Search

Abstract: Prolonged air leak (PAL) represents the most commonly encountered complication following pulmonary resection. This review aims to show the role of autologous blood pleurodesis (ABPP) in the management of PAL. A search was conducted on the Web of Science, PubMed, MEDLINE, and Google Scholar for English-language articles until September 15, 2023, with titles containing the related phrase "autologous blood patch pleurodesis (ABPP), and prolonged air leaks." Included studies comprised four randomised controlled trials, ten cohort studies, a case series, and nine case reports from various countries. Patients undergoing ABPP had a mean age of 52.7 years. Autologous blood volumes for pleurodesis varied (50 mL to 250 mL). Approximately 73.8% of cases responded to ABPP in 1 to 30 days (mean 3.75 days), and in-hospital complications were infrequent (3.9%). Follow-up durations post pleurodesis were up to 20 months. The evidence presented in this systematic review supports the role of ABPP as an effective and safe intervention for managing PAL, particularly after pulmonary resection., (Copyright © 2024 Copyright: © 2024 Indian Chest Society.)

The occurrence of crystals in semen is rare, with spermine phosphate crystals being the only type commonly described. Uric acid crystal formation is significantly influenced by pH levels. The present study reported a rare case of uric acid crystals in the semen of a patient with azoospermia associated with Sertoli cell-only syndrome (SCOS). A 28-year-old male with a four-year history of primary infertility underwent clinical assessment, including a normal physical examination with small testes. Seminal fluid analysis revealed abnormal uric acid crystals. Elevated follicle-stimulating hormone, luteinizing hormone and prolactin levels were observed. The diagnosis of SCOS was confirmed through testicular sperm aspiration. Azoospermia is a medical condition characterized by the absence of sperm in the semen, specifically the absence of sperm in the pellet obtained after centrifugation. It is classified into two primary types: Obstructive and non-obstructive azoospermia. Non-obstructive azoospermia is subdivided into three categories: SCOS, hypospermatogenesis and maturation arrest. The occurrence of SCOS in azoospermic males ranges from 26.3 to 57.8%. The diagnosis of azoospermia with SCOS can be achieved through the analysis of multiple semen samples, medical history, physical examination, hormonal analysis, histopathological examination and genetic testing. The presence of uric acid crystals in seminal fluid was first reported in patients with chronic prostatitis symptoms in 2005. Despite the rarity of crystals in semen, uric acid crystals were found in the semen of an azoospermic male with SCOS., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2024, Spandidos Publications.)

Background and Aims: Behçet's disease is a chronic, multisystemic, and relapsing inflammatory disorder. It lacks a permanent cure, the focus of treatment is on mitigating symptoms, decreasing the frequency and severity of relapses, and preventing life-threatening complications. This study aims to report the experience of a single center in managing patients with Behçet's disease and discuss the treatment outcomes., Methods: This study was a retrospective case series conducted over 2 years. All cases were clinically diagnosed according to the International Criteria for Behçet's Disease. The extracted data were demographics, family history, clinical findings, criteria scores, treatment, and outcomes., Results: A total of 31 patients were included, consisting of 13 males (42%) and 18 females (58%). Most cases were over the age of 30, and both genders were nearly equally distributed among age groups. The most commonly affected site was the oral cavity, observed in 96.77% of cases. Genital, cutaneous, and vascular involvements were more common in males, while females were more likely to have oral, ocular, and musculoskeletal involvements. For various treatment regimens, oral, cutaneous, vascular, and musculoskeletal involvements showed complete response in all cases. Among cases with genital involvement, complete response was achieved in seven cases (41.2%), while four cases (23.5%) showed only partial response, and six cases (35.3%) experienced recurrence. In cases with ocular involvement, only partial responses were observed., Conclusion: Oral, cutaneous, vascular, and musculoskeletal involvements may have a higher likelihood of a complete response to treatment regimens. However, genital involvement may be the most recurrent manifestation, followed by ocular involvement., Competing Interests: The authors declare no conflict of interest., (© 2024 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Urolithiasis is a common disease that affects approximately one-fifth of the global population. This systematic review explores the predictive role of inflammatory markers for the spontaneous passage of ureteral stones. The literature was systematically searched via Google Scholar, PubMed/MEDLINE, the Cochrane Library, Science Direct, CINAHL, Web of Science, and EMBASE databases to identify papers published until 2023. Overall, 26 articles were identified, of which 10 were excluded. The remaining 16 papers reported 2,695 patients (1,723 males and 972 females), with 1,654 (61.37%) experiencing spontaneous stone passage (SSP) and 1,041 (38.63%) not experiencing it (non-SSP). Stones located in the upper part of the ureter were less likely to pass spontaneously (152/959, 15.94% in the SSP group vs. 180/546, 32.48% in the non-SSP group; p < 0.001). Mid-ureteral stones were present in 180/959 (18.75%) of the SSP group compared to 84/546 (14.52%) of the non-SSP group (p = 0.0974). Lower ureteral stones were more likely to pass spontaneously, with 627/959 (63.31%) in the SSP group compared to 282/546 (49.36%) in the non-SSP group (p < 0.001). No significant correlation was found between most inflammatory markers and SSP (p > 0.05). However, procalcitonin levels were lower in the SSP group compared to the non-SSP group (132.7 ± 28.1 vs. 207 ± 145.1, respectively) (p < 0.001). This systematic review has revealed that except procalcitonin, most inflammatory markers do not offer significant predictive capability for ureteral SSP., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Mullerian anomalies occur as a result of errors during embryogenesis. The estimated incidence of these anomalies is around 1% in the general population and 3% in women complaining of suboptimal reproductive outcomes and infertility. A 21-year-old female patient was referred to our hospital due to primary infertility for 18 months. After a proper history, physical examination and further diagnostic steps, including ultrasound and magnetic resonance imaging, a diagnosis of complete septate uterus with septate cervix and longitudinal vaginal septum was made. Following hysteroscopic resection of all the septa and two cycles of ovulation induction, the patient was able to conceive. However, she needed cervical cerclage later due to cervical insufficiency. The baby was delivered at term and was healthy. A uterine, cervical and longitudinal vaginal septum is a unique entity of Mullerian anomalies. Resection of all septa through a hysteroscopic approach resulted in a good outcome for our patient., Competing Interests: None declared., (Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2024.)

