Year 2023, Volume 7 - Issue 7

Background: Hepatic Hemangioma (HH) is described as the most prevalent benign hepatic tumor, and it is usually discovered incidentally as a symptomless mass of less than 3 cm. Kasabach-Merritt Syndrome (KMS) is described as a rare but severe complication of some vascular tumors. This syndrome presents as severe thrombocytopenia accompanied with a consumptive coagulopathy. Case presentation: A 35-year-old female, with a history of a hepatic tumor that was incidentally diagnosed with an ultrasound, later develops abdominal distention, petechiae and prominent hematomas that appear with minimal trauma. At the initial approach are found hematological data of microangiopathic anemia, thrombocytopenia and consumptive coagulopathy accompanied with the histopathological and imaging diagnosis of a Giant HH. Conclusion: Although, it is a very rare complication, the severity of this Syndrome requires a prompt diagnosis and treatment.

Background: Alternative and less invasive methods for laparoscopic sleeve gastrectomy include endoscopic sleeve gastroplasty (ESG), where the stomach is transformed into a narrow tube by using an endoscopic suturing device. Despite satisfying weight loss results, severe adverse events, including gastric perforation, have occurred. Case Presentation: This case report describes a 38-year-old woman with acute abdominal pain four days after ESG. An emergency laparoscopic exploration revealed a stomach perforation fixed to the anterior abdominal wall by a suture anchor of the gastroplasty. Conclusion: A full-thickness perforation harming neighboring organs and structures is a possible complication after ESG. Therefore, this procedure should only be performed if morbidity can be monitored during the procedure to avoid situations where dangerous complications remain unrecognized for too long.

BACKGROUND Cerebral Gas embolism (CGE) is an uncommon and often preventable iatrogenic complication. Any peri-procedural neurological event should raise suspicion of CGE and treatment started immediately. Hyperbaric Oxygen Therapy (HBOT) is the treatment of choice and early referral is essential. However, HBOT has been shown to be beneficial with full recovery even after delays as long as 60 hours. This report is written to increase awareness about recognition and management of this dreaded complication. CASE PRESENTATION We report a case of a patient who suffered a cardiac arrest secondary to CGE during routine coronary angiography followed by ventriculogram. After successful resuscitation, review of imaging revealed air in the left ventricle and CT brain showed parenchymal air locules with surrounding ischemic changes. Neurological examination showed hypertonic reflexes with extensor plantar response and intermittent seizures. HBOT was arranged but there was a delay of about 14 hours between diagnosis and arrival due to logistical reasons. On arrival, the patient was still having seizures intermittently despite the anti-epileptics and sedative infusions. Seizures stopped within 20 minutes of HBOT initiation and 4 more sessions were provided in the following 72 hours. CT brain done 48 hours later demonstrated mild edema but no residual air. Upon eventual discharge, the patient had a near full neurological recovery, except for a mild left hemiparesis. CONCLUSION Acute neurological symptoms after an invasive procedure, should raise the suspicion of CGE. Early HBOT is the treatment of choice as minutes are equal to saved brain cells. However delayed treatment can still be lifesaving and should be considered.

Background: Schwannomas originating from the ansa cervicalis represent an exceptionally infrequent occurrence. To date, less than 5 cases have been reported in the English literature. We present a multimedia case report of an ansa cervicalis schwannoma, accompanied by a surgical video, in a patient whose initial clinical assessment suggested potential thyroid pathology. Case Presentation: A 51-year-old woman was referred to the otolaryngology department following an incidental finding of a thyroid nodule on a head and neck CT scan. Imaging revealed the presence of two lesions: a TIRADS 3 left thyroid nodule, and a benign tumor originating from the peripheral nerve sheath of the ansa cervicalis, located adjacent to the right thyroid lobe. Intraoperatively, the second lesion was discovered to originate from a branch of the superior root of the ansa cervicalis. Subsequent histopathological analysis confirmed the diagnosis of a schwannoma. Conclusion: Schwannomas originating from the ansa cervicalis pose a diagnostic challenge, often susceptible to misinterpretation and confusion with other lesions. This case report highlights radiological and surgical techniques that can be used to identify the origin of these tumors, both preoperatively and intraoperatively.

Background: Acute gastric volvulus is a rare condition that can cause significant morbidity and mortality. The presenting complaint is usually due to symptoms related to gastric outlet obstruction, which might include abdominal pain, nausea and vomiting, bowel obstruction, and even perforation or peritonitis. Case Presentation: A case of acute gastric volvulus was presented in a 78-years-old woman with a complaint of epigastric pain. The patient presented with sudden onset of abdominal pain and vomiting. She was diagnosed with acute gastric volvulus on abdominal imaging and was successfully treated with laparoscopic surgery. Conclusion: This case highlighted the importance of considering gastric volvulus in the differential diagnosis of acute abdominal pain, especially in patients with underlying risk factors.