by Hassan Mehmood, NomanAhmed Jang Khan, Umer Farooq and Khushbakht Ramsha Kamal
Case Report
Alcohol intake and Gallstones account for more than two third cases of acute pancreatitis with gallstones solely responsible for 30 to 40 % of cases. We herein, present a rare case of acute pancreatitis in a 94 years old nonalcoholic male with past surgical history of cholecystectomy performed 10 years ago. Patient presented with acute epigastric pain, lipase of 1083 U/L, amylase of 1634 U/L, obstructive LFTs pattern and normal pancreas on CT abdomen. CA 19-9 was checked due to the patient’s recent weight loss and was found elevated at 420 U/ML. Patient’s symptoms resolved with conservative management in 2 days and lipase normalized. Considering his elevated CA 19-9 and recent weight loss, he was referred for endoscopic ultrasound as an outpatient for further workup. He presented again within 2 days of discharge with similar symptoms and lipase of 1100 U/L. Gastroenterology was consulted and ERCP performed which showed intrahepatic and extrahepatic bile duct dilatation with a filling defect in the distal common bile duct. Multiple stones measuring 2-4 mm were removed along with some biliary sludge and the symptoms resolved right away. The lipase level normalized and CA 19-9 dropped down dramatically to 42 U/ML. Although the incidence of recurrent choledocholithiasis after cholecystectomy is 2 to 10 %, the diagnosis of acute pancreatitis secondary to recurrent choledocholithiasis with elevated CA 19-9 can easily be missed in post cholecystectomy patients. Our patient’s presentation is unique that he developed acute gallstone pancreatitis secondary to CBD stones 10 years after cholecystectomy.
American Journal of Medical Case Reports. 2017, 5(10), 267-269. DOI: 10.12691/ajmcr-5-10-5
Pub. Date: October 28, 2017
10999 Views2694 Downloads1 Likes
by Chiwen Liu, Chenglin Wang, Weibo Chen and Yong Jiang
Case Report
In traditional right hepatectomy, complete mobilization of the liver is usually conducted before parenchymal transection which may cause unfavourable complications like mass bleeding. So, people put forward the “anterior approach” and the “liver hanging maneuver”. We report a 60-year-old female was admitted to our hospital with the complaint of one-week of implicit inflation and discomfort of the right upper abdomen. In this case, combination of three hepatic portal dissection and liver hanging maneuver were successful used to resect the right liver with giant hemangioma.
American Journal of Medical Case Reports. 2017, 5(10), 264-266. DOI: 10.12691/ajmcr-5-10-4
Pub. Date: October 25, 2017
6463 Views1873 Downloads1 Likes
by Nazish Malik, Munawwar Hussain and Syed Mussadiq Ali Akbar Naqvi
Case Report
Choroidal melanoma is the most common primary intraocular malignant tumor and the second most common type of primary malignant melanoma in the body. The liver is main site of metastasis in more than 80% cases. There is no consensus regarding follow up with patient having ocular melanoma to see any metastatic disease. We present a case admitted with right upper quadrant pain and diagnosed with metastatic melanoma due to right ocular lesion treated 20 years ago. After the diagnosis was made patient survived only for two weeks. That further signifies the unpredictable course of the disease.
American Journal of Medical Case Reports. 2017, 5(10), 262-263. DOI: 10.12691/ajmcr-5-10-3
Pub. Date: October 23, 2017
10104 Views2993 Downloads3 Likes
by Nazish Malik, Munawwar Hussain and Syed Mussadiq Ali Akbar Naqvi
Case Report
Background: Dieulafoy lesion is a rare cause of acute gastrointestinal bleeding. It can present with sudden and massive bleeding without any prior symptoms. It causes massive hemorrhage leading to hemodynamic instability and this complicated nature of disease puts emphasis on its immediate diagnosis and treatment. Most commonly it presents with upper GIT bleeding but it can present with lower gastrointestinal bleeding. Case Presentation: We report a case of recurrent lower gastrointestinal bleeding that was miss diagnosed initially as internal hemorrhoids. A 91-year-old male was discharged 2 weeks ago, who presented again with rectal bleeding and low hemoglobin found on lab reports. He was admitted and transfused two packs of PRBC. After not finding any visible bleeding on upper endoscopy, he had colonoscopy and a bleeding vessel was found in rectum. Clipping was performed to stop bleeding and he was discharged home. Lower gastrointestinal bleeding is a very rare presentation of dieulafoy lesion. Conclusion: Dieulafoy lesion can present with upper or lower gastrointestinal bleeding. Diagnostic improvements and research for the detection of DL needs to be conducted to reduce hospital stay and improve survival. Endoscopic measures, mechanical banding, hemoclipping and electrocoagulation are some of the frequently used treatment options.
American Journal of Medical Case Reports. 2017, 5(10), 259-261. DOI: 10.12691/ajmcr-5-10-2
Pub. Date: October 23, 2017
9056 Views2709 Downloads3 Likes
by Bodar VH, Upadhyay A, Singh S, Ullah T, Colasacco JA and Pinsker R
Case Report
Left ventricular non-compaction (LVNC) is a rare form of cardiomyopathy, which leads to progressive heart failure, arrhythmias, and thromboembolic events. Due to variable clinical presentations, it is often misdiagnosed as another cardiomyopathy or asthma. Here we report a case of 50 year-old-male who had multiple emergency room visits for shortness of breath (SOB) which were treated acutely with bronchodilators for presumptive asthma exacerbations. Subsequently, a 2D, color flow transthoracic echocardiogram was performed, which revealed the presence of dilated cardiomyopathy, and a low LV ejection fraction. In addition, left ventricular trabeculation was greater than that anticipated, with prominent inter trabecular recesses, supporting the diagnosis of LVNC. A family history of early onset heart failure was present. This case is presented to help physicians consider non-compaction cardiomyopathy as an etiology in patients who present with SOB and low ejection fraction (EF).
American Journal of Medical Case Reports. 2017, 5(10), 256-258. DOI: 10.12691/ajmcr-5-10-1
Pub. Date: October 14, 2017
11080 Views3228 Downloads2 Likes