Introduction and Importance: A sacrococcygeal teratoma (SCT) is a rare embryonal tumor that emerges in the sacrococcygeal area. It affects one in every 35 000-40 000 live births. Herein, we report a case of a substantial SCT in a neonate., Case Presentation: A neonate girl from consanguineous parents was delivered by cesarean section with a large mass (18×17 cm) in the sacrococcygeal area. The baby's birth weight was 5 kg, of which 2.5 belonged to the mass. The vital signs were within normal ranges and she had weak movement with bluish peripheral limbs. Oxygen saturation was around 85% for a short period after birth. According to the American Academy of Pediatric Surgical Section, the tumor was type I. After the fifth day of delivery, a complete resection was done through a chevron incision. The patient was put on 'nil by mouth' for about 24 h and given intravenous fluid., Clinical Discussion: The histopathological examination of the surgical specimen confirmed extragonadal immature teratoma. The histological classification of SCT is divided into three types: malignant teratomas (consisting of malignant germ cells); immature teratomas (incompletely differentiated structures with a high risk of malignancy or embryonal components); and mature teratomas (fully differentiated tissues)., Conclusion: SCT has rarely been reported as a giant mass. Radiologic examinations in the early stages of pregnancy may be essential to the early diagnosis of the condition., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction: It is crucial to be aware of post-COVID-19 non-pulmonary complications. Avascular necrosis (AVN) is one of these complications. It should be noted that the risk of AVN persists in individuals who have recovered from the COVID-19 infection. The current study aims to report several cases of AVN after being infected with SARS-CoV-2., Materials and Methods: This is a single-centre retrospective case series conducted over a 2-year period (January 2021-December 2022) involving individuals who developed AVN after being infected with COVID-19., Result: The study included a total of 17 patients. The mean age of patients was 38.65±6.1 years. Twelve of them were male (70.6%) and five were female (29.4%), with a ratio of 3:1. The mean BMI of the patients was 28.3±2.4 kg/m 2 . Eleven (64.7%) patients reported administering steroid injections throughout the infection course. The mean interval between COVID-19 infection and presentation to the clinic was 6.53 months. The majority of patients (82.3%) complained of bilateral hip pain. Limping was observed in 47% of the cases. MRI showed AVN in all cases. Bilateral core decompression was performed in five cases (29.4%), total hip replacement in three cases (17.6%), and conservative treatment in nine cases (53%)., Conclusion: The ongoing pandemic may have many long-term sequelae. There is a risk of developing AVN after COVID-19., Competing Interests: The authors declare that they have no conflicts of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Various studies on the etiology and other aspects of granulomatous mastitis (GM) have been performed; however, a lot of controversies have arisen. The present study aimed to present the clinicopathological findings and identify the sensitivity and resistance of isolated bacteria in patients with GM. In this cross-sectional study 63 female patients with a confirmed histopathological diagnosis of GM were included. A core needle biopsy was conducted for the patients to obtain a sample for histopathological examination and bacterial culture. In total, 46 types of antibiotics were used to determine the sensitivity and resistance of each isolated bacterial species. All the medical and clinical records of the patients were acquired through the completion of a questionnaire form in person or, if necessary, through the evaluation of their medical records in the database of the relevant center. The majority of the patients were in the premenopausal or perimenopausal period. GM was unilateral in 58.7% of the patients. The most common symptom was pain, followed by fever and chills. The mean ranges of the erythrocyte sedimentation rate, C-reactive protein, IL-6, IL-17, C5a, white blood count, neutrophil-to-lymphocyte ratio, and prolactin tests were significantly elevated in comparison to the normal ranges. In total, nine different bacterial species were isolated from the bacterial culture of the core biopsy samples, and 50% of the isolated bacterial species were sensitive to trimethoprim-sulfamethoxazole. Since there is no consensus on the etiology of GM, any additional studies related to this aspect expand the current understanding of this puzzling condition., Competing Interests: The authors declare that they have no competing interests., (Copyright: © Esmaeil et al.)

Although some recent studies have found that original and generic clopidogrel brands are acceptable and have the same pharmacokinetic and pharmacodynamic properties, there is insufficient evidence to compare the clinical effectiveness and safety of brand and generic clopidogrel. The current study aims to evaluate the clinical safety of brand and generic clopidogrel by comparing clinical outcomes in patients undergoing carotid endarterectomy (CEA)., Method: This was a single centre, parallel-arm, phase III, open-label, and randomized group sequential trial. It was conducted to compare the clinical safety of a brand and three generic clopidogrel forms in patients who have undergone CEA. All enrolled subjects were treated perioperatively with dual antiplatelet (aspirin and clopidogrel). The involved participants were assigned randomly into four groups based on the type of clopidogrel. Safety parameters were measured, including haematoma, blood draining from drainage, mouth deviation, tongue deviation, and stroke. SPSS software was used to perform the data analysis., Results: The trial included 80 patients in total (20 patients per group). Thirty-one (38.8%) patients were male. The mean age of patients was 65.6 years (49-79). Eighteen (22.5%) patients had a history of previous coronary intervention, and seventeen (21.3%) had symptomatic carotid artery stenosis. Overall, Plavix or Piax combined with aspirin were linked to better clinical safety than the other two generic clopidogrel, as the amount of bleeding was nearly two times lower in patients treated with Plavix or Piax (270±92.39 and 271.5±80.60, respectively) compared to PlavigrelAwa or Plavineer (505.7±169.1 and 496.5±174.6, respectively) ( P ≤0.001)., Conclusion: The findings of the current study showed diversity in clinical safety of different clopidogrel formulations that were provided perioperatively in CEA patients., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Early diagnosis and appropriate staging workup are crucial for cancer patients. Whole-body magnetic resonance imaging (WB-MRI) has been proposed as another practical whole-body approach for assessing local invasiveness and distant metastases in patients newly diagnosed with cancer. The current study aimed to evaluate the efficacy of WB-MRI in assessing metastasis in patients newly diagnosed with cancer using histopathologic data as the reference method. A prospective observational study was performed from April 2018 to July 2020. MRI sequences were utilized to acquire anatomical and functional images in three orthogonal planes. The discovery was classified as nodal, skeletal and visceral metastases. Patient-based analysis was used for visceral metastasis and region-based for skeletal, systemic and lymph node metastases. A total of 43 consecutive patients (mean age, 56±15.2 years) were assessed successively. In 41 patients, there was a concordance between the WB-MRI and histological confirmation. The most prevalent site of metastasis was the skeletal system (18 patients). There were 12 individuals with liver metastasis, 10 with lung metastasis and 4 with peritoneal metastasis, with just one brain metastatic lesion found. On WB-MRI, 38 lymph node groups were deemed positive. Out of the total, 66 skeletal locations contained metastases. The accuracy of WB-MRI for nodal, skeletal and visceral metastases was (98.45, 100 and 100%, respectively). In conclusion, WB-MRI in three orthogonal planes, including the diffusion-weighted MRI with background body signal suppression sequence, may be utilized efficiently and accurately for assessing metastasis staging and may thus be utilized in patients with newly diagnosed cancer., Competing Interests: The authors declare that they have no competing interests., (Copyright: © Rashid et al.)

