International Medical Case Reports Journal最新文献

{"title":"Recognizing Cyanotic Congenital Heart Disease Masked by Infant Pneumonia in a Resource-Limited Setting: A Somali Case Report of Tetralogy of Fallot.","authors":"Abdillahi Bile Abdi, Ahmed Moumin Abdilahi, Mohamoud Hashi Abdi, Mustafe Abdilahi Khairdon, Abdirahman Omer Ali","doi":"10.2147/IMCRJ.S628455","DOIUrl":"10.2147/IMCRJ.S628455","url":null,"abstract":"<p><strong>Background: </strong>In resource-limited settings lacking routine newborn screening, common lower respiratory tract infections like community-acquired pneumonia (CAP) can obscure or delay the diagnosis of underlying cyanotic congenital heart disease (CHD). Tetralogy of Fallot (TOF) is the most common cyanotic CHD, yet its co-occurrence with CAP creates significant diagnostic masking, as acute pulmonary signs often conceal cardiac abnormalities.</p><p><strong>Case presentation: </strong>A 5-month-old male presented in Borama, Somalia, with severe respiratory distress, fever, cough, and bilateral crackles, leading to an initial clinical diagnosis of severe CAP. Detailed history revealed unrecognized pre-existing signs of structural heart disease, including failure to thrive (Moderate Acute Malnutrition, weight 4.6 kg, z-score < 2) and feeding diaphoresis. Although cardiovascular examination on admission demonstrated a precordial thrill and a harsh systolic murmur, clinical management was initially anchored on severe pneumonia. Following antibiotic escalation and resolution of acute fever and lung crackles, persistent resting oxygen desaturation (SpO2 88% on room air, dropping to 78-82% during crying) and unmasked feeding diaphoresis prompted echocardiography. Transthoracic echocardiography demonstrated features consistent with TOF (large 8.5 mm perimembranous ventricular septal defect, 45-50% overriding aorta, severe infundibular/valvular right ventricular outflow tract obstruction with a peak gradient of 67.2 mmHg, and severe right ventricular hypertrophy) with a concomitant 4.2 mm atrial septal defect. Double-outlet right ventricle and pulmonary atresia were ruled out. Given the total lack of open-heart surgical infrastructure in Somalia, the patient was stabilized on oral propranolol (1 mg/kg/day) and low-flow nasal cannula oxygen (1.5-2 L/min) and registered with international humanitarian cardiac surgical networks.</p><p><strong>Discussion: </strong>Acute respiratory infections can precipitate physiological stress and obscure classic cardiac physical signs in infants with underlying structural heart defects. Subtle red flags-such as feeding-induced sweating, fatigue during feeds, poor weight gain, and persistent post-pneumonia cyanosis-are critical diagnostic clues pointing to an underlying cardiac lesion in resource-limited environments.</p><p><strong>Conclusion: </strong>Persistent cyanosis, feeding diaphoresis, poor weight gain, or unexplained arterial desaturation following the resolution of acute pneumonia must serve as red flags for frontline clinicians. These findings should immediately prompt structured cardiovascular re-evaluation, pulse oximetry reassessment, and urgent echocardiography or pediatric surgical referral.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"19 ","pages":"628455"},"PeriodicalIF":0.7,"publicationDate":"2026-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13522739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accelerated Conservative Management of Severe Congenital Knee Hyperextension in a Low-Resource Setting: A Case Report.","authors":"Mohamed Farah Mohamoud, Abdirahman Omer Ali, Abdirahman Said Deheye, Farah Mahamed Farah, Abdifatah Mohamoud Ileeye, Mohamoud Mohamed Mohamoud, Abdirashid Dahir Aye","doi":"10.2147/IMCRJ.S608712","DOIUrl":"10.2147/IMCRJ.S608712","url":null,"abstract":"<p><p>Congenital knee hyperextension (CKH), or congenital genu recurvatum, is a rare orthopedic anomaly in neonates that requires prompt intervention to prevent long-term disability. This case report presents the successful non-surgical management of a one-day-old female neonate presenting with severe unilateral CKH (Leveuf Type I/II) in a resource-limited setting. The novelty of this case lies in the application of an accelerated, two-stage serial casting protocol spanning just 14 days, followed by targeted physiotherapy. This approach resulted in the complete resolution of the deformity and full functional recovery within three weeks. Clinical follow-up at 3 months confirmed durable joint stability and age-appropriate motor development. This case highlights the efficacy of early, tailored conservative intervention, offering a cost-effective alternative to surgical management or prolonged orthotic therapy in settings where advanced orthopedic resources are scarce.