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INTRODUCTION AND IMPORTANCE: Biliary cysts are rare congenital anomalies of the biliary ductal system. Cystic duct cysts in particular are not included in the widely used Todani classification and remain underreported. CASE PRESENTATION: A 28-year-old male presented with intermittent right upper quadrant pain exacerbated by fatty foods. Ultrasound showed a septate gallbladder. Laboratory tests were normal. Laparoscopic cholecystectomy identified a 1.5 cm cystic duct cyst. CLINICAL DISCUSSION: Cystic duct cysts arise from anomalous ductal recanalization/dilatation. Presentation mimics cholelithiasis. Complete surgical excision is the treatment to prevent complications. CONCLUSION: This case presents an incidental finding of a cystic duct cyst resected during cholecystectomy for septate gallbladder. Increased recognition can improve the management of these rare biliary anomalies.
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BACKGROUND: Emergence delirium (ED) has been reported among children at a postoperative setting, which delays their recovery and exposes them to traumas. The aim of this study was to determine the prevalence of ED and its associated factors among children who underwent surgeries at a major tertiary healthcare facility in Saudi Arabia. MATERIALS AND METHODS: Between March and August 2018, a retrospective cohort study was conducted based on a review of 413 medical charts of children (<14 years) who underwent an elective/nonemergency surgery and then were admitted to a Post Anesthesia Care Unit. Patient and surgery-related characteristics were analyzed as potential factors associated with ED. The anxiety level was assessed preoperatively using the Modified Yale Preoperative Anxiety Scale (four domains), while the ED was detected after surgery using the Watcha scale (child is agitated and thrashing around). RESULTS: The leading surgery category was ear, nose, and throat surgeries [184 (44.6%)] and dental surgeries [109 (26.4%)]. Almost one-third received only general anesthesia (31.2%), while 271 (68.8%) received an additional regional block/skin infiltrate. The anxiety domains preop showed that the percentage mean score ± standard deviation of expression of emotions was 37.1 ± 21.6, apparent arousal 33.7 ± 20.4, activeness 30.1 ± 13.5, and vocalization 26.9 ± 20.3. The prevalence of ED among children who underwent surgeries during the 6-month period was 23 (6.6%). Almost 18.8% of those who received opioid analgesics (fentanyl alone) developed ED, while 12% of those who received both opioid and nonopioid analgesics (fentanyl/paracetamol) developed ED. ED was significantly associated with longer recovery duration 69.5 + 27.1 min, P = 0.007. Binary logistics regression analysis showed that participants who did not receive Precedex were adj. odds ratio = 10.3 (2.4-48.9) times more likely to develop ED, compared with those who received it, adj. P = 0.003. Lower preoperative scores of expression of emotions and higher scores of apparent arousal were significantly associated with ED, adj. P = 0.035 and adj. P = 0.023, respectively. CONCLUSION: ED appears to be inevitable in postoperative settings. It is crucial to address any preoperative anxiety assessment as it is associated with ED. Anxiety remains a modifiable factor that can be managed, as well as to the administration of Precedex and adjunct analgesic treatments.
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PURPOSE: The purpose of this case report is to highlight the clinical characteristics of a recurrent chalazion through the use of digital photography and ultra-high resolution optical coherence tomography (UHROCT). CASE REPORT: A single case is presented, along with digital biomicroscopic photographs and UHROCT images. DISCUSSION: A review of the literature describing the histopathological and associations of chalazia and other disorders, suggest it may be possible to differentiate different eyelid conditions based on their clinical manifestations and appearance on UHROCT tomograms. Based on the images presented here, it appears that this case is typical of a post-menopausal incidence of chalazion and risk for acne rosacea.
