Papillary melanocytoma is a pigmented tumor of the optic nerve, benign, rare, and often asymptomatic. We report the case of a 28-year-old man, who presents a unilateral papillary melanocytoma, discovered fortuitously, during an ophthalmological consultation for optical correction. We performed an ocular ultrasound confirmed the diagnosis, and magnetic resonance imaging did not reveal any retrobulbar extension. Our patient was monitored for 24 months, without evolution of his tumor.
Chronic mesenteric ischaemia (CMI) has a wide variability of clinical presentation, often mimicking other more common causes of abdominal pain. Due to this, it remains underdiagnosed and requires a high clinical index of suspicion, making early accurate diagnosis challenging. Timely radiological imaging is vital for detection and early treatment to ensure a successful outcome and prevent complications such as bowel ischaemia and infarction which has a poor prognosis. Here, we present a case of mesenteric ischaemia requiring bowel resection and successfully treated with percutaneous transluminal angioplasty (PTA) in the same sitting.
Testicular torsion is a severe acute urological emergency caused by twisting of the spermatic cord. Unfortunately, its importance is still underestimated in everyday life. It requires prompt diagnosis and treatment. Early-detected testicular torsion can be cured in almost every case, whereas late identification may lead to loss of the testicles. We report two rare cases of post-traumatic testicular torsion and we will discuss the mechanism, diagnosis and the importance of rapid surgical management outcome, based on recently published articles.
In the 1st case, is about an adolescent A.K., 18 years old, without any particular pathological history, victim of a scrotal trauma whose mechanism is a kick on the testicles (brawl) leading to a closed trauma with the appearance of an atrocious pain. The patient was seen 2 hours after the occurrence of the trauma, the clinical examination found a conscious patient with a right testicle ascended to the inguinal ring, ecchymotic scrotum and a very intense pain on palpation. An ultrasound with color Doppler study was carried out in front of the traumatic context which had objectified a twisting spermatic (spiral twist) cord associated with hydrocele of low abundance. Surgical exploration found a reactive hydrocoele and a twisted spermatic cord with a viable testicle. An emergency detorsion was performed followed by orchidopexy. In the 2st case, is 16 years old boy, was consulting for a painful post-traumatic right scrotal swelling, that has been evolving for 12 hours. Clinical examination showed a patient conscious, with a right hemi -scrotum increased in volume, ascending, painful on palpation. The ultrasound scan showed a ruptured albuginea with hydrocele. Surgical exploration revealed a hematoma at the expense of the epididymis with the presence of a spiral twist at the level of the spermatic cord and a necrotic right testicle. The procedure consisted of detorsion and resuscitation with normal saline 0.9%. Despite the reanimation, the testicle kept the same aspect. An orchiectomy was performed.
The message is that the urological surgeon must keep in mind that scrotal trauma can lead to testicular torsion. So, consciousness and constant vigilance are required in order to avoid a catastrophic delay that can lead to an orchiectomy, which can have serious consequences.
Parathyroid carcinoma is a rare cause of Primary Hyperparathyroidism and this endocrine tumor may be aggressive or indolent. This disease is an enigma and there are challenges in diagnosis, management and adjuvant treatment and the endocrine surgeon should have a high index of suspicion based on clinical findings and investigationsin the form of very high parathyroid hormone levels, hard tumour, large tumour, severe hypercalcemia, compressive symptoms and ultrasound or imaging features suggestive of parathyroid carcinoma which is the key to preoperative diagnosis and appropriate and intraoperative managent and we report a classical case of parathyroid carcinoma with Hyperparthyroidism induced hypercalcemic crisis and classical pathological findings.
Introduction: Superior Mesenteric Artery (SMA) syndrome also known as chronic duodenal ileus, Wilkie syndrome, arterio-mesenteric duodenal compression syndrome and cast syndrome is a rare cause of proximal bowel obstruction with an incidence that range between 0.013 and 0.3%.
Case Report: Our patient aged 35 years female presented in emergency department with complaints of severe abdominal pain, excessive vomiting, inability to pass flatus and motion for 2 days. CT scan of abdomen with contrast showed that stomach and duodenum were grossly distended up to third part of duodenum which was compressed by SMA with reduced aorto-mesenteric angle of 18 degree and distance of 7.3 mm. Nasogastric tube was passed and parenteral nutrition was maintained. But patient did not respond to conservative management, hence decision for laparotomy was taken and Duodenojejunostomy was done.
Discussion: SMA syndrome is a diagnostic and therapeutic challenge because of its rarity. Various surgical procedures have been considered for surgical management including gastrojejunostomy, Strong procedure (a division of the ligament of Treitz) and duodenojejunostomy.
Most surgeons prefer duodenojejunostomy due to reported success rates of 80% to 100% with reduced postoperative pain, shortened hospital stay.
Conclusion: SMA syndrome is an underdiagnosed condition. CT scan is a highly useful modality to diagnose SMA syndrome.
