Open Access Indonesian Journal of Medical Reviews

Delayed Traumatic Diaphragmatic Hernia Presenting as Pneumothorax: A Case Report

2025-03-10T03:54:24+00:00

Traumatic diaphragmatic hernias (TDHs) are a serious complication of both blunt and penetrating trauma, often requiring prompt surgical intervention. While most TDHs present acutely, a subset of cases may have a delayed presentation, posing diagnostic and management challenges. This case report describes a 66-year-old woman who developed a delayed left-sided TDH following a motor vehicle accident, initially misdiagnosed as pneumothorax. A 66-year-old female presented to our hospital with complaints of severe left-sided chest pain and progressive dyspnea four days after a motor vehicle accident. Initial assessment at another hospital revealed rib fractures and pneumothorax, for which a chest tube was inserted. However, her respiratory symptoms persisted, prompting further evaluation. A chest X-ray and subsequent thoracoabdominal CT scan revealed a large left-sided diaphragmatic hernia with herniation of abdominal viscera into the thoracic cavity. The patient underwent emergency laparotomy and diaphragmatic hernia repair with primary closure. Postoperatively, the patient's symptoms improved significantly, and she was discharged home with complete resolution of her complaints. In conclusion, this case highlights the importance of maintaining a high index of suspicion for TDH in patients with a history of trauma, even in the absence of initial suggestive findings. Delayed presentation of TDH can occur, and a thorough evaluation, including imaging studies, is crucial for accurate diagnosis and timely management.

Mahogany (Swietenia mahagoni) Leaf Extract Exhibits Strong Antibacterial Activity Against Enterococcus faecalis: A Promising Natural Alternative to Chlorhexidine for Root Canal Infections

2025-03-14T06:34:25+00:00

Enterococcus faecalis is a prevalent bacterium in root canal infections, exhibiting high resistance to conventional antibacterial agents. Mahogany (Swietenia mahagoni) leaf extract, rich in flavonoids, saponins, and tannins, has demonstrated promising antibacterial properties. This study investigated the antibacterial efficacy of mahogany leaf extract against E. faecalis and compared its effectiveness to chlorhexidine, a commonly used root canal irrigant. A laboratory experimental study was conducted using the disk diffusion method on Mueller Hinton Agar (MHA). Mahogany leaf extract was prepared at concentrations of 25%, 50%, and 70%. Chlorhexidine (0.2%) served as the positive control, and dimethyl sulfoxide (DMSO) as the negative control. The diameter of inhibition zones was measured after 24 hours of incubation. Statistical analysis was performed using One-Way ANOVA and Post Hoc LSD tests. All concentrations of mahogany leaf extract exhibited significant antibacterial activity against E. faecalis (p < 0.05). The 70% concentration produced the largest inhibition zone (20.39 ± 1.38 mm), followed by 50% (18.67 ± 1.12 mm) and 25% (17.28 ± 0.60 mm). The inhibition zones of the 50% and 70% mahogany leaf extract were comparable to those of chlorhexidine (19.40 ± 0.70 mm). In conclusion, mahogany leaf extract demonstrates strong antibacterial activity against E. faecalis, suggesting its potential as a natural alternative to chlorhexidine for root canal infections. Further research is warranted to explore its clinical application in endodontic treatment.

Successful Management of Esophageal Atresia with Tracheoesophageal Fistula in a 7-Day-Old Male Infant

