolumbar spine pathologies. Recent studies report a modified single-position prone lateral transpsoas surgery which incorporates lumbar interbody fusion and pedicle screw fixation. However, few studies demonstrate its utility in corpectomy cases. This report aims to highlight the technique, efficacy, and implications associated with single-position prone lateral transpsoas corpectomy with short-segment posterior spinal fusion in two traumatic cases with unstable burst fractures. Patient demographics, as well as clinical and radiographic outcomes, were reviewed retrospectively. The first patient was a 29-year-old male who presented with severe back and right lower extremity pain after falling from a roof. Imaging revealed an L4 burst fracture with canal compromise and a ventral epidural hematoma. He underwent a single-stage prone lateral L4 corpectomy with open short-segment L3-5 decompression and fusion with complete resolution of symptoms, durable at 6 months follow-up. The second patient, a 60-year-old male, presented with severe back pain and right lower extremity proximal weakness with radiating leg pain after a motor vehicle accident. Imaging revealed an L3 burst fracture with canal compromise. The patient underwent a single-stage prone lateral L3 corpectomy with open short-segment L3-5 decompression and fusion with immediate improvement in pain and weakness. At 4 months follow-up, he continued to endorse resolution of pain with improving strength in his quadriceps. Initial reports regarding this novel approach for traumatic burst fractures demonstrate promising results in terms of safety and efficacy when compared with traditional techniques. Nevertheless, further studies using expanded cohorts with various underlying pathologies are warranted.

Organophosphates (OP) have a variety of applications, including widespread use as pesticides. Although OP poisoning in the U.S. has been declining, toxicity from intentional ingestions of commercially available preparations is still a concern. We describe a case of a 17-year-old female who intentionally ingested an acephate-based fire ant insecticide and developed severe cholinergic toxicity, despite acephate's classification as a safer OP. The patient was successfully treated with atropine and pralidoxime, but had recurrence of symptoms after long asymptomatic periods requiring repeat dosing, which is atypical. We encourage clinicians to have a low threshold for prolonged observation in these patients, even in the absence of symptoms.

Calcification of the lateral collateral ligament (LCL) of the knee is a rare cause of lateral knee pain related to hydroxyapatite crystal deposition. We report a case series of four patients presenting with lateral knee pain. Diagnosis was established using imaging. In one case, calcification was first detected on ultrasound and subsequently confirmed on radiography and MRI. In two other cases, calcification was identified on radiography and MRI, with spontaneous radiographic resolution on follow-up in one patient. In the fourth patient, dual-energy CT was additionally performed to exclude gout. All patients were treated conservatively with nonsteroidal anti-inflammatory drugs and physiotherapy, with symptomatic improvement. Our findings suggest that plain radiography is usually sufficient to identify LCL calcification, while advanced imaging aids in excluding other diagnoses and in assessing associated soft-tissue changes. Most patients can be managed conservatively, and spontaneous resolution of calcification may be observed in some cases.

Squamous cell carcinoma (SCC) of the colon is a rare malignancy. Unlike colonic adenocarcinomas, it lacks defined risk factors or established treatment guidelines. We describe a case of metastatic squamous cell carcinoma of the colon in a 77-year-old male with ulcerative colitis. The patient presented with abdominal pain and had labs that revealed transaminitis with conjugated hyperbilirubinemia. Imaging showed a large irregular mixed hyperechoic mass with fluid collection in the liver along with retroperitoneal lymphadenopathy concerning infection/abscess or malignancy. This was initially treated as an infection with broad-spectrum antibiotics and drain placement, but it failed to improve. Biopsy of the liver revealed carcinoma with squamous cell differentiation. In order to look for the primary site, the patient underwent a colonoscopy and esophagogastroduodenoscopy (EGD). EGD was negative, and colonoscopy revealed a mass at the hepatic flexure of the colon with pathology consistent with SCC. PET scan did not reveal any other sites suspicious for primary malignancy. Tempus tumor of origin testing was inconclusive. Hence, colon was thought to be the primary site for SCC with direct extension to the liver. Unlike colonic adenocarcinoma, colonic SCC lacks standardized treatment guidelines. Prognosis is also worse, especially in advanced stages. Surgical resection is preferred for localized disease, but evidence supporting systemic therapy is limited to case reports. The patient was not a surgical candidate and was initiated on FOLFOX (folinic acid, fluorouracil, and oxaliplatin) chemotherapy. This case overall highlights a rare case of colonic SCC and the need for more evidence to guide treatment.

