Medicna

We present a clinical case of synchronous colonic lesions, histologically different, associated with streptococcus gallolyticus subsp. gallolyticus (Sgg)/ Streptococcus bovis biotype I, bacteremia and infective endocarditis. A 53-year-old female, without history of CRC in her family, known with total hysterectomy for uterine fibromatosis, presents to Emergency Department for marked asthenia, nausea, weight loss (10 kgs in the last month), febrile episode associated with severe anemia, symptomatology that has increased in the last two weeks. The patient was admitted in the Internal Medicine Department for further investigations, under the suspicion of sepsis of unknown cause. On blood cultures grew Sgg bacteria. Both transthoracic echocardiography and transesophageal echocardiography were performed and diagnosed infective endocarditis with vegetations of the mitral and aortic valves. Antibiotics treatment was initiated, with ceftriaxone and gentamycin, according to antibiogram result...

Gallbladder inflammation is most often determined by the presence of gallstones. Acalculous cholecystitis usually occurs in patients with multiple comorbidities or with an immunosuppressed status, and therefore its evolution is faster and more severe compared to acute calculous cholecystitis. The presence of a fish bone into the peritoneal cavity, through a gastrointestinal fistula is not very rare, but acute cholecystitis caused by a fish bone is unexpected. Here, we present the case of a 75-year old woman who had eaten fish two months before and presented at the Emergency Room with perforated acalculous cholecystitis and a right subphrenic abscess. The laparoscopic approach permitted the evacuation of the subphrenic abscess, bipolar cholecystectomy and removal of a fish bone from nearby the cystic duct. Postoperative evolution was uneventful, with hospital discharge after five days. The patient was in good clinical condition at two months follow-up. .

Pancreatic abscesses are rare and usually occur as a pancreatitis complication. The absence of acute pancreatitis and the clinical presentation that mimics a neoplasm are very unexpected. A 49-year-old man, known with arterial hypertension and chronic infection with virus hepatitis B came to the hospital for weight loss, marked asthenia, nausea/vomiting and jaundice, associated with mild pain in the upper abdomen. At admission, without fever and no medical history of acute pancreatitis. Laboratory values showed an important inflammatory syndrome, near normal pancreatic enzymes and increased tumour markers. Abdominal computed tomography (CT) revealed a heterogeneous fluid collection with gas bubbles inside, localized into the lesser sac that tended to extend peri splenic, towards the anterior and posterior pararenal spaces and the pelvis. Surgery has led to evacuation of peripancreatic and left retrocolic abscesses, associated with debridement and peritoneal drainage. The culture yie...

Scrotal lipomas are benign tumours rarely seen in clinical practice. They can mimic common affections such as an an inguinoscrotal hernia, varicocele, hydrocele or a testicular tumour. Thus, in many cases, physical examination leads to a correct diagnosis, there are situations that require comprehensive imagistic examinations, to establish the preoperatory nature of the scrotal tumour. A case of 64-year-old male, known with arterial hypertension and gonarthrosis, came to the hospital for a painless scrotal tumour with a fast growth rate in dimensions over the last year. Physical examination detected an elastic, painless, irreducible, irregularly shaped mass of a right scrotal region. The scrotal ultrasound revealed a heterogeneous hyperechoic solid mass with 10x8.1x8cm in dimensions, localized in the right scrotal region. The magnetic resonance imaging (MRI) showed a globular shaped right scrotal tumour mass with well-defined margins, poorly vascularized at the lower pole. Surgery w...