bluuebunny/crossref_metadata_2025_split huggingface dataset:
976 Traumatic Damage to The Liver Capsule: An Unusual Cause of Small Bowel Obstruction
Authors: Aloni K , Harris H , Colucci G , McFall M 
Published: October 2021

Abstract
A 57-year-old man presented to the emergency department with severe abdominal pain. Three months prior to presentation, he had sustained blunt trauma to his right side whilst cycling but had not sought medical attention. On admission, a CT scan showed small bowel obstruction and he underwent an emergency laparotomy. Intraoperatively, a subcapsular liver haematoma was identified, with incarcerated, necrotic small bowel within the liver capsule. The patient underwent deroofing of the haematoma with an omental patch and a small bowel resection with primary anastomosis.
Small bowel obstruction is a common presentation in A&E and is responsible for half of emergency laparotomies in the UK each year. Although hepatic haematomas are also a relatively common complication of blunt trauma to the abdomen, associated bowel herniation into the liver capsule is very unusual. We believe this is the first time such a case of small bowel obstruction has been reported in the literature and we discuss details of operative management and highlight key learning points.
999 Case Report: A Rare Congenital Granular Cell Epulis In a Newborn Female Infant
Authors: O'Rorke R , Ramkumar D , Jones S 
Published: October 2021

Abstract

Background
A congenital granular cell epulis (CGCE) is a rare benign lesion of uncertain histologic origin that is found on the mucosa of the alveolar ridges of newborn babies. There have been less than 250 reported cases of CGCE. They are most commonly found in the anterior maxilla region in female infants.

Case Report
An 8-week-old female was referred from the Neonatal team with a 10mmX5mm lesion found at birth on the mucosa of the anterior maxilla. She was seen in the Oral and Maxillofacial Department where her parents reported that the lesion was causing discomfort when feeding and they were keen for its removal. On initial medical examination the patient was diagnosed with a Grade 1 ejection systolic murmur and was awaiting further cardiac investigations. With this in mind and the young age of the patient, it was decided an excisional biopsy of the lesion under local anaesthesia (LA) would be the safest option. The lesion was excised uneventfully when the patient was 9 weeks old. It was shown to be a congenital granular cell epulis following histopathological analysis. The patient was reviewed 8 weeks post-operatively. There were no signs of recurrence, the infant’s feeding had improved drastically, and she was thriving.

Discussion
CGCE is a rare and interesting lesion in neonates. Early diagnosis and treatment of CGCE is essential in facilitating infant feeding. This report highlights that a well-planned surgical excision under LA is a well-tolerated and safer option which is welcomed by parents.
1008 Incidental Solitary Cystic Mediastinal Lymphangioma with Mass Effect Complications: A Case Report
Authors: Youssef S , Iftikhar S , Haris M , Sundararajan S , Abid Q 
Published: October 2021

Abstract

Introduction
Cystic mediastinal lymphangiomas (CML) are exceedingly rare, representing &lt;1% of cystic lymphangiomas (CL), and typically present before 2 years of age. Few cases describe adult presentations of solitary CML and none describe symptomatic cases with ‘mass-effect’ complications. We describe an incidental finding of a symptomatic solitary CML causing mass effect complications and our definitive surgical management.

Case Report
A 44-year-old Caucasian male presented with reduced responsiveness due to mixed drug overdose of fluoxetine and ibuprofen. Plain chest radiograph (CXR) revealed incidental new mediastinal widening. Thoracic computed tomography (CT) showed a well-defined lesion (75x63mm) in the right paratracheal region, with associated compression of the superior vena cava, left brachiocephalic vein and displacement of the azygos vein. Further questioning revealed 6-months history of non-productive cough, worsening dyspnoea on exertion and chest pain radiating to the right of the chest. Complete surgical resection was performed via posterolateral thoracotomy. It was seen compressing the 2nd and 3rd intercostal nerves. Enlarged lymph nodes at station 4 and 10 were excised and sent for analysis with aspirate from the excised lesion. Pathological gross examination showed a multiloculated cystic lesion containing thin straw-coloured fluid. Microscopically, it was thin walled with smooth muscle and scattered clusters of lymphocytes; its lining was markedly attenuated comprising bland flat endothelial cells, positive for CD-31. Lymph node samples showed reactive changes.

