Obturator hernia is rare, but it must be considered in elderly patients who present with small
bowel obstruction. The diagnosis is challenging unless there is a high index of suspicion as
the presenting symptoms and signs are usually non-specific. Presence of positive HowshipRomberg sign is considered pathognomonic. Early diagnosis and rapid surgical intervention
will reduce the high morbidity and mortality associated with undiagnosed obturator hernia. We
report a case of a 93-year-old female patient who was admitted to our surgical department with
symptoms of intestinal obstruction of 3-days duration. Howship-Romberg sign was negative.
Computed tomography (CT) demonstrated the presence of left obturator hernia with proximal
small bowel obstruction and no sign of strangulation. The patient had emergency laparotomy
post-CT where the incarcerated bowel loop was released and the obstructed bowel was
decompressed without any complication. The hernial defect was close with a mesh and the
patient had an uneventful recovery post-surgery. In this case, we highlight that diagnosis of
obturator hernia must always be considered in elderly patients who present with intestinal
obstruction. Urgent CT could establish a rapid pre-operative diagnosis and aids in appropriate
surgical intervention planning which is crucial in optimising the outcome.
Intracranial dural arteriovenous fistulae (DAVF) are uncommon and account for approximately 1% of all strokes. All transverse-sigmoid sinus DAVFs require treatment because of the low rate of spontaneous regression and frequent association with aggressive neurologic symptoms. Endovascular embolization which aims for permanent obliteration of the lesion is now the primary treatment modality for all DAVFs. We present a 56-year-old patient with long standing history of intermittent transient ischaemic attack (TIA)-like symptoms. Magnetic resonance (MR) angiography revealed right transverse-sigmoid sinus DAVF and bilateral vertebral arteries occlusion. The patient’s symptoms completely resolved upon successful trans-arterial embolization of the DAVF
Intramuscular shoulder angiomyolipomas are very rare. We report a case in a 22-year-old male with a well circumscribed lesion located on the back of the shoulder. This lesion, differs from renal angiomyolipoma in terms of non-association with tuberous sclerosis, circumscription and male predominance. Another characteristic feature is the absence of epithelioid cells. Differential diagnosis includes lipoma, angiolipoma, angioleiomyoma, hemangioma, myolipoma and liposarcoma. It is distinguished from the above mentioned entities by the presence of a combination of thick-walled blood vessels, smooth muscle and fat.
Intramuscular shoulder angiomyolipomas are very rare. We report a case in a 22-year-old male with a well circumscribed lesion located on the back of the shoulder. This lesion, differs from renal angiomyolipoma in terms of non-association with tuberous sclerosis, circumscription and male predominance. Another characteristic feature is the absence of epithelioid cells. Differential diagnosis includes lipoma, angiolipoma, angioleiomyoma, hemangioma, myolipoma and liposarcoma. It is distinguished from the above mentioned entities by the presence of a combination of thick-walled blood vessels, smooth muscle and fat.