American Journal of Case Reports最新文献

Challenges in Treating Dermatomyositis-Related Rhabdomyolysis: A Case Report of Steroid-Induced Myopathy. 治疗皮肌炎相关横纹肌溶解的挑战：类固醇性肌病1例报告。

IF 1

American Journal of Case Reports Pub Date : 2025-05-17 DOI: 10.12659/AJCR.947064

Dawid Żyrek, Wioletta Sandłak

{"title":"Challenges in Treating Dermatomyositis-Related Rhabdomyolysis: A Case Report of Steroid-Induced Myopathy.","authors":"Dawid Żyrek, Wioletta Sandłak","doi":"10.12659/AJCR.947064","DOIUrl":"https://doi.org/10.12659/AJCR.947064","url":null,"abstract":"BACKGROUND Rhabdomyolysis, although typically associated with immobilization, trauma, or the use of certain medications, can also manifest as a severe and potentially life-threatening complication of dermatomyositis. This condition results from the breakdown of skeletal muscle, presenting with symptoms such as myalgia, muscle weakness, and myoglobinuria. Although high-dose steroids are the treatment of choice in cases of dermatomyositis-related rhabdomyolysis, they can trigger the onset of steroid-induced myopathy. CASE REPORT A 50-year-old woman with bilateral muscle weakness, myalgia, erythematous-papular rash, urine abnormalities, and significantly elevated liver transaminases was mistakenly admitted to the Gastroenterology Department due to suspected acute liver damage. After initial management, the patient was diagnosed with dermatomyositis-related rhabdomyolysis. The introduction of high-dose systemic steroid therapy resulted in a deterioration of her clinical condition and triggered the appearance of additional symptoms (dysphagia, dysphonia, difficulty breathing and coughing effectively). Due to the suspicion of the acute steroid-induced myopathy, the steroid was promptly discontinued, which resulted in a noticeable reduction in the severity of the new symptoms. After 2 days, we restarted steroid treatment at a lower dose, along with intravenous immunoglobulin therapy, obtaining gradual clinical improvement. CONCLUSIONS Deterioration of general condition or new symptoms appearing after steroid administration should always raise suspicion of acute steroid-induced myopathy, which may overlap with dermatomyositis. Differentiating between the exacerbation of myositis symptoms and steroid-induced myopathy is problematic and not always possible. In case of suspected steroid-induced myopathy, steroid should be used at the lowest effective dose or replaced by a non-steroidal agent.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e947064"},"PeriodicalIF":1.0,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086726","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}

引用次数: 0

CMV Viremia and Colitis in Simultaneous Pancreas-Kidney Transplantation. 同时胰肾移植的巨细胞病毒血症和结肠炎。

IF 1

American Journal of Case Reports Pub Date : 2025-05-16 DOI: 10.12659/AJCR.946818

Simardeep Singh, Aayushi J Rajani, Shifa Karatela, Mipasha Patel, Juhi V Amin, Devisha Gandhi, Justin Oring

{"title":"CMV Viremia and Colitis in Simultaneous Pancreas-Kidney Transplantation.","authors":"Simardeep Singh, Aayushi J Rajani, Shifa Karatela, Mipasha Patel, Juhi V Amin, Devisha Gandhi, Justin Oring","doi":"10.12659/AJCR.946818","DOIUrl":"https://doi.org/10.12659/AJCR.946818","url":null,"abstract":"BACKGROUND Cytomegalovirus (CMV) infection presents a significant challenge in transplant patients due to the limited arsenal of antiviral drugs and the potential for developing resistance. The treatment regimen typically involves the use of appropriate antivirals, routine CMV PCR monitoring, resistance testing, and managing associated drug toxicities. CASE REPORT Our case highlights the difficulties of managing CMV in transplant patients, particularly in the context of resistant strains. Key elements of the case include the development of significant and resistant viremia despite adequate prophylaxis, the strategic switch from ganciclovir to maribavir, and the persistent challenge of resistance. The subsequent introduction of foscarnet and the careful transition to letermovir after adequate viral suppression (<1000 UI/mL) were critical in maintaining it while minimizing drug toxicity. These strategic decisions ultimately led to a successful outcome for our patient, highlighting the importance of vigilant monitoring and timely therapeutic adjustments in preventing severe complications or even death. CONCLUSIONS In transplant patients, cytomegalovirus (CMV) infection, particularly when complicated by antiviral resistance, presents significant therapeutic challenges. A strategic approach, including the switch from ganciclovir to maribavir, foscarnet, and finally to letermovir, was critical in successfully managing the infection and preventing severe complications.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e946818"},"PeriodicalIF":1.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081158","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}

