Faculty Bibliography

Introduction: Splenic abscess is a rare, potentially lethal condition, with autopsy studies showing incidence rates between 0.14-0.7%. Mortality rates ranging from 47 to 100% making early diagnosis and prompt intervention vital. Several case reports have documented post surgical splenic abscess, most notably after laparoscopic sleeve gastrectomy. To the best of our knowledge, there has not been any reported cases of splenic abscess arising after laparoscopic cholecystectomy. It is important to remember this disease process for expeditious targeted treatment in future cases. Case Presentation: A 69 year-old female with past medical history significant for cholilithiasis, hypertension, and hyperlipidemia presented to the emergency department (ED) with a chief complaint of abdominal pain for two days. Labs and imaging were obtained which confirmed the diagnosis of choledocholithiasis and pancreatitis. ERCP was performed which showed a 1.5 cm stone causing obstruction, with several other smaller filling defects. The stones were removed after sphincterotomy. Post procedurally, the patient underwent an uncomplicated laparoscopic chole-cystectomy on Hospital Day (HD) $5. Post operatively, the patient had persistent leukocytosis peaking at 16.8 thousand on postoperative day (POD) $6. A CT scan was performed which showed a rim-enhancing splenic collection measuring 6.692.2 cm suggestive of an abscess. Interventional radiology was consulted and aspirated 50 ml of purulent fluid. Cultures grew out Klebsiella pneumoniae and Enterobacter cloacae complex, and the patient was discharged home on Zosyn. Discussion: Laparoscopic cholecystectomy has become the cornerstone in treatment of symp-tomatic biliary colic and acute cholecystitis. Of the many recognized complications of laparoscopic cholecystectomy, splenic abscess has not yet been reported in current literature. The nonspecific signs and symptoms of splenic abscess make clinical diagnosis difficult. The classic triad of fever, palpable spleen and left upper quadrant pain are only seen in about two-thirds of patients. CT scan has been shown to be the most sensitive imaging modality for diagnosis of splenic abscess. Current treatment options for splenic abscess are broken down into two subsets: percutaneous and surgical intervention. Percutaneous treatment includes image guided aspiration with or without placement of drainage catheter. Surgical intervention can be either laparoscopic or open and includes drainage of abscess with splenectomy or splenic conservation. The best treatment option remains unclear, and there is lacking prospective data demonstrating which modality is superior

Splenic abscess is a rare disease that has several predisposing factors. Case reports have documented post-surgical development of splenic abscesses, most commonly after laparoscopic sleeve gastrectomy. We present the case of a 69-year-old female with gallstone pancreatitis who underwent an uncomplicated laparoscopic cholecystectomy. The hospital course was complicated by persistent postoperative leukocytosis with a CT scan demonstrating a moderate sized splenic abscess. Interventional radiology was consulted for percutaneous drainage, and the patient was subsequently discharged home in stable condition. Splenic abscess is an important entity to remember as it is associated with significant mortality. Prompt treatment is vital for improving patient survival. Image guided percutaneous interventions have been increasing used and carry numerous benefits compared to surgical approaches. However, there is a paucity of data comparing the efficacy of percutaneous and surgical therapies. Percutaneous interventions can be successfully performed when the abscess is unilocular/bilocular, has a discrete wall, has no internal septations, or has thin liquid content. Further investigation through multicenter, prospective, randomized clinical trials are needed to analyze treatment options.

INTRODUCTION: Most cases of appendicitis associated with lymphoma reported in literature are in patients with Burkitt's or large B-cell lymphoma. Mantle cell lymphoma only makes up 4% of all lymphoma cases in the U.S. We report a case of a patient with mantle cell lymphoma presenting with acute appendicitis. PRESENTATION OF CASE: A 75 year old male with a history of left cervical lymphadenopathy biopsied to be mantle cell lymphoma presented with right lower abdomen pain for 3 days. An outpatient CT scan revealed acute appendicitis. Laparoscopic appendectomy was performed without any complication. The histologic examination showed mantle cell lymphoma occluding the lumen of appendix. DISCUSSION: Typically, appendicitis is caused by obstruction of the lumen of appendix by fecalith or lymphoma. A previously reported case of a patient with mantle cell lymphoma who developed appendicitis received chemotherapy before appendectomy. The author could not determine how mantle cell lymphoma contributed to appendicitis because the lumen of appendix was not occluded by the lymphoma, likely from cytoreduction from chemotherapy. We have a patient with mantle cell lymphoma before the patient received chemotherapy who presented with appendicitis. The appendiceal specimen shows the lumen filled with mantle cell lymphoma. CONCLUSION: This is a rare case of mantle cell lymphoma causing obstruction of appendiceal lumen and subsequently appendicitis, unaffected by chemotherapy.

Trauma is one of the most common causes of teeth loss. Assault with a gunshot and bullet shot is life threatening, and for patients who survive the injury, it results in hard and soft tissue loss in the tissues and organs crossed by the bullet. The tissue loss results in the loss of structure and function. Rehabilitation of these patients to function and aesthetics requires surgical and prosthodontic procedures over time. This report is of a 24-year-old male patient who had a bullet injury resulting in hard and soft tissue deficiency. The ridge deficiency was augmented with iliac bone graft, and 3 months later, implants were placed. Five months later, hybrid prosthesis was delivered. At 3-year follow-up visit, the hybrid prosthesis was replaced with porcelain fused to a metal bridge. The bone levels on all the implants were stable.