Journal of surgical case reports
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Shoulder dislocations with fractures are a possible complication of an epileptic seizure and are often missed on the first sight. The incidence of sustaining an avascular humeral head necrosis (AVN) is high, and primary prosthetic replacement is the choice of treatment. In this paper, we describe such a rare case: a 48-year-old male patient sustained simultaneous bilateral posterior shoulder dislocation with fractures of both humeral heads following the first episode of an epileptic convulsion. ⋯ In the same operation, a hemi-prosthesis was implanted on the right side. One and a half years postoperatively, function on the right side is unsatisfying and AVN is seen on the left side and secondary prosthetic replacement had to be performed. In case of a shoulder dislocation with a complex fracture after an epileptic seizure, prosthetic replacement is the choice of treatment.
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We report an interesting case of ileal diverticulitis which posed a diagnostic challenge. A 75-year-old female presented to the emergency department with severe right lower quadrant pain for 3 days. The clinical history, examination and imaging suggested a diagnosis of acute appendicitis. ⋯ It can often mimic other processes such as acute appendicitis. Once ileal diverticulitis is diagnosed, it should be treated with the same principles as for sigmoid diverticulitis. Though rare, ileal diverticulitis should be considered in the differential diagnosis of a patient who presents with right lower quadrant pain, and a computed tomography scan that shows an inflammatory process in the right lower quadrant, in the setting of a normal appendix.
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Trans-mesenteric hernia is a form of internal hernia which is an extremely rare cause of intestinal obstruction in adults compared with the pediatric population. It often presents with complications such as acute intestinal obstruction and peritonitis requiring immediate surgical intervention. We report a case of a 21-year-old woman who presented to us with an acute abdomen and peritonitis that required an immediate exploratory laparotomy. ⋯ Gangrenous portion of the ileum was resected and the congenital defect was closed. The patient made an uneventful recovery. The occurrence of trans-mesenteric hernia in adults is rare and difficult to be diagnosed clinically; thus, the patient's clinical features may lead to early surgical intervention in order to reduce morbidity and mortality.