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"19 ","pages":"608712"},"PeriodicalIF":0.7,"publicationDate":"2026-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13520963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Presumptive Ewing Sarcoma of the Jejunum Presenting with Metastatic Disease: A Case Report and Focused Narrative Review.","authors":"Shashikanth Kharat, Sanjana Mali, Prasanna R Deshpande, Gayatri Sanjay Korade, Vini Mehta","doi":"10.2147/IMCRJ.S622288","DOIUrl":"10.2147/IMCRJ.S622288","url":null,"abstract":"<p><strong>Objective: </strong>To report a rare case of presumptive Ewing sarcoma family tumor of the jejunum with disseminated metastases and cancer-associated stroke in an older adult, and to review the diagnostic challenges in differentiating jejunal EES from other gastrointestinal small round cell tumors.</p><p><strong>Material and methods: </strong>Clinical-imaging-pathological, and laboratory records from a 63-year-old man with presumptive jejunal Ewing sarcoma family tumor, disseminated intra‑abdominal metastases, and cancer‑associated ischemic stroke compiled into a detailed case report. A targeted literature search of PubMed and Google Scholar using combinations of \"jejunal Ewing sarcoma\", \"small bowel extraskeletal Ewing sarcoma\", and \"gastrointestinal Ewing sarcoma\", and reference lists of key articles were manually searched to capture additional reports.</p><p><strong>Results: </strong>Presenting with subacute abdominal pain, distension, weight loss, low-grade fever, and exertional dyspnea. CT showed a large circumferential jejunal mass with extensive hepatic, peritoneal, and pelvic metastases. Core biopsy was consistent with a malignant small round cell tumor positive for CD99 and nuclear NKX2.2, supporting a presumptive diagnosis of Ewing sarcoma family tumor, but extended immunohistochemistry and EWSR1 FISH/RT‑PCR were not available. He also developed an acute right fronto-parieto-occipital infarct with isolated left wrist drop and profound hypercoagulability with cancer-associated stroke considered the most likely etiology. Palliative chemotherapy was recommended, but no treatment was ultimately administered because he left against medical advice, and long-term follow-up was unavailable.</p><p><strong>Conclusion: </strong>This case report and focused narrative review illustrate a rare presentation of presumptive jejunal Ewing sarcoma family tumor with disseminated metastases and associated stroke in an older adult, emphasize diagnostic pitfalls versus GNET, clear cell sarcoma, GIST, lymphoma, and highlight central but incomplete role of CD99/NKX2.2 without molecular confirmation in resource‑limited settings.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"19 ","pages":"622288"},"PeriodicalIF":0.7,"publicationDate":"2026-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13522738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complete Neurological Recovery Following Combined Anterior-Posterior Cervical Corpectomy and Circumferential Stabilization for Severe Cervical Tuberculosis with Grade IV C3-C4 Spondylolisthesis: A Rare Case Report from Somalia.","authors":"Hussein Salad Yusuf, Mohamed Said Adan, Abdirisak Ali Abukar, Abdiaziz Siad Mohamed, Zakariye Yusuf Mohamed, Mustaf Abdi Ulusow, Mohamed Osman Dahir Alasow","doi":"10.2147/IMCRJ.S607930","DOIUrl":"10.2147/IMCRJ.S607930","url":null,"abstract":"<p><strong>Background: </strong>Cervical spinal tuberculosis accompanied by extensive vertebral destruction and high-grade spondylolisthesis is an uncommon but potentially disabling condition. Early surgical management combined with appropriate anti-tuberculous therapy (ATT) is essential to prevent irreversible neurological damage.</p><p><strong>Case presentation: </strong>A 30-year-old male presented with gradually worsening weakness in both upper and lower limbs over one month, associated with sensory disturbance. Neurological assessment demonstrated muscle strength of 2/5 in the upper extremities and 3/5 in the lower extremities. Magnetic resonance imaging (MRI) and computed tomography (CT) revealed advanced cervical tuberculosis characterized by Grade IV C3-C4 spondylolisthesis, dislocation of the left facet joint, spinal instability, epidural abscess formation, and early signs of myelomalacia. Routine laboratory investigations were within normal limits.</p><p><strong>Management and outcome: </strong>The patient underwent a combined anterior-posterior cervical surgical procedure. An anterior C4 corpectomy with removal of the infected C3-C4 and C4-C5 intervertebral discs was performed, followed by reconstruction using a corticocancellous iliac crest autograft and stabilization with anterior cervical plating from C3 to C5. Additional posterior stabilization was achieved through lateral mass screw fixation at C3, C4, C5, and C6, providing circumferential spinal support. GeneXpert testing confirmed drug-sensitive Mycobacterium tuberculosis. Postoperative imaging demonstrated satisfactory spinal alignment and adequate neural decompression. Standard ATT was initiated. At one-month follow-up, the patient achieved complete neurological recovery with full motor strength (5/5) and independent functional status.