Aneurysm of anomalous splenic artery arising from a splenomesenteric trunk: Review of the literature with a report of a new case.

INTRODUCTION: Aneurysm of splenic artery arising from splenomesentric trunk is an extremely rare condition. The aim of this study is to report a new case with literature review. PRESENTATION OF CASE: A 52-year-old housewife presented with mild central abdominal pain for two month duration. Abdomen was soft. Abdominal ultrasound examination showed a focal aneurysmal dilatation in the splenic artery (SA) near the portal vein. Abdominal computed tomographic angiography (CTA) revealed presence of the splenomesentric trunk with fusiform aneurysm (45 × 33 mm) of the proximal part of the SA. In supine position, through upper midline laparotomy incision, exploration of both superior mesenteric artery (SMA) and SA was performed, total excision of the aneurysm was done, the SMA was side-repaired and SA was ligated. The post-operative period was uneventful. DISCUSSION: It is interesting to note that orthotopic SA aneurysms, most commonly present in the distal third of the artery, followed by the middle third, while in cases of splenomesentric trunk, all reported cases of anomalous SA aneurysms including the current one, showed the aneurysms to be located in the proximal portion or root of the SA. CONCLUSION: Splenomesentric trunk is a rare anatomical anomaly, aneurysm of which is even rarer. It can be managed either by endovascular intervention or open surgery.

Post-thyroidectomy tracheocutaneous fistula; A case report with literature review.

INTRODUCTION: Total thyroidectomy represents one of the commonest procedures performed for thyroid diseases. The aim of this paper is to report a rare case of tracheocutaneous fistula after total thyroidectomy. CASE REPORT: A 44-year-age female presented with left side neck swelling for 2 month duration. Neck ultrasound showed a well-defined left thyroid nodule (25 × 15 × 14 mm) with features highly suggestive of malignancy, under general anesthesia total thyroidectomy was performed. On the third postoperative day, the patient came back with neck swelling especially during speaking, there was subcutaneous emphysema, wound opened with residual air leak. Under local anesthesia, the wound opened, there was 10 × 10 mm opening in the anterior aspect of trachea, a tracheostomy was inserted, the patient was sent home after decannulation with an opening in the anterior neck. Twenty days later the tracheal opening closed spontaneously. DISCUSSION: The possibility of a tracheal wall ischemic necrosis is plausible due to cautery use. Some autopsy studies have demonstrated that small branches of inferior thyroid artery form the main blood supply of the upper segment of trachea. These fragile branches have a lateral entry point that can be damaged readily leading to ischemia and necrosis. CONCLUSION: Ischemic tracheal necrosis, although very rare, is possible after total thyroidectomy, minimal use of electro-cautery is advised whenever possible.

Hydatid cyst of thyroid gland, a rare case report with a literature review.

INTRODUCTION: Although hydatid cysts can affect any organ in the body, reports regarding affection of thyroid gland are scanty in the literature. This report aims to present a case of thyroid hydatid disease with literature review. CASE REPORT: A 48-year-old female presented with painless anterior neck mass of about 2 year duration. There was an ill-defined, central anterior neck mass, with a smooth surface and mobile with deglutition. Ultrasound of the thyroid gland revealed an enlarged left lobe of thyroid gland due to well defined thick wall cystic nodule. The patient underwent left thyroid lobectomy under general anesthesia, the pathology report revealed hydatid cyst of thyroid gland. DISCUSSION: Liver and lungs are often the end destination for hydatid cysts, while other places like mediastinum, diaphragm, cardiac, smooth and skeletal muscles, abdominal and chest walls are rarely involved. In this case, the cyst affected even a rarer organ which was the left lobe of thyroid gland. Most of the time the disease is asymptomatic and is found accidentally, yet depending on the site and size of the cysts, symptoms can occur. CONCLUSION: Hydatid disease of thyroid gland is an extremely rare condition. The main presenting symptom is swelling. Operation under general anesthesia is the only modality of treatment.