Notes

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Crohn's disease is prevalent worldwide. It is an idiopathic, chronic and relapsing disease, characterized by chronic inflammation of any part of the gastrointestinal tract. Vascular involvement rarely occurs in Crohn's patients. However, the chronic inflammatory process leads to structural and functional changes in the vascular endothelium. We present a case of ileocolic artery pseudoaneurysm after laparoscopic ileocecectomy in a Crohn's patient.

We report a case of a 26-years-old male diagnosed with Crohn's disease 4months prior to an elective laparoscopic ileocecectomy. Before the operation, the patient suffered from severe terminal ileitis and typhlitis with signs of micro perforation. 3weeks following his discharge, the patient arrived at the ER complaining of severe right lower abdominal pain. Computerized Tomography (CT) scans revealed a 35mm ileocolic pseudoaneurysm that was treated urgently with coil-embolization via angiography.

Until recently, few reports regarding the involvement of pseudoaneurysm of mesenteric arteries in relation to bowel resection surgeries have been reported. It is believed that the chronic inflammatory process induces a potent effect on the vascular endothelium, leading to thick, inflamed and highly friable mesenteric vessel walls. We propose that the pseudoaneurysm occurred as a result of surgical intervention on a thickened and diseased mesentery artery branch.

Inclusion of mesenteric resection in Crohn patients' undergoing bowel resection may be an innovative way to avoid this complication and to reduce recurrence.
Inclusion of mesenteric resection in Crohn patients' undergoing bowel resection may be an innovative way to avoid this complication and to reduce recurrence.
Cutaneous squamous cell carcinoma (CSCC) is one of the most common malignant tumors of skin cancer. Most of these cancers occur on the head and neck. CSCC makes up the seventh most common type of cancer worldwide. The incidence of human papillomavirus (HPV)-associated head and neck squamous cell carcinoma became more prevalent, and HPV infection is mainly linked to head and neck squamous cell carcinoma (HNSCC).

A 57-year-old non-smoking man was admitted to Omid Hospital in Urmia, West Azerbaijan, Iran; there were extensive bleeding masses on his head and neck due to squamous cell carcinoma (SCC), and he has been diagnosed with HPV infection so accidentally. The operation room had prepared for excisional treatment and the masses had been removed as much as possible. Patient was referred to the wound care team to receive advanced treatment interventions.

Incidence of HPV-associated HNSCC has been more noticeable recently, and HPV infection alone can be a distinct risk factor for metastatic HNSCC. Most patients with HPV positive have peripheral lymph node involvement. Radiation therapy and surgery can offer equally good long-term results in small initial head and neck tumors. Traditionally, advanced head and neck tumors managed surgically more advantageous.

This case illustrates that history of HPV positive can be associated with a more severe and resistant type of HNSCC with poor treatment outcomes. Patients with HPV should be monitored regularly for HNSCC, and treatment should be started as soon as possible for a better result.
This case illustrates that history of HPV positive can be associated with a more severe and resistant type of HNSCC with poor treatment outcomes. Patients with HPV should be monitored regularly for HNSCC, and treatment should be started as soon as possible for a better result.
Cutaneous Mucormycosis (CM) is a less frequent type of fungal infection that can present with different skin lesions. Although these lesions appear to be benign and silent, CM rapidly progresses into the deeper layers. Selleckchem DMAMCL Given that no specific laboratory or imaging finding is described for the disease, the diagnosis is mainly based on history and physical examination. In addition, immediate debridement and antifungal agents must be commenced.

We present a 43-year-old septic man who was hospitalized for his forefoot infection. During his admission, he developed a necrotic-like ulcer in his antecubital fossa. After initial debridement, pathology examination revealed the infection with mucormycosis. We administered intravenous liposomal Amphotericin B, and also multiple surgeries were performed. Unfortunately, the sepsis progressed to multiorgan failure, and the patient passed away.

CM requires emergent diagnosis and treatment. Early surgical interventions like extensive debridement and repetitive wound irrigation alongside systemic antifungal therapy are the key steps to preventing the progression of the disease.
CM requires emergent diagnosis and treatment. Early surgical interventions like extensive debridement and repetitive wound irrigation alongside systemic antifungal therapy are the key steps to preventing the progression of the disease.
Cushing syndrome is a rare disorder with a variety of underlying etiologies, that can be exogenous or endogenous (adrenocorticotropic hormone (ACTH)-dependent or ACTH-independent). The current study aims to report a case of ACTH-independent Cushing syndrome with adrenal adenoma and nonfunctioning pituitary adenoma.

A 37-year-old female presented with amenorrhea for the last year, associated with weight gain. She had a moon face, buffalo hump, and central obesity. A 24-hour urine collection for cortisol was performed, revealed elevated cortisol. Cortisol level was non-suppressed after administering dexamethasone. MRI of the pituitary region revealed a pituitary microadenoma, and the CT scan of the abdomen with adrenal protocol revealed a left adrenal adenoma.

Early diagnosis may be postponed due to the variety of clinical presentations and the referral of the patient to different subspecialists based on their dominant symptoms (gynecological, dermatological, cardiovascular, psychiatric); it is, therefore, critical to consider the entire clinical presentation for correct diagnosis.