Conclusions
Although CMLs are benign, their location and growth in the mediastinum can result in compression of surrounding structures. Early detection and complete surgical resection are paramount to prevent such complications and lesion recurrence.
1033 Endobronchial Sclerotic Neurofibroma: A Case Report of a Very Rare Benign Tumour
Authors: Iftikhar S , Youssef S , Gey Van Pittius D , Ghosh S , Haris M 
Published: October 2021

Abstract

Introduction
Endobronchial neurofibromas are exceedingly rare benign lesions most commonly originating at the trachea. Primary pulmonary tumours of neurogenic origin such as peripheral nerve sheath tumours (PNSTs) are extremely rare, accounting for less than 0.2% of all lung tumours. Intrathoracic PNSTs are usually benign and are commonly found in the posterior mediastinum as schwannomas with female preponderance. We present the first reported occurrence of the sclerotic variant of endobronchial neurofibroma and the approach used in its definitive investigation and management.

Case Report
A 69-year-old Caucasian male with a 66 pack-year smoking history and a background of alcohol induced liver cirrhosis, peripheral vascular disease and dilated cardiomyopathy presented with dyspnoea and fatigue with severe normocytic anaemia. Computed Tomography (CT) chest, abdomen and pelvis revealed an indeterminate nodule at the secondary carina projecting into the bronchus intermedius (BI). Fibreoptic bronchoscopy showed a polypoid lesion with a vascular appearance. Under general anaesthetic, combined fibreoptic and rigid bronchoscopy was used to remove the lesion with rigid forceps. Gross histological appearance showed an 8x6x5mm pedunculated lesion with a 2mm diameter short stalk and histology of a sclerotic neurofibroma with fibroblasts and collagen, positively staining for S100 and LP10. This patient is due for follow up in 6-month with a CT chest to ensure no tumour recurrence.

Conclusions
Endobronchial neurofibromas appear highly vascular and demand extra caution at bronchoscopic intervention. Prompt, experienced thoracic surgical and intervention pulmonology input should always be sought. Combined approach of fibreoptic and rigid bronchoscopy allows better control of potential bleeding and the airway.
1068 Cranial Fasciitis of the Temporal Bone
Authors: Zuccarelli A , Wright B , Trimble K 
Published: October 2021

Abstract
We present the case of a child with a rare benign tumour of the temporal bone.
A nine-month-old girl was referred to her local paediatric hospital with a painless right-sided, post-auricular swelling increasing in size in the preceding two months. On examination there was a 2x2cm mass overlying the temporal bone posterior to the right ear. The mass was firm, immobile, non-tender and well circumscribed. Ultrasound demonstrated a 1.9cm subcuticular mass with evidence of intracranial extension through the suture. Vascular flow and hyperechoic foci were demonstrated within the lesion. The local paediatric team requested magnetic resonance imaging (MRI) and computed tomography (CT) of temporal bone prior to referral to tertiary care centre. Imaging displayed a 2cm expansile lesion of the temporal bone with cortical loss and effacement of underlying dural venous sinus. The patient proceeded to incisional biopsy for tissue diagnosis which was suggestive of cranial fasciitis. Following discussion at the regional multidisciplinary meeting, she underwent surgical excision of the tumour in a joint Neurosurgery/Otology case. The tumour was fully resected macroscopically, with the normal surrounding bone and mastoid air cells preserved. Final histopathology showed a highly cellular lesion composed of spindle cells arranged in fascicles, with areas of myxoid background and confirmed the tumour to be cranial fasciitis. The child has made a good recovery and will be kept under close clinical follow-up. This case demonstrates a rare benign tumour of the temporal bone that may present to an otolaryngologist and the importance of tissue diagnosis, imaging and multidisciplinary management.
1073 Synchronous Cholecystitis and Appendicitis: A Case Report Highlighting Learning Points on Medical Imaging and Consent
Authors: David B , Issa M , Gallucci A 
Published: October 2021

