A case report of blunt cardiac rupture.

INTRODUCTION: Cardiac rupture is a full thickness laceration of the myocardium that occurs after blunt chest trauma. They are notoriously fatal, with only a handful of patients documented to have survived. These injuries are not commonly associated with low energy chest trauma and may be overlooked as a differential in trauma cases if health care providers are not aware of their possibility. We now report the case of a patient who survived this injury. We believe this is the 16th reported survivor of blunt cardiac rupture. PRESENTATION OF CASE: A 46-year-old construction worker was brought to the emergency department following blunt chest trauma. On arrival he was hypotensive and tachycardic. There was a transient response to intravenous fluid resuscitation. He was found to have a contusion to the left anterior chest wall and left haemothorax on imaging with normal mediastinum. Emergency left anterolateral thoracotomy revealed a pericardial and left ventricular laceration which was repaired. He was weaned off ventilatory support on day 4 post exploration and had an uneventful recovery. DISCUSSION: Survival after blunt cardiac rupture is extremely low. In the past 60 years, only 15 cases have been described where patients survived this injury. They are usually immediately fatal and are caused by high velocity injuries. Our case was interesting because, this injury was due to a low velocity injury resulting in ventricular laceration due to a displaced rib fracture. We believe this is the 16th reported survivor of blunt cardiac rupture. CONCLUSION: It is important, therefore, for first responders to recognize that blunt cardiac rupture can also result from seemingly innocuous, low velocity injuries so that the diagnosis can at least be entertained early. Survival depends on early diagnosis and prompt thoracotomy.

Choledochal cyst mimicker-When small bowel length matters.

OBJECTIVE: Due to the risk of malignancy, the established management of choledochal cysts mandates bile duct excision and biliary reconstruction. While the reconstructive procedure of choice for most surgeons has traditionally been hepatico-jejunostomy, this may not be feasible in selected cases due to immobility or inadequacy of the jejunum. The following case will outline the management of a 32-year-old woman with short bowel syndrome, who was diagnosed with choledocholithiasis and a type 1 choledochal cyst. METHOD AND MATERIALS: As a child, our patient suffered midgut volvulus secondary to malrotation which resulted in extensive bowel resection and developed short bowel syndrome. She presented with recurrent bouts of cholangitis. Imaging of her biliary tree confirmed common duct stones extending into the branched hepatic ducts, as well as a fusiform dilatation of the common bile duct, that appeared consistent with a type 1 choledochal cyst. Laparoscopic excision of the cyst with reconstruction using a hepatico-duodenostomy was planned. RESULTS: The patient underwent successful laparoscopic cholecystectomy, CBD clearance with excision of the bile duct and reconstruction with hepatico-duodenostomy. Recovery was uneventful and she is asymptomatic on subsequent follow-up. Histology is consistent with a markedly dilated bile duct rather than a choledochal cyst. CONCLUSIONS: This case illustrates the dilemma of diagnosis and treatment of a dilated bile duct mimicking a choledochal cyst in the setting of short bowel syndrome and the feasibility of a laparoscopic approach in such cases. Also, it demonstrates that hepatico-duodenostomy may be a safe alternative in cases with limited material for conduit.

Mature Cystic Teratoma Hiding in the Retroperitoneum of an Adult.

We report a rare case of a mature cystic teratoma found in the retroperitoneum of a 28-year-old woman with vague symptomatology. We review the radiologic and pathologic features of this rare lesion.

The steel pan sign of sigmoid volvulus-A case series.

INTRODUCTION: Signs in radiology are usually based on many common objects or patterns that are easily recognizable in everyday life. The objective behind this association is to aid in the understanding and diagnosis of the disease process. These signs can be seen in different imaging modalities such as plain radiograph and computed tomography. PRESENTATION OF CASE: 4 consecutive cases of sigmoid volvulus presented at our tertiary hospital between January 2016 and June 2017. 2 of these cases were managed surgically and others were managed conservatively. The CT scan and abdominal radiographs in these patients were reviewed with consultant radiologist, which bear resemblance to the percussion instrument known as the steel pan. DISCUSSION: The literature has described few radiological signs of sigmoid volvulus in the past. In the following case series, we would like to introduce the "Steel pan Sign", a novel radiological pattern which bears a close resemblance to the percussion instrument known as the steel pan. The Steel pan sign is easier to recognize on CT scan of the abdomen. However, in some cases it can be seen on plain X-Rays. CONCLUSION: The appearance of sigmoid volvulus on CT scans as well as on plain abdominal X-rays bears a significant resemblance to the pattern observed on the face of the Trinidadian steel pan, the recognition of which can aid in the diagnosis of this disease.