Rapunzel syndrome trichobezoar

Sunday, 22 May 2011 13:17
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Background: Rapunzel syndrome is a rare type of trichobezoar with an extension of the hair into the small bowel. Clinical presentation is deceptive and vague ranging from abdominal mass to gastrointestinal symptoms.

Case presentation: We present a 7 years old girl with Rapunzel syndrome, where the trichobezoar was not suspected at all especially with negative history of trichophagia. In majority of the cases the diagnosis was made very late in the history of the disease, at a stage where surgery is the only cure for this syndrome.

Conclusion: In the paediatric age group with a long history of gastrointestinal symptom, endoscopy is a diagnostic as well as a therapeutic modality and may reduce surgery in trichobezoars.

Last Updated on Sunday, 22 May 2011 13:42

Hepatic artery aneurysm repair

Tuesday, 26 April 2011 00:45
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Hepatic artery aneurysms remain a clinically significant entity. Their incidence continues to rise slowly and mortality from spontaneous rupture is high. Repair is recommended in those aneurysms greater than 2 cm in diameter. It is not surprising that vascular comorbidities, such as ischaemic heart disease, are common in surgical patients, particularly those with arterial aneurysms such as these. The decision of when to operate on patients who require urgent surgery despite having recently suffered an acute coronary syndrome remains somewhat of a grey and controversial area. We discuss the role of delayed surgery and postoperative followup of this vascular problem.


Case presentation

A 58-year-old man was admitted with a 5.5 cm hepatic artery aneurysm. The aneurysm was asymptomatic and was an incidental finding as a result of an abdominal computed tomography scan to investigate an episode of haemoptysis (Figure 1). Three weeks prior to admission, the patient had suffered a large inferior myocardial infarction and was treated by thrombolysis and primary coronary angioplasty. Angiographic assessment revealed a large aneurysm of the common hepatic artery involving the origins of the hepatic, gastroduodenal, left and right gastric arteries and the splenic artery (Figures 2 and 3). Endovascular treatment was not considered feasible and immediate surgery was too high-risk in the early post-infarction period. Therefore, surgery was delayed for 3 months when aneurysm repair with reconstruction of the hepatic artery was successfully performed. Graft patency was confirmed with the aid of an abdominal arterial duplex. Plasma levels of conventional liver function enzymes and of alpha-glutathione-S-transferase were within normal limits. This was used to assess the extent of any hepatocellular damage perioperatively. The patient made a good recovery and was well at his routine outpatient check-ups.

Last Updated on Tuesday, 26 April 2011 01:01

Unusual cause of exercise-induced ventricular fibrillation

Monday, 25 April 2011 23:46
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Unusual cause of exercise-induced ventricular fibrillation in a well-trained adult endurance athlete


Sudden death has been defined as "an abrupt unexpected death of cardiovascular cause, in which the loss of consciousness occurs within 1 to 12 hours of onset of symptoms" [1]. Although sudden deaths in athletes are dramatic and tragic occurrences, the total incidence of sudden death during sport is rather low. The annual incidence of sudden deaths in athletes under 35 years is 2.62 per 100,000 for male and 1.07 for female athletes [2], whereas the risk of sudden death in athletes over 60 years old can be 100-fold higher compared with young athletes [3]. The precise diseases responsible for sudden death differ considerably with regard to age. In young athletes, congenital malformations of the heart and/or vascular system cause the majority of deaths and can only be detected noninvasively by complex diagnostics [4,5]. In contrast, the underlying cause in older athletes who die suddenly is usually atherosclerosis of the coronary arteries [3]. Reports of congenital coronary anomalies as a cause of sudden death in older athletes are rare.

Last Updated on Tuesday, 26 April 2011 00:33