引用次数: 0

Atorvastatin-Associated Acute Pancreatitis: A Case Report. 阿托伐他汀相关急性胰腺炎1例报告。

IF 1

American Journal of Case Reports Pub Date : 2025-05-15 DOI: 10.12659/AJCR.945772

Fahad Alshammari, Alwaleed Alharbi, Reem Ali Alshammari

{"title":"Atorvastatin-Associated Acute Pancreatitis: A Case Report.","authors":"Fahad Alshammari, Alwaleed Alharbi, Reem Ali Alshammari","doi":"10.12659/AJCR.945772","DOIUrl":"https://doi.org/10.12659/AJCR.945772","url":null,"abstract":"BACKGROUND Acute pancreatitis (AP) occurs when pancreatic enzymes activate within the pancreas, causing damage. In the USA, 210 000 patients are hospitalized annually due to AP. Although statin-induced pancreatitis is rare and often misdiagnosed, it is crucial to investigate, as avoiding the causative medication can prevent attacks. There is conflicting evidence, and further research is needed to determine if statins increase the risk of AP. CASE REPORT In this report, we detail the case of a 48-year-old man with a history of dyslipidemia, for which he was prescribed atorvastatin 40 mg/day as a lipid-lowering agent. He developed acute pancreatitis after using atorvastatin. He initially presented to the emergency room with worsening epigastric pain. Elevated levels of lipase, amylase, and alanine aminotransferases in laboratory tests indicated acute pancreatitis. Given these findings, supportive care was promptly initiated, and atorvastatin, identified as the potential trigger, was discontinued. Notably, the patient had no history of alcohol or tobacco use, and extensive diagnostic efforts ruled out other common causes of acute pancreatitis. The absence of other risk factors reinforced the likelihood that atorvastatin was responsible for his condition, as noted in Table 2. This case underscores the importance of careful monitoring of symptoms and laboratory findings in patients treated with statin medications, particularly when prescribed for dyslipidemia. CONCLUSIONS Documenting such unusual cases could help highlight the potential risks of acute pancreatitis associated with statin use.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e945772"},"PeriodicalIF":1.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081157","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}

引用次数: 0

Understanding Brugada Pattern in Elderly Patients with COVID-19: A Case Study. 老年COVID-19患者Brugada模式的研究

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American Journal of Case Reports Pub Date : 2025-05-14 DOI: 10.12659/AJCR.948042

