Journal of Medical Case Reports最新文献

{"title":"Trigeminal ganglion electrical stimulation relieves refractory trigeminal herpes zoster and prevents postherpetic neuralgia: a case report.","authors":"Wenhui Wu, Siwei Wang, Mo Zhou, Qian Ao, Jianhao Liao, Bangyong Qin, Jie Yuan","doi":"10.1186/s13256-025-05201-6","DOIUrl":"10.1186/s13256-025-05201-6","url":null,"abstract":"<p><strong>Introduction: </strong>Herpes zoster is an acute condition caused by the reactivation of varicella zoster virus, often affecting the skin and mucosa. When varicella zoster virus invades the trigeminal ganglion, it can lead to trigeminal herpes zoster, with postherpetic neuralgia as the most common complication. Postherpetic neuralgia, characterized by persistent pain for over 3 months after skin lesions heal, significantly impacts quality of life, including sleep, mood, and social interactions. Current treatments, including antiviral drugs, analgesics, and neurotrophic agents, are often insufficient, and many patients still suffer from refractory postherpetic neuralgia. This highlights the need for alternative treatments. Trigeminal ganglion electrical stimulation has shown potential in managing refractory trigeminal herpes zoster and preventing postherpetic neuralgia. However, reports on its effectiveness remain scarce. This article presents two rare cases where trigeminal ganglion electrical stimulation was successfully used to treat refractory trigeminal herpes zoster and prevent postherpetic neuralgia.</p><p><strong>Case presentation: </strong>This study reports two cases of trigeminal herpes zoster that were refractory to pharmacological treatment and successfully alleviated using trigeminal ganglion electrical stimulation, which also effectively prevented postherpetic neuralgia. Both patients, a 62-year-old Chinese female and a 65-year-old Chinese male, presented with severe pain, itching, sensory disturbances, and extensive vesicular lesions on the left side of the face, involving the ophthalmic (V1) and maxillary (V2) branches. Despite receiving antiviral drugs, analgesics, and neurotrophic agents, their symptoms remained inadequately controlled, with pain scores ranging from 8 to 10. After undergoing trigeminal ganglion electrical stimulation, the pain score of both patients dropped to 2-3 on the first day post-treatment, with significant improvement in the herpes zoster blisters and pain. During follow-up, the pain continued to improve, with marked reduction in the pain and itching in the affected areas, and sleep quality also improved. At 1, 3, and 6 months of follow-up, neither patient had developed postherpetic neuralgia. These cases suggest that trigeminal ganglion electrical stimulation may be an effective method for treating refractory trigeminal herpes zoster and preventing postherpetic neuralgia, significantly improving herpes symptoms and alleviating pain.</p><p><strong>Conclusions: </strong>These cases demonstrate that trigeminal ganglion electrical stimulation can provide rapid and sustained pain relief while preventing postherpetic neuralgia in refractory trigeminal herpes zoster patients. This highlights the potential of trigeminal ganglion electrical stimulation as a novel therapeutic approach, particularly for patients who do not respond to conventional treatments. Its success in these cases suggests a promisin","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":"19 1","pages":"162"},"PeriodicalIF":0.9,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Congenital absence of omentum with short bowel syndrome: a case report.","authors":"Ramtin Naderian, Zahra Khatibian Feyzabadi, Paniz Bahoush, Samira Sanami, Mir Siamak Khatami","doi":"10.1186/s13256-025-05205-2","DOIUrl":"https://doi.org/10.1186/s13256-025-05205-2","url":null,"abstract":"<p><strong>Introduction: </strong>Short bowel syndrome can manifest as either an inherited or acquired condition, with the inherited form occurring sporadically. Furthermore, the complete absence of the omentum at birth (congenital absence) is a highly uncommon event.</p><p><strong>Case report: </strong>This case report presents a unique confluence of these rare conditions in a 38-year-old Iranian male with a prior history of intestinal obstruction requiring right hemicolectomy and ileostomy. He subsequently presented to the emergency department experiencing intense abdominal pain and swelling in his lower extremities. Laboratory investigations revealed an elevated white blood cell count and metabolic alkalosis. During the surgical exploration prompted by his acute presentation, both congenital absence of the omentum and short bowel syndrome were confirmed. A jejunostomy was performed, but unfortunately, this intervention resulted in severe malabsorption and subsequent cachexia. This case sheds light on the rare occurrence of anastomotic leakage and subsequent peritonitis following right hemicolectomy and ileostomy in a patient with the combined conditions of congenital short bowel and congenital absence of the omentum.