</p><p><strong>Conclusion: </strong>This case illustrates that integrated anterior-posterior circumferential stabilization alongside anti-tuberculous treatment can provide favorable neurological recovery in specific patients with severe cervical tuberculosis and high-grade spondylolisthesis. More extensive investigations are required to ascertain the generalizability of this methodology.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"19 ","pages":"607930"},"PeriodicalIF":0.7,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13510238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148828509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Rare Case of Life-Threatening Gangrenous Ileosigmoid Knotting: Successful Primary Anastomosis Without Stoma in a Carefully Selected Patient.","authors":"Frank Joshua Ruhazwe, Demoz Abraha Weldemichael, Mugenyi Michael, Abdikani Ali Hassan, Bienfait Mumbere Vahwere, Mugarura Anwar, Maslah Osman Ali, Mohamed Abukar Nor, Mohamed Saleban Jama, Abdullahi Ahmed Ali","doi":"10.2147/IMCRJ.S611583","DOIUrl":"10.2147/IMCRJ.S611583","url":null,"abstract":"<p><p>Ileosigmoid knotting (ISK) is a rare, rapidly progressive cause of intestinal obstruction that frequently results in bowel ischemia, gangrene, and high mortality if not treated promptly. In patients with gangrenous ISK, surgical management has traditionally favored bowel resection with stoma formation because of concerns regarding anastomotic failure. We report the case of a 60-year-old man who presented with acute intestinal obstruction and generalized peritonitis after six days of progressive symptoms. Following prompt resuscitation, emergency exploratory laparotomy revealed gangrenous ileosigmoid knotting involving approximately 60 cm of the distal ileum and the sigmoid colon. Resection of the nonviable bowel was performed, followed by primary ileo-ileal and colo-colic anastomoses without a diverting stoma because the bowel ends were well perfused, suitable for primary anastomosis, and there was no gross fecal contamination. The postoperative course was uneventful, with restoration of bowel function by postoperative day 2, and the patient was discharged on postoperative day 9 with satisfactory recovery. This case demonstrates that primary anastomosis without a diverting stoma may be a safe and feasible option in carefully selected patients with gangrenous ISK when favorable intraoperative conditions are present. It underscores the importance of early resuscitation, meticulous intraoperative assessment, and individualized surgical decision-making rather than a uniform approach to stoma formation.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"19 ","pages":"611583"},"PeriodicalIF":0.7,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13502248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Small Bowel Ischemia Secondary to Splanchnic Venous Thrombosis in a Postpartum Patient-A Case Report.","authors":"Khalid Abdukadir Osman, Abdifatah Osman Nur, Abdullahi Abdi Farah, Abdulfatah Hassan Maqul, Ahmed Mohamed Warsame, Ahmed Abdi Yussuf, Walid Abdulkadir Osman","doi":"10.2147/IMCRJ.S624878","DOIUrl":"10.2147/IMCRJ.S624878","url":null,"abstract":"<p><strong>Background: </strong>Splanchnic vein thrombosis (SVT) is a rare but life-threatening condition. Pregnancy and the puerperium are hypercoagulable states that increase the risk of thrombosis, yet SVT remains an underrecognized cause of postpartum abdominal pain.</p><p><strong>Case presentation: </strong>A 40-year-old Somali woman, four weeks postpartum after an uncomplicated vaginal delivery, presented with two weeks of progressive abdominal pain, distension, and anorexia. Physical examination revealed diffuse abdominal tenderness with voluntary guarding. Contrast-enhanced CT demonstrated extensive thrombosis of the superior mesenteric, portal, splenic, and middle hepatic veins, with extension into the inferior vena cava and common iliac veins. The postpartum state was the major suspected risk factor, although an unrecognized thrombophilia could not be excluded. She underwent emergency laparotomy with resection of gangrenous bowel (distal jejunum and 75% of ileum). Intraoperative heparin was initiated. Postoperatively, she was transitioned to warfarin but developed supratherapeutic International Normalized Ratio (INR) of 6.2 with hematochezia requiring transfusion.