Gallstone ileus is a rare mechanical bowel obstruction caused by the migration of a gallstone through a biliary-enteric fistula, most commonly impacting at the ileocecal valve. Proximal obstruction is uncommon and is typically classified as Bouveret syndrome when involving the stomach or proximal duodenum. Obstruction near the ligament of Treitz represents an exceedingly rare variant. A 76-year-old female presented with nausea, vomiting, and abdominal distention. Computed tomography demonstrated gastric and proximal small bowel dilation secondary to an obstructing gallstone in the distal duodenum. After anticoagulation reversal, exploratory laparotomy was performed. The stone was manually advanced into the jejunum, followed by segmental resection and primary anastomosis. The gallstone measured 6 cm. The gallbladder and fistula were not addressed initially. The patient recovered well and was discharged on postoperative day four. She later underwent an elective robotic cholecystectomy with fistula takedown without complication. This case describes an atypical proximal gallstone ileus located near the ligament of Treitz, distinct from both classic gallstone ileus and Bouveret syndrome. A staged surgical approach allowed safe relief of obstruction followed by definitive biliary management. This case highlights the importance of individualized surgical planning and supports staged management as a safe and effective strategy for rare proximal gallstone ileus.
To summarize the clinical features, risk factors, and maternal and fetal outcomes of spontaneous complete uterine rupture during the second and third trimester of pregnancy, and to explore key aspects of early identification and management, especially in cases without prior cesarean section. This study aims to provide evidence-based insights for early warning and emergency intervention in clinical practice. This is a retrospective case series analysis of seven cases of spontaneous complete uterine rupture occurring in the second and third trimester of pregnancy. We analyzed patient demographics, obstetric history, gestational age at rupture, clinical presentation, management strategies, and outcomes. Descriptive statistical methods were employed, with continuous variables expressed as medians (range) and categorical variables as frequencies (percentages). The median age of the seven women was 30 years old, with a median gestational age at rupture of 27 weeks. Among them, 57.1% (4/7) experienced rupture in the second trimester (<28 weeks), and 71.4% (5/7) had non-labor ruptures. 42.9% (3/7) of the cases involved women without a previous cesarean section. The most common clinical symptom was sudden onset of abdominal pain, often accompanied by shoulder pain, abnormal fetal heart rate, or vaginal bleeding, though these symptoms were non-specific. Surgical confirmation revealed rupture sites in the lower uterine segment (3 cases), fundus (3 cases), and cornua (1 case). Hemorrhagic shock (blood loss ≥ 2000 mL) occurred in 85.7% (6/7) of cases, with three cases complicated by placenta accreta spectrum (PAS). While all mothers survived, the perinatal mortality rate was 85.7% (6/7), with only one surviving fetus. Spontaneous complete uterine rupture during the second and third trimester of pregnancy typically presents as non-labor acute abdominal pain and may occur in women without a prior uterine surgery history, especially in the second trimester, where fetal outcomes are poor. Clinicians should maintain a high index of suspicion for uterine rupture in pregnant women presenting with acute abdominal pain, regardless of previous cesarean history. Early diagnosis and the establishment of a rapid, multidisciplinary emergency response are critical to improving maternal and fetal outcomes.
Internal hernias are a rare but critical cause of small bowel obstruction, with paraduodenal hernias being the most common subtype. They pose a significant diagnostic challenge due to non-specific symptoms and can lead to catastrophic outcomes like bowel strangulation. This report details a case of acute small bowel obstruction secondary to a paraduodenal Treitz hernia to highlight the diagnostic and therapeutic challenges and discuss key management decisions. A 53-year-old male, smoker, with no surgical history, presented with severe progressive abdominal pain, vomiting, and constipation. Examination revealed abdominal tenderness and rigidity. Laboratory findings showed leukocytosis with neutrophilia, a markedly elevated creatine kinase and C-reactive protein. CT scan confirmed a small bowel obstruction with a tight transition point. An initial laparoscopic exploration was converted to open laparotomy due to poor visualization, revealing a non-strangulated paraduodenal Treitz hernia, which was successfully reduced. The patient's postoperative course was uncomplicated, with a rapid return to a liquid diet by postoperative day one. This case underscores that internal hernias must be considered in patients with small bowel obstruction and no prior abdominal surgery. Timely CT imaging is crucial for diagnosis, and surgical flexibility, with a readiness to convert to open laparotomy, is essential for safe management and optimal outcomes.