</p><p><strong>Conclusion: </strong>This unique presentation highlights the potential complexities that can arise due to the convergence of these rare medical conditions.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":"19 1","pages":"161"},"PeriodicalIF":0.9,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bilateral papillary cystadenoma of the broad ligament: a manifestation of Von Hippel-Lindau disease: a case report.","authors":"Haifa Bergaoui, Imen Ghaddab, Wafa Dhouib, Manel Njima, Ichrak Belghaib, Imen Ben Farhat, Nedra Gharbi, Yessine Bel Haj Taher, Olfa Zoukar, Dhekra Toumi, Raja Faleh","doi":"10.1186/s13256-025-05196-0","DOIUrl":"https://doi.org/10.1186/s13256-025-05196-0","url":null,"abstract":"<p><strong>Background: </strong>While papillary cystadenomas of the epididymis are relatively common, the occurrence of papillary cystadenomas in female individuals, particularly in the ovaries, remains exceedingly rare.</p><p><strong>Case presentation: </strong>A 62-year-old white North African woman diagnosed with Von Hippel-Lindau disease in 2021 presented with multiple manifestations, including a left petrous bone tumor, left pheochromocytoma, left renal cell carcinoma, multi-cystic right kidney, and pancreatic masses. She underwent various treatments, including radiotherapy, adrenalectomy, nephrectomy, and cephalic duodenopancreatectomy. Ultrasonographic and magnetic resonance imaging examinations revealed a solid cystic mass in the left adnexal region. Laparoscopy identified cystic tumors in the right and left mesosalpinx. Following a hysterectomy with bilateral adnexectomy, histological examination revealed bilateral clear-cell papillary cystadenomas of the mesosalpinx and broad ligament, consistent with Von Hippel-Lindau disease.</p><p><strong>Conclusion: </strong>This case highlights the rare occurrence of bilateral clear-cell papillary cystadenomas of the mesosalpinx and broad ligament in a woman with Von Hippel-Lindau disease, a condition typically associated with men. The comprehensive diagnostic and therapeutic approach, including imaging studies, laparoscopy, and histological examination, underscores the importance of vigilant monitoring and tailored management in patients with this complex, multisystem disorder.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":"19 1","pages":"159"},"PeriodicalIF":0.9,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidermatomal herpes zoster in an immunocompetent, fully vaccinated 17-year-old female: a case report.","authors":"Katherine Teixeira, Shannon Williams, Spencer Morton, Amanda Harding","doi":"10.1186/s13256-025-05123-3","DOIUrl":"https://doi.org/10.1186/s13256-025-05123-3","url":null,"abstract":"<p><strong>Background: </strong>Herpes zoster, commonly known as shingles, results from the reactivation of varicella zoster virus, typically occurring in older adults. The advent of varicella vaccination has caused a decline in primary varicella infection cases; however, herpes zoster still occurs, albeit rarely, in fully vaccinated children.</p><p><strong>Case presentation: </strong>This report presents a case of herpes zoster in a fully vaccinated 17-year-old white American female, highlighting the importance of considering herpes zoster in immunocompetent, vaccinated children. The patient presented with a rash along multiple dermatomes, which spread despite antiviral treatment. After completion of the antiviral treatment, the rash eventually receded, and she was left with no residual symptoms.</p><p><strong>Conclusion: </strong>This case underscores the need for clinicians to recognize and manage uncommon diseases such as herpes zoster in the pediatric population, regardless of vaccination status, to prevent adverse outcomes. Although this patient did not have any residual symptoms, mortality, or morbidity, there could be a high probability for complications if there becomes optical or meningeal involvement.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":"19 1","pages":"160"},"PeriodicalIF":0.9,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative anesthesia management for elderly patients with permanent pacemakers undergoing retropubic prostatectomy in Ethiopia East Africa: a case report and review of the literature.","authors":"Eniyew Assimie Alemu, Biruk Adie Admass, Demelash Gedefaye Anteneh, Desyibelew Chanie Mekonnen, Molla Amsalu Tadesse","doi":"10.1186/s13256-025-05113-5","DOIUrl":"10.1186/s13256-025-05113-5","url":null,"abstract":"<p><strong>Backround: </strong>Perioperative anesthesia management for elderly patients with permanent pacemakers is complex, particularly in low-income countries. Preoperative pacemaker assessment and adjusting to asynchronous mode are crucial to avoid adverse events. Positioning electrocautery below the umbilicus and planning anesthesia to minimize pacemaker interference can reduce perioperative complications. This case involves an elderly male undergoing retropubic prostatectomy with a permanent pacemaker in dual-chamber, rate-modulated mode, without changing it to asynchronous mode, highlighting a rare anesthetic challenge in such settings.