Acute B-lymphoblastic leukemia (B-ALL) with t(5;14)(q31;q32) is a very rare subtype of B-ALL, accounting for <1% of cases and often presenting with significant eosinophilia but without peripheral blasts. This condition is driven by a t(5;14)(q31;q32) that juxtaposes the immunoglobulin heavy-chain (IGH) enhancer on chromosome 14q32 with the interleukin-3 (IL-3) gene on 5q31. This results in increased IL-3 production and a characteristic eosinophilia. While this translocation is primarily seen in pediatric patients, it rarely occurs in adults. We report two cases of a young adult aged 20-25 years and a 30-year-old man with 25 diagnosis of common B-ALL/B-lymphoblastic lymphoma. In one case, the only clinical symptom was back pain, but laboratory results showed leukocytosis with prominent neutrophilia and eosinophilia. The other case presented with fever, chills, diarrhea, vomiting, and myalgia, accompanied by leukocytosis and eosinophilia. No peripheral blasts were detected. FISH analysis revealed rearrangement of the IGH locus (14q32) in both patients, and karyotyping confirmed a t(5;14)(q31;q32). Both patients were treated according to the GMALL (German Multicenter Study Group for Adult Acute Lymphoblastic Leukemia) recommendations, including allogeneic stem cell transplantation (ASCT). ASCT was performed due to high-risk disease in one case and an early relapse during first-line treatment in the other. During 3 years of follow-up, the first patient remained relapse-free and in good general condition; the second patient died due to septic shock on day 16 after ASCT. B-ALL with t(5;14)(q31;q32) is an extremely rare entity in adults and may present with pronounced eosinophilia in the absence of peripheral blasts, posing a significant diagnostic challenge. As eosinophilia is often interpreted as reactive, this leukemia subtype may be overlooked or diagnosed late. Therefore, unexplained eosinophilia should prompt early bone marrow investigation with flow cytometry and cytogenetic analysis, even when peripheral blood findings do not suggest acute leukemia.

Currently, there is a paucity of accurate, convenient, rapid, and efficient diagnostic approaches for myocardial infarction with non-obstructive coronary arteries (MINOCA) in patients who have undergone coronary angiography (CAG) or coronary computed tomography angiography (CCTA) confirming non-obstructive coronary arteries, particularly when the ECG is normal or non-diagnostic. Given that MINOCA is pathologically characterized by myocardial ischemia and abnormal local electrical activity, magnetocardiography (MCG), which can sensitively detect changes in myocardial depolarization and repolarization current density, may provide a promising diagnostic option. This case series includes 2 patients with non-ST-segment elevation myocardial infarction (NSTEMI), both of whom were confirmed to have a subtype: MINOCA, and all underwent MCG. In both cases, serial ECG findings were normal, yet myocardial enzymes were elevated (suggestive of infarction); thus to resolve this diagnostic ambiguity, we assessed infarction-related waveform features by referencing previously observed infarction characteristics and confirmed that even without ECG-detectable infarction, MCG waveforms still exhibit highly prominent infarction-related features. Subsequent cardiac catheterization confirmed no coronary artery stenosis in both patients. In the second case, cardiac magnetic resonance (CMR) further completed the guideline-specified final diagnostic workflow for MINOCA, which retrospectively validated the diagnostic accuracy of MCG. In real-world clinical practice, conventional diagnostic pathways frequently face challenges in the underdiagnosis and suboptimal classification of MINOCA. As a rapid, painless, non-invasive, and radiation-free technique, MCG may serve as a complementary functional assessment tool for patients with suspected MINOCA and elevated myocardial biomarkers. Based on these preliminary case observations, MCG shows potential to identify subtle electrical abnormalities related to myocardial ischemia that are not readily captured by routine examinations. This study provides exploratory evidence supporting the possible additive value of MCG in refining the diagnostic workflow of MINOCA, and warrants further larger-scale investigations to validate its clinical utility, including differentiation from other non-ischemic myocardial injury conditions.