Kiera Brigh Turner, Murali Iyyani, Joel A Garcia Fernandez, Stephen J Carlan

{"title":"Understanding Brugada Pattern in Elderly Patients with COVID-19: A Case Study.","authors":"Kiera Brigh Turner, Murali Iyyani, Joel A Garcia Fernandez, Stephen J Carlan","doi":"10.12659/AJCR.948042","DOIUrl":"https://doi.org/10.12659/AJCR.948042","url":null,"abstract":"BACKGROUND Brugada syndrome is a hereditary condition characterized by sudden cardiac death or electrocardiogram (EKG)-documented ventricular arrhythmias or arrhythmia-related symptoms in patients without structural cardiac pathology. Brugada phenocopy is a condition with EKG changes consistent with Brugada syndrome, without any hereditary cause. SARS-CoV-2 is a respiratory virus associated with many cardiovascular complications, one of which is new-onset arrhythmia, including Brugada phenocopy or the unmasking of the Brugada syndrome. PPublished cases have revealed the emergence of Brugada pattern among patients with afebrile SARS-CoV-2 infection, suggesting a link with the virus itself and not simply fever. Treatment for Brugada syndrome and Brugada phenocopy involves avoidance of modulating factors that can generate recurrent Brugada patterns. Additional therapy for Brugada syndrome may include implantable cardioverter-defibrillator (ICD) placement, but this treatment was considered unnecessary for a Brugada phenocopy and too risky for a nonagenarian man. Asymptomatic Brugada phenocopy in a COVID-19 patient requires close observation to manage. CASE REPORT A nonagenarian man with SARS-CoV-2 infection presented with chest pain, mild fever, and a Brugada pattern on EKG. He was treated with steroids, remdesivir, and antipyretics, before his Brugada phenocopy resolved. CONCLUSIONS Brugada phenocopy is characterized by fluctuating ST elevations triggered by modulating factors, including electrolyte derangements, fever, infection, and various medications or drugs. Prompt management of Brugada phenocopy is necessary to avoid the development of malignant arrhythmias or sudden cardiac death. Differentiation of Brugada phenocopy and Brugada syndrome is essential to avoid unnecessary ICD placement for Brugada phenocopy.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e948042"},"PeriodicalIF":1.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081159","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}

引用次数: 0

Novel Approach to Retro-Odontoid Pseudotumor Resection without Atlantoaxial Dislocation. 无寰枢关节脱位后齿状假瘤切除的新方法。

IF 1

American Journal of Case Reports Pub Date : 2025-05-14 DOI: 10.12659/AJCR.946611

Jia Shao, Yan Zheng Gao, Kun Gao, Ke Zheng Mao, Xiu Ru Zhang

{"title":"Novel Approach to Retro-Odontoid Pseudotumor Resection without Atlantoaxial Dislocation.","authors":"Jia Shao, Yan Zheng Gao, Kun Gao, Ke Zheng Mao, Xiu Ru Zhang","doi":"10.12659/AJCR.946611","DOIUrl":"https://doi.org/10.12659/AJCR.946611","url":null,"abstract":"BACKGROUND Retro-odontoid pseudotumor is a fibrous or pannus mass behind the odontoid process, mainly caused by atlantoaxial instability, degeneration, or abnormal deposits behind the dens. Most scholars agree immobilization of the upper cervical spine can solve this problem; the mass can absorb spontaneously. However, retro-odontoid pseudotumor cases without atlantoaxial instability are limited, and it remains controversial whether the mass should be removed. CASE REPORT A 67-year-old man had intermittent neck pain for 10 years and numbness and weakness of the extremities for 1 month. Primary diagnosis was intra-spinal neoplasm (C1), cervical spondylotic myelopathy, and subaxial cervical stenosis. After C3-C7 laminoplasty, we removed the posterior arch of the atlas, and the mass was resected via the lateral side of the spinal cord using a curette and clamp, followed by C1-C2 fixation and bilateral lateral atlantoaxial joint fusion in single stage. The intra-spinal neoplasm was debunked, and a diagnosis of a retro-odontoid pseudotumor was made based on pathology. Postoperative radiography showed sufficient decompression of C3-C7 and sufficient grafted bone in the lateral atlantoaxial joints. The pseudotumor was completely resected, and no compression was seen on MRI. The symptoms resolved immediately after the procedure. The Japanese Orthopaedic Association score was 16, and 1-year follow-up showed no tumor recurrence. CONCLUSIONS The retro-odontoid pseudotumor should be removed if there is obvious compression of the spinal cord. Lateral atlantoaxial joint bone grafting is recommended because of the removal of the grafting bed (posterior C1 arch) for posterior fusion. C1-C2 fixation and fusion could reserve the motion of C0-C1.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e946611"},"PeriodicalIF":1.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043135","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}

