Mansour, Marah

ABSTRACT The term “trichobezoar” refers to foreign and indigestible material in the gastrointestinal tract, and it can indicate several underlying mental illnesses. A 38‐year‐old woman reported experiencing sudden intensive abdominal pain, along with a two‐month history of vomiting, nausea, exhaustion, and abdominal discomfort. The diagnosis of gastrointestinal perforation was validated by investigations. During an emergency laparotomy, a perforated stomach ulcer with enormous trichobezoar occupying the entire gastric lumen was revealed. The giant trichobezoar was removed, along with the appendix. The pathology report revealed serositis, fibrosis, and active chronic Helicobacter pylori gastritis. Trichobezoar exhibits variation in locations and volumes. These frequently starts with minimal symptoms but over time can produce nausea, vomiting, peritonitis, hematemesis, abdominal pain, or even perforation, especially in patients who are at risk of developing ulcers and have a large trichobezoar.

Abstract Aquagenic palmoplantar keratoderma is a rare dermatological condition characterized by mild palmar thickening and burning pain upon exposure to water. A 31-year-old female with aquagenic keratoderma of the palms associated with palmoplantar hyperhidrosis presenting with wrinkling and hyperkeratosis within minutes of hand contact with water, resolving quickly after drying. While cystic fibrosis is a known association, most cases remain idiopathic. Treatment options such as 20% aluminum hydroxide, aluminum chloride (15%–20%), urea, salicylic acid, and botulinum toxin can be challenging, with the patient being evaluated after treatment with 16% aluminum chloride.

ABSTRACT Cervical leiomyomas are rare pelvic tumors, with interstitial subtypes being the least common. This case highlights a 44‐year‐old female with a 14‐mm interstitial cervical leiomyoma, successfully treated with myomectomy. This approach preserved fertility, demonstrating its feasibility as an alternative to hysterectomy for select patients.

ABSTRACTSpigelian hernia is a rare type of abdominal hernia; diagnosis is primarily through computed tomography, which is crucial for accurate diagnosis and planning early surgical intervention to preserve the herniated sac's contents.

Introduction: Univentricular heart disease is a relatively rare condition that affects infants, with a prevalence ranging from 0.05 to 0.1 per 1000 live births. It is characterized by an abnormality in the structure of the heart, specifically the presence of only one main pumping chamber (ventricle) instead of the usual two. Presentation of case: In this particular case, a newborn male was diagnosed with double-inlet left ventricle (DILV), a specific form of univentricular heart disease. Following his birth, he exhibited symptoms of central cyanosis (a bluish tint to the skin due to poor oxygenation) and difficulties with breastfeeding. Clinical evaluation, along with a heart ultrasound, confirmed the need for palliative surgery. At the age of 6 months, the patient is scheduled to undergo the Glenn procedure, a surgical intervention that aims to redirect blood flow to the lungs and improve oxygenation. Clinical discussion: Given the complexity of double-inlet single ventricle anomalies, there are multiple differential diagnoses that need to be considered for accurate diagnosis, including conditions such as tricuspid atresia, large ventricular septal defect and corrected transposition of the great arteries with ventricular septal defect. Conclusion: Early intervention in the immediate postnatal period plays a crucial role in improving survival rates and reducing long-term complications. It is, therefore, essential to continue researching and refining treatment approaches.

Background: Opalski syndrome is a rare variant of Wallenberg syndrome (lateral medullary syndrome) that demonstrates concomitant ipsilateral hemiplegia due to infarctions within the lateral medulla and the cervical spinal cord, which also extend to the post-pyramidal decussation to affect the corticospinal tract. Case presentation: A 56-year-old man initially presented with a unilateral headache with right cervical pain. Consequently, he developed symptoms that indicate Wallenberg syndrome: vertigo, dysphonia, dysarthria, right limb ataxia with a tendency to fall, and ptosis, in addition to ipsilateral hemiparesis. The diffusion-weighted imaging MRI (DWI MRI) performed initially demonstrated an acute infarct in the dorsolateral medulla. Accordingly, an axial T2-weighted MRI showed a hyperintense focal region in the same area, even as magnetic resonance angiography (MRA) revealed complete stenosis of the corresponding vertebral artery. Discussion: Opalski syndrome can result from different etiologies such as vascular occlusion or dissection. Although symptoms may vary, patients commonly present with sudden weakness, vertigo, and gait instability. Diagnosis often relies on MRI or DW-MRI. Treatment is tailored depending on individual factors and may involve medications and monitoring. Complications like respiratory failure can occur but are not directly linked to Opalski syndrome. Proper management includes addressing ischemic risk factors and ensuring appropriate nutrition. Conclusion: This case highlights the importance of including Opalski syndrome early in the differential diagnosis of patients with clinically suspected ipsilateral lateral medullary infarction and hyperacute ipsilateral hemiparesis.