BACKGROUND Fournier gangrene is a rare, life-threatening necrotizing fasciitis involving the perineum and external genitalia. It predominantly affects men, while cases in women are uncommon and often underrecognized, leading to delays in diagnosis and treatment. Although Fournier gangrene is frequently associated with immunocompromised states and diabetes mellitus, cases occurring in immunocompetent individuals remain exceptional. CASE REPORT We report a 40-year-old woman with obesity (BMI 39 kg/m&#xb2;) and without immunodeficiency who presented with severe left labial pain and swelling 1 week after perineal shaving and topical herbal application. On examination, she had tachycardia, with marked tenderness and swelling extending to the suprapubic region. Laboratory investigations revealed significant inflammatory response. Computed tomography demonstrated extensive subcutaneous gas and fascial involvement of the vulva and perineum, consistent with necrotizing fasciitis. The patient underwent urgent surgical debridement followed by multiple re-explorations and negative-pressure wound therapy. Cultures identified extended-spectrum &#xdf;-lactamase-producing Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae. Empirical broad-spectrum antibiotics were initiated, and subsequent culture-guided therapy allowed step-down from meropenem to amoxicillin-clavulanate. Definitive wound closure was achieved by secondary intention after prolonged inpatient care. CONCLUSIONS This case highlights that Fournier gangrene can occur following minor perineal manipulation in women without immunodeficiency. Obesity may mask early clinical signs and contribute to diagnostic delay. Early recognition, prompt imaging, aggressive surgical debridement, and multidisciplinary management remain essential for favorable outcomes, even in patients without classical risk factors. These findings reinforce the need to maintain a high index of suspicion in atypical presentations.

Perilunate dislocations are uncommon and frequently missed wrist injuries that can lead to significant morbidity, such as median nerve injury, carpal instability, and poor functional outcomes, if not promptly identified and treated. Early recognition and coordinated management are especially important in rural trauma settings where subspecialty resources are limited. This case describes a 17-year-old male who presented to a rural emergency department following a motorcycle accident. Initial evaluation showed extensive road rash and a gross deformity of the left elbow. Radiographs of the chest, pelvis, left elbow, and right wrist were obtained. The right wrist demonstrated a scaphoid fracture with a perilunate dislocation. A telemedicine consultation was performed with an emergency medicine physician and the patient was transferred for higher-level care. Upon arrival, orthopedic surgery was consulted. Physical exam showed tenderness to palpation and pain with passive wrist motion. Attempted closed reduction of the perilunate injury was unsuccessful. The wrist was splinted, and the orthopedic hand surgeon was consulted. Open reduction of the perilunate dislocation and carpal tunnel release were performed under general anesthesia. A volar approach was performed, with a longitudinal incision made over the palmar aspect of the hand along the radial border of the ring finger. The median nerve was decompressed, a hematoma was removed, and the capitate was reduced back over the lunate with traction, wrist flexion, and direct pressure on the dorsal aspect of the capitate. Reduction was confirmed on orthogonal fluoroscopic views. The wound was irrigated, closed with nylon suture, and a splint was applied. At 2 month follow-up, the patient was doing well and demonstrated stable wrist alignment with interval healing of all injuries. This case highlights the complexity of managing perilunate dislocations in resource-limited healthcare settings and the importance of prompt diagnosis, appropriate care, and timely surgical referral.

We report a case of immune-related aseptic meningitis (irAE meningitis) presenting with multiple cranial nerve symptoms during immune checkpoint inhibitor therapy for lung adenocarcinoma. A 72-year-old woman diagnosed with left lower lobe lung adenocarcinoma initiated combination therapy consisting of carboplatin, paclitaxel, bevacizumab, and atezolizumab. Paclitaxel was subsequently discontinued due to peripheral neuropathy, and maintenance therapy with bevacizumab and atezolizumab followed. Eight months after starting treatment (after four cycles of atezolizumab maintenance), the patient presented with a three-week history of dysgeusia, anosmia, trismus, and neck pain. Cerebrospinal fluid (CSF) analysis revealed lymphocytic and monocytic pleocytosis, while cytological examination showed no malignant cells and bacterial cultures were negative. Brain and neck magnetic resonance imaging (MRI) showed no alternative etiologies. Intravenous prednisolone led to a rapid resolution of all symptoms. The patient was diagnosed with irAE meningitis with concomitant cranial nerve involvement, including the olfactory (I), trigeminal (V), facial (VII), and/or glossopharyngeal (IX) nerves. Intravenous prednisolone led to a rapid resolution of all symptoms. Although irAE meningitis is a known rare adverse event, cases complicated by multiple cranial nerve symptoms are extremely uncommon. This case highlights the phenotypic diversity of neurotoxicity associated with immune checkpoint inhibitors.