De Quervain's tenosynovitis (DQT) is a painful stenosing tenosynovitis of the first dorsal compartment of the wrist, which may be refractory to conservative treatments. The present study aimed to evaluate the efficacy of ultrasound (US)-guided platelet-rich plasma (PRP) injection for the management of DQT. For this purpose, from January, 2020 to February, 2021, 12 patients with DQT who received the US-guided PRP injection were studied prospectively. All patients were evaluated clinically for pain intensity using the visual analog scale and sonographically prior to treatment. The patients were followed-up at 1 and 3 months after the procedure to evaluate the efficacy of the treatment. In total, 12 hands of 12 female patients with DQT were analyzed in the present study. The post-treatment clinical evaluation revealed complete recovery in 4 (33.3%) of the patients, and 6 (50%) of them had recovered and returned to their daily activities. The sonographic evaluation revealed a significant reduction in the mean retinaculum thickness from 1.84 to 1.069 mm, and mean tendon sheath effusion from 2.06 to 1.25 mm, with only 58% of the cases having tendon sheath effusion at 3 months post-treatment. On the whole, the findings of the present study demonstrate that US-guided PRP injection with needle tenotomy can be used as an alternative non-surgical therapy for patients who do not respond to conventional conservative treatments, particularly in cases with sub-compartmentalization. The use of US may play a crucial role in the treatment of DQT, as improved clinical outcomes can be obtained with US-guided injections, particularly in cases with sub-compartmentalization., Competing Interests: The authors declare that they have no competing interests., (Copyright: © Asaad et al.)

Testicular cancers comprise 1-1.5% of entire cancers in men, and sex cord-stromal tumors include 5% of testicular cancers. This study aims to report a simultaneous Sertoli cell-only syndrome and Leydig cell tumor in the same patient. A 32-year-old man presented with a history of primary infertility for 3 years. Physical examination revealed normal secondary sexual characteristics. Two successive seminal fluid analyses revealed azoospermia. A scrotal ultrasound scan showed a 28 × 27 mm hypoechoic and hypervascular right testicular mass. Right radical orchiectomy and simultaneous left testicular biopsy were conducted. The histopathological examination revealed Sertoli cell-only syndrome and Leydig cell tumor with focal Leydig cell hyperplasia. Reversing fertility following the management of Leydig cell tumor is rarely mentioned in the literature. A study revealed that fertility recovered following 4 months of management in a primary infertile male. However, infertile men with nonobstructive azoospermia due to SCOS can only have a child by testicular sperm extraction technique. Despite the rare occurrence of Leydig cell tumor, it could be seen in association with Sertoli cell-only syndrome in infertile men with azoospermia. Clinical examination and imaging studies are important in these patients as the possibility of having a testicular mass is high among them., Competing Interests: The authors have no conflicts of interest to declare., (© 2022 The Author(s). Published by S. Karger AG, Basel.)

Introduction: Ureteral stone is a worldwide disease and accounts for 20% of all urolithiasis. There is a widespread discussion on the preferred initial treatment method, whether medical or surgical, and each has its pros and cons. In this study, we aimed to assess the role of both ureteral wall thickness around the stone and inflammatory markers in guiding the decision-making process., Methods: In this prospective study, 161 patients who presented with ureteric colic and were diagnosed with ureteral stone with NCCT were included. UWT around the stone was measured, and the NLR and PLR were calculated. The patients were given a single daily dose of tamsulosin 0.4 mg for 4 weeks with weekly follow-up to determine SSP or failure., Results: Of the 161 patients with a mean age 40.12 ± 12.36 SD, 55.9% had a spontaneous stone passage. Receiver operating characteristics showed a cut off value of 2.45 mm UWT of non SSP patients with an 83% sensitivity and 86% specificity. Moreover, there was a significant correlation between higher NLR, PLR and increased UWT (Pearson correlation of 0.314 and 0.426 respectively). The combined higher NLR, PLR and increased UWT were associated with failure of SSP (p-value <0.001)., Conclusion: Many factors play a role in decision making for management of ureteral stones. Our study concludes that patients with high NLR, PLR, and UWT around the stone have lesser chance of SSP using MET. Their rise can be used as predictors to decide early intervention., Competing Interests: There is no conflict to be declared., (© 2022 The Authors.)

Objective: This study was performed to report and analyze the prevalence of permanent facial nerve paralysis following parotidectomy for various benign and malignant lesions in a single center., Methods: This single-center retrospective study included all patients who underwent parotidectomy (total and superficial) for benign and malignant tumors and chronic inflammatory diseases during a 6-year period. Patients who had previously undergone an operation of the parotid gland and those with preoperative facial weakness were excluded., Results: The study included 127 patients ranging in age from 14 to 83 years (median, 45.89 years). Most patients were female (n = 83, 65.4%). The most prevalent procedure was superficial parotidectomy (n = 117, 92.1%), followed by total parotidectomy (n = 6, 4.7%). The average operative duration was 138 minutes (range, 80-400 minutes). Histopathology revealed that 109 (85.8%) patients had benign tumors, 14 (11.0%) had malignant tumors, and 4 (3.1%) had chronic sialadenitis. Only two patients sustained an injury to the cervical branch of the facial nerve., Conclusion: In this single-center experience of parotid surgery, the rates of transient and permanent facial paralysis were acceptably low at 9.0% and 1.6%, respectively, for all pathologies.

