A 65-year-old woman with a long surgical history was referred to our hospital’s Colorectal Unit for ileostomy management. The patient retained an ileostomy for almost a decade after a series of complicated operations she had undergone, which had several side effects such as electrolyte imbalances, high output, weight loss, and a parastomal hernia. Our hospital’s colorectal surgeon proposed to replace the ileostomy with a permanent sigmoidostomy and asked for an imaging evaluation of the parastomal hernia content before the surgery. A computed tomography of the abdomen was performed using our Computed Tomography Department’s 64-detector row CT scanner after oral administration of contrast media, without intravenous contrast media injection due to allergy. Concerning the parastomal ileostomal hernia, besides small bowel loops with intraluminal gastrografin, inside the parastomal hernial sac, there also was an almost rounded cystic lesion. Absence of the gallbladder at its typical position and no record of cholecystectomy raised suspicion for gallbladder projection inside the sac. Our suspicion was confirmed during the surgery. Nonexisting acute cholecystitis allowed easy reduction of the gallbladder along with the small bowel loops inside the peritoneal cavity, without proceeding to cholecystectomy at the same time. Finally, ileostomy was annulated and an end colostomy was established. Four days after the surgery, the patient was discharged from the hospital and was happy to live an almost normal life thereafter.

International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations.IJCRI publishes Review Articles, Case Series, Case Reports, Case in Images, Clinical Images and Letters to Editor.

We are suggesting the preventive implantation of radiopaque landmarks, during SAVRs using tissue valves which are lacking fixed anatomic markers, as a guide for a presumptive TAV-in-SAV procedure, keeping in mind that appropriate guidance is crucial and can prevent valve misplacement, coronary obstruction and other potentially lethal complications.

A 74-year-old male patient was presented with scrotal swelling and a pulsatile mass of the left femoro-inguinal region. His medical history included hypertension, coronary artery disease, respiratory failure, and an aortobifemoral bypass surgery performed 7 years ago. Ultrasound evaluation revealed a massive scrotal hematoma. Computed tomography angiography (CTA) was conducted, confirming the aortobifemoral graft existence and revealing bilateral anastomotic pseudoaneurysms with the left one being ruptured, resulting in extension of the hematoma to the left femoro-inguinal region and the scrotum. An emergency surgery was performed, where proximal control of the left limb of the synthetic graft as well as distal control of the iliac vessels were accomplished. After the control of the hemorrhage, an iliofemoral bypass with a Polytetrafluoroethylene (PTFE) 6 mm synthetic graft was placed. Unfortunately, the patient passed away during the first postoperative day due to myocardial infarction.