Ado-trastuzumab emtansine (T-DM1) is an effective adjuvant therapy for human epidermal growth factor receptor 2-positive breast cancer; however, its surgical safety profile remains unclear. We observed delayed bleeding with variable and often subtle clinical manifestations during implant-based breast reconstruction (IBBR). Two patients who received adjuvant T-DM1 therapy after IBBR were retrospectively reviewed. The patient in Case 1 developed a recurrent seroma and liquefied hematoma requiring repeated aspirations, with platelet counts decreasing from 218 × 10⁹/L to 33 × 10⁹/L before expander removal. The patient in Case 2 experienced an acute massive hematoma on postoperative day (POD) 2, prior to T-DM1 initiation, which resolved after re-exploration; a temporally distinct delayed hemorrhagic event occurred on POD 175 during T-DM1 therapy after radiotherapy, accompanied by a platelet nadir of 34 × 10⁹/L. Both patients required plateletpheresis and prolonged drainage. Delayed bleeding during T-DM1 therapy may reflect a combination of hematological suppression and vascular vulnerability. Therefore, vigilant surveillance and cautious postoperative rehabilitation are warranted.
Anatomical variations are common and often clinically important, yet their description frequently relies on isolated case reports or small series with heterogeneous reporting quality. Incomplete documentation of specimen characteristics, inconsistent anatomical definitions and terminology, insufficient description of visualization methods, limited quantitative measurements, and suboptimal figures all reduce reproducibility and limit comparison and data synthesis. To address the lack of an anatomy-specific quality assessment, the Anatomical Variation Quality Assessment Tool (AVQAT) is introduced as a structured instrument intended for authors, reviewers, and editors. AVQAT comprises two sections organized into nine domains. Section A evaluates technical and descriptive quality across six domains: general aspects, specimen characteristics, anatomical definition, methods of visualization, quantitative description and measurements, and quality and use of figures. Section B evaluates interpretative and contextual quality in three domains: differential diagnostic considerations, identification and integration of previous studies, and ethical and regulatory considerations. Each domain contains targeted items that can be assessed systematically using "Yes," "No," or "Not applicable" responses. The tool is designed to complement, not replace, generic case-report guidance by focusing on the specific demands of anatomical documentation and thereby facilitating higher-quality reporting and more reliable evidence synthesis in scoping and systematic reviews.
Inguinal herniation containing a gravid uterus, also referred to as inguinal gravid hysterocele (IGH), is an uncommon clinical condition in dogs characterized by protrusion of the pregnant uterus through the inguinal canal. Only a few cases have been documented, and most were diagnosed in early gestation or following complications such as fetal death. To our knowledge, reports of IGH diagnosed close to term and successfully managed surgically, resulting in live offspring, are limited. A 7-year-old, 16 kg, intact mixed-breed female dog presented with a large, non-painful inguinal mass. Diagnostic imaging revealed a left-sided inguinal hernia containing the uterus with two viable fetuses, intestinal loops, and the spleen. Ultrasonographic biometry suggested day 55 of gestation, consistent with advanced pregnancy. Physical examination and hematological and biochemical parameters were within reference ranges. Based on stable clinical findings and fetal viability assessment, a cesarean section combined with herniorrhaphy and simultaneous ovariohysterectomy was scheduled two days later. Both fetuses were delivered alive and initially showed good vitality. Postoperative recovery of the dam was uneventful, with no recurrence of herniation. One neonate died at 14 days postpartum, whereas the second survived and was successfully weaned. This case highlights the importance of thorough diagnostic evaluation and strategic surgical planning in managing IGH. This represents one of the few reported cases of IGH diagnosed at a late stage of gestation and managed at term without prior surgical correction, demonstrating that favorable maternal and neonatal outcomes are achievable with timely intervention.
Anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) is a group of small-vessel necrotizing vasculitides with minimal immune complex deposition. Hypertrophic cranial pachymeningitis, a rare complication of AAV, is characterized by focal/diffuse dural thickening and fibrosis, causing neurological dysfunction such as headache and optic nerve injury. While AAV-associated hypertrophic cranial pachymeningitis is well documented, reports of concurrent spinal dural involvement remain scarce. This case highlights the rare co-occurrence of cranial and spinal dural involvement in AAV, providing new clinical evidence to expand the understanding of AAV-related dural manifestations and improve diagnostic awareness among clinicians. A 57-year-old male presented with fever, headache, otalgia, and hearing loss, and was diagnosed with granulomatosis with polyangiitis based on positive anti-proteinase 3 antibodies (664.3), cytoplasmic anti-neutrophil cytoplasmic antibody (1:10). Symptoms resolved with glucocorticoids, disease-modifying antirheumatic drugs, and anti-infective therapy. He later developed recurrent headache and lumbodorsal pain. Thoracic magnetic resonance imaging (MRI) revealed a T10 to 12 epidural lesion, which was surgically resected. Pathology confirmed epidural vasculitis with necrotic/fibrous tissue, granulation, and inflammatory cell infiltration. Methylprednisolone and cyclophosphamide relieved back pain, but headaches persisted. Cranial MRI showed dural thickening in the cerebellar, posterior fossa, and foramen magnum regions, consistent with pachymeningitis. Cerebrospinal fluid analysis showed elevated mononuclear cells (35.00 × 106/L), nucleated cells (40.00 × 106/L), and protein (1.49 g/L), with negative cultures. The final diagnosis was granulomatosis with polyangiitis complicated by concurrent cranial and spinal dural involvement. Initial management included glucocorticoids, disease-modifying antirheumatic drugs, and anti-infective therapy, which resolved the patient's fever, otalgia, and hearing loss. Surgical resection was performed for the T10 to 12 epidural lesion, followed by immunosuppressive therapy with methylprednisolone and cyclophosphamide. After adjustment of the treatment regimen, the patient's headache improved. Initial therapy resolved the patient's fever, otalgia, and hearing loss. Surgical resection combined with immunosuppressive therapy relieved lumbodorsal pain but failed to resolve headaches initially; cranial MRI confirmed pachymeningitis, and cerebrospinal fluid analysis indicated inflammatory changes. After adjustment of the treatment regimen, the patient's headache improved, and he has remained clinically stable during follow-up. This case demonstrates that AAV can involve both cranial and spinal dura mater. Clinicians should consider dural involvement in AAV patients presenting with lumbodorsal pain.
Gallbladder cancer is one of the most aggressive malignancies in the biliary system, and there is currently no internationally recognized standardized treatment protocol. Reports on the management of rare pathological types of gallbladder cancer are particularly limited. We present 2 cases of gallbladder cancer with rare pathological subtypes and their diagnostic and therapeutic processes, aiming to further enhance clinicians' understanding of these uncommon entities. This report describes 2 cases of gallbladder cancer, both presenting with abdominal discomfort, raising concerns about the nature of the lesion and effective treatment strategies. Postoperative pathology confirmed one case as gallbladder sarcomatoid carcinoma and the other as gallbladder carcinosarcoma, both of which are clinically rare types. Both patients underwent laparoscopic cholecystectomy at our institution, with subsequent pathological and immunohistochemical examination. As of the end of follow-up (November 30, 2025), both patients recovered well postoperatively. Rare types of gallbladder cancer lack specific clinical manifestations, making early screening difficult. Most patients are diagnosed at an advanced stage. Surgical intervention should be performed as early as possible upon discovery.
