Challenging Management of Acute Cholangitis in a Patient With Unextractable Common Bile Duct Stone Post Gastrojejunostomy Surgery.

This case report details the management of an 89-year-old female with a complex surgical history, including cholecystectomy, left hepatectomy, and repair of an iatrogenic duodenal perforation, who presented with acute cholangitis due to a large common bile duct stone. Faced with the challenges of altered anatomy and the patient's frailty, a multidisciplinary team employed a series of interventions, including percutaneous transhepatic biliary drainage and endoscopic retrograde cholangiopancreatography (ERCP). The case was further complicated by difficulties in navigating the altered biliary tract, necessitating the use of advanced endoscopic techniques such as cholangioscopy and electrohydraulic lithotripsy (EHL) for stone fragmentation and removal, leading to the successful resolution of the obstruction. This report underscores the importance of individualized care and highlights the efficacy of innovative endoscopic approaches in managing complex biliary disorders in elderly patients with significant surgical histories.

Anaplastic Pleomorphic Xanthoastrocytoma Presenting with Musical Hallucination.

Musical hallucinations are a relatively rare form of auditory hallucination characterized by hearing of music in the absence of any external stimuli. This phenomenon has been linked to both psychiatric and structural lesions. We present the case of a previously healthy young male whose presentation with musical hallucinations led to the diagnosis of a rare tumour, anaplastic pleomorphic xanthoastrocytoma.

Posttransplant Lymphoproliferative Disorder Presenting as Testicular Lymphoma in a Kidney Transplant Recipient: A Case Report and Review of the Literature.

Posttransplant lymphoproliferative disorder (PTLD) is a malignancy caused by the immunosuppression that occurs after transplantation. It is primarily a nodal lesion but frequently it involves extranodal masses. Treatment is usually by reducing immunosuppressive therapy. Testicular lymphoma as PTLD is notably rare in documented literature and there is limited evidence of definitive treatment guidelines. This manuscript describes a patient who developed diffuse large B-cell lymphoma of his right testis one year following kidney transplantation. A diagnosis of PTLD was made and treatment with rituximab, locoregional radiotherapy, and intrathecal methotrexate in addition to the standard reduction of immunosuppression resulted in complete remission until now. We submit this case along with literature review of similar cases in the past and a review of specific peculiarities of our case with emphasis on our treatment plan to further the understanding of this diversiform disease.