Ileal Schwannoma: A Rare Cause of Pelvic Mass.

The incidence of small bowel schwannomas is extremely low. In the current literature, we found just a few reported small intestine schwannomas that were located in the duodenum, jejunum, or ileum. This study reports a surprising finding of a relatively large size ileal schwannoma in a patient whose preoperative magnetic resonance imaging described a tumour in the lesser pelvis probably derived from the right adnexa. Pfannenstiel incision was made by the gynaecology team, which found a large mass lesion arising from the small intestine and occupying nearly the entire lesser pelvis. The general surgeon was invited, and pathology was successfully managed by segmental resection of the small bowel with primary end-to-end anastomosis. The histopathology study reported a submucosal tumour composed of S-100 protein-positive spindle cells, and the diagnosis of ileal schwannoma was made. The possibility of intestinal neoplasms, including schwannomas, might be contemplated in the differential diagnosis of any pelvic mass lesions. A detailed histology study and immunohistochemical stain are required for the final diagnosis of intestinal schwannomas and to rule out malignant changes, which are extremely important for the further management of patients. To the best knowledge, our case is one of the biggest intestinal schwannomas reported in the current literature.

Concomitant Presentation of Acute Acalculous Cholecystitis and Acute Colitis in a Patient with Behcet's Disease.

In this study, we present a case of Behcet's colitis that caused acute inflammation in the gallbladder and mimicked the clinical picture of an acute abdomen: severe right-sided abdominal pain, nausea, fever, and tenderness in the right hypochondrium, right flank, right loin, and right iliac fossa (RIF), with severely elevated white blood cell (WBC) count. The picture of acute acalculous cholecystitis and acute abdomen was resolved after three days of antibiotic therapy. Then, the pain mainly was localized in the right flank and loin, with mild pain in the right iliac fossa, with positive Rovsing's and psoas signs. The pain in the right flank, loin, and RIF dramatically subsided after initiating a low dose of steroid injections. The colonoscopy, which was performed after the marked improvement of the patient's general condition, showed large, deep ulcers with severe colitis in the proximal transverse colon and the ascending colon. There was no cobblestone appearance. The histopathology of the colonoscopic biopsy showed surface ulceration with marked inflammatory infiltrates, mainly neutrophils, and no granulomas were found. The acid-fast bacillus (AFB) test was reported negative. Detailed history-taking, repeated clinical examinations, laboratory studies, and careful interpretation of ultrasound (US) and contrast-enhanced computed tomography (CECT) findings may prevent unnecessary surgical interventions in such fragile patients and lead to a better prognosis. A diagnosis of Behcet's colitis was made, taking into consideration the patient's past medical history, mucocutaneous lesions, and US, CECT, colonoscopic, and histopathology findings. Although there are no specific investigations and tests for Behcet's colitis, sparing of the rectosigmoid area, the absence of cobblestone appearance, the presence of deep, large round ulcers, patchy localization of the lesions, the absence of granulomas, and negative AFB are helpful for confidently excluding other specific colitis such as Crohn's disease, ulcerative colitis, intestinal tuberculosis (TB), diverticulitis, and ischemic colitis. In our view, in the differential diagnosis of the non-surgical cause of acute abdomen, Behcet's colitis must be considered among other rare causes, such as inferior myocardial infarction, diabetic ketoacidosis, sickle cell disease, familial Mediterranean fever, and acute intermittent porphyria, especially for the population of Mediterranean coast and Middle East countries.

Symptomatic Carotid Artery Thrombosis in a Patient Recently Recovered From a COVID-19 Infection.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2), was initially discovered in December 2019 in China and rapidly spread all over the world to become a pandemic. The most common symptoms of a disease are fever, cough, generalized body ache, weakness, dyspnoea, nausea, vomiting, and diarrhea. Among vascular complications of COVID-19, the venous thrombotic complications, like pulmonary embolism and lower limb deep veins thrombosis, are not uncommon. But data about arterial thrombotic complications of COVID-19, especially carotid thrombosis, are still limited. We are describing a case of stroke due to thrombosis of the right carotid arteries, in a patient who had recovered from asymptomatic COVID-19. A 66-year-old male with arterial hypertension presented to the emergency department with a history of repeated collapse, dysarthria, weakness in the left extremities, and a drop in the left angle of his mouth (National Institutes of Health Stroke Scale [NIHSS]-4). The patient was swabbed for COVID-19 which was negative. A computed tomography angiography (CTA) was obtained which showed thrombosis in the branching point of the brachiocephalic trunk (BCT) continuing into the right subclavian artery (SA) and also into the right common carotid artery (CCA), with a subtotal occlusion of the right CCA, extending into the internal carotid artery (ICA) as well. From the apical lung tissue caught during the CT scan, bilateral, irregular widespread ground-glass opacifications, as well as consolidations and small reticular changes were seen in the lungs, which is typical for COVID-19 infection. A quantitative antibody test for COVID-19 infection was performed with the results showing a strong positivity for IgG antibodies, indicating previous COVID-19 infection. The patient was indicated for a standard carotid thrombectomy, which was performed without complications. It seems that one of the important factors that led to the formation of the thrombus in the carotid arteries was COVID-19 infection-induced inflammation in the atherosclerotic carotid vessels and generalized hypercoagulability as well as hyperviscosity. COVID-19 infection is an independent and important risk factor for the formation of an arterial thrombus during the acute illness and in the early post-COVID-19 period also, regardless of the severity of its course. Prophylactic anticoagulation is needed not only at the time of acute illness but also at the early post-COVID-19 time.