Atraumatic splenic rupture (ASR) is a rare but life-threatening surgical emergency that most commonly occurs in pathologically abnormal spleens. We present a unique case of ASR in a middle-aged man with recent use of performance-enhancing compounds, managed with both embolization and surgery. This case highlights an unusual potential contributing risk factor and underscores the importance of prompt diagnosis and definitive management of ASR. A 54-year-old male presented to the emergency department with acute left upper quadrant abdominal pain and vomiting. Notably, he had recently been using MK-677 (ibutamoren), a growth hormone secretagogue, and RAD-140 (testolone), a selective androgen receptor modulator (SARM), for bodybuilding purposes. The patient denied any history of trauma. Computed tomography revealed a large perisplenic hematoma consistent with splenic rupture. Following initial resuscitation, emergent splenic artery embolization was performed to control hemorrhage. This intervention stabilized the patient transiently; however, he ultimately required an emergency laparotomy with total splenectomy. Histopathological examination demonstrated large areas of splenic infarction, with features raising the possibility of an underlying vascular malformation.  These findings underscore the importance of recognising ASR in patients with acute abdominal pain and vascular risk factors. We explore the potential and speculative role of performance-enhancing compounds in precipitating splenic complications, drawing parallels to the established association between traditional anabolic steroids and peliosis - blood-filled vascular cavities that predispose to rupture. While RAD-140 and MK-677 have not been previously linked to splenic pathology, their pharmacological effects on androgen receptor signalling and IGF-1 pathways warrant consideration as possible contributing factors, particularly in the context of a suspected pre-existing vascular malformation. Early recognition, aggressive resuscitation, and timely surgical intervention remain critical, as delayed diagnosis carries significant mortality.
Complex Regional Pain Syndrome (CRPS) is an uncommon and potentially debilitating neuropathic pain condition that may develop after surgical or iatrogenic nerve injury. Although CRPS predominantly affects the extremities, pelvic and perineal involvement is rare and poorly characterized. We report the case of a 54-year-old woman who developed CRPS following CO₂ laser labioplasty performed as part of a combined gynecologic surgical procedure. The patient presented with progressive neuropathic pain, allodynia, vasomotor and trophic skin changes, and motor impairment predominantly affecting the perineal region and right lower limb. Structural pathology was excluded by imaging. The diagnosis of CRPS was established using the Budapest Criteria. Initial pharmacologic therapy and a selective pudendal nerve block provided limited and transient relief. A multimodal interventional strategy combining repeated caudal epidural blocks, intravenous lidocaine and magnesium sulfate, and epidural preservative-free ketamine resulted in complete pain resolution, reversal of trophic changes, and full functional recovery. This case highlights CRPS as a potential complication of CO₂ laser labioplasty and supports early, mechanism-based multimodal interventional management in refractory cases, particularly when central sensitization is suspected.
Bilateral femoral neck fractures associated with transient osteoporosis of the hip (TOH) during pregnancy are rare. We report a case of a 46-year-old woman at 35 weeks of gestation who presented with progressive bilateral hip pain and impaired mobility without preceding trauma. Only a limited number of similar cases have been reported, underscoring the importance of considering TOH in the differential diagnosis of pelvic girdle pain in pregnant and postpartum women. Magnetic resonance imaging (MRI) remains the gold standard for diagnosis. Initial conservative management with analgesia and supportive care was unsuccessful, and the patient's condition deteriorated, resulting in immobility and severe pain. Delivery was performed via cesarean section based on a multidisciplinary team decision. Postpartum MRI revealed bilateral subcapital femoral neck fractures. Surgical treatment consisted of bilateral closed reduction and internal fixation using the Femoral Neck System (FNS), achieving satisfactory reduction and stable fixation. Six months postoperatively, clinical deterioration of the left hip required implantation of a non-cemented total hip arthroplasty due to partial avascular necrosis of the weight-bearing portion of the femoral head. Identified risk factors included advanced maternal age, obesity, pregnancy achieved through assisted reproductive technology (IVF), hypothyroidism, and presumed osteopenia. This case highlights the diagnostic and therapeutic challenges of TOH and emphasizes the importance of early recognition to prevent severe complications.
Anomalous aortic origin of a coronary artery (AAOCA) is an uncommon congenital abnormality associated with sudden cardiac death (SCD), particularly in young athletes. We present a case of a 4-time Olympic medalist track cyclist who experienced sporadic anginal symptoms during maximal efforts and was found to have an anomalous aortic origin of the right coronary artery (AAORCA). The athlete had a successful surgical reimplantation and returned to elite sport. Management decisions are complex: The investigations used to confirm ischemia and to stratify SCD risk are imperfect, and the surgical treatment carries potential risk. Furthermore, the impact of a sternotomy and coronary reimplantation on competitive sports performance has not been detailed. In the absence of definitive ischemic evidence from history or diagnostic tests, diagnosing high-risk AAOCA can be challenging. The decision to pursue surgical intervention should carefully consider the low rate of SCD and the risk/impact of surgery.
