American Journal of Medical and Clinical Research & Reviews

Complicated Subhepatic Acute Appendicitis with Extensive Abscess Involving the Liver and Gallbladder in a Young Adult: Diagnostic and Surgical Challenges, Case Report and Literature Review

2026-05-30T14:03:15+02:00

Subhepatic acute appendicitis is a rare anatomical variant associated with atypical clinical presentations and frequent diagnostic delays, often leading to complicated forms. We report the case of a 23-year-old patient with no significant past medical history, admitted with right flank and right hypochondrial pain evolving over 12 days in a febrile context. Laboratory investigations revealed a marked inflammatory syndrome. Abdominal computed tomography demonstrated perforated subhepatic appendicitis complicated by a localized abscess. Surgical management proved challenging, requiring conversion from laparoscopy to laparotomy, with retrograde appendectomy, drainage, and concomitant cholecystectomy. Postoperative recovery was uneventful. This case highlights the diagnostic pitfalls and technical surgical difficulties associated with subhepatic appendicitis, particularly in complicated forms, and underscores the importance of individualized intraoperative decision-making.

Multivisceral and Iliac Vascular Resection for Recurrent Locally Advanced Colon Cancer: A Case Report

2026-05-22T12:02:47+02:00

Locally advanced colorectal cancers with vascular invasion are rare and represent a major surgical challenge, achieving negative surgical margins often requires multivisceral and vascular resection. We report the case of a patient previously treated for sigmoid colon adenocarcinoma followed by adjuvant chemotherapy. Four years later, she developed a recurrent right-sided colonic adenocarcinoma invading the iliac vessels. Initial surgery consisted of a right hemicolectomy; however, the procedure resulted in an R2 resection because of unexpected iliac vascular involvement, leaving residual tumor tissue marked with surgical clips. The patient subsequently received adjuvant FOLFOX chemotherapy.

Follow-up imaging, including CT angiography and PET scan, demonstrated a hypermetabolic residual tumor in the right iliac fossa encasing the right external and internal iliac arteries, involving the iliac veins and the right ureter, with secondary severe hydronephrosis and loss of right renal function. Following multidisciplinary team discussion, a curative surgical approach was undertaken. The patient underwent en bloc resection of the residual tumor with resection of the right iliac vascular pedicle, arterial and venous iliofemoral bypass reconstruction using a graft from the small saphenous vein, segmental small bowel resections with enteroenteric anastomosis, and total right nephrectomy.

This case highlights the importance of multidisciplinary management and aggressive surgical resection in selected patients with recurrent colorectal cancer involving major vascular structures. Despite the technical complexity and potential morbidity, vascular reconstruction associated with radical oncologic resection may improve long-term survival and quality of life in carefully selected patients.

Exploring knowledge, perceptions and health care seeking behaviours among women diagnosed with cervical cancer at Ocean Road Cancer Institute, Tanzania

2026-05-17T18:49:21+02:00

Background: Globally, cervical Cancer (CC) ranks the fourth most common cancer in women. In Tanzania, CC is the leading female malignancy, and a major cause of cancer related mortality and morbidity among women. Several initiatives have been used to improve awareness on the disease, nevertheless more than 80% of patients with CC are diagnosed at an advanced stage. This study aimed to explore knowledge, perception and barriers to health seeking behaviour among women diagnosed with CC at Ocean Road Cancer Institute (ORCI) in Tanzania.

Methodology: A hospital based qualitative study using in-depth interview (IDI)was conducted between November to December 2021 at the ORCI. A purposive selection of women diagnosed with late stage CC was made, and eleven IDI were conducted. The interviews were audio recorded and transcribed verbatim. Data analysis was done manually using a thematic approach.

Results: The results showed that participants had poor knowledge about CC disease, its causes, risk factors, preventive measures and treatment options. Women perceived and misinterpreted the CC symptoms as other non-serious urogenital conditions like fungus and urinary tract infection. In addition, financial challenges, long distances to health facilities and poor services at primary level facilities were the barriers to early diagnosis and appropriate care.

Conclusion: Participants demonstrated poor knowledge of the CC disease and at an early stage confuse the symptoms of CC with those of UTI. The study recommends intensive health promotion efforts and education on cervical cancer disease and the importance of regular screening.

The mockingbird and the concealment of innocence

2026-06-03T19:38:56+02:00

Harper Lee’s To Kill a Mockingbird is conventionally read as a moral fable about racial injustice and the costs of moral courage. This essay argues that beneath its juridical surface the novel articulates a theology of vulnerability whose deepest concerns are ontological rather than ethical. The mockingbird—Lee’s figure for that which only sings—names a category of being whose expressive innocence cannot survive the social and epistemic structures that encounter it. Reading Tom Robinson as exposed innocence and Boo Radley as concealed innocence, and bringing the doublet into dialogue with the Akedah, the Levitical scapegoat, and the Book of Job, the paper proposes that the destruction of the mockingbird is structurally analogous to the rupture of unmediated divine presence in Lurianic theology. Drawing on Wolfson’s apophatic acosmism, the Lurianic and Chabad doctrines of tzimtzum, and the post-Holocaust theology of hester panim, the essay reframes concealment as not merely a metaphysical condition but an ethical imperative. Building on prior work in hermeneutic medicine and the tzimtzum model of therapeutic presence,^1,2,3 the paper concludes that the clinical encounter—properly understood—constitutes a contracted space in which the fragile song of the mockingbird may be heard without being silenced. Implications are drawn for medical humanities, narrative ethics, and the phenomenology of clinical witness.