Abstract
Laparoscopic appendicectomy and laparoscopic cholecystectomy are separately two of the most common emergency surgical procedures carried out in the UK. Only a small number of synchronous presentations of acute appendicitis and acute cholecystitis have been reported in surgical literature and this rare co-existent pathology gives rise to several valuable learning points with regards to laparoscopy, medical imaging interpretation and the consent process.
Our case report involves a 58-year-old female patient presenting with both RUQ and RIF pain and positive Murphy’s sign on clinical examination. US scan demonstrated several gallstones within a thin-walled gallbladder. Subsequent CT scan reported acute appendicitis which was treated definitively with laparoscopic surgery. Intraoperatively a perforated gangrenous gallbladder containing multiple calculi was discovered, and the decision was made to perform a double procedure of laparoscopic appendicectomy and cholecystectomy. Histopathology confirmed synchronous pathology of appendicitis with faecolith and calculus cholecystitis.
This case demonstrates the importance of considering multiple pathologies when assessing a patient with ambiguous and migratory abdominal pain. It reinforces the importance of diagnostic laparoscopy to rule out multiple pathologies. This acts as a cautionary case against over-reliance on medical imaging and reminds surgeons of their obligation to maintain competence in CT interpretation plus correlation of imaging with clinical assessment of the patient. Readers should also be reminded that the consent process for surgical interventions should be undertaken meticulously in patients with ambiguous abdominal pain.
1074 Gallstone Ileus: Two Decades After Cholecystectomy
Authors: Matwala K , Iqbal M R , Shakir T , Chicken D W 
Published: October 2021

Abstract

Introduction
Gallstone ileus is a rare complication of gallstones that occurs in 1%-4% of all cases of bowel obstruction. We present a surprising case of gallstone ileus causing small bowel obstruction 19 years after open cholecystectomy.

Case Report
A 77-year-old male presented with a 3-day history of abdominal pain, 4 episodes of vomiting and absolute constipation. He had a surgical background of an open cholecystectomy and open appendicectomy 19 years and 45 years ago respectively. Medically, he had well-controlled hypertension and experienced a TIA 5 years prior. Computed Tomography Scan of the abdomen and pelvis revealed features consistent with an obstructing, heterogenous opacity in the distal small bowel without pneumobilia. The patient subsequently underwent diagnostic laparoscopy. Intraoperatively, an obstructing gallstone, measuring 4 cm, was found 50cm proximal to the ileocaecal junction, with dilatation of the proximal small bowel and distal collapse. Enterotomy and removal of the stone was done. Post-operatively, this gentleman recovered without complications and was discharged home two days later after being able to tolerate a solid diet.

Conclusions
This is the second reported case of gallstone ileus in a patient with previous cholecystectomy about two decades ago, according to our literature search. Although extremely rare, absence of the gallbladder does not exclude the possibility of gallstone ileus.
1223 Cholelithiasis and Choledocholithiasis with Migration of Stones into Right Psoas Muscle Cavity
Authors: Hunter J 
Published: October 2021

Abstract

Aim
To highlight the importance of appropriate imaging modalities for abnormal clinical presentations.

Method
Xyo woman presented with severe right upper-quadrant pain to the emergency department. Prior history of colicky abdominal pain for 1 year, right-sided nephrectomy and hypertension. She stated that the current epsiode of pain was the worst so far, becoming more persistent, prompting her to call an ambulance. Cholecystitis was suspected, so a Computed Tomography abdomen/pelvis was performed. A dilated, inflamed gallbladder was noted in contact with the right psoas major, with what appeared to be an abscess in the right psoas major.

Results
A Magnetic Resonance Cholangiopancreatography was performed, which demonstrated that the aforementioned abscess was in fact a large cavity within the psoas major, containing up to 15 gallstones. Cholelithiasis was also seen, with common bile duct dilatation and evidence of a common bile duct stone. An Endoscopic Retrograde Cholangiopancreatography was performed, and X recovered well post-procedure with analgesia and antibiotics.

Conclusions
Acute cholecystitis/intra-abdominal gallstones may result in abscess/cavity formations and abnormal biliary clinical presentations. It is important therefore to fully investigate abnormal hepatobiliary imaging with multiple imaging modalities to allow for accurate diagnosis and appropriate further management of presentations.
1228 Massive Gastrointestinal Bleeding Secondary to Bleeding Jejunal Diverticulum
Authors: Mukhtar A. Mukhtar A , Alshareif B.A. Abdalaziz , Hijazi M. Gareeballah Yousif , Ibrahim M Y 
Published: October 2021

