Unusual Complication Research Articles

An unusual complication: Preeclampsia-associated unilateral retinal detachment

An unusual complication: Preeclampsia-associated unilateral retinal detachment

Superficial dermatomycosis on a tattoo: an unusual complication

Superficial dermatomycosis on a tattoo: an unusual complication

An unusual complication of ureteric obstruction after transplant Kidney biopsy: A case report

Percutaneous renal biopsy was an incidental discovery when physicians obtained renal tissue accidentally while performing intended liver biopsies. Subsequently, Iversen and Brun in Copenhagen described their results using cutting and aspiration techniques in 1951 [1]. However, the success was inconsistent and operator-dependent.

Recurrent urinary tract infection, unusual complication of Remeex regulable sling. A case report

Recurrent urinary tract infection, unusual complication of Remeex regulable sling. A case report

Bilateral Facial Nerve Palsy as a Rare Presentation of Systemic Lupus Erythematosus

Abstract Systemic lupus erythematosus (SLE), a disease of the immune system, has a relapsing-remitting course. It is known to affect multiple organ systems of the body, including the nervous system. Cranial neuropathy, particularly facial neuropathy, is an unusual complication of SLE whose pathogenic mechanism is still not understood. Cardiac involvement, like myocarditis and papilledema, is another rare presentation of SLE. A 23-year-old male had bilateral lower motor neuron type of facial palsy which on a thorough investigation was found to be as a manifestation of SLE confirmed by antinuclear antibodies and double-stranded DNA antibody positive test. Electrocardiogram and echocardiography were suggestive of myocarditis. Fundus examination revealed Grade 2 papilledema. The patient was managed with symptomatic treatment along with corticosteroids, to which he responded gradually. Bilateral facial nerve lower motor neuron type palsy is a rare manifestation of SLE which should be diagnosed promptly and can be managed with corticosteroids. The clinician should also keep an eye on infrequent manifestations like myocarditis and papilledema.

Acute severe thrombocytopenia following iodinated radiographic contrast medium infusion: a case report.

The authors report the case of a 79-year-old male patient with severe, life-threatening thrombocytopenia after administration of intravenous nonionic low-osmolarity contrast medium. His platelet count dropped from 179×109/l to 2×109/l after 1h of radiocontrast infusion. Which has returned gradually to normal level within days with corticosteroid administration and platelet transfusion. Iodinated contrast-induced thrombocytopenia is a rare complication with an unknown causative mechanism. There is no definitive treatment for this condition, with corticosteroids being used in most cases. The platelet count normalizes within a few days regardless of any interventions, but supportive treatment is important to avoid any unwanted complications. Further studies are still needed for a better understanding of the exact mechanism of this condition.

Enterococcus faecalis endocarditis resulting in annular rupture: a case report.

Enterococcus faecalis is the third most common organism to cause infective endocarditis and is associated with high rates of morbidity and mortality. E. faecalis infective endocarditis often presents with a subacute course and with nonspecific constitutional symptoms. Complications related to E. faecalis infective endocarditis are common and include embolic events, abscess formation and pseudoaneurysm formation. Contained annular rupture is a complication of E. faecalis infective endocarditis that, to the authors knowledge, has not been previously described in the literature. Herein, we present an unusual case of a 62-year-old male presenting with classical symptoms of E. faecalis infective endocarditis which resulted in an unusual complication of this condition, a contained annular rupture and the surgical management undertaken to correct this condition.

Pulmonary Complications in a Patient with Common Variable Hypogammaglobulinemia

Common variable immunodeficiency (CVID) is a rare disorder characterized by primary antibody deficiency leading to hypogammaglobulinemia and increased risk of infections. Pulmonary hypertension (PH) is an unusual complication of CVID and may be associated with chronic hypoxemic respiratory failure.We described the case of a 47-year-old female patient hospitalized with worsening dyspnea, which had emerged about 10 days before and was associated with productive cough. 26 years before, she was diagnosed with common variable hypogammaglobulinemia, that was treated with intravenous immunoglobulin infusions for at least 20 years. She had suffered from recurrent secondary infections of the respiratory tract with inveterate bronchiectasis, pulmonary hypertension, and chronic respiratory failure.This case suggests that Internal Medicine wards, due to their global vision of the patient, are well suited to manage subjects with serious, complex, and genetically determined pathologies.

