Academic Journal of Surgery

Acute incidence of Inflammatory bowel disease and Guillain-Barré syndrome following COVID-19 vaccination

2024-09-10T07:26:24+0430

Background: Since 2019, the Covid-19 pandemic has led to the manufacturing of a wide range of different
types of vaccines with different mechanisms of action. The data collected from various studies indicate that
complications such as injection site pain, headache, fatigue, fever, and malaise are the most common side effects
of Covid-19 vaccination. The most common site-specific complications in the gastrointestinal tract and nervous
system in different studies were diarrhea, abdominal pain, nausea, vomiting, dizziness, headache, myalgia,
peripheral neuropathy, and demyelinating diseases, respectively. In this study, we report a case that developed
complications such as Guillain-Barré syndrome and Crohn’s colitis following Sinopharm/BBIBP COVID-19
vaccination. The course of Crohn’s disease (CD) was also complicated by CMV, and the patient developed
fulminant colitis, which led to peritonitis.
Case presentation: The patient was a 36-year-old Caucasian male who presented with severe generalized
abdominal pain, nausea, vomiting, fever, dyspnea, and fatigue 4 days prior to admission. He mentioned a
recent hospitalization due to bilateral ascending paraparesis, which was diagnosed as Guillain-Barré syndrome
and treated with intravenous immunoglobulin. He also complained of watery diarrhea for a few weeks. The
mentioned symptoms occurred following the injection of the Sinopharm/BBIBP COVID-19 vaccine. Due to the
presence of pneumoperitoneum on chest radiography, the patient was transferred to the operating room with a diagnosis of generalized peritonitis and underwent midline laparotomy. On exploration of the abdominal cavity, the colon was perforated at two points: the sigmoid colon and the transverse colon. Signs of inflammation were observed around the perforated edges, but not elsewhere. The patient underwent an extended left hemicolectomy with end colostomy. The postoperative pathology report was consistent with CD, showing transmural chronic inflammation, deep fissuring ulcers, and cryptitis in the surgical specimen. Additionally, the immunohistochemical study for CMV was positive.
Discussion: Inflammatory bowel disease (IBD) is a chronic gastrointestinal inflammatory disease with a wide
spectrum of extraintestinal manifestations. Due to the incidence of IBD and Guillain-Barré syndrome in the
mentioned patient following vaccination, there is a possibility of the same pathogenesis for both diseases. The
incidence of Guillain-Barré syndrome as one of the extraintestinal complications of IBD has been reported
in numerous studies as a result of the coexistence of both diseases. Also, according to the recent history of
vaccination in a previously healthy individual, it is possible to justify the association of Guillain-Barré syndrome
and IBD with the vaccine. So far, many studies have reported the development of Guillain-Barré syndrome
following vaccination, but to the best of our knowledge, no studies have reported IBD following Covid-19
vaccination yet. Another issue in this patient was the complication of Crohn’s colitis with CMV. Despite the
7-8-fold higher incidence of CMV infection in patients with IBD, the role of CMV infection in Crohn’s colitis
has not been determined.

Sigmoid Duplication a Rare Cause of Colon Obstruction Due to Fecal Material Bezoar; A Case Report

2024-09-10T07:26:24+0430

Intestinal duplication is a rare congenital disorder that can occur anywhere in the gastrointestinal tract. The
pathophysiology of duplications remains unclear, and various theories have been proposed. This report presents a case of a young man who came to the clinic with constipation and obstructive defecatory syndrome. Preoperative colonoscopy and imaging revealed no abnormalities in the colon. During the operation, a large colon mass was found and resected, and a primary colocolic anastomosis was performed laparoscopically. After specimen extraction, the colon was cut to assess the etiology. A congenital duplicated lumen of the sigmoid was found, with an accumulation of fecal material in the second lumen causing pressure and obstructing the main lumen. Duplications are a rare cause of intestinal obstruction and should be considered in the differential diagnosis of chronic or partial obstruction. This appears to be the first reported case of laparoscopic resection of sigmoid duplication in an adult man with chronic constipation in the literature.

Acute Aortic and Carotid Dissection Presenting with a Headache, a Case Report

2024-09-10T07:26:24+0430

Background: Aortic dissection is an uncommon medical emergency with an incidence rate of approximately
three per 100,000 people; the diagnosis of aortic dissection is often missed in the absence of chest pain in
approximately 6% of cases.
Case Presentation: There was a 53-year-old man with a history of migraines and high blood pressure who
woke up in the morning with a severe headache and was diagnosed with carotid dissection and thoracic aortic
dissection involving the ascending aorta and descending aorta.
Conclusion: Aortic dissections rarely present with severe headaches as their initial symptom, but aortic dissections with carotid artery dissections are typically accompanied by headache; it is important to keep in mind that the sudden onset of a frontal headache may necessitate sonography of the carotid arteries and echocardiography.

Suture Granoloma Mimicking Bladder Stone: A Diagnostic Challenge

2024-09-10T07:26:24+0430

Bladder stones are a rare complication of urinary stones, with a higher prevalence in male patients. They can be categorized as primary or secondary, with secondary bladder stones often associated with underlying conditions such as bladder outlet obstruction, urinary tract infections, and foreign bodies. This case report presents the surgical intervention for a 27-year-old woman with a history of mental retardation and asthma who presented with urinary incontinence and other urinary symptoms. Imaging confirmed the presence of a large bladder stone attached to a nylon suture string. The stone was successfully fragmented and removed, and the suture material was cut and extracted. Follow-up showed resolution of symptoms, and the patient was discharged with appropriate medication. This study highlights the association between bladder stones and foreign bodies, particularly suture materials used in vesicle surgeries. Previous studies have reported bladder stone formation related to both absorbable and non-absorbable sutures. This emphasizes the need for further research to investigate preventative measures and the choice of suture materials to minimize the risk of bladder stone formation. It is important for clinicians to be aware of this potential complication when performing bladder surgeries and to consider alternative suturing techniques or materials to reduce the risk of stone formation.