Emergent method for management of splenic artery aneurysms rupture: A case report

INTRODUCTION AND IMPORTANCE

Although endovascular therapy is becoming more used for the treatment of splenic artery aneurysms (SAAs) instead of open surgery, there is limited information available on the emergent hybrid approach, selectively. We present our experience of hybrid therapy using an emergent endovascular balloon for inflow control and open resection.

CASE PRESENTATION

A 34-year-old woman was brought to the emergency room after it was reported that she had a pseudoaneurysm in her splenic artery at a different medical facility. The patient was hemodynamically stable. Then we underwent a combination of endovascular and open procedures, using balloon proximal control and open aneurysm resection. She was discharged from hospital on the fifth postoperative day after the operation.

CLINICAL DISCUSSION

There is no agreement on how to treat SAA patients. Endovascular procedures such as endovascular intervention are also being used, minimizing the risks of surgery and shortening the patient's hospital stay, but complications remain. We propose to try SAA's emergency hybrid strategy operation with a good prognosis and fewer complications.

CONCLUSION

It seems that, compared to open surgery alone when endovascular procedures were impossible, elective hybrid procedures are more secure and efficient in stable patients and could make the operation easier without more dissection for proximal control of splenic artery.

Aortic reimplantation of the superior mesenteric artery (SMA) for SMA stenosis in a previously stented patient: New technique and a case report

INTRODUCTION AND IMPORTANCE

Mesenteric artery stenosis leads to inadequate blood flow toward various parts of the gastrointestinal tract. Revascularization is the primary aim of treatment regardless of its approach. During the last decades, open revascularization has been replaced by endovascular-first approach. Mesenteric artery in-stent restenosis occurs in a considerable number of patients that need reintervention in up to half of them using redo endovascular revascularization or open surgery. Here, we reported a case of SMA and celiac artery stenoses treated by aortic reimplantation of the SMA.

CASE PRESENTATION

A 62-year-old man with history of previous stenting of CA and SMA was referred due to chronic intermittent abdominal. CT angiography of the abdomen showed restenosis of both arteries. A transection distal part of the occlusions SMA and reimplantation of it into the SMA on the anterolateral face of the infrarenal aorta as the end-to-side anastomosis were performed resulting in resolving the patient problem.

CLINICAL DISCUSSION

Chronic mesenteric ischemia can result from various medical conditions. Mesenteric vascular surgical revascularization through open laparotomy had been considered the standard of care. However, minimally invasive surgery such as endovascular therapy has attracted attention in the recent decades. There are some concerns about the difficulties of further surgery in case of re-occlusion. The end-to-side anastomosis and aortic reimplantation can be considered in patients with appropriate runoff in the remaining parts of corresponding vessels.

CONCLUSION

Aortic reimplantation of the superior mesenteric artery in patients with restenosis of stents is a viable option especially in case of inappropriate iliac artery to perform retrograde mesenteric bypass.

Three patients with acute appendicitis diagnosis following blunt abdominal trauma

Objective: One of the most prevalent surgical emergencies is appendicitis, caused by different factors. However, its relation to trauma has not been well-known yet. Here we have described three cases with blunt abdominal trauma and a secondary diagnosis of appendicitis that were transferred to the operation room. Case Presentation: Three patients suffering from blunt trauma and abdominal pain were referred to the emergency department (ED). Of these patients, one of them was transferred to the operation room (OR) with a peritonitis diagnosis and the other two patients had appendicitis signs and symptoms. The abdominal pain and related signs and symptoms of these three patients were due to appendicitis. All three patients were discharged from the hospital with normal vital signs. Conclusion: Traumatic appendicitis might be regarded as one of the differential diagnoses of the patients referred to the ED with blunt abdominal trauma and abdominal pain; hence, appendicitis and blunt abdominal trauma have some unknown relations.

Total Gastric Necrosis as a Presentation of Aluminum Phosphide Poisoning: A Case Report

Background: Rice pill poisoning is among the most frequent causes of death among prisoners. Despite advances in the treatment of this poisoning, its mortality rate remains high. The symptoms of Aluminum Phosphide (AlP) poisoning are varied and progressive. One of the essential foundations of diagnosis is based on the history of swallowing the pill by the patient or their companions. Case report: A 20-year-old woman with generalized abdominal pain and a diagnosis of peritonitis was operated. The operative finding was total gastric necrosis. After the operation, the patient's husband claimed that she had consumed some rice pills, intending to commit suicide. Despite all efforts, she remained in persistent septic shock and multi-organ failure and passed away after surgery. Conclusion: Total gastric necrosis could be among the lethal complications of rice tablet (AlP) poisoning.

Relationship Between Obesity and Liver Enzymes Levels in Turner's Syndrome

Background

Liver enzyme abnormalities have been reported in Turner’s syndrome (TS). There are some studies about possible causes of abnormal levels of liver enzymes. One of the main suggestions is obesity. The study aimed to determine the relationship between obesity and liver enzymes levels in patients with TS.

Methods

Forty-one karyotype-proven TS patients referred to Endocrinology and Metabolism Research Center were included in this cross-sectional study. Height and weight of patients were measured and their body mass index (BMI) was calculated. The patients were divided into two groups as the control group including 27 cases (65.8%) with normal BMI (defined as < 85th percentile for age and gender), and the overweight group including 14 cases (34.2%) (defined as BMI > 85th percentile for age and gender). Serum levels of aspartate transaminase (AST), alanine transaminase (ALT) and alkaline phosphatase (AlkPh) were measured.

Results

There were no statistically significant differences regarding AST (27 ± 2.7 vs. 29.6 ± 5.85 U/L; P = 0.3), ALT (20.1 ± 2.45 vs. 22.2 ± 5.85 U/L; P = 0.5), and AlkPh (583.4 ± 2.45 vs. 472.8 ± 161.5 U/L; P = 0.28) between overweight TS patients and those with normal BMI.

Conclusion

There was no significant difference in liver enzyme levels between TS patients with normal BMI and those who were overweight.