Abstract
Usually, the Jejunal diverticula appeared multiple and vary in size. These false diverticula lack the muscular coat of the normal intestinal walls, and most patients presented with it were asymptomatic. Although 10% of all patients develop complications such as perforation, obstruction, or bleeding, which then requires surgical intervention, but bleeding is relatively rare among these complications.
A case of 74 years old lady was referred to our hospital because of persistent hematemesis and fresh melena. Her previous and recent upper gastrointestinal endoscopy both revealed only gastric erosions without any active bleeding. Also, previous, and recent colonoscopy was done but not completed due to the presents of fresh blood and blood clots along the colon, which led to improper visualization. Her selective mesenteric angiography was done together with upper and lower endoscopy, but none of them revealed the source of bleeding. Emergency exploratory laparotomy was undertaken, and a prominent single jejunal diverticulum with a prominent vessel entering it was noted, and no bleeding from other sites detected. Enterotomy was performed, and enteroscopy confirmed ulceration at the jejunal diverticulum site. Resection of the portion containing the diverticulum and primary anastomosis was done, and this cured the patient. The histopathological examination of the specimen showed an ulcerative lesion with an exposed vessel suggestive of the source of bleeding. Although jejunal diverticula incidence is rare, it is important to look for such lesions in patients with intestinal bleeding.
Keywords: jejunal diverticulum, small intestine, intestinal bleeding.
1246 Partial Phalloplasty After Oncologic Resection: A Challenge for Health Centers in Remote Area of Indonesia
Authors: Amelinda D A , Santoso A , Fawzy A 
Published: October 2021

Abstract

Background
Restoring penile function for urination and sexual activity, and achieving cosmetic result, are the goals of penile reconstruction including in post-malignancy reconstruction. Lack of studies has reported the usage of radial forearm flap on partial phalloplasty.

Case Presentation
A 31-years old male presented with fragile, cauliflower-like mass sizing 6x8 cm. The tumor had covered whole glans until the middle shaft of the penis. Plan of treatment for this patient started with complete excision of the tumor (partial penectomy), continued with phalloplasty. Phalloplasty consisted of using radial forearm flap (RFF) for penile foreskin (including glans), reconstructing corporal bodies using sartorius muscle, reshaping the penile glans, and urethroplasty to correct the hypospadic-looking urethra. Radial forearm flap of the non-dominant arm was implanted on the remaining foreskin of the penis, continued with wound care. On the 7th day postoperatively, no signs of necrotic, wound dehiscence, nor pus were observed, with capillary refill time on the distal fingers shown less than 2 seconds. Further evaluation is scheduled.

Conclusions
Loss of physiologic function usually follows partial penilectomy, which could lead to decrease in psychological quality of life. The main goal of the reconstruction of penile foreskin (including glans) using RFF is to form a newly formed penile glans that would have a cosmetic appearance nearly similar to a normal glans, which could improve its physiologic function and benefit psychologically. A challenge for health care centers in remote is is how to monitor and maintain a viable flap after the reconstruction and to keep a regular evaluation from the patient.
1247 Fusobacterium Necrophorum - A Rare Thyroglossal Cyst Habitat That Can Be Lethal
Authors: Goel A , Oikonomou C , Amini A 
Published: October 2021

Abstract
Thyroglossal cyst is the most frequent developmental cervical anomaly with a prevalence of 7% in the population. Infection and abscess formation are common complications. Isolation of Fusobacterium Necrophorum (F. Necrophorum) made the management of this case challenging.
An 18-year-old male presented to the emergency department with a 3-day history of a neck mass, sore throat, cachexia, dysphagia and fever. Clinical examination revealed an erythematous 4 x 5 fluctuant swelling in the midline of the neck with evident lymphadenopathy on level II on the left-hand side. A CT neck that was undertaken nine months ago was suggestive of a thyroglossal cyst and the patient was placed in the waiting list for surgical excision under general anaesthesia. He reported three episodes of midline neck swelling since then.
Upon admission, ultrasound guided drainage was arranged, and a pus sample obtained. The presence of F. Necrophorum was reported by microbiology with instructions of urgent admission and strict antibiotic regime. Excision of the cyst was scheduled after the completion of the antibiotic course.
Fusobacterium Necrophorum is a rare microorganism with increased virulence and a significant mortality rate. It has been involved in oropharyngeal infections complicated by Lemierre’s syndrome, necrobacillosis, post anginal sepsis and septic jugular thrombophlebitis making this case of particular interest.
1293 Hibernoma: Rare Case of An Intense 18F-FDG Uptake Mediastinal Lesion Mimicking Thymic Carcinoma
Authors: Ndukauba C , Coelho-Lima J , Pai K , Gey Van Pittius D , Satur C 
Published: October 2021