Introduction: Heparin-induced thrombocytopenia (HIT) is a rare and serious immune-mediated complication of heparin therapy which is seldom reported in association with COVID-19. This report aims to present a case of accelerated HIT in a severe COVID-19 patient., Case Report: A 63-year-old man presents with symptoms of COVID-19 for one week. He was conscious, ordinated, feverish, and had diffused chest crackles. Initial laboratory tests revealed elevated C-reactive protein of 87.66 mg/dL, elevated D-dimmer of 1258.9 ng/ml, elevated ferritin of 1020 ng/ml, and his platelet count was within the normal range. Polymerase chain reaction (PCR) confirmed the diagnosis of COVID-19. On the 9th day of admission, he developed a progressive worsening of dyspnea. His D-dimmer level significantly increased to 7020 ng/ml, and his interleukin-6 was 27.3 pg/ml. Hence, we started him on unfractionated heparin (UFH) for thromboprophylaxis. On the 12th day of hospitalization, the platelet count dropped from 258000 to 111000 cells/μL. He had a high probability of HIT (4Ts score = 6). As a result, we discontinued UFH and switched him to apixaban. His platelet count normalized (174000 cells/μL) within two weeks of ceasing UHF., Discussion: HIT results from the production of antibodies against platelet factor 4/heparin complexes. It is associated with a diminished platelet count within 5-10 days post heparin initiation. Because thrombocytopenia can occur in COVID-19 patients, HIT is seldom suspected., Conclusion: HIT should be considered a differential diagnosis in COVID-19 patients with thrombocytopenia., Competing Interests: None to be declared., (© 2022 The Authors.)

Introduction: Cushing syndrome is a rare disorder with a variety of underlying etiologies, that can be exogenous or endogenous (adrenocorticotropic hormone (ACTH)-dependent or ACTH-independent). The current study aims to report a case of ACTH-independent Cushing syndrome with adrenal adenoma and nonfunctioning pituitary adenoma., Case Report: A 37-year-old female presented with amenorrhea for the last year, associated with weight gain. She had a moon face, buffalo hump, and central obesity. A 24-hour urine collection for cortisol was performed, revealed elevated cortisol. Cortisol level was non-suppressed after administering dexamethasone. MRI of the pituitary region revealed a pituitary microadenoma, and the CT scan of the abdomen with adrenal protocol revealed a left adrenal adenoma., Discussion: Early diagnosis may be postponed due to the variety of clinical presentations and the referral of the patient to different subspecialists based on their dominant symptoms (gynecological, dermatological, cardiovascular, psychiatric); it is, therefore, critical to consider the entire clinical presentation for correct diagnosis., Conclusion: Due to the diversity in the presentation of CS, an accurate clinical, physical and endocrine examination is always recommended., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction; Pulmonary fibrosis is a frequently reported COVID-19 sequela in which the exact prevalence and risk factors are yet to be established. This meta-analysis aims to investigate the prevalence of post-COVID-19 pulmonary fibrosis (PCPF) and the potential risk factors. Methods; CINAHL, PubMed/MEDLINE, Cochrane Library, Web of Science, and EMBASE databases were searched to identify English language studies published up to December 3, 2021. Results; The systematic search initially revealed a total of 618 articles - of which only 13 studies reporting 2018 patients were included in this study. Among the patients, 1047 (51.9%) were male and 971 (48.1%) were female. The mean age was 54.5 years (15-94). The prevalence of PCPF was 44.9%. The mean age was 59 years in fibrotic patients and 48.5 years in non-fibrotic patients. Chronic obstructive pulmonary disease was the only comorbidity associated with PCPF. Fibrotic patients more commonly suffered from persistent symptoms of dyspnea, cough, chest pain, fatigue, and myalgia (p-value < 0.05). Factors related to COVID-19 severity that were associated with PCPF development included computed tomography score of ≥18, ICU admission, invasive/non-invasive mechanical ventilation, longer hospitalization period, and steroid, antibiotic and immunoglobulin treatments (p-value < 0.05). Parenchymal bands (284/341), ground-glass opacities (552/753), interlobular septal thickening (220/381), and consolidation (197/319) were the most common lung abnormalities found in fibrotic patients. Conclusion, About 44.9% of COVID-19 survivors appear to have developed pulmonary fibrosis. Factors related to COVID-19 severity were significantly associated with PCPF development., (© 2022 The Authors.)

Introduction: Coronavirus disease 2019 (COVID-19) has evolved as a result of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). With the rise of cases worldwide, plenty of potential COVID-19 complications have emerged, including increased susceptibility to subsequent bacterial and fungal infections. This study aims to report four cases of COVID-19 associated with pulmonary mucormycosis., Method: This is a multi-center case series study. Diagnosis of COVID-19 was confirmed by reverse transcriptase-polymerase chain reaction., Result: A total of 4 patients infected with SARS-CoV2 were involved in this study. The majority of the cases were female, aged >42 years old. All patients developed severe symptoms. All of the patients had received steroids, half of them had co-morbidities. The most common computerized tomography (CT) scan findings were pulmonary cavitation and empyema. All of the cases were treated with a combination of surgery and antifungal treatment., Conclusion: As the number of COVID-19 cases rises, enhanced surveillance for co-infections with unusual pathogens should be continued. Clinicians should raise awareness of these deadly infections, which can further aggravate severe COVID-19., Competing Interests: There is no conflict to be declared., (© 2022 The Authors.)