2025-03-12T06:27:57+00:00

Esophageal atresia (EA) with tracheoesophageal fistula (TEF) is a rare congenital anomaly characterized by an incomplete esophagus and an abnormal connection between the trachea and esophagus. This condition occurs in approximately 1 in 3000 to 5000 live births and requires prompt diagnosis and surgical intervention to prevent life-threatening complications. The most common type of EA with TEF involves a proximal esophageal atresia and a distal TEF (Type C). Early diagnosis is crucial to prevent complications such as aspiration pneumonia. Surgical repair is the definitive treatment for EA with TEF, and the surgical approach involves thoracotomy, fistula ligation, and end-to-end esophageal anastomosis. This report describes the case of a 7-day-old male infant who presented with respiratory distress, excessive oral secretions, and an inability to pass a nasogastric tube. Radiographic imaging confirmed the diagnosis of EA with TEF Type C. The infant underwent successful surgical repair, including thoracotomy, fistula ligation, and end-to-end esophageal anastomosis. The postoperative course was complicated by minor wound dehiscence, which healed with secondary intention. The infant was discharged on the 10th postoperative day with no further complications. In conclusion, This case highlights the importance of a multidisciplinary approach involving neonatologists, pediatric surgeons, anesthesiologists, and nurses in the successful management of EA with TEF. Early diagnosis, prompt surgical intervention, and comprehensive postoperative care are essential for achieving favorable outcomes in infants with this condition. With appropriate management, most infants with EA with TEF can achieve normal growth and development.

Two Cases of Acute Urinary Retention in Early Pregnancy: A Rare Obstetric Emergency

2025-03-12T08:28:09+00:00

Acute urinary retention (AUR) is a rare but potentially serious complication in early pregnancy, characterized by the sudden inability to void, resulting in bladder distension and lower abdominal pain. The incidence of AUR in pregnancy is estimated to be around 1 in 3000 to 1 in 8000 pregnancies. While AUR can occur at any gestational age, it is most frequently encountered in the first and second trimesters. A retroverted uterus, where the uterus tilts backward instead of forward, is present in approximately 11-15% of women and is a major contributing factor to AUR. This case series presents two cases of AUR managed at our institution. The first case involved a 28-year-old woman, gravida 2, para 1, who presented at 14 weeks and 3 days gestation with continuous suprapubic pain and a sensation of incomplete bladder emptying. The second case involved a 38-year-old woman, gravida 6, para 3, who presented at 9 weeks and 2 days gestation with an inability to void since the previous night, along with suprapubic pain and a sensation of incomplete bladder emptying. Both women had a retroverted uterus on ultrasound. Successful management involved bladder decompression with a Foley catheter for 48 hours, followed by bladder training. In conclusion, AUR in early pregnancy necessitates prompt diagnosis and management to prevent maternal and fetal complications. A retroverted uterus is a significant risk factor. Catheterization and bladder training are effective in most cases.

Coiling Versus Stenting for Giant Cavernous Sinus Aneurysms: A Case Report on the Resolution of Oculomotor Nerve Palsy

2025-03-17T04:16:40+00:00

Giant intracranial aneurysms (GIAs), defined as those exceeding 25 mm, represent a subset of cerebrovascular lesions with significant potential for morbidity due to mass effect and rupture. Compression of cranial nerves, particularly the oculomotor nerve (N. III), by these aneurysms can lead to debilitating symptoms such as ptosis, ophthalmoplegia, and diplopia. Endovascular management, including coiling and stenting, offers minimally invasive treatment options, but the optimal approach remains a subject of ongoing investigation. We present a case of a 28-year-old male with a giant aneurysm of the right cavernous sinus who presented with progressive right oculomotor nerve palsy, characterized by marked ptosis and visual impairment. Initially scheduled for stent placement, the patient underwent endovascular coiling following diagnostic digital subtraction angiography (DSA). Serial neurological assessments and follow-up DSA evaluations were conducted to monitor treatment efficacy and aneurysm stability. In conclusion, this case demonstrates that endovascular coiling can be a valuable therapeutic strategy for giant cavernous sinus aneurysms manifesting with oculomotor nerve compression. Despite the theoretical advantages of stenting in promoting aneurysm obliteration and reducing mass effect, coiling facilitated significant and sustained clinical improvement, specifically the resolution of ptosis and amelioration of visual deficits in this patient. This case underscores the importance of individualized treatment planning in the management of complex intracranial aneurysms.