引用次数: 0

Thoracic Aortic Dissection (Type B) Managed with Emergency Cesarean Section and Thoracic Endovascular Aortic Repair. 胸主动脉夹层（B型）急诊剖宫产术及胸血管内主动脉修复术

IF 1

American Journal of Case Reports Pub Date : 2025-05-13 DOI: 10.12659/AJCR.947148

Julia Tarnowska, Oskar Gąsiorowski, Jerzy Leszczyński, Kamil Stępkowski, Zbigniew Gałązka, Ewa Romejko-Wolniewicz

{"title":"Thoracic Aortic Dissection (Type B) Managed with Emergency Cesarean Section and Thoracic Endovascular Aortic Repair.","authors":"Julia Tarnowska, Oskar Gąsiorowski, Jerzy Leszczyński, Kamil Stępkowski, Zbigniew Gałązka, Ewa Romejko-Wolniewicz","doi":"10.12659/AJCR.947148","DOIUrl":"10.12659/AJCR.947148","url":null,"abstract":"BACKGROUND Type B aortic dissection occurring after labor can be life-threatening. Severe hypertension is among the main risk factors. This report highlights the role of early intervention and special monitoring of pregnant women, and their effects on symptoms. CASE REPORT A 28-year-old women with a history of hypertension was admitted to the obstetrics hospital. Two attempts at labor induction were unsuccessful. A decision was made to proceed with a cesarean section. Due to the patient's deteriorating condition, 2 laparotomies were performed, 1 at the initial hospital and another after transfer. Postoperatively, she required intensive care monitoring. Based on imaging studies, a diagnosis of type B thoracoabdominal aortic dissection complicated by malperfusion was established. Endovascular aortic repair involved placement of an aortic stent graft under imaging guidance. A Zenith TX2 Dissection endovascular stent graft with a Pro Form Z-Track Plus delivery system was introduced. Afterward, the patient underwent 2 more surgeries: duodenum resection and creation of a gastro-descending colon anastomosis. Upon hospital admission, the patient was in very serious general condition. However, after 2 months of treatment and improvement, she was discharged. CONCLUSIONS This report demonstrates that hypertension during pregnancy, combined with unsuccessful attempts at delivery, may be a significant risk factor for aortic dissection. Effective diagnosis and management of these patients is challenging and requires multidisciplinary care, including the use of computed tomography with contrast as soon as possible due to its higher benefits, and the immediate endovascular approach as the safest method of treating postpartum aortic dissection.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e947148"},"PeriodicalIF":1.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986812","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}

引用次数: 0

Vancomycin Treatment for Pneumobilia in Clostridioides difficile Infection: A Case Analysis. 万古霉素治疗难辨梭菌感染肺炎一例分析。

IF 1

American Journal of Case Reports Pub Date : 2025-05-13 DOI: 10.12659/AJCR.947628

Christos Vallilas, Alexandros Avdis, Olympia Alexandri, Georgia Philippa, Konstantinos Cardamakis, Penelope Lampropoulou, Aikaterini Touliatou

{"title":"Vancomycin Treatment for Pneumobilia in Clostridioides difficile Infection: A Case Analysis.","authors":"Christos Vallilas, Alexandros Avdis, Olympia Alexandri, Georgia Philippa, Konstantinos Cardamakis, Penelope Lampropoulou, Aikaterini Touliatou","doi":"10.12659/AJCR.947628","DOIUrl":"10.12659/AJCR.947628","url":null,"abstract":"BACKGROUND Pneumobilia is the presence of air within the biliary tree. It is a relatively rare condition, usually caused by an abnormal communication between the biliary system and the gastrointestinal tract, or by infection from gas-forming bacteria. Antibiotic agents such as fluoroquinolones have many adverse effects, including Clostridioides difficile infection manifesting as colitis. Metronidazole has been used in the past and vancomycin and fidaxomicin can have good therapeutic results. CASE REPORT A 20-year-old man presented to Gennimatas General Hospital in Athens, Greece due to multiple episodes of diarrhea. He had received a 7-day treatment of oral levofloxacin, a common antibiotic treatment often used to treat Clostridioides difficile infection, until 10 days before presentation to our hospital as an outpatient treatment for mild pneumonia. Blood test revealed neutropenia and thrombocytopenia, and biochemical tests revealed hypokalemia and elevated inflammation markers. A CT scan of the abdomen showed pneumobilia. Blood and urine cultures were sterile, whereas Clostridioides difficile toxins A+ and B+ were detected in stool culture. Treatment with oral vancomycin had excellent results. The patient improved clinically and remained afebrile, with cessation of diarrhea, correction of electrolytic disorders, and disappearance of pneumobilia on a repeat CT scan after 1 week. CONCLUSIONS Pneumobilia caused by Clostridioides difficile infection was effectively treated with orally administered vancomycin, which cured our patient's diarrhea and pneumobilia.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e947628"},"PeriodicalIF":1.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062534","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}