Introduction: Thin-section chest computed tomography is an important diagnostic test and utilized to determine the severity of lung involvement in COVID-19 pneumonia. The goal of this study is to examine the relationship between CT severity and the oxygen saturation level of individuals with COVID-19., Method: This is a single-center retrospective study of COVID-19 patients that were admitted at a COVID-19 hospital. Patients confirming COVID-19 with PCR testing, patients undergoing lung CT-scan and measures of capillary oxygen saturation using pulse oximetry at the time of admission were all included., Result: The total number of the cases were 105. The age was classified into four age groups, with the majority of them falling into the fourth to sixth decade of life (42, 40%). Diabetes was the most common comorbidity disease (29, 27.6%). Pulse oximetry showed hypoxemia in 87 (82.9%) cases. The most common CT finding was ground glass opacities (GGO) (45, 42.9%). The data showed a significant positive correlation between oxygen saturation and CT severity in patients infected with covid-19., Conclusion: These findings support the importance of using pulse oximetry to monitor COVID-19 patients in order to evaluate or even estimate their clinical situations., Competing Interests: There is no conflict to be declared.l, (© 2022 The Authors.)

Introduction: Despite numerous studies regarding neurological manifestations and complications of COVID-19, only a few cases of neurological consequences following complete recovery from SARS-CoV-2 infection have been described., Objectives: The current study aims to present a quantitative meta-analysis of published studies regarding the post-infectious neurological complications of COVID-19., Data Sources: The Web of Science, PubMed, MEDLINE on OVID, and Google scholar were searched for English-language researches published after January 1, 2020., Result: The review of the literature revealed 60 cases - of which 40 (66.7%) cases were male, and 18 (30%) were female. The average age was 44.95 years. Overall, 17 (28.3%) patients had comorbid conditions. Twenty-four (40%) patients were hospitalized during an active COVID-19 infection. The average interval from the COVID-19 infection to the onset of neurological sequelae was 33.2 days. Guillain-Barre syndrome was the most commonly reported neurological condition (15, 25%)., Conclusion: Despite recovery from acute infection, the pandemic highlights the significance of ongoing, comprehensive follow-up of all COVID-19 patients - even those initially were believed to be asymptomatic., (© 2022 The Authors.)

Introduction: Mixed germ cell tumors are uncommon tumors that contain two or more types of malignant, primitive, or germ cell components. This study aims to report a rare case of extragonadal mixed germ cell tumor of the sacrococcygeal area., Case Report: A 4-year-old female presented with lower back swelling for two weeks. It was associated with pain and fever. Investigations showed elevated Alpha-fetoprotein and normal beta HCG levels. Magnetic resonance imaging showed a large well defined heterogeneous mass at the midline of the lower coccygeal region, which displaced the rectum anteriorly without invasion. Surgical dissection of the mass with excision of the coccyx was performed. Afterward, the patient was referred to an oncology center for chemotherapy., Discussion: The emergence of extragonadal germ cell tumors may be caused by a disruption in the migration of primordial germ cells along the urogenital ridge, which then undergo a malignant transformation as a consequence of their microenvironment. Another idea states that extragonadal germ cell tumors occur when germ cells that routinely migrate into the extragonadal region during embryogenesis undergo malignant transformation., Competing Interests: There is no conflict to be declared., (© 2022 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.)

Introduction: Although the rate and severity of complications after coronavirus 2019 disease (COVID-19) resolution is currently unknown, evidence regarding their presence is increasing in the literature. This study presents a series of cases with post COVID-19 short-term pulmonary complications., Methods: This is a single center retrospective case series study. The demographic and clinical data were collected from the center's electronic records. All the included cases were confirmed COVID-19 patients who had pulmonary complications even after their recovery., Results: Nineteen COVID-19 patients were involved in this study. Fourteen of them were male (73.7%) and only 5 (26.3%) cases were female, with a mean age of 52.05 years (26-77). All of the patients developed severe COVID-19 and were admitted to intensive care unit (ICU). The average infection duration was 13.5 days (10-21). The most common complaints after recovery from COVID-19 were shortness of breath, fever, and hemoptysis. Computed tomography scan showed different pulmonary abnormalities between the cases. Different surgical procedures were performed for the patients according to their conditions, such as decortications, lobectomy, and bullectomy. More than half of the patients (n = 10) recovered and were discharged from hospital without complications, five patients were admitted to the ICU, 3 cases developed mucormycosis, and one case passed away., Conclusion: Following the resolution of COVID-19, patients may experience severe pulmonary complications that may last for months and can affect quality of life, ICU admission, or even death., Competing Interests: There is no conflict to be declared., (© 2021 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.)

Introduction: A small portion of Corona Virus disease-2019 (COVID-19) cases associated with co-infections, however occasionally they turn out to be false positive due to possible cross-reactivities. The current report aims to present a rare case of false-positive human immunodeficiency virus (HIV) in a COVID-19 patient., Case Report: A 32-year-old female complaining from thyroid problems referred for thyroid operation. She had mild symptoms of COVID-19. Her preoperative laboratory findings were normal, except for HIV screening test which was repetitively positive. RNA PCR was performed to confirm the diagnosis of HIV, it revealed a negative result. The patient underwent thyroidectomy as planned and was given the required supportive treatment to recover from COVID-19. Two-month follow up revealed that she was negative for COVID-19 on PCR testing, and HIV immunoassay test was no longer positive., Discussion: Due to structural similarities between the spike protein chains of SARS-CoV-2 and some other viruses such as dengue, Zika, and other closely related coronaviruses (SARS-CoV, MERS-CoV), the protein can potentially interfere with the immunoassay tests. Although HIV immunoassay tests have high sensitivity and specificity, false-positive results have been reported, such as in the case of Epstein Barr virus, Influenza vaccination, and the Australian COVID-19 vaccination., Conclusion: Similarity between HIV and SARS-CoV-2 spike proteins can lead to antibody cross-reactivities, yielding false-positive results on immunoassay screening tests., Competing Interests: None to be declared., (© 2021 The Authors.)

Introduction: Coronavirus disease 2019 (COVID-19) has emerged as severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). Recently, various complications have been reported. The aim of the current study is to report a rare case of transverse myelitis after recovering from COVID-19., Case Report: A 34-year-old lady, presented with inability to walk for one day duration due to the lower limb weakness. After two weeks from the recovery of COVID-19; she developed progressive intermittent leg pain, paresthesia and weakness on both sides. Brain and cervical MRI showed evidence of a short segment inflammatory enhancing lesion at upper cervical region (at C1 level). The patient was treated conservatively., Discussion: Transverse myelitis has many different causes, it occurs as an autoimmune phenomenon post-infection and vaccination, or it may result from direct infection or acquired demyelinating disease like multiple sclerosis., Conclusion: Although it is a sporadic finding, SARS-CoV-2 can cause transverse myelitis. The condition responds to medical therapy., Competing Interests: There is no conflict to be declared., (© 2021 The Authors.)