</p><p><strong>Clinical presentation: </strong>A 78-year-old male from the Amhara region, Ethiopia, with a permanent pacemaker for complete heart block was scheduled for retropubic prostatectomy. Preoperative assessments by the anesthetist and cardiologist recommended reprogramming the pacemaker to asynchronous mode to reduce risks related to its dual-chamber, rate-modulated mode setting. However, the patient could not afford reprogramming and opted to proceed with the existing perioperative plan. Informed consent was obtained, and case report publication permission was obtained after operation. The patient received combined epidural-spinal anesthesia with 2.50 ml of 0.5% isobaric bupivacaine and 50 µg fentanyl at the L3-L4 interspace. Standard American Society of Anesthesiology monitoring was applied, with a focus on cardiac stability. The patient remained stable with minimal vital sign fluctuations and maintained adequate blood pressure using isotonic saline. Postoperatively, the patient was transferred to the postanesthesia care unit, receiving analgesia after 4 hours and an epidural top-up. After 6 hours, he was transferred to the ward in stable condition. Epidural analgesia was continued for 72 hours, and the patient was discharged on the 88th postoperative hour in stable condition.</p><p><strong>Conclusion: </strong>Elderly patients with permanent pacemakers undergoing noncardiac surgery require thorough preoperative assessment and careful anesthesia management. In this case, financial constraints led to the decision not to reprogram the pacemaker, necessitating meticulous planning and monitoring during surgery. Using combined epidural-spinal anesthesia can enhance safety and outcomes, especially in low-resource settings where alternative anesthetic and resuscitative options may be limited.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":"19 1","pages":"157"},"PeriodicalIF":0.9,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788521","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":"Visualizing epileptogenic regions using the chemical exchange saturation transfer method in a patient with drug-resistant focal epilepsy: a case report.","authors":"Yosuke Ito, Masafumi Fukuda, Ken Ohno, Tomoyoshi Ota, Masaki Watanabe, Tsuyoshi Matsuda, Masahiro Hatakeyama, Hiroshi Masuda, Hiroki Kitaua, Akiyoshi Kakita, Hitoshi Shimada, Makoto Oishi, Hironaka Igarashi","doi":"10.1186/s13256-025-05191-5","DOIUrl":"10.1186/s13256-025-05191-5","url":null,"abstract":"<p><strong>Background: </strong>Sustained elevations in extracellular glutamate levels within astrocytes may precipitate epileptic seizures. In this report, chemical exchange saturation transfer imaging was used to measure brain glutamate concentrations in a patient who underwent focal resection surgery.</p><p><strong>Case presentation: </strong>A male Japanese patient in his 30s with drug-resistant focal epilepsy underwent preoperative assessment at our institute. Preoperative magnetic resonance imaging was performed using an ultra-high-field magnetic resonance imaging system. The results of intracranial electroencephalography and chemical exchange saturation transfer imaging were compared. Head magnetic resonance imaging revealed no abnormalities. However, fluorodeoxyglucose-positron emission tomography revealed reduced glucose metabolism in the distal left temporal lobe. Preoperative fluorodeoxyglucose-positron emission tomography and intracranial electroencephalography indicated abnormal interictal waves and identified the seizure onset site. Ablation was performed from the distal to the basal region of the temporal lobe. Pathological examination revealed focal cortical dysplasia type IIa. Chemical exchange saturation transfer imaging delineated an elevated glutamate concentration extending from the distal tip of the left temporal lobe to the medial temporal lobe. These regions included the areas of seizure onset identified by intracranial electroencephalography and matched the extent of the resection surgery. Four months postoperatively, focal aware seizures recurred; however, no focal impaired awareness seizures were observed at 1 year postoperatively. Elevated glutamate levels were detected in the hippocampus head, suspected to be associated with residual focal aware seizures.