</p><p><strong>Conclusion: </strong>SVT should be considered in postpartum patients with disproportionate abdominal pain. Prompt CT imaging is essential. Thrombophilia screening should be considered in postpartum patients with unprovoked SVT. Anticoagulation management requires careful monitoring, and direct oral anticoagulants (DOACs) may be considered in selected patients, though the evidence base after major bowel resection is limited.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"19 ","pages":"624878"},"PeriodicalIF":0.7,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13507632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148828537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Suspected Paralytic Rabies in an 8 Years 6 Months Old Boy Following Incomplete Post-Exposure Prophylaxis in Rural North Eastern Uganda: A Case Report.","authors":"Moses Ochora, Charles E Engoru, Joseph Emuron, Fridah Akello, Precious Boss Kasasira, Grace Joan Nalikka, Faustine Erau, David Okiror, Amos Odiit","doi":"10.2147/IMCRJ.S627834","DOIUrl":"10.2147/IMCRJ.S627834","url":null,"abstract":"<p><strong>Background: </strong>Rabies is still a public health concern, especially in low resource settings with poor animal health management, stock out of rabies vaccine and immunoglobulin. Only 20% of patients present with paralytic rabies and it is at times difficult to distinguish from Guillain-Barre syndrome. In malaria endemic areas, rabies may have atypical presentation. Rabies encephalitis is almost always fatal.</p><p><strong>Case presentation: </strong>We report an 8‑year‑and‑6‑month‑old African boy from Katakwi district in North Eastern Uganda who presented with headache, fever and waist pain followed by progressive lower‑limb weakness 28 days after a bite by a stray dog. There was no trauma, and he had no signs of meningeal irritation. He received anti-rabies vaccine on day 0.7 and 16 but did not get rabies immunoglobulin. He received supportive care including intravenous fluids and antibiotics at the hospital and died 7 days after the onset of symptoms.</p><p><strong>Conclusion: </strong>Paralytic rabies in children can be fatal even after vaccination, especially if rabies immunoglobulin is not given when there is a high risk exposure. There are also diagnostic challenges if there is an atypical presentation, particularly in children. Health system gaps around animal health can lead to preventable deaths from rabies.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"19 ","pages":"627834"},"PeriodicalIF":0.7,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13499557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Traumatic Posterior Atlantoaxial Dislocation with Intact Odontoid Treated by C2 Laminar Screw Fixation: A Case Report.","authors":"XinQia Huang, Han Li, Xu Fang, ZhiLiang Wu, Junfeng Dong","doi":"10.2147/IMCRJ.S619565","DOIUrl":"10.2147/IMCRJ.S619565","url":null,"abstract":"<p><strong>Background: </strong>Atlantoaxial dislocation (AAD) is a rare but potentially life-threatening condition characterized by an abnormal alignment between the atlas and axis. Traumatic AAD are commonly associated with severe ligamentous injury and may result in spinal cord compression or neurological deficits. Posterior atlantoaxial dislocation with an intact odontoid process and without associated fracture is extremely uncommon and has rarely been reported in literature.</p><p><strong>Objective: </strong>To report a rare case of traumatic posterior atlantoaxial dislocation with an intact odontoid process and describe its management strategy, including emergency reduction and posterior C1-C2 fixation using a C2 laminar screw.</p><p><strong>Methods: </strong>A 51-year-old man was admitted after a traffic accident with severe polytrauma including traumatic brain injury, multiple rib fractures, bilateral hemopneumothorax, splenic injury, and fractures of the left tibia and fibula. Cervical computed tomography revealed a posterior atlantoaxial dislocation without odontoid fracture. Emergency skull traction was performed under general anesthesia with a gradual increase in traction weight from 5 to 10 kg under fluoroscopic guidance. Posterior C1-C2 fixation was subsequently performed because of the redislocation observed on follow-up imaging. Because of a narrow left C2 pedicle and a high-riding vertebral artery, a C2 laminar screw was used as an alternative fixation technique.</p><p><strong>Results: </strong>Intraoperative fluoroscopy and postoperative imaging confirmed a satisfactory reduction and stable fixation of the atlantoaxial complex. However, despite intensive treatment, the patient died 10 days postoperatively due to multiple organ failure secondary to severe polytrauma rather than complications related to the spinal procedure.</p><p><strong>Conclusion: </strong>Emergency skull traction may achieve temporary reduction in traumatic atlantoaxial dislocation; however, surgical stabilization is often required in cases with significant instability. C2 laminar screw fixation is a safe and effective alternative when pedicle screw placement is limited by anatomical variations.