A tangential gunshot wound to the head: case report and review of the literature.

BACKGROUND: Patients with tangential gunshot wounds (TGSWs) commonly present with a good Glasgow Coma Scale score and without a history of loss of consciousness. Typically, the bullet does not breach the skull, however, there is a considerable force directed into the brain, and these patients are best treated as sustaining a moderate-to-severe blunt head injury. These patients require observation and repeat imaging. Physicians should be aware of this entity as these patients can deteriorate in a delayed fashion. OBJECTIVES: The authors present a case of a TGSW to the head in a neurologically intact patient. The initial post-injury computed tomography (CT) scan showed a very small subdural hematoma (SDH) with no overlying fracture of the skull. A delayed CT scan performed 4 h after arrival to the Emergency Department and 6 h after injury demonstrated an increase in size of the SDH, new traumatic subarachnoid hemorrhage, and bilateral cerebral contusions. Clinically, the patient showed worsening of her neurological examination. She underwent aggressive non-surgical treatment for increased intracranial pressure with almost complete recovery. CONCLUSION: Although patients with TGSWs are typically in good condition upon presentation, these injuries are not always trivial, and these patients should have, at minimum, a non-contrast brain CT scan to evaluate underlying damage to the brain and skull. In addition, a delayed CT scan and close observation on a neurosurgical service are indicated.

Giant sigmoid diverticulum with coexisting metastatic rectal carcinoma: a case report.

INTRODUCTION: Giant diverticulum of the colon is a rare but clinically significant condition, usually regarded as a complication of an already existing colonic diverticular disease. This is the first report of a giant diverticulum of the colon with a co-existing rectal carcinoma. CASE PRESENTATION: We report a case of a 66-year-old Caucasian woman who presented with lower abdominal pain, chronic constipation and abdominal swelling. Preoperative abdominal computed tomography revealed a giant diverticulum of the colon with a coexisting rectal carcinoma and pulmonary metastasis revealed on a further thoracic computed tomography. An en bloc anterior resection of the rectum along with sigmoid colectomy, partial hysterectomy and right salpingoophorectomy was subsequently performed due to extensive adhesions. CONCLUSION: This report shows that the presence of a co-existing distal colorectal cancer can potentially lead to progressive development of a colonic diverticulum to become a giant diverticulum by increasing colonic intra-luminal pressure and through the ball-valve mechanism. This may be of interest to practising surgeons and surgical trainees.

N-Butyl-2-cyanoacrylate use in intraoperative ruptured aneurysms as a salvage rescue: case report.

OBJECTIVE AND IMPORTANCE: The use of N-butyl-2-cyanoacrylate (n-BCA) acrylic glue as a salvage rescue in procedural ruptured aneurysm should be part of the neurointerventionalist's armamentarium. CLINICAL PRESENTATION: Two patients, age 44 and 60 years, presented with Hunt and Hess grade 3 subarachnoid hemorrhage from aneurysmal rupture. INTERVENTION: We report 2 cases in which n-BCA was used effectively as a salvage rescue in aneurysms that ruptured during coil embolization. CONCLUSION: These 2 cases demonstrate a feasible technique for the salvage of iatrogenic aneurysm perforation during coil embolization, which, to our knowledge, has not been previously reported.