引用次数: 0

Managing Necrotizing Soft-Tissue Infection in Breast Cancer: A Case of Emergency Toilet Mastectomy. 处理坏死性软组织感染的乳腺癌：一例紧急厕所乳房切除术。

IF 1

American Journal of Case Reports Pub Date : 2025-05-12 DOI: 10.12659/AJCR.946669

Jessica J Farzan, Jiddu A Guart, Nichita Kulkarni, Sarah Roberts, Gabriel De la Cruz-Ku, Donald R Czerniach, Kate H Dinh

{"title":"Managing Necrotizing Soft-Tissue Infection in Breast Cancer: A Case of Emergency Toilet Mastectomy.","authors":"Jessica J Farzan, Jiddu A Guart, Nichita Kulkarni, Sarah Roberts, Gabriel De la Cruz-Ku, Donald R Czerniach, Kate H Dinh","doi":"10.12659/AJCR.946669","DOIUrl":"10.12659/AJCR.946669","url":null,"abstract":"BACKGROUND This case report presents a rare instance of advanced breast cancer presenting with superimposed necrotizing soft-tissue infection (NSTI) and sepsis, uniquely managed with an emergency toilet mastectomy. Toilet mastectomies have become increasingly rare and controversial in modern surgical oncology and are generally limited to palliative indications. This report contributes to the limited literature on NSTI of the breast in the setting of malignancy and highlights the potential utility of toilet mastectomy as a palliative option for carefully selected patients with advanced breast cancer complicated by infection. CASE REPORT A 71-year-old woman presented with a large fungating right breast mass after 50 years of receiving no health care. She was septic, with clinical signs of NSTI. Emergency surgical intervention involved a toilet mastectomy with extensive debridement. Histopathological analysis confirmed high-grade invasive ductal carcinoma of the breast with skin involvement, ER/PR-positive, HER2-negative, pT4bN0Mx. Cultures were consistent with type 1 NSTI. The postoperative course was complicated, requiring prolonged ICU care, multiple debridements, and advanced wound management. Significant complications included septic shock, acute kidney injury, and wound dehiscence. CONCLUSIONS This case is notable for 3 key aspects: (1) NSTI and sepsis are rare but serious complications of advanced breast cancer, underscoring the need for clinicians to maintain a high index of suspicion for this condition; (2) timely and aggressive management of NSTI, regardless of its association with underlying malignancy, is critical for reducing morbidity and mortality; and (3) toilet mastectomy, although less commonly performed today, remains an appropriate palliative intervention in select cases.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e946669"},"PeriodicalIF":1.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040580","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}

引用次数: 0

Enhancing Renal Stone Management: Tip-Flexible Ureteral Access Sheath in Cystine Stone Surgery. 加强肾结石管理：膀胱胱氨酸结石手术中尖端柔性输尿管通路鞘。