Persistent urethral burning without identifiable infection represents a diagnostically challenging condition in male urology and may lead to repeated empirical treatment with limited benefit. We report the case of a 35-year-old man who experienced isolated urethral burning for approximately six years after an initial urinary tract infection. Despite repeated evaluations and multiple conventional treatments, his symptoms persisted. Laboratory investigations, including urinalysis, urine culture, gonococcal smear examination, and prostatic fluid analysis, showed no evidence of active infection or clinically significant prostatic inflammation. Transabdominal pelvic ultrasonography revealed only mild nonspecific prostatic changes without major structural abnormalities. Given the chronic refractory symptoms and negative diagnostic findings, an integrative symptom-oriented management strategy incorporating a modified Gancao Xiexin decoction was initiated. The patient reported gradual improvement, with the visual analogue scale score decreasing from 8 at baseline to 4 after one week and to 0 after two months. Anxiety, sleep quality, bowel habits, and overall well-being also improved, and no adverse effects or symptom recurrence were reported during follow-up. This case highlights the diagnostic uncertainty associated with persistent urethral burning without identifiable infection and suggests that noninfectious pain-related mechanisms may deserve consideration in selected patients. The observed improvement should be interpreted as a temporal association rather than evidence of therapeutic efficacy, and further studies are needed to clarify the underlying mechanisms and evaluate integrative management approaches for chronic unexplained urethral pain conditions.

Purulent pericarditis is a rare, but life-threatening condition occurring in roughly 27.7 cases of pericarditis per 100,000 population per year in developed countries. Gram positive cocci are the predominant causative pathogens with Staphylococcus aureus and Streptococcus species being the most common. Early recognition is essential in preventing complications such as cardiac tamponade, constrictive pericarditis, and effusive-constitutive pericarditis. Despite appropriate medical management including both drainage and antibiotics, mortality rates remain elevated and approximately 50% of cases are diagnosed postmortem. An 84-year-old male with a history of myelodysplastic syndrome, permanent atrial fibrillation and heart failure with preserved ejection fraction presented to the emergency department with sharp, left-sided chest pain radiating to the right shoulder, worsened by inspiration. A computed tomography angiogram performed to evaluate for pulmonary embolisms revealed a large pericardial effusion. Electrocardiogram (EKG) demonstrated low-voltage tachycardia. Transthoracic echocardiography showed a large circumferential pericardial effusion with fibrinous strands. The patient underwent pericardiocentesis with drainage of 450 cc of purulent fluid, followed by placement of a pericardial drain. Fluid analysis revealed a pH of 6.9 and 15,095 nucleated cells/&#x3bc;L with 89% neutrophils. Pericardial fluid and blood cultures were positive for MRSA. The patient was initiated on intravenous vancomycin and transesophageal echocardiography was negative for infective endocarditis. He was subsequently transitioned to daptomycin to complete a four-week course of antibiotics. Repeat blood cultures were negative. This case illustrates the diagnostic challenges and management considerations for MRSA-associated purulent pericarditis in a frail host. Early echocardiography and pericardiocentesis are critical in management. Despite source control and target antibiotics, mortality remains high in frail hosts.

BACKGROUND Over 5000 plant species produce milky latex sap utilized in decoration and various industries. Sap exposure, however, can elicit toxic reactions, including acute keratoconjunctivitis and corneal stromal infiltration. The common ornamental plant Dieffenbachia can cause acute keratoconjunctivitis and the deposition of fine blue crystals within the corneal stroma. This report analyzes 3 cases of Dieffenbachia-induced keratitis and reviews existing literature on plant-induced keratitis. CASE REPORT Three patients presented with ocular irritation, pain, and redness following accidental exposure to Dieffenbachia sap. Clinical examination revealed chemosis and corneal edema in all cases. Slit-lamp microscopy identified fine, needle-like oxalate crystals located within the epithelial and stromal layers of the inferior cornea. The 3 patients received conservative management: ocular irrigation, topical antibiotics, and localized anti-inflammatory agents. The treatment protocol was altered, depending on the clinical ocular response. When symptoms gradual improved, anti-inflammatory medication was decreased by 1 to 2 doses after 1 to 2 weeks, throughout a treatment duration of 4 to 8 weeks. Complete resolution of crystal deposits in the cornea was observed after a 4- to 8-week follow-up period. All patients retained satisfactory visual acuity and exhibited no corneal opacities. CONCLUSIONS Patients with keratitis caused by Dieffenbachia sap typically achieve full recovery without complications, but the potential for crystal deposition in the cornea must be recognized. Safety measures, including protective eyewear, gloves, and long-sleeved clothing during plant maintenance are essential. Comprehensive knowledge of the pathogenesis and clinical trajectory of ocular Dieffenbachia exposure will enable ophthalmologists to optimize treatment strategies.

