Year 2024, Volume 8 - Issue 7

Background: Chylous ascites (CA) is very rare in the pediatric population. It is defined as whitish ascitic fluid with lymphocyte predominance. Congenital CA is probably the most common cause of CA in children. We report a case of an infant with CA; the cause of which remains unidentified, with full recovery. We have included a relevant literature review as well. Case Presentation: A previously well 4-month-old baby girl was referred for worsening ascites. Despite extensive workup, no cause was found. Treatment options including diuretics, medium chain triglyceride formula (MCT) feeds, abdominal paracentesis, and total parenteral nutrition (TPN) were attempted. She recovered fully with no residual morbidity. Conclusion: CA very rare in the pediatric population. Extensive workup excluded known causes and the yield was negative. Treatment is mainly supportive. MCT formula, fasting, and TPN were reported to have variable effects. Surgery could required in limited cases.

Background: Amyloidosis is a multisystemic disease that may be hereditary, characterized by the deposit of amyloid in the extracellular space. Transthyretin-mediated (ATTRm) amyloidosis is the most common subtype of heredofamilial amyloidosis. The diagnosis is based on clinical suspicion and amyloid in tissues. Hepatic transplantation is the only treatment that prevents the synthesis of the amyloidogenic variants of transthyretin protein. Case Presentation: A 34-year-old male presented with weight loss, gastrointestinal symptomatology, and polyneuropathy associated with histopathologic deposits of amyloid in gastrointestinal and fat tissue as well as peripheral nerve. Conclusion: Hereditary familial amyloidosis (HFA) is a relatively rare disorder that leads to erroneous and delayed definitive diagnosis. Therefore, the diagnosis should be first based on a suspicion of the disease, and then proceed according to complete protocol.

Background: Extramedullary solitary plasmacytomas (EMD) are an uncommon manifestation of plasma cell disorders. The median survival rate is less than 6 months. EMD rarely involves the digestive tract, the liver is the most common site with only a 2.3% incidence rate for pancreatic involvement. Case Presentation: We report a case of a patient with a history of multiple myeloma who presented with painless obstructive jaundice and EUS findings of hypoechoic, solid irregular mass in the pancreatic head with surrounding peripancreatic lymphadenopathy. Fine needle aspirate (FNA) confirmed malignant infiltration of plasma cell neoplasm. The patient rapidly deteriorated and succumbed to his illness within 6 weeks of diagnosis.  Conclusion: Extramedullary plasmacytomas (EMD) involving the pancreas are uncommon and associated with a poor prognosis. Our case highlights the importance of considering extramedullary plasmacytoma when a patient with MM presents with a pancreatic mass, particularly one showing a rapid interval growth. This rate of growth is not seen with primary pancreatic parenchymal diseases such as cancer, cysts, and so on. This case highlights the importance of considering rare differentials while evaluating patients with pancreatic mass.

Background: Situs inversus totalis (SIT) is a rare congenital condition characterized by the mirror-image reversal of the thoracic and abdominal organs. SIT presents significant challenges during surgical procedures that require anatomical familiarity and dexterity, such as laparoscopic cholecystectomy. Case Presentation: A 73-year-old woman with SIT presented with a 2-day history of left-sided hypochondrial colicky abdominal pain aggravated by food intake and associated with nausea. Physical examination revealed a positive Murphy's sign in the left hypochondrium. Laboratory tests showed leukocytosis and elevated liver enzymes. Imaging (See Figures 1-4) confirmed acute cholecystitis with the gallbladder in the left upper quadrant. The patient was scheduled for laparoscopic cholecystectomy. Preoperative planning involved detailed imaging and coordination with the anesthesiology team. The surgical technique was adapted for SIT, including specific patient positioning and a mirror-image approach. The gallbladder was successfully removed, with careful dissection of the cystic duct and artery. Postoperative management included non-steroidal anti-inflammatory drugs, opioids, and monitoring. The patient's recovery was uneventful, and she was discharged on the third postoperative day with follow-up instructions. The care plan included pain management, regular monitoring, early mobilization, diet progression, and scheduled outpatient visits. Conclusion: Laparoscopic cholecystectomy in patients with SIT requires careful preoperative planning, skilled surgical techniques, and effective team communication. Despite these challenges, successful outcomes are possible with meticulous attention to detail and adaptation to the reversed anatomy.

Background: Lupin beans, a yellow legume seed from the Lupinus plant, are commonly used in Southern Europe, Latin America, and the Middle East. Despite their bitter taste, lupin beans are highly nutritious and rich in protein, making them popular snacks. The bitter taste is due to the presence of over 150 quinolizidine alkaloids, with Lupanine being the predominant alkaloid. If not properly debittered before ingestion, lupin toxicity and anticholinergic symptoms can occur. Case Presentation: A 49-year-old healthy Egyptian man presented with symptoms such as dry mouth, unsteadiness, constipation, and urinary retention for 6 hours. After investigation, it was discovered that he had consumed 400 g of bitter lupin beans within a 1-hour period, around 4-6 hours before the symptom onset. The patient was oriented, conscious, and alert, showing no signs of pain or distress. His vital signs were normal, and he had normal cardiovascular, pulmonary, gastrointestinal, and neurological examinations. His eye examination revealed fixed, dilated pupils bilaterally, blurry vision, and normal eye movement bilaterally. Laboratory tests were normal. The patient received Ringer's lactate intravenously and was closely monitored in the emergency department. Over a 3-hour period, all symptoms and signs resolved with fluid management alone, and the patient was discharged home following his improvement. Conclusion: This report highlights the importance of history taking in diagnosing food-related diseases and emphasizes that physicians should consider lupin toxicity as a differential diagnosis in cases presenting with anticholinergic symptoms.