Due to the diversity in the presentation of CS, an accurate clinical, physical and endocrine examination is always recommended.
Due to the diversity in the presentation of CS, an accurate clinical, physical and endocrine examination is always recommended.
The omphalomesenteric duct (OMD) usually involutes by the ninth gestational week. If this obliteration fails, OMD remnant will result in different pathologies mostly in the pediatrics and infrequently in adults. The most well-known OMD remnant disease is Meckel's diverticulum. Omphalomesenteric cyst is rather rare, and their combination is even more exceptional with few cases in literature.

We present an adolescent patient with nausea and vomiting and occasional periumbilical abdominal pain who was diagnosed with concurrent omphalomesenteric cyst and ileal diverticulum, causing internal hernia and bowel obstruction that underwent surgery.

OMD remnants mostly present in childhood with symptoms of intestinal obstruction, and rarely internal hernias for which conservative management is usually not curative, warranting surgery. Imaging presence of cystic lesion in mid abdomen in young patient with bowel obstruction should raise the suspicion for OMD remnants. Presence of OMD cyst together with Meckel's diverticulum necessitates more extensive resection, rare concurrence which is better to be prepared for in advance.

Preoperative radiologic workup is helpful to diagnose the obstruction and its probable cause. Presence of periumbilical cyst should raise the suspicion of OMD remnant specially in young adults with previous episodes of crampy abdominal pain and obstruction without history of abdominal surgery. Being familiar with possible concurrence of OMD cyst and Meckel's diverticulum will increase preparedness at the time of surgery.
Preoperative radiologic workup is helpful to diagnose the obstruction and its probable cause. Presence of periumbilical cyst should raise the suspicion of OMD remnant specially in young adults with previous episodes of crampy abdominal pain and obstruction without history of abdominal surgery. Being familiar with possible concurrence of OMD cyst and Meckel's diverticulum will increase preparedness at the time of surgery.
Follicular thyroid carcinoma (FTC) is the second most common thyroid cancer subtype after papillary thyroid cancer (PTC), and it accounts for approximately 10% of all thyroid cancers, the incidence of distant metastasis in FTC has been reported to be 6-20%, bones and lungs are the most frequent sites of distant metastases. Most occult thyroid carcinomas are papillary carcinoma.

We describe an extremely rare case of a 74-year-old woman who had a history of right thyroid lobectomy 20years ago, was referred to our hospital for metastatic thyroid follicular carcinoma to the sacral region confirmed by the biopsy of the sacral mass. The patient was treated by analgesic radiotherapy, surgical totalisation of thyroidectomy, and Radioactive Iodine, with thyroid replacement by levothyroxine. In the follow up we noticed a significant symptom reduction leading to a much better quality of life.

Increasing importance should be given to rare metastases in DTP patients. Early detection will help in the early diagnosis and treatment of the disease, thereby improving the patient's survival rate and quality of life.
Increasing importance should be given to rare metastases in DTP patients. Early detection will help in the early diagnosis and treatment of the disease, thereby improving the patient's survival rate and quality of life.
Surgical treatment of scoliosis includes long and invasive multi-level instrumentation and correction which may result in high rates of postoperative complications, especially in elderly patients with osteopenia or multiple comorbidities. Minimally invasive surgical options may benefit these patients.

A 73-year-old female patient with a history of degenerative lumbar scoliosis, L4-5 pseudarthrosis, and resulting L5-S1 adjacent segment following prior unsuccessful lateral L4-5 interbody fusion presented to the clinic with severe lower back pain and lower extremity radiculopathy. The decision was made to proceed with surgical correction via a robotic-guided prone transpsoas (PTP) approach, which is a novel approach similar to lateral lumbar interbody fusion (LLIF) with the patient in a prone decubitus position. Excellent spinal alignment was achieved with no complications. On two-month follow-up, imaging revealed pedicle screws at the L3, L4, L5 levels and at the sacrum without change and continued interbodhe prone positional effect compared to LLIF and comparable approaches.
Our experience suggests that the PTP approach is safe and effective because it does not require patient repositioning, easily interfaces with robotic guidance, and achieves increased lordosis gains via the prone positional effect compared to LLIF and comparable approaches.
Lumbar Spine Chondrosarcomas are rare entities that accounts for less than 10% of all spinal Chondrosarcomas, patients can present with symptoms of nerve root irritation secondary to direct compression caused by the tumor mass effect. Radiologically these tumors are destructive in nature with soft tissues classifications, and the treatment of choice for it is complete surgical excision, however in some scenarios they are difficult to access and complete resection becomes not feasible.

A 37years old male, presented to our spine clinic with chief complaint of chronic low back pain with radicular symptoms, normal power in both lower limbs, while his radiological evaluation showed intra-spinal extra-dural Chondrosarcoma arising from the posterior cortex of the 5th vertebral body, for which he underwent surgical decompression of the lumbar canal with resection of the lesion and unilateral stabilization of the spinal segment.

Unlike Chondrosarcomas of the appendicular skeleton, lesions arising in the spinal element may be difficult to detect on plain radiographs and further imaging is crucial for better evaluation, as this will help in surgical planning for excision of the tumor.
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