Hemorrhagic infarction of bilateral lateral geniculate bodies – unusual complication of pancreatitis

We report a case of 10-year-male child diagnosed as acute pancreatitis with deranged liver and renal functions, who presented with sudden onset bilateral painless vision loss 2 days after initial diagnosis. Neuroophthalmological examination including deep tendon reflex, plantar reflex, visual acuity, pupillary reflexes, and fundus was performed. Magnetic resonance imaging brain demonstrated features of hemorrhagic infarction involving bilateral lateral geniculate bodies (LGBs) and posterior end of optic tracts. Two major causes of bilateral LGBs lesions include vascular ischemia and osmotic demyelination. Possible mechanism of involvement of bilateral LGBs in present case is coagulopathy in the settings of acute pancreatitis attributed to pro-thrombotic state leading to microvascular occlusions.

Unusual Complication of Urethral Sounding with a Knitting Needle

Urethral sounding is defined as the insertion of an object or liquid into the urethra. The most common reason reported in the medical literature for deliberate urethral insertion is erotic gratification [1]. The aim of this report is to describe a rare complication of this practice. Herein we present a case of a male in his 60’s who presented to our emergency department with a 20 cm (8 inches) knitting needle stuck in his urethra. The whole needle was inserted. One ending was palpable through the body of the penis, the other penetrating left the medial gluteal adipose tissue.

Managing Multiple Schwannomatosis of Vagus and Hypoglossal Nerves: The Unanticipated Complications.

Schwannomas are rare benign tumours of the nerve sheath. Extracranial schwannomas are usually found solitary, in the absence of other features of neurofibromatosis. The non NF1/2 multiple schwannomas are collectively described as the clinical scenario called schwannomatosis. We present a rare case of two extracranial schwannomas involving vagus and hypoglossal nerves in a 22-year-old female along with an unusual surgical complication of CSF leak presenting as post-op neck mass and a review of previously reported similar cases. A thorough literature search using the MeSH terms-'schwannomatosis' or 'Multiple Schwannoma' and 'Vagal Schwannoma' and 'Hypoglossal Schwannoma', was conducted using online databases and augmentated by hand search. A total of 13 reported cases were found and reviewed. Of the 14 cases described from review of literature and our case, 50% had involvement of vagus nerve as one of the components. 12.5% had hypoglossal and cervical sympathetic plexus involvement each. All patients underwent surgical excision. Half of the patients suffered intraoperative nerve sacrifice with resultant severe functional deficits like vocal cord paralysis, Horners syndrome, hypoglossal palsy, facial palsy and eleventh nerve palsy. In our case, there was un-unusual complication of CSF leak presenting as a cervical neck mass. Multiple extracranial head and neck schwannomas are rare and their management is fraught with several complications. Decision to operate is often perplexing. However, early planned surgical excision and preservation of nerve of origin minimizes the impact on quality of life postoperatively.

An unusual complication after a variceal glue injection

A 64-year-old man with a history of atrial fibrillation with portal vein and superior mesenteric vein thrombosis was admitted to hospital with haematemesis. He was diagnosed with non-cirrhotic portal hypertension leading to variceal bleeding. He had two endoscopies with variceal banding and gastric variceal glue injection within 1 month that were unsuccessful; hence, he was referred to a tertiary unit for further management. Given his performance status and comorbidities, he was neither a candidate for surgery nor transjugular intrahepatic portosystemic shunt; therefore, after careful counselling, glue embolisation of the culprit vein was performed via an endovascular approach.

Type IIIb Endoleak: The Great "Masquerader" - Risks of Liquid Agent Dislocation During Sac Embolization Techniques.