Introduction: Cancer of the breast is the most common cancer among females. The current study aims to report and discuss a rare case of breast cancer in the intermammary region., Case Report: A 61-year-old lady presented with intermammary swelling for three months. Ultrasound examination showed a hypoechoic micro lobulated mass with internal vascularity seated on the chest wall. There was pathological lymphnodes in the right axilla. Core needle biopsy suspected invasive ductal carcinoma of no specific type. The patient was referred to an oncology center receiving 21 cycles of radiotherapy and hormonal therapy., Discussion: The most common site of the occurrence of breast cancer is the upper outer quadrant (found in one-third of patients), followed by the upper inner quadrant (9.4%)-both lower outer and inner quadrants (5.2%) and rarely in the central portion. Intermammary breast cancer is an infrequent finding., Conclusion: Although it is extremely rare, breast cancer could occur in the intermammary region. It has the same management strategy as breast cancer., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Hurthle cell carcinoma (HCC) is a rare type of thyroid cancer while Hodgkin's lymphoma (HL) is an uncommon cancer of the lymphocytes. The synchronous occurrence of HCC and HL in a single person has not been described in the literature. This report aims to present the first case of synchronous HCC and HL., Case Report: A 31-year-old male presented with a right side neck swelling for three months. Laboratory findings revealed elevated thyroglobulin (286.7 ng/ml). Ultrasound (US) examination showed several enlarged lymph nodes (<20mm) in the right side of the neck with increased vascularity. There was also a solitary solid thyroid nodule (23*20mm) in the right lobe. Fine needle aspiration cytology (FNAC) of the right lobe revealed Hurthle cell neoplasm, and right cervical lymph node was suspicious for Hodgkin's lymphoma. Right lobectomy with right lateral cervical excisional biopsy was performed. Histopathology confirmed HCC and HL., Discussion: HCC is a differentiated cancer occurring in old age population. Multiple factors increase the risk of HCC, including the excess iodine, history of thyroid diseases, and exposure to radiation. HL is a cancer of the lymphatic system that affects young adults and older population. There is a significant association between excess body weight and cigarette smoking with the risk of HL., Conclusion: Although extremely rare, occurrence of a few cases of other thyroid carcinomas and HL could occur. However, no relation has been described between the two cancers., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© 2021 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.)

Introduction and Importance: The thymus is a primary lymphatic organ within the mediastinum that plays an essential role in developing and maintaining cell-mediated immunity. The current study aims to report a case of intra-tumoral osseous metaplasia of the thymus gland, which is an infrequent phenomenon., Case Presentation: A 43-year-old male presented with weakness and easy fatigability for 2 months. The patient had an elevated anti-acetylcholinesterase antibody (19.5 nmole/L). Magnetic resonance imaging showed a round, capsulated, enhanced mass in the anterior mediastinum measuring 5.5 × 3.5 cm, suspecting thymoma. The patient underwent plasmapheresis three times in one week, under general anesthesia, in a supine position, sternotomy was performed, and the thymoma was totally resected., Discussion: Thymomas are known to occur in all age groups with the peak of nearly between 35 and 70 years with the median age of 54 years. The sex distribution of thymoma is approximately equal with slight predilection of women in old age groups. However, among all reported cases of thymomas with osseous metaplasia, the majorities are female. The significance of this ossification is still to be clarified., Conclusion: Although it is rare, secondary changes in thymoma may occur including calcification and ossification., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Subcutaneous emphysema is an extremely rare complication after lobectomy. The current study aims to report a case of lung cancer developing extensive subcutaneous emphysema after lobectomy., Case Presentation: A 73-year-old man presented with dyspnea and cough for one month duration associated with wheeze and sputum. He was a chronic heavy smoker (100 pack/year). Work up revealed squamous cell carcinoma. Although he had poor pulmonary function tests, he underwent left upper lobectomy. On the fifth postoperative day, he was discharged from the hospital as there was no air leak and the lung remained expanded 15 hours after clamping of the thoracostomy tube. Two days later, the patient developed generalized subcutaneous emphysema. The patient was re-admitted to the hospital and a thoracostomy tube was inserted. The lung expanded upon insertion while the subcutaneous emphysema remained the same and even slightly increased over night. A 3 cm incision was made at the left infra-clavicular area and a negative pressure applied to it. The subcutaneous emphysema completely subsided a few hours after this intervention., Discussion: Because of the benign course, the majority of cases of subcutaneous emphysema (mild to moderate) only need nonoperative management alongside treatment of the predisposing factors. These patients may need nothing other than bed rest, good analgesia, supplemental oxygen, and reassurance., Conclusion: Subcutaneous emphysema after lobectomy prolongs hospital stay. It mainly occurs in cases with poor pulmonary function tests, steroid use, and those with extensive adhesion., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© 2021 The Authors.)

