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1.
Cureus ; 16(5): e60097, 2024 May.
Article in English | MEDLINE | ID: mdl-38860101

ABSTRACT

Lemmel syndrome, characterized by biliary and pancreatic duct obstruction secondary to a periampullary duodenal diverticulum (PAD), remains a rare and often overlooked diagnosis. Although duodenal diverticula are found in approximately 23% of the population, only about 5% of these cases lead to complications such as obstructions. A new case of Lemmel syndrome is demonstrated in the article about a middle-aged woman with chronic epigastric pain and right upper abdominal quadrant initially misdiagnosed as cholelithiasis. The accuracy of diagnosis was made possible by multimodal imaging methods, such as ultrasound, magnetic resonance cholangiopancreatography (MRCP), and computed tomography (CT) with oral contrast when a diffuse common bile duct was compressed by a PAD. Additionally, it highlights the necessity of including Lemmel syndrome in cases where patients have dilated bile ducts without calculi or mass lesions while emphasizing advanced imaging techniques for the revelation of structural malformations that underlay these conditions. The endoscopic intervention was minimally invasive but effective in relieving symptoms through sphincterotomy followed by laparoscopic cholecystectomy and biliary stent placement, thus making a point of the need for multiple disciplinary approaches toward treatment rare phenomenon like this one. This case report not only sheds light on the diagnostic and therapeutic avenues for Lemmel syndrome but also serves as a valuable educational resource for healthcare professionals. It emphasizes the need for heightened clinical vigilance and the adept use of imaging modalities in cases of biliary obstruction with obscure etiology. By contributing to the growing knowledge of this rare condition, we aim to facilitate timely diagnosis and optimize patient outcomes.

2.
Cureus ; 16(2): e55283, 2024 Feb.
Article in English | MEDLINE | ID: mdl-38562269

ABSTRACT

INTRODUCTION: Hip fractures, including femoral neck fractures (FNFs), represent a significant health challenge globally. Fractures of the hip can be categorized as either intracapsular or extracapsular. Among the elderly, FNFs are particularly prevalent and account for approximately half of all hip fractures. AIM: This study aimed to evaluate the clinical and radiological outcomes of intracapsular FNFs in the elderly treated with cemented bipolar prostheses.  Objectives: This study aims to: (i) assess the clinical outcomes, including pain relief, functional mobility, and patient satisfaction, in elderly individuals with intracapsular FNFs treated with cemented bipolar prosthesis; (ii) examine the radiological outcomes of intracapsular FNFs in the elderly following treatment with cemented bipolar prosthesis, focusing on factors such as implant stability, fracture healing, and any signs of complications. METHODS: A prospective study included elderly patients (aged 55 and above) with intracapsular FNFs treated with cemented bipolar prostheses. Data were collected using a structured proforma, and outcomes were assessed through clinical and radiological evaluations at regular follow-ups. RESULTS: The study included 60 participants with a mean age of 65.25 years. Most fractures were subcapital, and the majority of participants did not experience complications after surgery. The average length of the pre-operative hospital stay was 2.35 days, and the post-operative hospital stay was 6.75 days. Functional outcomes, evaluated using the Harris Hip Scoring System, showed varying degrees, with 70% of participants experiencing good outcomes. CONCLUSION: The management of intracapsular femoral neck fractures in the elderly with cemented bipolar prostheses demonstrated favorable outcomes, including low morbidity, simple operative procedures, and satisfactory early functional results. The study supports the recommendation of cemented bipolar prostheses for femoral neck fractures in individuals over 60, emphasizing their superiority over bipolar hemiarthroplasty. The results contribute valuable insights for treatment decisions in hip fractures, especially considering evolving reimbursement mechanisms and merit-based incentive payments.

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