Unraveling a Thyroid Collision Tumor: A Rare Case of Concurrent Papillary and Follicular Carcinoma

2025-03-18T02:42:55+00:00

Papillary thyroid carcinoma (PTC) represents the most common thyroid malignancy, accounting for 70-80% of cases, while follicular thyroid carcinoma (FTC) constitutes the second most prevalent differentiated thyroid cancer, comprising 10-15% of thyroid malignancies. The concurrent occurrence of PTC and FTC within the same thyroid gland, known as a collision tumor, is a rare phenomenon, posing diagnostic and therapeutic challenges. This case report aims to describe a unique presentation of this rare entity and discuss its clinicopathological features. We present the case of a 61-year-old female with a history of left thyroidectomy 25 years prior, who presented to our surgical oncology department with a palpable right breast mass. The initial workup revealed metastatic papillary thyroid carcinoma in the breast. Subsequent evaluation of the thyroid bed, including neck ultrasound and fine needle aspiration biopsy (FNAB) of a right thyroid nodule, led to the suspicion of a thyroid malignancy. The patient underwent completion thyroidectomy and central neck dissection. Final histopathological examination of the surgical specimen confirmed the rare diagnosis of a collision tumor, revealing the simultaneous presence of both PTC and FTC within the right thyroid lobe remnant. Immunohistochemical staining further characterized the distinct tumor components. The patient received postoperative radioactive iodine (RAI) ablation and thyroid hormone suppressive therapy. In conclusion, this case underscores the importance of considering the possibility of thyroid collision tumors in patients with thyroid nodules, especially in those with a history of thyroid disease or presentations of metastatic disease from an unknown primary. A comprehensive diagnostic approach, integrating clinical findings, radiological imaging, cytological examination, and detailed histopathological analysis with immunohistochemistry, is crucial for accurate diagnosis.

Unusual Presentation of Malignant Melanoma: A Case of Giant Amelanotic Involvement of the Hand

2025-03-21T03:28:34+00:00

Malignant melanoma, a cancer originating from melanocytes, typically presents as a pigmented lesion. Amelanotic melanoma, a subtype lacking pigmentation, poses diagnostic challenges due to its varied clinical appearance. Acral amelanotic melanoma (AAM), occurring on the palms, soles, and subungual areas, is particularly rare. This case report describes an unusual presentation of a giant amelanotic malignant melanoma on the left hand, highlighting the diagnostic and management complexities. A 45-year-old male presented to the surgical oncology clinic with a three-year history of a progressively enlarging lump on his left hand. Initially small, the lesion rapidly grew in the past year, accompanied by ulceration and bleeding. Physical examination revealed an 8 cm x 6 cm x 4 cm rough-shaped, skin-colored mass with crusting and easily bleeding sores on the left palm. No axillary lymphadenopathy was noted. Histopathological examination of a biopsy sample indicated amelanotic malignant melanoma, which was confirmed by positive HMB-45 staining on immunohistochemistry. Magnetic Resonance Imaging (MRI) revealed a large soft tissue mass infiltrating the muscles of the left hand and causing bone marrow replacement in the 4th and 5th metacarpal bones. The patient subsequently underwent wrist disarticulation. Postoperative follow-up at one and six months showed good recovery without recurrence. In conclusion, this case underscores the importance of considering amelanotic melanoma in the differential diagnosis of unusual hand lesions, even in the absence of typical pigmentation. Proper histopathology and immunohistochemistry are crucial for accurate diagnosis and to rule out other malignancies. This report contributes to the limited literature on giant AAM of the hand and highlights the surgical management of this rare entity.

