Journal of the College of Physicians and Surgeons--Pakistan : JCPSP
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J Coll Physicians Surg Pak · Dec 2019
Case ReportsPartial Malrotation of Bowel Loops in an Adolescent with Left Hypochondrial Pain.
In the embroyological development, any deviation from physiological midgutrotation results in intestinal malrotation, which may further cause midgutvolulus or intestinal obstruction. It is predominantly a pediatric diagnosis; however, it may occur in adolescent or adult life. A case is presented here of a 17-year boy who came in Accident and Emergency Department, Abbasi Shaheed Hospital with complaint of intermittent and severe intensity pain in left upper quadrant of abdomen. ⋯ He underwent barium enema, which revealed features of intestinal malrotation. He was further investigated with contrast-enhanced CT abdomen for complications, which confirmed the aforementioned abnormal orientation of superior mesenteric vessels and diagnosis of intestinal malrotation without any complication. In summary, any non-specific abdominal complaint with or without intestinal obstruction in an adolescent or adult patient should be investigated for the possibility of intestinal malrotation.
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J Coll Physicians Surg Pak · Dec 2019
Case ReportsThe First Described Case of Bizarre Leiomyoma of the Portal Vein.
Vascular leiomyomas with bizarre nuclei are rare. Differentiation of these tumors from malignant lesions is essential to avoid unnecessary dissection and organ loss in surgery. Herein, we present a 39-year Kosovo woman with a bizarre leiomyoma arising from the portal vein. ⋯ In conclusion, vascular bizarre leiomyomas are rare tumors. It is impossible to diagnose these correctly before surgery. Perioperative use of pathological examination as a frozen section can be helpful to avoid unnecessary surgical procedures.
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J Coll Physicians Surg Pak · Dec 2019
Case ReportsIsolated Bilateral Superior Rectii Paresis: A Rare Anomaly.
We present a case of bilateral isolated superior rectus paresis in a 13-year girl who presented with alternating exotropia and hypertropia. She demonstrated bilateral paresis of elevation in abduction with an overaction of both the contralateral yoke muscles, i.e. inferior obliques. Neuroimaging did not reveal a lesion along the pathway of the third nerve nor hypoplasia of the superior rectus muscle. ⋯ At 1 year, the patient is well aligned and happy. Isolated extraocular muscle pareses are rare events, which present occasionally to the strabismus surgeons and need to be looked out for if the patient's strabismus looks peculiar. We believe we are the first to report an isolated paresis of the superior rectus muscle in Pakistan.
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J Coll Physicians Surg Pak · Dec 2019
Case ReportsBladder-sparing Approach in a Woman with Muscle-invasive Primary Bladder Melanoma.
Primary bladder melanoma (PBM) is an extremely rare tumor. Herein, we present a 39-year female evaluated for a history of dysuria and hematuria for one month and a solid mass of 23x15 mm detected on the left lateral wall of the bladder. ⋯ Laparoscopic partial cystectomy (LPC) and bilateral pelvic lymph node dissection (BPLND) were performed since other sites of melanoma were excluded. In this article, the effects of tumor characteristics and minimally invasive treatment options on survival are discussed in a patient with muscle-invasive PBM.
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J Coll Physicians Surg Pak · Dec 2019
Case ReportsRobot-assisted Laparoscopic Nephroureterectomy for a Nephrogenic Adenoma of Ureter.
Nephrogenic adenoma is a rare and benign tumour of the urinary tract thought to be caused by metaplastic change of native urothelial tissue. The majority of cases arise in the bladder, with very few cases affecting the ureter reported in the literature. Herein, we describe the presentation, diagnostic challenges, and the eventual management of a nephrogenic adenoma of the ureter by robot-assisted laparoscopic nephroureterectomy. Urologists and pathologists should be aware of the potential diagnostic and management pitfalls associated with this rare tumour, as well as the sparsity of evidence with respect to follow-up.