Open Access Case Report

An Unusual Case of Vulvar Myiasis: A Case Report

Digant Patel, Jagrut Patel, Bindu Madhavi, Rutul Shah, Vivek Yadav

Asian Journal of Case Reports in Surgery, Page 7-10

Introduction: Myiasis is the infestation of dipterous larva (maggots) in humans and other vertebrate animals. Presence of maggots in other body parts is common, but on covered parts like external genitalia is very rare [1]. We here by describe a case of young unmarried female who presented with multiple sinuses over external genitalia along with maggots coming out of it.

Patient Information: An 18 year old female presented to us in emergency with complaints of maggots from external genitalia since 3 days.

Therapeutic Intervention: Patient was given injectable antibiotics and daily dressing was done with turpentine oil. Patient was discharged on day 4 with personal hygiene explained.

Conclusion: In this modern era maggots infestation in external genitalia is rarely seen but in this case it is likely due to unhygienic practice of cloth usage during menstruation instead of sanitary napkins.

Open Access Case Report

A Rare Case of Recurrent Breast Malignant Phyllodes Tumor with Lung, Axillary and Mediastinal Lymph Nodes Metastasis

H. Mohd Azren, Mat Salleh, Shahidah Che Al Hadi, K. A. Affandi

Asian Journal of Case Reports in Surgery, Page 21-29

Background: Phyllodes  tumour (PT)  is very rare fibroepithelial  tumor  of  the  breast and  divided  based  on  the  World  Health  Organization into  benign,  borderline, and malignant subtypes. The most common type of phyllodes tumor is benign, however malignant phyllodes tumors have important clinical implications, as they are more likely to recur locally and potentially metastasize. The most common sites of distant metastasis include the lung, bone, and liver.

Case Presentation: A 34 year-old female presented with right nipple blood discharge with palpable right breast lump. Tru cut biopsy showed Atypical Cell and subsequently she underwent right wide local excision and histopathological examination showed malignant phyllodes tumor. She then presented again with recurrent ulcerated right breast lump. Repeated tru cut biopsy showed atypical cell for which she underwent simple mastectomy with final diagnosis of malignant phyllodes tumor. Two weeks after surgery, she presented with right axillary mass with anterior right chest wall mass. Further evaluation demonstrated that masses over right axillary, right anterior mediastinal and bilateral lung suggestive of metastasis.

Conclusion: We presented a rare case of aggressive malignant phyllodes tumor with recurrent and distant metastasis to bilateral lungs, axillary and mediastinal lymph nodes.

Open Access Case Study

A Case Report of Endoscopic Management of Traumatic Intrahepatic Bile Duct Injury

Amol Nanasaheb Wagh, Parth Bhavesh Gada, Hemant Muktaram Jawale, Snehal Milind Dandge

Asian Journal of Case Reports in Surgery, Page 1-6

Introduction: Penetrating Abdominal Trauma is less common than Blunt Abdominal Trauma in India. The clinical appearance of bile duct injuries is highly variable and depends primarily on the underlying cause.

Case: We present a case of a stab injury ie penetrating abdominal injury who developed AAST grade III hepatic injury, for which exploratory laparotomy with perihepatic packing was done as patient was hemodynamically unstable and an abdominal drain was also placed. Bilious drain was seen on fifth post-operative day, which was managed by Endoscopic Retrograde Cholangiopancreatography (ERCP) with sphincterotomy and 7 Fr x 10 cm stent placed up to distal right main hepatic duct. Bile leak stopped after ERCP.

Discussion: Traumatic biliary tree injury should be kept in consideration when dealing with trauma patients. Surgeons should bear in mind the good success rates of ERCP to avoid more morbid procedures, unless indicated.

Open Access Case Study

Laparoscopic Guided Trans-Gastric Balloon Deflation: A Novel Technique in the Emergency Retrieval of Intragastric Balloons

Almazroui Latefa, Alshamali Mohammed, Abdulraheem Joud, Mohammad Khaleel

Asian Journal of Case Reports in Surgery, Page 11-16

Introduction: Obesity is a global disease, causing a vast array of metabolic diseases and creating a significant burden on the individuals well being and the health system in general. Endoscopic adjuncts such as the intragastric balloon (IGB) have been developed to assist in weight loss. This device requires endoscopic placement and removal and although rare, can lead to complications during the treatment period.

Case presentation: A 27 years old patient with a history of smoking and excessive NSAIDS use presented with a gastric perforation, 6 weeks after placement of an intragastric balloon. She required an endoscopic / laparoscopic assisted balloon deflation and removal as well as laparoscopic abdominal washout, repair of gastric perforation and placement of intraperitoneal drains. Due to the unavailability of the endoscopic balloon deflation catheter, we used a laparoscopically guided transgastric Verres needle to puncture and deflate the balloon during the procedure, combined with endoscopic removal of the balloon through the oral route.

Discussion: Intragastric balloons are widely produced by different companies and may require manufacturer specific endoscopic needle tip deflation catheter to deflate the device and a specific endoscopic grasper to retrieve it. Due to its size, caliber and mechanism of action, the Verres needle might be a useful balloon deflation adjunct in case the proper equipment is not available in emergency situations.

Conclusion: Patients should be properly selected prior to balloon placement according to the probability of complication development and the benefit of the gastric balloon in comparison to other bariatric modalities. The Verres needle provides an additional tool, which may be used in certain situations to deflate the balloon, such as gastric perforations when the proper endoscopic tools aren't available.

Open Access Case Study

Bilateral Persistent Pupillary Membrane: Bilateral Obturating Form

Ayoub Redouan, Mohamed Khalifi, Loubna El Maaloum, . Bouchra, . Allali, Asmae El kettani

Asian Journal of Case Reports in Surgery, Page 17-20

Persistence of the pupillary membrane (PPM) is a congenital pathology characterized by the persistence of Tunica vasculosa lentis anterior, which normally resolves during the third trimester by the apoptotic phenomena.

We report the case of a girl referred for an esotropia, at the ophthalmologic examination we found a dense bilateral pupillary membrane blocking the visual axis, Surgical resection of the pupillary membrane is the technique of choice in thick pupillary membranes that completely cover the visual axis, because of the major risk of amblyopia.