Tehran University of Medical Sciences (TUMS) Academic Journal of Surgery 2423-3218 7 0 2024 09 10 1 7 Mohammadmahdi Abbasi Department of General Surgery, School of medicine, Tehran university of medical sciences, Tehran, Iran Ghavam Panahbar Department of General Surgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Aidin Yaghoobi Notash Department of General Surgery, School of Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran 2024 07 14 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. https://ajs.tums.ac.ir/index.php/ajs/article/view/268

Tehran University of Medical Sciences (TUMS) Academic Journal of Surgery 2423-3218 7 0 2024 09 10 8 11 Mahdi Alemrajabi Fellow of colorectal surgery. FCRDC. Iran University of Medical Sciences. Tehran. Iran Morteza Khavaninzadeh Hasheminejad Kidney Center (HKC), Iran University of Medical Sciences. Tehran, Iran Mohammad Moradi Colorectal clinical fellow, Christie NHS Foundation Trust, Manchester, UK Ali dahmardeh Ei Department of general surgery, Shariati Hospital, TUMS, Iran 2024 01 25 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. https://ajs.tums.ac.ir/index.php/ajs/article/view/247

Tehran University of Medical Sciences (TUMS) Academic Journal of Surgery 2423-3218 7 0 2024 09 10 12 17 Alireza Bahmani Department of Emergency Medicine, Khatam Al-Anbia Hospital, Zahedan University of Medical Sciences, Zahedan 2024 08 14 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. https://ajs.tums.ac.ir/index.php/ajs/article/view/275

Tehran University of Medical Sciences (TUMS) Academic Journal of Surgery 2423-3218 7 0 2024 09 10 18 20 Manouchehr Nasrollahzadeh Saravi Tehran pediatrics urology research center Mahdi Mohseni Tehran pediatrics urology research center Simin Vahidi Tehran pediatrics urology research center 2023 11 08 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. https://ajs.tums.ac.ir/index.php/ajs/article/view/242