Obstructive jaundice, early satiety and xerostomia in an 82-year-old woman.

Amyloid light-chain (AL) amyloidosis is a multisystem disease with obstructive jaundice and gastrointestinal (GI) involvement being uncommon initial presentations. Patients with AL amyloidosis seldom have jaundice and advanced GI tract involvement as their presenting symptoms. This case report describes an 82-year-old lady who presented with a 6-month history of early satiety, weight loss, xerostomia and progressive jaundice. Imaging did not suggest a biliary cause but demonstrated hepatomegaly and ascites. Oesophagogastroduodenoscopy revealed a duodenal stricture. Duodenal and liver biopsies were consistent with amyloid deposition. Multiple myeloma was confirmed to be the underlying cause. Significant cholestatic liver dysfunction and a duodenal stricture have not been previously described as simultaneous manifestations of amyloidosis. This case also highlights the difficulty in treating multiple myeloma as the cause of AL amyloidosis in the context of liver dysfunction, given that many chemotherapy agents undergo hepatic metabolism.

Bilateral synchronous intravaginal testicular torsion presenting with unilateral testicular pain.

An adolescent presented with a 5 hour of history of unilateral testicular pain and examination findings in keeping with a unilateral testicular torsion. On scrotal exploration, there was evidence of bilateral testicular torsion and bilateral orchidopexy was subsequently performed. Intravaginal bilateral testicular torsion is scarcely reported in adolescents and adults. Both unilateral and bilateral testicular torsions in adolescents are commonly associated with anatomical anomalies, which were not evident in this case. Despite warming the symptomatic testis for 40 minutes, viability was indeterminate. Guidelines remain equivocal about adequate reperfusion period before considering orchiectomy. Interval sonographic follow-up is recommended to assess testicular atrophy; however, considerable variation exists in practice. This is an atypical case of bilateral synchronous testicular torsion demonstrable by an absence of classical risk-factors, alongside unilateral clinical signs and symptoms. Inconsistency in guidelines for attempted reperfusion could result in orchiectomy where testicular salvage is possible.