RESUMEN
BACKGROUND Neurofibromatosis 1 is a neurocutaneous disorder with multisystemic manifestations. When patients are lacking overt cutaneous manifestations, diagnosis may be delayed and may complicate diagnosis and management of atypical presentations of this disease. It is thus important to strive to obtain relevant and/or complete history to arrive at the appropriate diagnosis. Furthermore, maintaining an index of suspicion in cases of vague abdominal pain may guide the clinician in establishing the correct diagnosis of mesenteric plexiform neurofibroma in the setting of known/presumed neurofibromatosis 1 patients presenting with acute and/or chronic vague abdominal symptoms. CASE REPORT This is a case of a teenage boy who presented with acute, vague abdominal pain over a period of 2 weeks. Laboratory tests and physical exam findings in primary and secondary care settings were unremarkable, and thus the patient was discharged home only to continue with abdominal pain, thus seeking additional medical care. After admission to our facility and exhaustive history taking, physical examination, and imaging, a prospective diagnosis of neurofibromatosis with mesenteric neurofibroma was made. Upon surgical exploration, a mesenteric mass with corresponding volvulized, ischemic small bowel was removed. Histopathology confirmed a plexiform neurofibroma. The patient recovered adequately and was discharged home without complications. CONCLUSIONS This case highlights the importance of exhaustive history taking to obtain an accurate diagnosis as well as the importance of a high index of clinical suspicion for mesenteric neurofibromatosis in patients with presumed or known neurofibromatosis and presenting with vague abdominal symptoms.
Asunto(s)
Vólvulo Intestinal , Neurofibroma Plexiforme , Neurofibromatosis , Neurofibromatosis 1 , Enfermedades Vasculares , Masculino , Adolescente , Humanos , Niño , Neurofibromatosis 1/complicaciones , Neurofibromatosis 1/diagnóstico , Neurofibroma Plexiforme/diagnóstico , Neurofibroma Plexiforme/patología , Neurofibroma Plexiforme/cirugía , Vólvulo Intestinal/diagnóstico , Vólvulo Intestinal/cirugía , Vólvulo Intestinal/complicaciones , Estudios Prospectivos , Neurofibromatosis/complicaciones , Dolor Abdominal/etiologíaRESUMEN
Alimentary tract duplication is a rare congenital malformation that usually presents with gastrointestinal obstruction. Colonic duplication is associated with other anomalies as duplication of the anus and genitourinary tract. It is uncommon and very few cases have been reported were a colonic duplication is associated with intestinal malrotation. We present a case of a newborn that presented with a double bubble sign in a prenatal ultrasound that resulted to be the colonic duplication and not the typical duodenal obstruction.
Asunto(s)
Colon/anomalías , Colon/diagnóstico por imagen , Ultrasonografía Prenatal , Femenino , Humanos , Recién NacidoRESUMEN
BACKGROUND: Carotid stenosis is the most common cause of ischemic stroke and is managed by carotid endarterectomy. We report our ten-year results of carotid surgery for stenosis and kinking of the internal carotid artery (ICA). METHODS: Four hundred sixty nine patients underwent surgery: 306 localized carotid endarterectomy, 107 extensive endarterectomy, 18 shortening of the ICA plus endarterectomy, 42 endarterectomy plus coronary artery bypass, 11 endarterectomy plus bypass to another cervical artery, and 1 endarterectomy with aortic valve replacement. RESULTS: Three patients had an ipsilateral stroke, 2 due to technical reasons and one for a stroke in evolution. Six had transient facial nerve dysfunction, 2 division of the hypoglossal nerve and one vocal cord paralysis. Thirty-one patients died, 16 during the hospital stay and 15 during the follow up. CONCLUSIONS: The short and long-term results of carotid endarterectomy are excellent. Carotid endarterectomy remains the "gold standard" for the treatment of carotid stenosis.