The diagnosis of late type III endoleaks may be very challenging on non-invasive imaging studies, and it is not unusual for type IIIb endoleaks to be misdiagnosed as type I endoleaks. The present report illustrates a type III endoleak that was misdiagnosed and treated as Type Ia endoleak. Embolization of the endoleak using a liquid embolic agent (Squid) was complicated by intraluminal graft dislodgement of the liquid agent. This unusual complication was recognised and treated successfully. Type IIIb endoleaks should always be considered in patients with persistent aneurysm sac perfusion treated with embolization using liquid embolic agents.

Fractured guide wire in the main pancreatic duct during ERCP: A case report

Endoscopic retrograde cholangiopancreatography (ERCP) is an excellent endoscopic method with a wide range of diagnostic and therapeutic utility. The most common complication is post-ERCP pancreatitis with a reported incidence of 3.5% followed by cholangitis, cholecystitis, gastrointestinal bleeding and duodenal perforation. Uncommon complications of the procedure reported in the literature include contrast allergy, cardio-pulmonary compromise, problems related to instruments such as impaction of a retrieval basket, fractured guidewire in the biliary or pancreatic channel, extravasation of contrast medium into the duodenal wall, splenic hemorrhage, hepatic trauma and complications related to the electrosurgical risk. We present a case of a 37-year old woman referred to the Department of Abdominal Surgery because of severe abdominal pain and jaundice. Medical personal history of the patient was normal and she denied taking any medication. Following radiological and laboratory analysis, ERCP was completed. In our first attempt to selectively cannulate the CBD, unintentionally a guide wire passed in the main pancreatic duct. Attempting to retract the guide wire under fluoroscopy surveillance, the guide wire was fractured and fragments were left in the main pancreatic duct. Removal of the fragments was unsuccessful in several attempts. Consecutively, selective cannulation of the main pancreatic duct with placement of the pancreatic stent 5Fr/5cm was performed and careful cannulation of CBD was achieved. After the sphincterotomy, the biliary sludge and microlites were dispatched into the duodenum. The pancreatic stent was removed seven days later and patient underwent cholecystectomy four months later. No complications related to the procedure were revealed during the 24months of follow-up. A fractured guide-wire during the ERCP is an uncommon event that can occur during the selective cannulation of the common bile duct or pancreatic duct as in our presented case. However, data regarding the guidewire fracture during the ERCP are scarce since it is an uncommon occurrence. Our case is an example of rare and unusual complication during the ERCP, which was managed conservatively at our unit. Based on our research successful retrievals of the fractured guidewire from the main pancreatic duct are rarely reported and we found only two cases in the available literature. Concordantly with our case, acute and long-term pancreatico-biliary complications were not reported in previously published case reports with retained guide wire during the ERCP as we found only one case report in which authors report development of cholangitis related to the fracture of the hydrophilic guidewire. However, rare but serious life-threatening complications that can occur during the ERCP procedure should be identified in a timely manner and treated accordingly. Fractured guide wire during the ERCP is very uncommon complication of the procedure with only few cases reported in the literature. Our experience suggests that no adverse sequels were triggered by the wire pieces left in the main pancreatic duct as the patient remained asymptomatic 2years after the guide wire fracture.

Unusual Complication after Endovascular Management of Ruptured Pseudoaneurysm Postpancreatectomy

Unusual Complication after Endovascular Management of Ruptured Pseudoaneurysm Postpancreatectomy

Takotsubo Cardiomyopathy as an Unusual Complication after Mechanical Thrombectomy for Acute Ischemic Stroke.

Takotsubo Cardiomyopathy as an Unusual Complication after Mechanical Thrombectomy for Acute Ischemic Stroke.

Survivorship of Allologous Structural Bone Graft at a Minimum of 2 Years When Used to Address Significant Glenoid Bone Loss in Revision Shoulder Arthroplasty: A Computed Tomographic and Clinical Review.