</p><p><strong>Conclusion: </strong>Glutamate-chemical exchange saturation transfer magnetic resonance imaging was used to noninvasively measure brain glutamate concentrations, providing new insights into identifying epileptogenic zones when conventional imaging techniques fail.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":"19 1","pages":"158"},"PeriodicalIF":0.9,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11971810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788523","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":"Assessment of chromatin remodeling of acute myeloid leukemia cells treated with gilteritinib: a case report.","authors":"Jinichi Mori, Takahiro Sawada, Koki Nojiri, Yoshiaki Kanemoto, Tadashi Okada, Tomohiro Kurokawa, Shigeaki Kato","doi":"10.1186/s13256-025-05186-2","DOIUrl":"10.1186/s13256-025-05186-2","url":null,"abstract":"<p><strong>Background: </strong>Acute myeloid leukemia is a hematological malignancy characterized by acquired genomic aberrations. Mutations in the FMS-like tyrosine kinase 3 gene cause constitutive activation of downstream signaling pathways, thereby driving disease progression and conferring a poor prognosis. Gilteritinib, a tyrosine kinase inhibitor, is a promising treatment for FMS-like tyrosine kinase 3-mutated acute myeloid leukemia. However, gilteritinib resistance remains a significant concern, and its underlying mechanisms are not yet understood.</p><p><strong>Case presentation: </strong>A 65-year-old Japanese male patient who was receiving regular hemodialysis developed pancytopenia in 2017. He required recurrent red blood cell transfusions due to anemia in 2018. In 2019, he was diagnosed with myelodysplastic syndrome with excess blasts. We administered three courses of azacitidine but ceased it due to severe cytopenia. His disease had transformed to acute myeloid leukemia. The fourth course of azacitidine was administered, but it was ineffective. Since a tyrosine kinase domain mutation in FMS-like tyrosine kinase 3 was detected in the acute myeloid leukemia cells, we administered gilteritinib at a dose of 120 mg. Although the treatment initially showed efficacy, the disease progressed, and he died 7 days after the initiation of gilteritinib. To assess the epigenetic changes in acute myeloid leukemia during the treatment with gilteritinb, we performed the assay for transposase-accessible chromatin with sequencing using the leukemia cells obtained from the patient before and after gilteritinib treatment. After the treatment, greater than fivefold changed assay for transposase-accessible chromatin peaks were detected in 137 (upregulated) and 105 (downregulated) regions. Among them, half of the regions were located in the intergenic regions. A Gene Ontology analysis of affected genes listed the mitogen‑activated protein kinase pathway, which is potentiated by the FMS-like tyrosine kinase 3 genetic mutations in leukemia cells. No significant changes were noted at the FMS-like tyrosine kinase 3 locus. On the gene locus of PPP2R2B, a known cancer-associated gene, the peaks were decreased, suggesting reduced chromatin accessibility. Conversely, upregulation peaks were observed on the gene locus and adjacent noncoding region of PDGFD that is associated with the progression of various types of cancer including acute myeloid leukemia.</p><p><strong>Conclusions: </strong>Our study demonstrated the epigenetic changes in acute myeloid leukemia cells that may be associated with gilteritinib resistance.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":"19 1","pages":"153"},"PeriodicalIF":0.9,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780308","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":"Polyostotic Langerhans cell histiocytosis presenting as halitosis in a 24-year-old man: a case report.","authors":"Hassan Mirmohammad Sadeghi, Sanaz Gholami Toghchi, Fatemeh Mashhadiabbas, Milad Baseri, Maryam Mohammadalizadeh Chafjiri, Parnian Nikraftar, Ardeshir Khorsand","doi":"10.1186/s13256-025-05062-z","DOIUrl":"10.1186/s13256-025-05062-z","url":null,"abstract":"<p><strong>Background: </strong>Langerhans cell histiocytosis is a rare disease of the reticuloendothelial system. This report presents a novel case of Langerhans cell histiocytosis with systemic involvement that started with a simple chief complaint. The reporting of this case raises awareness of the distinctive characteristics of this challenging disorder.