Electrodiagnostic description of a rare variant of Berrettini anastomois: A case report.

INTRODUCTION: Berrettini Anastomosis is a common purely sensory anastomosis between ulnar and median nerves in palm. Here, via a communicating branch, ulnar nerve can provide sensory supply to digits 3 and 2.There have been electrodiagnostic (EDX) descriptions of the former. However, till date, to the best of our knowledge, there have been no EDX descriptions of the latter. Here, in our case report we would like to describe first instance of the same. PRESENTATION OF CASE: During an assault with a knife a 25-year-old male sustained laceration injury of right median nerve and flexor tendons which were repaired surgically. During rehabilitation, a nerve conduction study (NCS) was performed which incidentally revealed that ulnar nerve was responsible for sensory innervation of digit 2. DISCUSSION: Until recently, it was generally believed that EDX of BA was not possible. However, recent studies on EDX features in BA, have recorded small sensory nerve action potentials (SNAP) from digit 3 on distal ulnar nerve stimulation. But there are no published reports where SNAP from digit 2 on ulnar nerve stimulation were studied, even though anatomical evidence of the same exists. In our patient, we incidentally recorded the same. CONCLUSION: Although our patient had a complete laceration of median nerve, he did not have major sensory disturbances. NCS findings suggested sensory supply of digits 5, 4, 3 and 2 were by ulnar nerve. Without adequate knowledge of communicating branch crossovers in palm, there is a possibility that clinical findings can be misdiagnosed and NCS features can be misinterpreted. For surgeons, awareness of these communicating branches can prevent iatrogenic injuries during surgical interventions.

Undescended cecum with accessory right colic artery: a rare case report.

Midgut malrotation and incomplete rotation are common causes of neonatal intestinal obstruction. At end of 10 week of intrauterine life, cecum will be placed in subhepatic region temporarily and descends to right lower quadrant by eleventh week. Arrest of cecum in subhepatic region or undescended cecum is a rare congenital anomaly of mid gut. Usually, it remains asymptomatic and is diagnosed incidentally. If any pathology occurs in anomalous part, like appendicitis then the diagnosis and treatment will be challenging in all age groups. Variation in blood supply have also been reported with anomalies leading to iatrogenic injuries during colonoscopy and surgeries. Lack of knowledge of these rare variations may lead to delayed diagnosis of appendicitis leading to perforation and surgical emergencies. In the present case, we describe an undescended cecum and its associated variation in branching pattern of superior mesenteric artery.