Sigmoid Volvulus Complicating the Postpartum Period After Cesarean Section: A Rare Case Report

2026-05-25T14:09:00+02:00

Sigmoid volvulus during pregnancy and the postpartum period is a rare but serious cause of acute intestinal obstruction [1]. Its diagnosis remains challenging because symptoms may mimic common gastrointestinal manifestations occurring during the postpartum period, leading to delayed diagnosis and increasing the risk of bowel ischemia, necrosis, and peritonitis [2,4].

We report the case of a 34-year-old woman with a history of two cesarean deliveries, the most recent performed 21 days prior to admission. She presented with a 6-day history of bowel obstruction characterized by abdominal pain, constipation with absence of stool and flatus, and recurrent bilious vomiting.

Physical examination revealed marked abdominal distension associated with diffuse tympany. Abdominopelvic computed tomography demonstrated severe colonic distension upstream from a transition point associated with a characteristic whirl sign suggestive of sigmoid volvulus.

Emergency exploratory laparotomy revealed a mesenterico-axial sigmoid volvulus complicated by extensive colonic necrosis extending to the rectosigmoid junction, associated with stercoral peritonitis. Sigmoid resection with end colostomy according to the Hartmann procedure was performed.

Postpartum sigmoid volvulus remains an uncommon surgical emergency whose prognosis mainly depends on early diagnosis and prompt surgical management.

Makom, Tzimtzum, and the Collapse of the Horseand-Rider Parable/mashal

2026-06-03T19:29:18+02:00

This essay argues that the rabbinic designation of God as Makom—"He is the place of the world, but the world is not His place" (Bereishit Rabbah 68:9)— functions not as a tidy preservation of divine transcendence but as a controlled detonation of spatial metaphysics. Read alongside the Chabad polemic against a literal reading of tzimtzum and in conversation with Elliot R. Wolfson’s apophatic phenomenology, the Midrash discloses a topology in which nothing stands outside divine being even while divine essence infinitely exceeds every manifestation. The familiar parable/mashal of horse and rider, deployed by the Midrash itself, presupposes precisely the dualism it is meant to instruct, and consequently collapses under its own weight. What emerges from this collapse is what I term, with Wolfson, an apophatic acosmism: an ontology of concealed immanence whose clinical analogue is the therapeutic space. Drawing on my earlier work on divine presence and concealment, sacred and profane space, and the patient as sacred text,^1–6

We argue that the therapeutic encounter is not a neutral interpersonal zone hospitable to occasional religious experience, but a region ontologically suspended within Makom—a place where rupture itself becomes a mode of disclosure.

In the Addendum, we descend from this philosophical claim into the operational disciplines of clinical posture, sacred listening, the topology of the clinic, the figure of the wounded healer, and the formation rather than mere training of clinicians.

Gross Hematuria Leading to Incidental Diagnosis of Chronic Type B Aortic Dissection and Penetrating Aortic Ulcer

2026-05-25T06:23:38+02:00

A 71-year-old man with a history of hypertension, hyperlipidemia, and coronary artery disease status post coronary stent placement on dual antiplatelet therapy presented with 1 week of intermittent gross hematuria, dysuria, urinary frequency, nocturia, and lower abdominal pain. Laboratory evaluation demonstrated stable hemoglobin and renal function with significant hematuria in the absence of urinary tract infection. Computed tomography (CT) of the abdomen and pelvis revealed a 2.9-cm Bosniak category I right renal cyst, a prostatic median lobe mass protruding into the urinary bladder, and extensive atherosclerotic disease with infrarenal aortic dissection extending into the left common iliac artery. Subsequent CT angiography demonstrated ulcerated atherosclerotic plaques and a penetrating aortic ulcer involving the thoracic aorta. Transthoracic echocardiography demonstrated preserved left ventricular systolic function with mild valvular regurgitation. Vascular surgery and cardiology recommended conservative management with blood pressure optimization and outpatient surveillance because there was no evidence of visceral or lower extremity malperfusion. Hematuria evaluation, including cystoscopy, was negative. This case highlights the incidental discovery of chronic type B aortic dissection and penetrating aortic ulcer during evaluation of gross hematuria and reviews the potential vascular mechanisms contributing to hematuria in chronic aortic dissection.

The Wound That Gives The Pain of Self-Contraction in Creation, Revelation, and the Therapeutic Encounter

2026-06-03T19:47:54+02:00

This essay extends the hermeneutic framework by pressing a single claim that Elliot R. Wolfson’s analysis of Lurianic mythology makes available but does not itself develop: that the pain of tzimtzum—the primordial self-contraction by which the Infinite makes room for a world—and the pain of revelation at Sinai are not two pains but one. Both are the suffering of self-limitation undertaken for the sake of an other; both are instances of a revealing that is simultaneously a concealing. I argue further that this pain is located with precision: not in Ein-Sof as undifferentiated plenitude, the One that has not yet thought, and not in the emptied ayin achieved by contraction, but at the threshold between them—the moment thought first arises in the Infinite and the One becomes capable, in a single act, of an other and of suffering. Drawing on Wolfson’s reading of simsum as the othering of Ein-Sof, on Schelling’s account of self-revelation as the expulsion of a dark remainder, and decisively on Simone Weil’s doctrine of décréation and attention, I argue that the doctor-patient relationship is structured by this same ache. The physician becomes present not by adding more of himself but by a decreation of the clinical “I”—a self-effacement that, turned as attention toward the patient’s affliction, reveals rather than conceals: in effacing himself the physician discloses his pain, and that revealed pain is the presence. The clinical encounter is thus not merely analogous to creation and revelation but a third instance of the same gesture: a wound that gives. An addendum explores a possible connection between Schelling and the kabbalist Jonathan Eybeschütz.