A Rare Case of Dorsal Agenesis of Pancreas, Choledochal Cyst, and Hirschsprung Disease in a Young Patient.

Dorsal pancreatic agenesis is a rare congenital pancreatic malformation. There is just 1 reported case associating it with choledochal cyst. However, no cases have reported yet with both coexisting with Hirschsprung disease. We report a case of a 23-year-old man, presenting with on and off epigastric pain, sometimes radiating to the back. His medical records showed he had Hirschsprung disease as a neonate, for which he underwent Duhamel procedure. Ultrasound imaging revealed a choledochal cyst and a nonvisualized distal portion of the pancreas. Further cross-sectional imaging confirmed the findings-a type 1 choledochal cyst and a dorsal agenesis of the pancreas in a patient with Hirschsprung disease.

Giant Celiac Artery Pseudoaneurysm in a Case of Chronic Pancreatitis: A Rare Case Report With Literature Review.

Pancreatic pseudoaneurysms though uncommon can result in life-threatening spontaneous acute gastrointestinal or intraperitoneal hemorrhage. Celiac artery pseudoaneurysm in a background of chronic pancreatitis is a very rare event. Digital Subtraction Angiography is an important adjunct in the diagnosis and follow-up with the advantage of providing therapeutic options along with giving other details regarding the site, size, and flow characteristics. It has replaced emergency surgical procedures with the added advantage of fewer postoperative complications and lower morbidity and mortality. An urgent surgical intervention remains the only option when such endovascular management fails, not feasible, or is unavailable. Surgical options include proximal arterial ligation or a pancreatic resection, depending on the location of the pseudoaneurysm. We report a case of a 35-year-old gentleman, a known patient of chronic pancreatitis, who presented to our emergency with clinical features of hypovolemic shock and was diagnosed to have celiac artery pseudoaneurysm. Following a failed endovascular coiling, he was successfully managed with operative celiac artery ligation.

Arterio-Hepatic Venous Fistula Following Liver Biopsy: A Rare Case Report and Literature Review.

Arterio-hepatic venous fistula (AHVF) is an exceedingly rare phenomenon compared to arterio-portal venous fistula with only 8 cases reported in world literature. Many listed causes can be attributed to the development of there are no reported cases of AHVF following a core-needle biopsy. We report a case of 38 year-old-female with EHPVO, who underwent splenectomy with a proximal splenorenal shunt. She had an injury to left hepatic artery, consequent to a blind intra-operative core needle biopsy from the liver, which led to the development of a fistulous connection between left hepatic artery and middle hepatic vein causing high output cardiac failure. She was successfully managed with trans-arterial embolization. The present review emphasizes the possibility of AHVF following a liver biopsy and the role of digital subtraction angiography in the diagnosis, therapeutic intravascular interventions, and follow-up.

Role of Phenytoin in Diabetic Foot Ulcers.

Of the complications of diabetes mellitus, foot ulcers are the most dreaded complications, as they can progress at an alarming rate and can be very difficult to treat. Various modalities have been described in the treatment of diabetic foot ulcers. One such modality of phenytoin therapy uses the disadvantage of the drug, that is, gingival hyperplasia to the advantage of wound healing. We hereby report a case of diabetic foot ulcer managed with injection phenytoin sprayed topically over the wound.