This study assesses outcomes in revision shoulder replacements where the glenoid bone loss was managed using a structural allograft (donated femoral head) in combination with a trabecular titanium (TT) implant. We contacted patients who had undergone revision shoulder arthroplasty using the Lima Axioma TT metal-backed glenoid with an allologous bone graft as a composite who were over 2 years since surgery. Patients underwent computerd tomography evaluation, clinical review, and scoring preoperatively, at 6 months and the latest follow-up. Fifteen patients were included with a mean age of 59 (33-76). The average follow-up period was 40.5 months (24-51). 80% showed satisfactory bone graft incorporation and peg integration at the latest follow-up. Three had signs of significant bone graft resorption, although in 2 patients the pegs were still soundly fixed in the host bone. Clinically all patients showed a statistically significant improvement in pain relief, movement, and function. No unusual complications were reported. Results show femoral head structural allograft in combination with TT metal-backed glenoid baseplate is a viable option for revision total shoulder replacement in the context of massive glenoid bone loss. We do, however, acknowledge that this resorption rate is higher than in other reported series where autograft is used.

COVID 19: An unusual pulmonary complication

A 23 years old man attended hospital with a 10 days history of breathlessness, cough and fever. He was diagnosed to have Covid in the community. In A&E, his SaO2 was 85% on 10 L oxygen. He was treated with tocilizumab and dexamethasone. FBC, kidney function and electrolytes were normal. He had a chest x-ray (Figure 1). What does the x ray show?

Unusual cutaneous and neurological complications in a child with Multisystem inflammatory syndrome

Unusual cutaneous and neurological complications in a child with Multisystem inflammatory syndrome

SJLA_2024_A16: Unusual Complications of Open Preperitoneal Tension-Free Inguinal Hernia Repair

Background: The purpose of this study is to report two patients referred to our hospital after developing unusual complications attributed to prior open preperitoneal tension-free inguinal hernia repair. Methods: Case # 1 A 75-year-old male developed a left proximal thigh abscess requiring incision and drainage 5 years after open prosthetic, preperitoneal inguinal hernia repair with single-layer mesh. A pelvic computed tomography (CT) scan demonstrated an abscess in the left inguinal preperitoneal space as well as diverticulosis but no diverticulitis. A colonoscopy was negative for any additional findings. The patient underwent groin exploration, debridement of the inguinal canal and sinus tract, and mesh resection followed by JP drain placement. The inguinal defect was repaired utilizing the should ice technique. Intraoperative cultures revealed penicillin-resistant Staphylococcus aureus. The drain was removed on postoperative day nine, and his recovery remains uneventful without hernia recurrence or infectious complications at 11-month follow-up. Case # 2 An 82-year-old man developed progressive left lower extremity edema and disabling claudication 1 month after open prosthetic inguinal hernia repair with a bilayer disc mesh. Venous duplex imaging revealed compression of the left common femoral and external iliac veins. A CT angiogram demonstrated left external iliac and common femoral artery thrombosis and a 5.2 cm fluid collection consistent with hematoma. An inferior vena cava filter was placed. The common femoral artery was controlled after initial exploration revealed a common femoral artery pseudoaneurysm. The mesh was densely adherent to the external iliac vein and was thus not resected. The common femoral artery pseudoaneurysm was repaired and the profunda femoris artery over sewn. An external iliac to superficial femoral artery 8 mm Polytetrafluoroethylene bypass graft was placed. The patient was discharged on systemic anticoagulation without claudication on postoperative day thirteen. Results: Laparoscopic inguinal hernia repair and novel, open techniques and mesh devices have popularized the placement of mesh in the preperitoneal space. Acute, severe vascular complications and latent infectious complications can occur after open, preperitoneal tension-free inguinal hernia repair and may require remedial surgery. CT scans and angiogram pictures are available. Discussion: Laparoscopic inguinal hernia repair and novel, open techniques and mesh devices have popularized the placement of mesh in the preperitoneal space. Acute, severe vascular complications and latent infectious complications can occur after open, preperitoneal tension-free inguinal hernia repair and may require remedial surgery. CT scans and angiogram pictures are available. Conclusion: Laparoscopic inguinal hernia repair and novel, open techniques and mesh devices have popularized the placement of mesh in the preperitoneal space. Acute, severe vascular complications and latent infectious complications can occur after open, preperitoneal tension-free inguinal hernia repair and may require remedial surgery. CT scans and angiogram pictures are available.