Abstract
Hibernoma is a rare benign neoplasia derived from remnants of brown adipose tissue. Here, we describe an unusual case of mediastinal hibernoma which radiologically mimicked a thymic malignancy. The patients had presented with chest pain, associated with palpitations and dizziness suggestive of cardiac pathology. Investigation of coronary anatomy by CT scan, incompletely revealed the presence of the lesion situated in the region of the thymus gland, 48 mm x 94 mm. The mass was smooth walled with evidence of invasion of local structures. Whole-body positron-emission tomography (PET) demonstrated the mass had a very high uptake, SUV 55.2.
The mass was excised by total thymectomy through a sternotomy. Histopathological analysis revealed it to be fibro-fatty in nature. Light microscopy demonstrated the presence of large multi-vacuolated cells, with appearances typical of brown fat, a hibernoma. This is one of only 7 reported cases. Its findings highlight the importance of careful interpretation of PET studies in hibernoma cases. We propose hibernoma should be included as a differential diagnosis of growing mediastinal masses.
1351 Primary Pituitary Abscess Presenting as An Isolated Bitemporal Hemianopia
Authors: Tan E , Zammit A 
Published: October 2021

Abstract
Pituitary abscesses are rare yet life-threatening entities. Most common presenting features are headache, hypopituitarism, and visual changes. Majority of patients are found to have a predisposing risk factor, such as a pre-existing pituitary lesion, recent pituitary surgery or irradiation, or a primary source of infection. We present the case of a 53-year-old male with a spontaneous pituitary abscess, who presented with an isolated bitemporal hemianopia, but was otherwise asymptomatic with no known risk factors. Magnetic resonance imaging showed a sellar and suprasellar mass, thought to be a pituitary macroadenoma. He underwent endoscopic transsphenoidal adenectomy and cystic fluid was seen intraoperatively. Microbiology analysis showed Staphylococcus Aureus, and a course of intravenous ceftriaxone was commenced. Histopathology reported no evidence of adenoma and impression was of a pituitary abscess. Following transsphenoidal resection and commencement of antibiotic therapy, the bitemporal hemianopia resolved. We therefore report a rare case of primary pituitary abscess and emphasise the importance of including this condition as a differential diagnosis in any patient with a visual deficit or new pituitary lesion.
1392 Challenges of Heart Surgery on A Patient with Anorexia Nervosa: A Rare Case Report of The Perilous Effects on The Myocardium
Authors: Ashraf M , Zargaran D , Lucchese G , Bosco P 
Published: October 2021

Abstract
This peculiar case highlights the detrimental effects of Anorexia Nervosa (AN) on myocardial tissue, and the significant impact this can have on surgical outcome.
A 49-year-old female with history of AN presented acutely unwell with confusion, dizziness, deranged electrolytes and metabolic acidosis. She had lost significant weight in the past month with suspected laxative abuse. She required intubation due to extensive bilateral pulmonary effusions and multiple organ failure. Echocardiogram showed appearance of a rheumatic mitral valve with severe stenosis, a mean gradient of 16mmHg and moderate regurgitation.
Urgent surgical intervention to replace the valve was indicated. Following replacement of the mitral valve, torrential bleeding ensued after coming off bypass. This had resulted from a dramatic atrio-ventricular dissociation. Attempts to repair the deficit were hampered by extremely fragile myocardial tissue. Unfortunately, despite extensive efforts to repair the damage and control bleeding, it was ultimately in vain.
Histology of the myocardium in AN patient has revealed evidence of diffuse endocardial and interstitial fibrosis and myxoid material deposition. This case is the first to illustrate the sequelae of AN on myocardial tissue with its subsequent peri-operative impact. Before surgical intervention we suggest that maximal efforts to optimize nutrition should be undertaken pre-operatively, seeking to reverse the structural changes caused by AN. This case highlights the need for further exploration of the effects that a patient’s nutritional status can have on the quality of tissue being operated on.