</p><p><strong>Case presentation: </strong>A 24-year-old male patient of Persian ethnicity presented with a chief complaint of halitosis following coronavirus disease 2019 recovery to his general dentist's office. Intraoral and extraoral examinations revealed no specific problem. In the follow-up session after phase I periodontal treatment, teeth sensitivity to cold stimulus was evident, and radiographs revealed a large lytic intraosseous lesion in the mandible. An incisional biopsy revealed Langerhans cells and a positive reaction to Langerin and cluster of differentiation 1a, thus, he was diagnosed with Langerhans cell histiocytosis. After performing positron emission tomography with fluoro-2-deoxyglucose and computed tomography, magnetic resonance imaging, and cone beam computed tomography, owing to generalized disease involvement, the patient was referred to an oncologist. Ultimately, it was found that the patient's childhood health issues, including endocrine problems, were likely caused by an undiagnosed Langerhans cell histiocytosis. The oncologist chose denosumab, vinblastine, etoposide, 6-mercaptopurine, methotrexate, and pegfilgrastim regimen. The follow-up was not possible as the patient died following an accident.</p><p><strong>Conclusion: </strong>This reveals the vitality of the early diagnosis of Langerhans cell histiocytosis to prevent disease progression. Awareness of diverse and nonpathognomonic manifestations of Langerhans cell histiocytosis, proper medical interview and history taking, and the use of routine radiographs may aid clinicians in lowering morbidity and mortality rates associated with such conditions.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":"19 1","pages":"155"},"PeriodicalIF":0.9,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779807","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":"Pneumomediastinum after laughing gas inhalation: not a laughing matter anymore-a case report.","authors":"Mariya George, Keshav Jindal, Athanasios Michailidis","doi":"10.1186/s13256-025-05053-0","DOIUrl":"10.1186/s13256-025-05053-0","url":null,"abstract":"<p><strong>Introduction: </strong>Nitrous oxide, popularly known as laughing gas, is a colorless gas with a faint, sweet odor, which has been used for recreational purposes since the nineteenth century. We present the case of an 18-year-old male who presented with spontaneous pneumomediastinum after nitrous oxide inhalation.</p><p><strong>Case presentation: </strong>An 18-year-old Caucasian British male patient presented to the emergency department complaining of sharp, central, pleuritic chest pain that radiated up to the throat and was worse on lying down. On examination, palpable surgical emphysema was noted on the neck and was noted on chest X-ray. A computed tomography of neck and chest was then performed, which revealed extensive pneumomediastinum tracking along the cervical, axillary, presternal, and anterior pericardial regions. A water-soluble contrast study was performed, which showed no evidence of esophageal perforation.</p><p><strong>Conclusion: </strong>Nitrous oxide is a substance that is widely and easily available and used recreationally for its euphoric effects. There are uncommon but significant side effects that can occur with its use; having an awareness of this and covering illicit drug use in history-taking will help guide further management plans.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":"19 1","pages":"156"},"PeriodicalIF":0.9,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779706","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":"Duodenal diverticulitis: a crossroad between conservative therapy and surgery: a case report.","authors":"Stefano Mattacchione, Giuseppe Mezzetti","doi":"10.1186/s13256-025-05159-5","DOIUrl":"10.1186/s13256-025-05159-5","url":null,"abstract":"<p><strong>Background: </strong>In total, 90% of patients with duodenal diverticulum are asymptomatic; 5% of patients present with symptoms due to its complications, as compression of neighboring organs, cholestasis (in cases of periampullary diverticulum), hemorrhage, inflammation (diverticulitis), or perforation. Duodenal diverticulitis represent a diagnostic challenge because of nonspecific symptoms and indeterminate computed tomography images, leading to diagnostic delay with possible complications such as perforation.</p><p><strong>Case presentation: </strong>A 68-year-old Caucasian Italian female patient presented with large retroperitoneal fluid collection (5.5 × 5.6 × 4.8 cm) with air-fluid level around the second part of the duodenum, initially interpreted as localized duodenal perforation. An effective conservative management was performed with good outcomes.</p><p><strong>Conclusion: </strong>With the exception of cases of peritonitis or frank sepsis, the treatment of duodenal diverticulitis, with or without retroperitoneal perforation, is based on the patient's clinical manifestation, and in selected patients, conservative treatment may be a valid alternative to surgery, avoiding over-treatment and potential serious complications of a very difficult surgery.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":"19 1","pages":"154"},"PeriodicalIF":0.9,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780309","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}