Extranodal marginal zone lymphoma (EMZL) is a type of low-grade B-cell lymphoma that most commonly occurs in gastric tissue. To our knowledge, only five cases have been documented noting primary EMZL of the fallopian tube and only one case involving the ovary. We describe a rare case of extranodal marginal zone B-cell lymphoma, involving the left fallopian tube, left ovary, uterus, and left pelvic sentinel lymph node. A 78-year-old female presented to her gynecologist due to worsening of vulvar pain. A transvaginal ultrasound revealed a left adnexal tubular mass. The patient had a total robotic hysterectomy and bilateral salpingo-oophorectomy. Intraoperative frozen section of the left fallopian tube mass showed a small blue cell tumor, favoring lymphoma. Histologic sections of the ovary revealed effacement of the architecture by a diffuse atypical lymphoid infiltrate composed predominately of small CD20(+) B-lymphocytes, including few with pale cytoplasm. Similar findings were noted in the endometrium, myometrium, serosa, left fallopian tube and ovary, and left pelvic sentinel lymph node. Molecular testing was positive for MYD88 mutation but negative for CXCR4 mutation. Differential diagnosis included EMZL and lymphoplasmacytic lymphoma; however, given the absence of IgM paraprotein/monoclonal protein, a diagnosis of EMZL was favored. The patient was managed with surveillance; positron emission tomography scan was negative for recurrence at one year. Although EMZL of the ovary and fallopian tube is rare, it should be maintained on the differential diagnosis if atypical lymphoid cells or dense lymphoid aggregates are observed in the surgical specimen.
Pheochromocytoma is a rare neuroendocrine tumor characterized by excessive catecholamine secretion, typically presenting with hypertension, headache, palpitations, and sweating. Giant pheochromocytomas (commonly defined as tumors with diameter >4-6cm) are even rarer and may lead to severe cardiovascular complications, including catecholamine-induced cardiomyopathy and thromboembolic events. We report the case of a 76-year-old female who presented with acute pulmonary embolism and heart failure as the initial features of a giant pheochromocytoma, with concurrent deep vein thrombosis and catecholamine- induced cardiomyopathy. Laboratory tests revealed markedly elevated catecholamine metabolites, while imaging confirmed a right adrenal mass measuring 11.1×7.9 cm, along with bilateral pulmonary artery emboli and left lower extremity deep vein thrombosis. After multidisciplinary evaluation, the patient was managed with α- and β-blockers, anticoagulation, and subsequent surgical resection of the tumor. Postoperative follow-up showed significant improvement in cardiac function and complete resolution of thrombotic events. This case demonstrates the importance of including pheochromocytoma in the differential diagnosis of patients with unexplained thromboembolism or cardiovascular collapse, particularly when an adrenal mass is identified on imaging. Early diagnosis, multidisciplinary management, and timely intervention are crucial for favorable outcomes in such complex and life-threatening presentations.
We report a rare case in which a lip piercing led to Staphylococcus aureus bacteremia and subsequent prosthetic aortic graft infection complicated by anterior mediastinitis in a patient with filaminopathy A. A 32-year-old woman, who had undergone valve-sparing aortic root and arch replacement with a hybrid thoracic stent graft 5 years earlier, presented 3 weeks after a lip piercing with fever, chest pain, and elevated inflammatory markers. Computed tomography revealed a periprosthetic fluid collection and mediastinal inflammation consistent with graft infection. Blood cultures grew methicillin-sensitive S aureus. Despite early intravenous antibiotics, rapid progression to anterior mediastinitis and a large retrosternal abscess mandated radical surgical explantation of all prosthetic material and in situ reconstruction using multiple cryopreserved aortic allografts. She completed 6 weeks of intravenous cefazoline followed by prolonged oral antimicrobial therapy. At 4 months, imaging showed patent reconstruction and no residual infection. This case underscores the potential increased risk in patients with heritable aortopathies and vascular prostheses to bacteremia-related complications and highlights the importance of preventive counseling regarding procedures that may cause transient bacteremia, including oral piercings.