Key Clinical MessageInflammatory bowel disease is rare in infants and it includes perianal Crohn's disease, which is inflammation at or near the anus. An early diagnosis is essential to prevent the complications that may affect the development and growth of the child.

Abstract Subclavian steal syndrome (SSS) is a rare vascular condition characterized by retrograde blood flow in the vertebral artery, often discovered incidentally in asymptomatic patients. We present a 65-year-old male with recurrent transient ischemic attacks (TIAs) attributed to 99% stenosis at the origin of the left subclavian artery, leading to SSS. Diagnostic modalities included duplex ultrasound, confirming inverted left vertebral artery flow, and multi-slice computed tomography angiography, confirming the diagnosis. Despite an unsuccessful attempt at balloon angioplasty, successful vascular surgery was performed, establishing a left carotid-vertebral artery bypass. The patient recovered well without complications. This case underscores the importance of considering SSS in TIA cases, utilizing non-invasive diagnostic tools, and highlighting the successful management of symptomatic SSS through surgical intervention.

Introduction and importance: Cor triatriatum sinister (CTS) is an uncommon heterogeneous congenital cardiac defect that may manifest in adulthood when symptomatic blockage manifests due to a change in hemodynamic physiology or when a condition such as atrial fibrillation (AF) arises. The incidence of cor triatriatum with cardiomyopathy and congenital heart illness ranges from 0.1 to 0.4%. Case presentation: The Department of Cardiology examined a 10-year-old girl for a diastolic murmur. The patient’s medical history was ordinary, and no previously known co-morbid illnesses were present. Pneumonia was the patient’s original medical condition. A cardiac murmur was also discovered during the physical examination, and the patient was forwarded for more research. Physical examination revealed just a diastolic murmur, which was noteworthy. The patient’s care plan includes routine echocardiographic monitoring. Since the deformity was not clinically significant, surgical repair was not advised. Clinical discussion: It is unclear what caused this flaw. A full, incomplete, or fenestrated septum may be the result of the common pulmonary vein failing to merge with the left atrium during embryonic development. The existence of a fibromuscular membrane, which separates the left atrium (LA) into two chambers—the proximal chamber receiving the pulmonary veins (PVs) and the distal chamber contains the mitral valves and LA appendages defines the disease. Conclusion: The diagnostic procedure should be carried out in the optimal settings, however, in cases of frail health systems, employing accessible alternatives might help the early diagnosis. Early referral to a cardiologist is required in case of CTS suspicion.

Abstract Introduction Hydatid disease, caused by the parasite Echinococcus granulosus, is a prevalent parasitic infection found in various regions worldwide, including the Middle East, southern Europe, and Africa. Although hepatic and pulmonary involvements are well-documented, atypical presentations of the disease remain significant. Case Presentation This case report discusses a 32-year-old female patient who sought medical attention due to right hypochondrial pain, and pallor. Initial imaging revealed a hepatic cyst, but an incidental finding of a pericardial cyst further complicated the diagnosis. Subsequent evaluations confirmed the presence of a pericardial hydatid cyst, which is an uncommon manifestation of the disease. The patient presented with a multi-organ infection, which included a cardiac cyst—an unusual occurrence in hydatid disease. Additionally, the pericardial cyst was situated in the pericardium, a rare location, accounting for 2–10% of all cardiac cysts. Importantly, this cyst lacked myocardial involvement, adding to its uniqueness. Conclusion This case underscores the importance of considering hydatid disease in patients with non-specific symptoms, particularly in endemic regions, as timely diagnosis is crucial in preventing severe complications.