IntroductionCongenital fourth-ray brachymetatarsia and juvenile hallux valgus are rare forefoot deformities that, when coexisting, may amplify biomechanical dysfunction, pain, and footwear intolerance, particularly in adolescent athletic patients. No reports describe a combined surgical approach to correct both conditions in adolescents.MethodsA 15-year-old female with bilateral symptomatic juvenile hallux valgus and congenital fourth-ray brachymetatarsia was treated with staged unilateral biplanar first metatarsal chevron osteotomies and fourth metatarsal distraction osteogenesis with the use of an external fixator. Distraction was performed at approximately 0.5 mm per day to a planned length of approximately 13.5 mm, followed by consolidation and device removal. The contralateral side was treated after functional recovery of the first foot.ResultsBoth feet achieved successful correction of hallux valgus and restoration of fourth-ray length with radiographic confirmation. The patient had maintained alignment, resolution of forefoot pain, tolerance of standard footwear, and return to baseline athletic activity without complications or recurrence. Conclusion.ConclusionThis case demonstrates that staged biplanar first metatarsal osteotomy combined with fourth metatarsal distraction osteogenesis can safely and effectively restore forefoot alignment and function in adolescents with coexisting hallux valgus and brachymetatarsia. This combined strategy offers a viable treatment pathway for complex bilateral forefoot deformities in young active patients.

Thrombotic microangiopathy (TMA) is a process characterized by thrombocytopenia, microangiopathic hemolytic anemia, and end-organ injury. Malignancy-associated TMA is uncommon and may resemble primary TMA syndromes, particularly when renal dysfunction predominates and peripheral smear findings are limited. We present a case of biopsy-confirmed renal TMA in the setting of newly diagnosed metastatic squamous cell carcinoma (SCC) following significant diagnostic uncertainty. A 59-year-old man with insulin-dependent diabetes mellitus presented with worsening headache, neck pain, dysphagia, shortness of breath, poor oral intake, and significant weight loss. Initial evaluation demonstrated acute hypoxic respiratory failure, progressive renal failure, thrombocytopenia, and a newly identified right-sided neck mass. Laboratory studies showed anemia, elevated lactate dehydrogenase, low haptoglobin, and reticulocytosis, raising concern for TMA. Peripheral smear showed few schistocytes, while ADAMTS13 (a disintegrin and metalloproteinase with thrombospondin type 1 motif member 13) activity was reduced but not severely deficient. Autoimmune and complement studies were unrevealing. Renal function progressively worsened, requiring initiation of hemodialysis. Renal biopsy demonstrated acute and chronic TMA with chronic vascular changes. Additional otolaryngologic evaluation confirmed invasive, moderately differentiated nonkeratinizing SCC of the uvula with metastatic cervical disease. Given the biopsy findings, lack of severe ADAMTS13 deficiency, unrevealing autoimmune workup, and overall clinical course, malignancy-associated TMA was favored over primary thrombotic thrombocytopenic purpura and other secondary causes. Renal TMA in patients with newly diagnosed malignancy may present with a broad and overlapping differential diagnosis. In this case, renal biopsy clarified this mechanism, as the limited peripheral smear findings and multiple overlapping causes of secondary TMA had posed significant diagnostic challenges.