Introduction: Aneurysm of splenic artery arising from splenomesentric trunk is an extremely rare condition. The aim of this study is to report a new case with literature review., Presentation of Case: A 52-year-old housewife presented with mild central abdominal pain for two month duration. Abdomen was soft. Abdominal ultrasound examination showed a focal aneurysmal dilatation in the splenic artery (SA) near the portal vein. Abdominal computed tomographic angiography (CTA) revealed presence of the splenomesentric trunk with fusiform aneurysm (45 × 33 mm) of the proximal part of the SA. In supine position, through upper midline laparotomy incision, exploration of both superior mesenteric artery (SMA) and SA was performed, total excision of the aneurysm was done, the SMA was side-repaired and SA was ligated. The post-operative period was uneventful., Discussion: It is interesting to note that orthotopic SA aneurysms, most commonly present in the distal third of the artery, followed by the middle third, while in cases of splenomesentric trunk, all reported cases of anomalous SA aneurysms including the current one, showed the aneurysms to be located in the proximal portion or root of the SA., Conclusion: Splenomesentric trunk is a rare anatomical anomaly, aneurysm of which is even rarer. It can be managed either by endovascular intervention or open surgery., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Pin inhalation is an accidental entry of a pin into the respiratory passages. This study aims to shed the light on pin inhalation as a hazard and show the magnitude of such preventable thoracic problem and determine the safest method of management., Patients and Methods: This is a retrospective single center case series, conducted during 18 month period from January 2016 to April 2017, All patients with pin inhalation had been collected and analyzed according to the age, gender, time between aspiration to presentation and symptoms and signs, number of attempts, bronchoscopic or open removal of the pins with complications., Results: The total number of patients in this study was 162. The mean age was 11years. Pin inhalation accident was more common in patients less than 10 years in males and less than 20 years in females. The most common gender was female (73%). The most common presenting symptom was cough (54%). The left tracheobronchial tree was the most common site for pin lodgment 107 (67.3%) followed by the right side 23 (14.4%). The majority of the pins were extracted in one piece (94%). Thoracotomy was done in one patient, no death reported., Conclusion: Sharp pin inhalation is a serious hazard and can have lethal outcome. History is the major parameter to start the diagnosis of pin inhalation and radiography is the gold standard to confirm the diagnosis., Competing Interests: None to be declared., (© 2021 The Authors.)

Introduction: Although some medicines are under research, currently, no specific antiviral drug has been approved to target 2019 novel coronavirus. In this report two severe cases of 2019 novel coronavirus disease (COVID-19) patients have been described who received convalescent plasma (CP)., Case Report: Two male cases (a 46-year-old and a 56-year-old) after being diagnosed with severe COVID-19, they deteriorated despite supportive care and antiviral therapy. They started to improve with CP infusion both clinically and radiologically. Finally they were discharged in a very well condition with negative virology tests., Conclusion: CP might be an effective therapy for severe COVID-19 patients., Competing Interests: None to be declared., (© 2020 The Authors.)

Introduction: Total thyroidectomy represents one of the commonest procedures performed for thyroid diseases. The aim of this paper is to report a rare case of tracheocutaneous fistula after total thyroidectomy., Case Report: A 44-year-age female presented with left side neck swelling for 2 month duration. Neck ultrasound showed a well-defined left thyroid nodule (25 × 15 × 14 mm) with features highly suggestive of malignancy, under general anesthesia total thyroidectomy was performed. On the third postoperative day, the patient came back with neck swelling especially during speaking, there was subcutaneous emphysema, wound opened with residual air leak. Under local anesthesia, the wound opened, there was 10 × 10 mm opening in the anterior aspect of trachea, a tracheostomy was inserted, the patient was sent home after decannulation with an opening in the anterior neck. Twenty days later the tracheal opening closed spontaneously., Discussion: The possibility of a tracheal wall ischemic necrosis is plausible due to cautery use. Some autopsy studies have demonstrated that small branches of inferior thyroid artery form the main blood supply of the upper segment of trachea. These fragile branches have a lateral entry point that can be damaged readily leading to ischemia and necrosis., Conclusion: Ischemic tracheal necrosis, although very rare, is possible after total thyroidectomy, minimal use of electro-cautery is advised whenever possible., (Copyright © 2020. Published by Elsevier Ltd.)