Rare Presentations of Male Breast Cancer: A Case Series Highlighting Diagnostic and Therapeutic Challenges

2025-03-24T05:29:13+00:00

Male breast cancer (MBC) is a rare disease with a rising incidence, accounting for less than 1% of all breast cancer cases. It typically presents in older men and outcome-based studies in adolescent and young adult (AYA) males are scarce due to its rarity. This case series aims to highlight the diagnostic and therapeutic challenges encountered in two rare presentations of MBC. The first case involved an 18-year-old male who presented with left chest pain and a rapidly growing breast mass. Histopathological analysis revealed invasive ductal carcinoma (IDC) NST grade III with positive margins, staged as cT2N0M0. He also presented with anemia and elevated transaminase enzymes. The second case was a 59-year-old male with a history of mucinous adenocarcinoma of the right breast who presented with the right arm and shoulder pain and a supraclavicular mass. Imaging revealed extensive metastatic disease in the lungs, liver, and bones, and he was diagnosed with cT2N3cM1. Both patients underwent different treatment approaches based on their disease stage and presentation. In conclusion, MBC, especially in AYA patients, presents unique diagnostic and therapeutic challenges due to its rarity and potential for aggressive behavior. These cases underscore the importance of considering MBC in differential diagnoses, even in younger males, and the need for tailored treatment strategies based on the specific clinicopathological features and stage of the disease. Early detection, comprehensive nodal evaluation, and adherence to established treatment guidelines are crucial for improving outcomes in MBC patients. Further research is warranted to better understand the biological characteristics and optimal management of MBC in rare presentations and younger populations.

Neutrophil-Lymphocyte Ratio as a Predictor of Ulcer Severity in Type 2 Diabetes

2025-03-24T08:28:32+00:00

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder with increasing global prevalence, frequently complicated by foot ulcers. These ulcers present a significant burden, often leading to amputation and increased mortality. The neutrophil-lymphocyte ratio (NLR), a readily available marker of systemic inflammation, has emerged as a potential prognostic indicator in various diseases. This study investigated the correlation between NLR and the severity of foot ulcers in patients with T2DM. A retrospective, cross-sectional study was conducted, analyzing data from 60 patients with T2DM and foot ulcers admitted to Dr. Moewardi General Hospital, Surakarta, between January 1^st, 2022, and December 31^st, 2023. NLR was calculated from routine complete blood counts. Ulcer severity was graded using the Meggitt-Wagner classification. Statistical analysis included Spearman's rank correlation and Kruskal-Wallis tests. Our study found a significant correlation observed between NLR and ulcer severity (ρ = 0.524, p < 0.001), with NLR values increasing with ulcer grade. Amputation was significantly associated with ulcer severity (p=0.009). In conclusion, NLR is a valuable and readily available biomarker for assessing the severity of foot ulcers in patients with T2DM. Elevated NLR is associated with more severe ulcers and a higher likelihood of amputation. Incorporating the assessment of NLR into the routine evaluation of patients with diabetic foot ulcers can aid in risk stratification and guide clinical management.

Rare Presentation of Emphysematous Cystitis with Culture-Proven Urosepsis in a Geriatric Female: A Case Report

2025-03-25T05:01:02+00:00

Emphysematous cystitis (EC) is a rare and potentially life-threatening infection of the bladder wall characterized by the presence of gas. It predominantly affects elderly females with diabetes mellitus. While the clinical presentation can vary, it commonly involves symptoms of urinary tract infection. This case report describes an unusual presentation of EC in a geriatric female complicated by culture-proven urosepsis. A 66-year-old female with a history of type 2 diabetes mellitus presented to the emergency department with fever, dyspnea, and tachypnea. She reported suprapubic pain, dysuria, and foul-smelling, murky urine for two days. Initial laboratory findings revealed leukocytosis, hyperglycemia, and elevated procalcitonin levels, indicating sepsis. Computed tomography (CT) of the abdomen and pelvis revealed air foci within the bladder wall, consistent with EC. Blood and urine cultures grew Escherichia coli resistant to multiple antibiotics but susceptible to amikacin and gentamicin. The patient was treated with intravenous amikacin and showed significant clinical improvement, with subsequent negative urine cultures. In conclusion, our study highlights a rare presentation of emphysematous cystitis complicated by culture-proven urosepsis in a geriatric female with multidrug-resistant Escherichia coli. Prompt diagnosis using CT imaging and appropriate antibiotic therapy based on culture sensitivities led to a successful outcome. This case underscores the importance of considering EC in elderly diabetic patients presenting with sepsis and urinary symptoms, even with atypical features.