The co-occurrence of &#x3b2;-thalassemia major and inflammatory bowel disease is exceedingly rare, yet clinically important, as overlapping manifestations such as severe anemia, fatigue, abdominal pain and dysentery may mask the underlying inflammatory bowel disease and delay diagnosis. The patients described in the present case report exhibited markedly elevated levels of inflammatory markers and fecal calprotectin levels (>1,000 &#xb5;g/g); these findings, together with colonoscopic and histopathological findings, enabled the diagnosis of both major inflammatory bowel disease subtypes, namely Crohn's disease and ulcerative colitis. These cases add to the limited literature available by demonstrating that inflammatory bowel disease should be considered in patients with &#x3b2;-thalassemia major presenting with persistent gastrointestinal symptoms, particularly when symptoms are disproportionate to baseline disease manifestations. Early clinical suspicion, prompt diagnostic evaluation, and multidisciplinary management are crucial for preventing further clinical deterioration, minimizing complications and improving long-term outcomes. However, further studies are warranted to clarify the potential pathophysiological association and establish optimal management strategies for this rare coexistence.

Report on surgical management of ulnar impaction syndrome secondary to chronic Monteggia fractures are limited, and optimal techniques and outcomes remain unclear. Herein, we report a case in which preoperative stress evaluation followed by diaphyseal-level ulnar-shortening osteotomy led to favorable clinical outcomes. A 54-year-old woman with a childhood forearm injury presented with ulnar-sided wrist pain. Imaging revealed ulnar impaction syndrome with foveal triangular fibrocartilage complex (TFCC) injury. An asymptomatic anterior radial head dislocation, consistent with a chronic Monteggia fracture, was also identified. Conservative management was unsuccessful; thus, she underwent diaphyseal-level ulnar-shortening osteotomy and TFCC reconstruction. The dislocated radial head remained stable under longitudinal stress, justifying the ostomy alone without radial head intervention. Postoperatively, distal radioulnar joint instability resolved immediately. At 18 months, the radial head had not migrated proximally, and the patient was pain-free. Ulnar-shortening osteotomy for ulnar impaction syndrome secondary to chronic Monteggia fracture raises concerns about proximal radial head migration through the interosseous membrane. However, our findings indicate that when the dislocated radial head remains stable under longitudinal stress, diaphyseal ulnar-shortening osteotomy may be an effective treatment option.

Uterine leiomyomas are a common benign neoplasm of the female reproductive tract. They are often asymptomatic and can be present during pregnancy without complication. When leiomyomas outgrow their blood supply, the tissue undergoes degeneration. This process is most often seen in pregnancy. A rare complication of this process is spontaneous rupture, which is a surgical emergency often resulting in intra-abdominal leakage, bleeding, and peritonitis. This report describes the case of a 36-year-old White woman (G1P0) at 35&#xa0;weeks of gestation with a known enlarging anterior fundal leiomyoma with degeneration who presented with worsening abdominal pain and contractions in the setting of gestational diabetes mellitus. Imaging and clinical findings were concerning for rupture of a degenerating fibroid with intra-abdominal fluid leakage. This event resulted in threatened preterm labor. She underwent low transverse cesarean section, resulting in delivery of a viable neonate. Intraoperative findings included a broad-based fundal leiomyoma with a 1.5&#xa0;cm defect and drainage of degenerative contents. Six months postpartum, the patient had persistent fibroid degeneration requiring robotic-assisted laparoscopic myomectomy. This case highlights the rare but serious complications of leiomyoma rupture in pregnancy and underscores the importance of close monitoring and appropriate surgical intervention for patients with degenerating leiomyomas.

Hepatic artery pseudoaneurysm (HAP) with arterioportal fistula (APF) is a rare but potentially life-threatening vascular complication of hepatic trauma, most commonly described after blunt or iatrogenic injury and infrequently following penetrating trauma. Early identification and prompt endovascular management are essential to prevent severe outcomes. We report the case of a 25-year-old previously healthy male who sustained a stab wound to the right upper quadrant and epigastrium and underwent exploratory laparotomy for a grade III left hepatic lobe laceration. During postoperative recovery, he developed persistent blood-tinged drain output and epigastric pain. Contrast-enhanced CT and subsequent angiography confirmed a left hepatic artery pseudoaneurysm with an associated arterioportal fistula. Initial Gelfoam embolization failed, but definitive coil embolization via the femoral artery successfully excluded the lesion and resolved the fistulous communication. The patient experienced symptomatic improvement and was discharged in stable condition. This case underscores the importance of recognizing delayed vascular complications following penetrating liver trauma and highlights endovascular coil embolization as a safe and effective therapeutic approach. Structured postoperative follow-up remains crucial for optimal outcomes.