Introduction: Breast pilonidal sinus is an extremely rare variant of the condition, the report aims to present a case of pilonidal sinus occurring in the breast., Case Presentation: A 35-year-old female presented with a left breast discharging lesion for a 5-month duration. There was a local redness with multiple discharging sinuses on her left breast at 3-5 o'clock, 3-4 cm away from the nipple. The discharge was serosanguinous in appearance. The lesion was excised totally with primary closure under general anesthesia. Histopathological examination was consistent with pilonidal sinus., Discussion: For atypical pilonidal sinus disease, surgery is the modality of choice but regarding sacrococcygeal pilonidal sinus, non-operative treatment begins to grow. The cardinal risk factors for recurrence and complications are male gender, family history, tobacco smoking, obesity, size of sinus, poor personal hygiene and surgical methods., Conclusion: Breast pilonidal sinus is an extremely rare variant of the condition. It should be suspected on clinical examination. Surgical excision is the definitive treatment strategy., Competing Interests: Declaration of Competing Interest There is no conflict to be declared., (Copyright © 2019 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Introduction: Zenker's diverticulum is an acquired mucosal pulsion of the upper esophagus. The aim of this paper is to report a case of Zenker's diverticulum with a complicated postoperative course including infection by Acinetobacter baumannii causing diagnostic as well as management dilemma., Case Report: A 43-year-old male complained from dysphagia for three months. Barium swallow revealed Zenker's diverticulum. Under general anesthesia, the small Zenker's diverticulum was ligated and myotomy was done. He developed erythematous swelling at the site of the operation. The patient was taken to the operation theater. The esophagus was tested, no trace of leak was found. The patient developed cardiac arrest. He was admitted to the intensive care unit and remained there for twenty eight days. Bronchial wash culture showed Acinetobacter baumannii. The patient was on antibiotic, supportive treatment and enteral feeding through nasogastric tube. After recovery he was extubated and barium swallow was done which was normal and showed no signs of leak. Three months after the operation, the patient was completely normal., Discussion: This case had a positive culture for Acinetobacter baumannii. It is commonly accounted for nosocomial infections. It has been documented as a serious threat worldwide because of the emerging prevalence of multidrug resistant. However, an inadequate understanding of A. baumannii pathophysiology and ecosystem confines the progress of alternative therapeutic policies. In the current case, it was not clear either leak or Acinetobacter baumannii was the cause of deterioration., Conclusion: Both esophageal leak and infection with Acinetobacter baumannii are fulminant debilitating conditions that could be managed with conservative strategies., Competing Interests: Declaration of Competing Interest None to be declared., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Although hydatid cysts can affect any organ in the body, reports regarding affection of thyroid gland are scanty in the literature. This report aims to present a case of thyroid hydatid disease with literature review., Case Report: A 48-year-old female presented with painless anterior neck mass of about 2 year duration. There was an ill-defined, central anterior neck mass, with a smooth surface and mobile with deglutition. Ultrasound of the thyroid gland revealed an enlarged left lobe of thyroid gland due to well defined thick wall cystic nodule. The patient underwent left thyroid lobectomy under general anesthesia, the pathology report revealed hydatid cyst of thyroid gland., Discussion: Liver and lungs are often the end destination for hydatid cysts, while other places like mediastinum, diaphragm, cardiac, smooth and skeletal muscles, abdominal and chest walls are rarely involved. In this case, the cyst affected even a rarer organ which was the left lobe of thyroid gland. Most of the time the disease is asymptomatic and is found accidentally, yet depending on the site and size of the cysts, symptoms can occur., Conclusion: Hydatid disease of thyroid gland is an extremely rare condition. The main presenting symptom is swelling. Operation under general anesthesia is the only modality of treatment., Competing Interests: Declaration of Competing Interest Here is no conflict to be declared., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Introduction: Phytobezoar which is described as an undigested or incompletely digested food. It is an odd cause of gastric outlet obstruction (GOO). The aim of this study is to present and discuss a case of GOO caused by multiple giant bezoars., Case Report: A 24-year-old female, presented with abdominal pain and vomiting (non-bilious) with negative past history. Examination and investigations revealed multiple giant bezoars requiring emergent surgical intervention. An exploratory laparotomy was conducted. Two giant bezoars were palpated in the stomach and removed through an anterior gastrotomy., Discussion: Bezoars are regarded as rare benign causes of GOO. Bezoars can present with vomiting, nausea, and/or symptoms of GOO. Predisposing risk factors include delayed gastric emptying (as in case of diabetic mellitus) vagotomy, partial gastrectomy pyloroplasty, peptic ulcer disease, chronic gastritis, Crohn's disease, and carcinoma of the gastrointestinal tract. The current case had phytobezoar without any known risk factor., Conclusion: GOO caused by phytobezoar can occur in patients without history of previous gastric surgery or diabetes mellitus. Urgent laparotomy may be indicated., Competing Interests: Declaration of Competing Interest There is no conflict to be declared., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Pilonidal sinus disease is a common perianal inflammatory condition. Currently, operative therapy is the standard management strategy. The aim of this study is to investigate the efficacy of a preparation with antimicrobial, sclerosing, and wound-enhancing properties in the nonoperative management of pilonidal sinus disease., Methods: A parallel randomized controlled trial was conducted between January 2013 and January 2017 to investigate the effect of a mixture of sclerosing agent and herbal product (Lawsonia inermis powder) in the management of sacrococcygeal pilonidal sinus disease. The patients were allocated randomly into the study group (group receiving injection of the mixture into the sinus track) and the control group (group receiving the classic technique of operative excision and primary closure)., Results: This study was conducted among 400 patients, 316 (79%) male, 84 (21%) female. The age range was 18 to 40 years with a mean age of 27.1 years (standard deviation, ±2.4); each group included 200 patients. None of the patients had an abscess or complicated pilonidal disease. Cure rate, defined as complete healing of the sinus, was high among both groups after the first intervention (94% for control group and 89% for the test group, respectively; P = .051). In the study group, there was a statistically significant decrease in hospital stay, cost, perioperative pain, duration of absence from work, and duration of the procedure., Conclusion: According to this trial, the injection of this mixture appears to be better than the other therapeutic options for pilonidal sinus disease in terms of cost effectiveness, time off work, rate of complication, and perioperative pain., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Introduction: Hydatid diseases are cystic parasitic infestation caused by Echinococci. The most frequently affected organs are liver and lung. The aim of this study is to report a rare case of hydatid disease of the thigh., Presentation of Case: A 34-year-old female presented with mild, continuous lower abdominal pain. Concomitantly, she was complaining of gradually increasing swelling of the left thigh for about 9 month duration. On examination, there was tender, 3 × 4 cm, suprapubic mass with firm non-tender 10 × 17 cm swelling at the lateral aspect of left thigh. Magnetic resonance imaging confirmed the diagnosis thigh hydatid cyst. It was managed by surgical resection., Discussion: In endemic regions, hydatidosis can be controlled by several preventive mechanisms including regular medication of definitive hosts by praziquantel, vaccinating sheep, preventing dog's access to intermediate hosts, boiling or safe disposal of offal. The current case reported positive history of animal contact without fulfilling any preventive measure., Conclusion: Hydatid cyst of the thigh is a very rare parasitic manifestation presenting as a painless swelling, diagnosed typically by MRI and managed with en bloc resection., (Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: porocarcinoma is a rare sort of skin cancer developing from sweat glands. Its clinical course and management are not well understood., Objectives: the current meta-analysis is to address the presentation and management of porocarcinoma., Data Sources: Web of Science, PubMed, MEDLINE on OVID and Google scholar were searched for English-language studies published before December 1, 2016., Results: The review of literature revealed 453 cases. From which 222 (49%) cases were male and female were 231 (51%). The mean age was 67.57 years. The mean duration of presentation was 5.57 years ranging from 4 days to 60 years of age. The most common site of affection is the head and neck (39.9%) followed by lower extremity (33.9%). Mass and nodule are the most common modes of presentation. Metastasis occurred at presentation in 110 (31%) cases. The most common organ to which porocarcinoma metastizes is the nearby lymph node (57.7%)., Conclusions: Porocarcinoma is an aggressive skin cancer. Surgery is the main modality of treatment., Systematic Review Registration Number: reviewregistry233.

Introduction: Although cystic duct variation is quite common, duplication of cystic duct is an extreme rare variant. We report a case of double cystic duct with literature review. A 33-year old female presented with right upper quadrant pain of three day duration, associated with nausea and poor appetite. The patient reported previous three attacks of right upper quadrant pain within the last two years. On examination: Murphy's sign was positive and the right upper quadrant was tender. Abdominal ultrasound showed multiple gall stones. Oesophago-gastro- duodenoscopy was normal. Under general anesthesia, four port formal laparoscopy was done, double cystic duct was found. Histopathological examination showed features of chronic cholecystitis., Conclusion: double cystic duct is a very rare variant of the cystic duct anomaly. Identification pre or intraoperatively is very important to prevent ductal injury., (Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.)