Laparoscopic cholecystectomy is the standard surgical treatment for gallbladder stones, traditionally performed under general anesthesia with endotracheal intubation. Spinal anesthesia has emerged as a potential alternative for healthy patients. This systematic review compares the safety and efficacy of the aforementioned techniques for laparoscopic cholecystectomy. A systematic search of PubMed, Scopus, and Google Scholar (2010–2025) identified 8 randomized controlled trials (RCTs) involving 718 adult patients (ASA I–III) undergoing elective laparoscopic cholecystectomy. Quality assessment was performed using the Cochrane Risk of Bias 2 (RoB 2) tool. Data extraction focused on operative duration, intra-abdominal pressures, and postoperative complications, including pain and hospital stay. Spinal anesthesia was associated with significantly lower immediate postoperative pain scores and a reduced incidence of shoulder tip pain compared with general anesthesia. Operative durations were comparable between techniques, typically ranging from 30 to 97.2 minutes. Spinal anesthesia required lower pneumoperitoneum pressures for patient comfort and facilitated rapid recovery, with some studies reporting 100% same-day discharge suitability. The risk-of-bias assessment showed four studies at low risk, while four had “some concerns” primarily due to the inability to blind anesthesia providers. Spinal anesthesia is a safe and effective alternative to general anesthesia for LC in ASA I–III patients. It offers superior immediate pain control and supports “fast-track” surgical models through shorter hospital stays. Despite minor technical challenges, spinal anesthesia provides significant physiological and economic advantages in modern laparoscopic practice.
Introduction and importance: Grayanotoxin is found in honey harvested from high-altitude areas where Rhododendron species grow. Grayanotoxin poisoning (GP), also called mad honey poisoning, can occur when honey containing grayanotoxin is ingested. This toxin persistently activates sodium channels and depolarizes cells, which can produce prolonged vagal stimulation, causing hypotension and sinus bradycardia. Case presentation: We present the case of a 36-year-old male with GP. The case presented with abdominal discomfort and multiple episodes of vomiting after consuming honey. On arrival at the emergency department, he was found to have bradycardia and hypotension. Clinical discussion: Patients with GP may present with sinus bradycardia, hypotension, and neurological symptoms, along with nausea, vomiting, vertigo, and headaches. Serious manifestations such as cardiac arrhythmias, seizures, loss of consciousness, and, rarely, atrioventricular block, myocardial infarction, asystole, and hepatotoxicity have also been reported. Lower doses of mad honey may cause milder symptoms, while higher doses may require medical intervention. In this case, the patient was managed with intravenous ondansetron, fluids, and atropine. The patient was discharged after an overnight stay in the hospital, with no complications noted during follow-up. Conclusion: Mad honey poisoning should be suspected in patients who present with clinical manifestations such as bradycardia and hypotension, along with a history of ingesting honey from high-altitude areas where rhododendrons are prevalent.
Introduction/rationale: Pyostercoral phlegmon – a mixed purulent-fecal collection arising from transmural bowel perforation within the hernial sac – is a rare, life-threatening complication of strangulated inguinal hernia, with an incidence <5%, for which optimal management in resource-limited settings remains debated. We report a case successfully treated by one-stage surgery. Patient concerns: A 56-year-old male laborer presented with a 7-day history of painful, irreducible right inguinoscrotal swelling and a febrile obstructive syndrome, on a background of a 10-year history of an untreated hernia. Examination revealed septic shock (BP 90/60 mmHg, HR 120/min, T 38.3°C) and a scrotal fistulous opening draining foul-smelling pus. Diagnostic assessment: Laboratory findings confirmed severe sepsis (WBC, 23 000/mm 3 ; CRP, 126 mg/L; prothrombin time, 66%). The diagnosis was established clinically; no preoperative imaging was performed, given the unambiguous presentation and hemodynamic urgency. Therapeutic interventions: After hemodynamic stabilization with fluid resuscitation and norepinephrine, a one-stage procedure was performed: (1) a midline laparotomy with end-to-side ileocolic resection and anastomosis for cecal and terminal ileal necrosis; (2) a mesh-free Bassini hernia repair via an inguinal approach; and (3) wide scrotal debridement with partial vaginectomy and drainage. Total operative time was 3 hours and 20 minutes. Outcomes: Recovery was uneventful. The patient was discharged on postoperative day 7 (CRP, 62 mg/L; WBC, 11 000/mm 3 ). Complete wound healing and no recurrence were documented at 12 months. Lessons: One-stage surgery combining bowel resection-anastomosis, mesh-free parietal repair, and wide scrotal debridement is safe and reproducible in adequately resuscitated patients. A structured narrative literature review identified 78 published cases worldwide (2000–2025); reported mortality reached 15–20% in the setting of established septic shock. Early diagnosis, aggressive resuscitation, and multidisciplinary collaboration are the critical determinants of outcome.
Introduction: Systemic lupus erythematosus (SLE) is a chronic condition that can affect various organs, including the eyes. Ocular involvement occurs in 30% of patients with SLE, with scleritis being rare. Case report: A 33-year-old Syrian female presented with a painful left eye of 24 hours’ duration, similar to an episode the previous year. No history of medical issues or trauma was noted. Examination revealed sectoral episcleritis with conjunctival hyperemia. SLE was diagnosed on the basis of positive antinuclear antibody and anti-dsDNA tests. The patient was treated with topical prednisolone acetate, methylprednisolone, and mycophenolate mofetil, resulting in symptom improvement within a week. Discussion: Scleritis, an inflammatory condition, can be an early manifestation of SLE. Prompt treatment is necessary to prevent complications. Conclusion: Scleritis can be an early sign of SLE, so thorough examination and consideration of SLE are crucial, even in the absence of systemic symptoms.