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"19 ","pages":"619565"},"PeriodicalIF":0.7,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13499539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Direct-Vision Removal of an Impacted Esophageal Padlock in a 7-year-Old at a Resource-Limited Facility: A Case Report.","authors":"Hervé Mbuyamba, Albert Kapongo, Pierre Tangila, Eugène Mukeba, Séraphin Binene, Alidor Mbangila, Godefroid Cibangu, Mike Kabamba, Trésor Kabuya Kabamba, Pascal Cimpaka, Dédé Kabunda, Jérémie Mbuyamba, Pascal Shambuyi Kayembe, Antipas Mulumba, Mukadi Kabeya Alain, Joseph Luboya, Jenny Nshimba, Edmond Kanda, Franҫois Kabumba, Joseph Tshilunda Ngandu, Séverin Akinja Uwonda","doi":"10.2147/IMCRJ.S629139","DOIUrl":"10.2147/IMCRJ.S629139","url":null,"abstract":"<p><strong>Background: </strong>Oesophageal foreign-body impaction is a frequent emergency that is typically managed with endoscopy. In resource-limited and remote health facilities, strict adherence to standard algorithms is impractical. Context-adapted clinical reasoning is sometimes critical for ensuring safe and timely management.</p><p><strong>Case presentation: </strong>We report a case of a 7-year-old male child who presented to a remote health facility with acute dysphagia and odynophagia following accidental ingestion of a padlock confirmed on neck radiography. In the absence of endoscopic services, the padlock was successfully removed under direct laryngoscopy with Magill forceps under general anesthesia. The patient recovered uneventfully and was discharged 24 hours after observation.</p><p><strong>Conclusion: </strong>This case highlights the importance of pragmatic clinical judgment and adaptive decision making in low-resource settings. When standard endoscopic services are unavailable, carefully selected alternative approaches can save life.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"19 ","pages":"629139"},"PeriodicalIF":0.7,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13499565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hereditary Multiple Exostoses Presenting with Urinary Tract Obstruction Secondary to Imaging-Suspected Malignant Transformation: A Case Report.","authors":"Mehdi Ghaderian Jahromi, Farima Safari, Ali Nabavi, Mohammad Bagher Shamsodini Moghadam, Hossein Afrakhteh","doi":"10.2147/IMCRJ.S628522","DOIUrl":"10.2147/IMCRJ.S628522","url":null,"abstract":"<p><strong>Background: </strong>Hereditary multiple exostoses is a rare autosomal dominant skeletal disorder characterized by the development of multiple osteochondromas, with imaging findings suggestive of malignant transformation to chondrosarcoma occurring in a small proportion of patients. Such transformation typically presents with localized pain or deformity. Few reports describe urinary tract manifestations of pelvic osteochondromas; however, presentation with urinary obstruction secondary to imaging-suspected malignant transformation appears to be exceptionally rare.</p><p><strong>Case presentation: </strong>A 28-year-old Iranian man presented with a three-week history of dull right lower back pain and progressive urinary difficulty. No gross hematuria was reported although microscopic hematuria was detected on urinalysis. Ultrasonography demonstrated moderate right-sided hydronephrosis. Contrast-enhanced computed tomography of the abdomen and pelvis revealed multiple osteochondromatous lesions arising from the bilateral iliac and femoral bones, along with an infiltrative heterogeneous soft-tissue mass originating from the largest pelvic exostosis, were suspicious for malignant transformation to chondrosarcoma. The mass caused extrinsic compression of the right distal ureter, explaining the patient's urinary symptoms. Based on imaging findings, a provisional diagnosis of hereditary multiple exostoses complicated by secondary chondrosarcoma was made. Histopathological confirmation was not obtained because the patient was lost to follow-up, therefore the diagnosis remained presumptive.</p><p><strong>Conclusion: </strong>This case highlights a rare and atypical presentation of hereditary multiple exostoses with suspected malignant transformation manifesting primarily as urinary tract obstruction. Clinicians should consider underlying skeletal pathology in patients with unexplained urinary obstruction, particularly when imaging reveals pelvic masses. Early recognition of imaging features suspicious for malignant transformation through cross-sectional imaging is crucial for timely diagnosis and management in patients with hereditary multiple exostoses.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"19 ","pages":"628522"},"PeriodicalIF":0.7,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13496134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}