Abdominal pain with oral pigmentations as a clue for Peutz-Jeghers syndrome

A 33-year-old woman presented to the emergency department with colicky abdominal pain, nausea and vomiting, constipation, obstipation, and rectorragia. She had a history of similar abdominal pain from a few months ago. She had no history of any specific disease and taking any medication. She had no history of surgery and specific family diseases. Her vital signs on admission were heart rate 90/minute, respiratory rate 18/minute, blood pressure 110/70 mmHg, and temperature of 37.1°C. There were several brown spots on her lips and inside her mouth. On abdominal examination, she had a generalized tenderness, especially in the LLQ. In the digital rectal examination, the rectum was empty. Lab tests showed the following results: leukocyte count 4000/mm3 with 80.9% neutrophils, hemoglobin 12.1 g/dl, platelet 320000/µl, and creatinine 0.6 mg/dl, BUN 14 mg/dl, glucose 152 mg/dl, sodium 137 mEq/L, potassium 4.5 mEq/L. Chest and abdominal radiographs were performed on the patient (Figure 1). No subdiaphragmatic free air was seen in the chest x-ray. The abdominal x-ray showed no air-fluid levels as well as any gas in the rectum. On abdominal and pelvic ultrasound, a moderate amount of free fluid was seen in the abdomen along with jejunoileal intussusception in the LLQ with an intestinal loops thickness increase

Jejunal Dieulafoy’s Lesion as a Rare Cause of Massive Gastrointestinal Bleeding; a Case Report and Literature Review

Jejunal Dieulafoy's lesion is difficult to diagnose due to its rarity, intermittent hemorrhage, and lesion site, which is largely inaccessible to conventional endoscopes. A 39-year-old man, who had no underlying disease, presented to the emergency department (ED) with weakness, dizziness, and dry cough with a history of several rectal bleeding episodes in the last few years. Endoscopy was normal, and the colon was full of clots on colonoscopy, and no gross pathology was found. On computed tomography (CT) angiography, a hyperdensity was seen in the middle of the jejunum, possibly suggesting contrast extravasation. Due to decreased hemoglobin of the patient, and hemodynamic instability, the patient became a candidate for surgery. A palpable lesion in the Jejunum was touched that opened longitudinally, which revealed active arterial bleeding from the nipple-like lesion. This segment was resected, and an anastomosis was performed. Histopathological examination of the small intestine confirmed a Dieulafoy’s lesion. It seems that, when upper endoscopy and colonoscopy fail to identify the cause of gastrointestinal bleeding, a Dieulafoy’s lesion should be included in the differential diagnoses

Rebar Impalement Trauma in A Construction Worker: A Case Report and Literature Review

Coincident impalement trauma to the neck and chest is infrequent but life-threatening. Our case was a 35-year-old man, who presented with rebar penetration injury to the neck and mediastinal area. He was conscious and his vital signs were stable. After initial imaging, the patient was transferred to the operation room for explorative surgery; however, as the rebar was loos in its site, we simply pulled out the rod. The patient developed acute respiratory distress syndrome (ARDS) during their administration and was eventually discharged without further complications and comorbidities

Angiomyofibroblastoma as a rare cause of vulvar mass: A case report and literature review

Key Clinical Message Angiomyofibroblastoma is a benign soft tissue tumor and a form of genital stromal mesenchymal tumor that primarily affects the vulva. It could possibly affect the reproductive‐aged women's lower genital tract (vagina). Abstract Angiomyofibroblastoma is a rare benign soft tissue tumor primarily affecting the vulva in reproductive‐aged women. We report a 67‐year‐old female complaining of a painless mass in her right vulva spreading to the right inguinal region over the past 2 years. The first clinical impression was a canal of Nuck hernia, diagnostic laparoscopy was planned to rule hernia out. The vulvar mass was excised, and a histopathology examination revealed Angiomyofibroblastoma

A Novel Minimally Invasive technique for dilatation of hepaticojejunostomy stricture: A case report

Abstract Using a nephroscope in a laparoscopic operation to relieve the hepaticojejunostomy stricture (HJS) by transjejunal dilatation is a minimally invasive and applicable method. It can be used as the first step for such patients

A rare presentation of gastro‐pleural fistula after Roux‐en‐Y gastric bypass, simultaneous fistula of gastric pouch, and remnant to the pleural space

Key Clinical Message Although gastro‐pleural fistulas after bariatric surgeries are rare, they are life‐threatening complications that should be suspected in patients who present with gastrointestinal or respiratory symptoms after bariatric surgery. Abstract Previous studies showed an incidence rate of 0.2%–0.37% for gastro‐pleural fistulas after bariatric surgery. We report a 56‐year‐old female with a rare presentation of gastro‐pleural fistula after Roux‐en‐Y gastric bypass, simultaneous fistula of the gastric pouch, and remnant to the pleural space