The solitary fibrous tumor (SFT) in its lipomatous variant is very rare, with only a few cases described in the literature. It is a myofibroblastic mesenchymal tumor with intermediate behavior. We report the case of a 33-year-old patient with no notable pathological history, admitted following the incidental discovery of a dorsal mass involving the soft tissues, whose radiological examination suggested a schwannoma. The patient underwent a surgical biopsy showing a tumoral proliferation composed of spindle cells within mature adipose tissue. Immunohistochemical studies were necessary to rule out differential diagnoses before establishing the final diagnosis.
Obstructing rectal cancer complicated by sepsis represents a surgical emergency. When definitive oncologic resection is not feasible, alternative diversion strategies are required to safely decompress the bowel and control sepsis. We report the case of a 67-year-old woman with known rectal adenocarcinoma who presented in septic shock due to distal large bowel obstruction. Intraoperative evaluation revealed a completely obstructing fungating rectal mass that precluded Hartmann's procedure or diverting loop colostomy. Emergent diversion with an end colostomy and concomitant mucous fistula was performed to decompress the excluded distal bowel segment and prevent mucofecal accumulation and perforation. This case highlights mucous fistula creation as a viable and underutilized adjunct in the emergency management of obstructing rectal cancer when standard diversion or resection is not appropriate. Early shared decision-making and timely definitive management of rectal cancer may reduce the risk of high-acuity emergent presentations.
Crystalglobulin-induced nephropathy (CIN) is a rare renal disorder associated with multiple myeloma, characterized by crystal-induced damage in multiple organs, with diagnosis based on the identification of crystals within affected tissues. Conversely, cardiac nonamyloidotic immunoglobulin deposition disease (CIDD) involves the deposition of nonamyloid light chains in the myocardium. In this study, we report a case of CIN combined with CIDD in a 55-year-old woman. Renal biopsy revealed crystalline structures within the interlobular artery, which stained positive for immunoglobulin G1 and lambda chains on fluorescent antibody analysis. Immunoelectron microscopy confirmed the deposition of lambda light chains within the crystalline structures. Fluorescent antibody staining demonstrated lambda-chain deposition in the skin, duodenum, and cardiac tissue. The patient was diagnosed with CIN and chemotherapy was initiated. However, the patient died owing to acute renal failure and rapidly progressive cardiac dysfunction. Autopsy findings revealed no crystalline structures in the myocardium, suggesting an association between CIN and CIDD. Reports on CIN are scarce, and its pathogenesis remains poorly understood. CIDD is also rare, and to date, no previous reports have described concurrent CIN and CIDD with such an abrupt clinical course. Early diagnosis and prompt therapeutic intervention are necessary.
Coenurosis is a rare zoonotic parasitic infection in humans, caused by the larval stage (coenurus) of Multiceps multiceps, typically acquired through ingestion of ova shed in the feces of infected canids. While the central nervous system is the most commonly affected site, extracranial involvement, particularly in the head and neck region, is exceedingly uncommon. In pediatric patients, such presentations may closely mimic congenital cystic lesions, leading to potential delays in diagnosis and management. We present the case of a 4-year-old male from the pastoralist Karamoja region of Northeastern Uganda who presented with a painless, slow-growing midline cystic neck mass of unspecified duration. The mass was mobile, located in the subcutaneous plane superficial to the strap muscles, and lacked communication with the deeper neck structures or oral cavity. Initially presumed to be a thyroglossal duct cyst, the lesion was managed via total surgical excision through a transverse neck incision. Histopathological examination revealed a thin-walled cyst containing multiple protoscolices with characteristic hooklets, consistent with a coenurus cyst caused by Multiceps multiceps. The patient's postoperative recovery was uneventful. This case, the first of its kind reported in Uganda, demonstrates that Multiceps multiceps can clinically mimic a thyroglossal duct cyst. It underscores the necessity of histopathologic evaluation for all pediatric neck masses in endemic regions. Definitive management requires a high index of suspicion for multi-organ involvement, necessitating postoperative systemic anthelmintics and screening for occult central nervous system or ocular disease to ensure comprehensive care.
The long-term clinical outcome of cross-femoral venous bypasses is rarely described. We present a case of a 60-year-old man who maintained secondary graft patency for 35 years after left common iliac vein ligation owing to trauma, with multiple subsequent surgical revisions for symptomatic complications. This case supports the clinical durability and potential for extended patency of cross-femoral venous bypasses, underscoring the necessity of continuous patient surveillance and intervention.