Year 2021, Volume 5 - Issue 6

Background: Ventriculoperitoneal shunt (VPS) is one of the most common procedures for the treatment of hydrocephalus. However, there are a number of complications associated with it. Case Presentation: We aim to present a rare complication of complete intraventricular migration of the VPS system. Our patient was a 12-month-old child who presented 8 months following placement of a right VPS for congenital hydrocephalus. He complained of progressive enlargement of head and vomiting. Examination did not reveal any palpable shunt under the skin on head, neck, or torso. An X-ray showed the presence of the complete shunt coiled within the ventricles. The shunt was removed endoscopically and third ventriculostomy was performed. Conclusion: Complete intracranial migration of VPS is a rare complication and can be avoided by making a small burr hole and careful anchoring of shunt. Trans-cranial endoscope is a useful tool for retrieval in such case and avoid more invasive procedure.

Background: Gallbladder agenesis is an extremely rare, usually asymptomatic anatomic variation. Enterogastric reflux (EGR) in a patient with gallbladder agenesis was not reported previously. We report a rare case of EGR in a patient with gallbladder agenesis, diagnosed on 99mTc HIDA (hepatobilliary iminodiacetic acid) SPECT-CT (single-photon emission computed tomography-computed tomography) scintigraphy. Case Presentation: A 35-year-old female was referred to Nuclear Medicine Department for Tc99m HIDA scan. She had history of surgical exploration to remove the gallbladder due to suspicion of chronic cholecystitis. But intraoperatively gallbladder was not localized and the patient was referred for Tc99m HIDA scan. Tc99m HIDA scan along with SPECT-CT showed reflux of tracer into the stomach and non-visualized gallbladder. Further imaging by magnetic resonance cholangiopancreatography confirmed the diagnosis of congenital absence of the gallbladder. Conclusion: We conclude that 99mTc HIDA SPECT-CT scintigraphy is helpful in evaluating the true etiology of biliary colic. It should be cautiously reported, mentioning the EGR if present as it may be the true etiology of biliary colic in patients with and without gall bladder. It prevents the added morbidity of surgery, performed with the suspicion of cholecystitis.

Background: Conjoined twins have invariably been a subject of revulsion among many societies across the world despite the fact that they can be diagnosed early in pregnancy and optimal obstetric management instituted accordingly. Case Presentation: We present a case of a prenatally undiagnosed derodidymus (dicephalous diauchenos) twins, an extremely unusual variant of conjoined twins. The case was such a petrifying unanticipated phenomenon to both the parents and medical staff. Conclusion: Routine prenatal ultrasonograhy and careful prenatal screening must be strongly emphasized if we are to minimize such perinatal mysteries.

Background: Whipple disease (WD) is an exceedingly rare disease. Despite its rarity, there has been a longstanding allure with this disease. The classic form manifests with arthralgia, weight loss, abdominal pain, and diarrhea. However, the infection may involve other organs causing a great diversity of symptoms. Case Presentation: We report a case of a patient presenting to the emergency room with weight loss, abdominal pain and diarrhea. Duodenal biopsies revealed periodic acid Schiff-positive macrophages and Tropheryma whipplei was detected on a cervical lymph node. Diagnosis of WD was established. The patient also had multifocal secondary amyloidosis. We started the patient on a standardized antibiotic regimen for 1 year. Clinical improvement was seen early during the treatment. Conclusion: This case is an example of the protean nature of WD. To the authors’ knowledge, this is the first case report on WD with multifocal secondary amyloidosis affecting several digestive organs.

Background: Tube thoracostomy is a routine life-saving procedure with vast implications in the management of various thoracic conditions that include pleural effusion, pneumothorax, empyema, blunt, and penetrating thoracic trauma. Though a simple procedure, a high rate of morbidity and mortality is associated if a complication occurs. Case Presentation: An intercostal chest tube was inserted by trocar method in a 47-year-old female with rheumatic heart disease associated cardiomegaly, which resulted in right atrial perforation. The patient was managed successfully by an emergency thoracotomy followed by cardiac repair surgery. Our case report demonstrates a very unusual yet life-threatening complication of a simple intervention such as intercostal chest tube insertion and highlights the management of the same. Aim of this case report is to discuss the clinical implications and literature pertaining to the iatrogenic cardiac injury during tube thoracostomy. Conclusion: The use of the blind method of intercostal chest drain insertion using a trocar should be discouraged, particularly in cases with dense pleural adhesions or cardiomegaly.

Background: Calcium, the major inorganic component in bone, plays an important role in insulin secretion and insulin resistance. Insulin resistance is essential in the pathophysiology of non-alcoholic steatohepatitis (NASH), polycystic ovarian syndrome (PCOS), and Type 2 diabetes mellitus (DM). Case Presentation: We present a case of chronic asymptomatic hypercalcemia in an individual with NASH, PCOS, and DM. She was noted to have a serum calcium of 12.8 mg/dl and a homeostatic model assessment of insulin resistance (HOMA-IR) of 4.7 in the last 2 years. Almost all other causes of hypercalcemia were ruled out. The patient was treated conservatively and advised to avoid factors that can aggravate hypercalcemia. Conclusion: The insulin effect on calcium homeostasis is impaired in conditions of insulin resistance. There is increasing evidence of the association between hypercalcemia and insulin resistance. However, it remains a diagnosis of exclusion.