European Journal of Molecular & Clinical Medicine

Background:As an uncommon cause of portal hypertension, splenic arteriovenous fistula (SAVF) may show as stomach discomfort, diarrhea, ascites, and/or hematemesis. Formation of a fistula may be traumatic or spontaneous..^[1,2]
Case Presentation : A 7 years old Female with history of recurrent episodes of hematemesis, endoscopy in 2021 showed tortous esophageal varices with multiple site of bleeding, Thoraco-abdominal CTA in 2021 showed thrombus in portal vein and Splenomegaly. During operation there was incidental finding of SAVF, the fistula then ligated and followed by retrograde thrombectomy portal vein and distal splenorenal shunt. Post operative abdominal ultrasound showed portal vein diameter 6mm with velocity 15.7cm/s, there was no recurrent hematemesis and patient was discharge on 7^th day post operation.
Disscussion : Several misunderstandings regarding shunt surgery in the pediatric age range, such as increased failure rates in children less than 10 years, especially those with veins smaller than 10 mm in diameter. No long-term evidence exist to support these assumptions. Moreover, shunts are cost-effective, less distressing psychologically than recurrent endoscopic operations, and promote normal physical growth in youngsters. [4,5] Distal splenorenal shunt surgery provides a safe and reliable alternative to recurrent endoscopic operations for the avoidance of bleeding and improvement of hypersplenism in children with portal hypertension, according to a study published in the journal Pediatric Surgery.

Idiopathic orbital inflammation (IOI) is a benign, non-infective clinical syndrome
characterized by inflammation of the orbit without identifiable local or systemic disorders. Orbital
myositis is one classification of IOI and rare in adult male patients. In this article, we report a 41-yearsold
male who presented to the eye clinic with swollen, redness, pain, chemosis, and squints on his left
eye 2 weeks ago. He had a history of recurrent swollen on his left eyelid and self-treated with
methylprednisolone. Visual acuity on right and left eye were 20/25 and 20/30, respectively. The
intraocular pressure on the right and left eyes were 18 mmHg and 24 mmHg, respectively. No
abnormality in the fundus examination. There was a restriction on the left eye movement to all gaze,
and the eye was fixed to the superior temporal direction. Head MRI-scan showed hypertrophy of the
lateral and medial rectus muscles on the left eye without any other abnormality in the intracranial
cavity. The laboratory examination showed leukocytosis, neutrophilia, lymphopenia, normal thyroid
function, low C-Reactive Protein level, and a negative result for the antinuclear antibody test and antids-
DNA test. The patient was diagnosed with myositis of idiopathic orbital inflammation and was
treated with a high dose of methylprednisolone 1 mg/kg BW/day. Two weeks later, the patient had
improvement in his eye movement and the swollen was resolved. The treatment is still ongoing. Finally,
we can conclude that comprehensive evaluation and treatment with high-dose corticosteroid results in a
better outcome in an adult male patient with myositis IOI.

Spontaneous esophageal rupture is a rare clinical condition, occurs most often in the lateral,
lower 1/3 of the esophagus and is associated with a mortality rate of 20–75%. As a result of
these nonspecific findings, Spontaneous esophageal perforation is often misdiagnosed as an
aortic emergency, pericarditis, myocardial infarction, pulmonary embolus, spontaneous
pneumothorax, perforated peptic ulcer, or pancreatitis .We outline 6 cases of spontaneous
esophageal perforation came to our institution and will discuss about their diagnosis ,required
interventions ,complications and 2-year follow up.

Sebaceous glands are exocrine glands that constitute an integral part of the skin. Ectopic sebaceous glands commonly seen in the buccal mucosa and the lateral part of the vermillion border of the lips in the oral cavity are called fordyce granules and are observed in 80% of the population. Sebaceous elements in odontogenic cysts are relatively rare. Pluripotency of odontogenic epithelium explains the concurrent occurrence of sebaceous glands with odontogenic cystic lesions. A case report of orthokeratinized odontogenic cyst with sebaceous differentiation in a 24-year-old male patient is discussed in this article with emphasis on histogenesis, literature review and differential diagnosis.

Acquired angioedema is a rare complication of systemic lupus erythematosus (SLE). It is generally secondary to C1 inhibitor deficiency due to antibody formation directed against the C1 inhibitor molecule. Face, mouth, tongue, lips, extremities and genitalia are generally involved but also respiratory and gastrointestinal mucosa may be affected. We report a case of a young woman with SLE who presented a severe airway obstruction caused by angioedema. We discuss her diagnostic and therapeutic management including a review of the literature.