IF 1

American Journal of Case Reports Pub Date : 2025-05-12 DOI: 10.12659/AJCR.946800

Ting Xu, Kristine Joy Shan Kwan, Lin Xiong

{"title":"Enhancing Renal Stone Management: Tip-Flexible Ureteral Access Sheath in Cystine Stone Surgery.","authors":"Ting Xu, Kristine Joy Shan Kwan, Lin Xiong","doi":"10.12659/AJCR.946800","DOIUrl":"10.12659/AJCR.946800","url":null,"abstract":"BACKGROUND Cystinuria is a rare cause of urolithiasis. The condition is often inherited and controlled medically. A large symptomatic stone is indicated for surgery, and complete stone clearance is recommended to reduce the risk of infection and stone recurrence. CASE REPORT A 24-year-old healthy man was incidentally discovered to have multiple bilateral renal stones during a routine health examination. Upon admission to the Urology Department, preoperative computed tomography (CT) identified a large right renal stone measuring 30×25 mm and smaller, clinically insignificant stones in the left kidney. The patient opted to undergo removal of the right stone only, as he was asymptomatic and chose not to have the left stones extracted. He underwent right disposable digital flexible ureteroscopic lithotripsy using a tip-flexible suctioning ureteral access sheath, achieving complete stone clearance. His postoperative recovery was uneventful. At 1-month follow-up, stone composition analysis revealed that the stones were composed of L-cystine, leading to a diagnosis of cystinuria, a condition the patient was previously unaware of. He was prescribed urine alkalizing agents as part of his management. At the 6-month follow-up, CT confirmed that the right kidney remained stone-free. However, the left renal stones had significantly grown despite the use of urine alkalizing agents. To date, the patient has declined further surgical interventions for the left renal stones. CONCLUSIONS Early minimally-invasive intervention for cystine stones, including asymptomatic ones, may be necessary, as achieving complete stone clearance can improve prognosis by preventing complications associated with the stones.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e946800"},"PeriodicalIF":1.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052084","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}

引用次数: 0

Anatomical Challenges in Laparoscopic Cholecystectomy: Five Arterial Branches from a Right Hepatic Caterpillar Hump. 腹腔镜胆囊切除术的解剖学挑战：来自右肝毛虫驼峰的五个动脉分支。

IF 1

American Journal of Case Reports Pub Date : 2025-05-11 DOI: 10.12659/AJCR.947240

Odysseas Mouzakis, Efstratios Konidis, Panagiotis Poulokefalos, Spyridon Stavros Arnaoutos

{"title":"Anatomical Challenges in Laparoscopic Cholecystectomy: Five Arterial Branches from a Right Hepatic Caterpillar Hump.","authors":"Odysseas Mouzakis, Efstratios Konidis, Panagiotis Poulokefalos, Spyridon Stavros Arnaoutos","doi":"10.12659/AJCR.947240","DOIUrl":"10.12659/AJCR.947240","url":null,"abstract":"BACKGROUND Caterpillar hump, also referred to as Moynihan's hump, is a right hepatic artery with tortuous course within the Calot's triangle, which carries a major risk of accidental injury and ligation during laparoscopic cholecystectomy. Its already rare incidence (about 3.81%), in association with the typical presence of 1 or 2 cystic arteries, makes our case unique since it involves a caterpillar hump with 5 distinct arterial branches. CASE REPORT We report a case of caterpillar hump detected during elective laparoscopic cholecystectomy for symptomatic cholelithiasis in a 49-year-old man. A large vessel-like structure with an uncertain termination was initially identified after the hepatocystic triangle dissection. The structure was eventually discovered to have a helical route and re-enter the liver. Although more than 2 elements entered the gallbladder, which exceeded the 'critical view of safety' requirements, a thorough dissection was performed. The surgery is successfully completed when all branches end up in the gallbladder. CONCLUSIONS This report summarizes the clinical and surgical importance of the caterpillar hump, highlighting the necessity for precise anatomical knowledge and the implementation of a \"culture of safety\" to prevent complications. The concept of \"structure\" in achieving the \"critical view of safety\" must encompass its variations and anomalies. Therefore, surgeons must be aware of the potential for multiple arterial branches supplying the gallbladder.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e947240"},"PeriodicalIF":1.0,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12080282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043479","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}

引用次数: 0