COVID-19 with spontaneous pneumothorax, pneumomediastinum, and subcutaneous emphysema in the intensive care unit: Two case reports.

Real-Time-reverse-transcription-Polymerase-Chain-Reaction from nasopharyngeal swabs and chest computed tomography (CT) depicting typically bilateral ground-glass opacities with a peripheral and/or posterior distribution are mandatory in the diagnosis of COVID-19. COVID-19 pneumonia may present though with atypical features such as pleural and pericardial effusions, lymphadenopathy, cavitations, and CT halo sign. In these two case-reports, COVID-19 presented as pneumothorax, pneumomediastinum and subcutaneous emphysema in critically ill patients. These disorders may require treatment or can be even self-limiting. Clinicians should be aware of their potential effects on the cardiorespiratory status of critically ill COVID-19 patients. Finally, pneumothorax can be promptly diagnosed by means of lung ultrasound. Although operator dependent, lung ultrasound is a useful bedside diagnostic tool that could alleviate the risk of cross-infection related to COVID-19 patient transport.

Left inferior epigastric artery injury in COVID-19 patient. Case report and literature review.

INTRODUCTION: Management of COVID-19 pneumonia cases is a medical challenge. However, the situation becomes worse if the patient has coexisting morbidities or newly developed complications. The study is about managing rectus sheath haematoma (RSH) in a patient with COVID-19 pneumonia. PRESENTATION OF CASE: The patient was a 75-year-old male, presenting with bilateral COVID-19 pneumonia, with pulmonary embolism complications. Therapeutic anticoagulation by subcutaneous Clexane injection was administered. A left rectus haematoma was observed, and the patient fell and underwent haemorrhagic shock. Laparotomy was done for the evacuation of the haematoma. DISCUSSION: Contrast-enhanced computed tomography (CECT) is an essential tool for diagnosing RSH, identifying the source of bleeding, type of haematoma, and compression of the urinary system. CONCLUSION: Surgical management of RSH in COVID-19 patients is superior to interventional radiology during the rush pandemic period.

Fulminant septic shock due to Edwardsiella tarda infection associated with multiple liver abscesses: a case report and review of the literature.

INTRODUCTION: Edwardsiella tarda uncommonly infects humans. The usual presentation is mild gastroenteritis, but systemic manifestations may occur. Lethal infections are rarely documented in patients with underlying disorders. CASE PRESENTATION: A previously healthy 37-year-old Southeast Asian woman presented to our hospital with recent onset of abdominal pain, fever, and vomiting. Her condition rapidly deteriorated with signs and symptoms of fulminant septic shock; thus, she was intubated, supported with intravenous vasopressors and fluids, and transferred to the intensive care unit. An abdominal computed tomographic scan with contrast revealed multiple liver abscesses. Blood cultures were obtained and computed tomography-guided percutaneous drainage of the liver abscesses with supplementary cultures was performed; thereafter, empirical broad-spectrum antibiotics were initiated. All cultures grew E. tarda, whereas an antibiogram showed resistance to broad-spectrum antibiotics and sensitivity to ciprofloxacin and aminoglycosides; thus, the antibiotic regimen was updated accordingly. The patient made an uneventful recovery and was discharged from the intensive care unit 14 days after admission. CONCLUSION: E. tarda human infection can present as liver abscess and fulminant septic shock. E. tarda strains can be resistant to broad-spectrum antibiotics; hence, culture-based antibiotics should be used accordingly. Clinicians should be aware of this rare and potentially lethal infection.