Alobar holoprosencephaly (HPE) is a severe malformation where the embryonic forebrain fails to divide, characterized by profound midline facial defects and high mortality. We report a case of a term neonate born to a grand multigravida mother from a rural area with no prior antenatal screening. At birth, the neonate presented with severe midline craniofacial anomalies, including arrhinia and anophthalmia. Transcranial ultrasonography demonstrated findings highly suggestive of alobar HPE, including a single monoventricle and absence of key midline structures, while additional findings included a congenital diaphragmatic hernia and an Acyanotic perimembranous ventricular septal defect. Due to the severity of these multisystem malformations, the patient was managed with supportive care and succumbed to multisystem failure on the third day of life. Alobar holoprosencephaly has an extremely poor prognosis, with most affected neonates not surviving long after birth; therefore, management focuses on supportive care, such as respiratory stabilization, feeding, and comfort. This case highlights the crucial role of early prenatal screening, detailed ultrasound, and genetic counseling especially in resource-limited settings to allow for timely diagnosis, informed parental counseling, and better planning for neonatal care.

Radiomics has emerged as a transformative tool in medical imaging, offering the ability to extract complex quantitative features that are generally indiscernible to the human eye. These radiomic features can be interrogated non-invasively on medical imaging. Importantly, in contrast to traditional diagnostic methods reliant on a single, often scalar, measure, radiomics features can form a high-dimensional data space from imaging data suitable for machine learning. Within the framework of artificial intelligence, radiomic features can be harnessed for differentiating healthy from pathological tissue, risk-stratifying patients for benign and malignant fractures, and clinical outcome measures. This review presents an introduction to the methodology underlying radiomics feature selection, reproducibility, feature analysis and model building, assessment of model performance, and open-source libraries for extracting radiomics features from imaging. The review then highlights the application of radiomics in osseous and cartilaginous spinal imaging for identifying osteoporosis and the prediction of fragility vertebral fractures, chronic low back pain and the assessment of intervertebral disc degeneration and herniation, cancer metastatic spine disease and the differentiation of benign vs. malignant lesions and the classification of benign vs. malignant vertebral fractures. Throughout this stage, we endeavor to demonstrate how radiomics can analyze imaging biomarkers to detect subtle structural changes in vertebral bone microarchitecture, assess tissue quality and early-stage fractures, and identify radiomic biomarkers of low back pain chronicity and intervertebral disc heterogeneity that signal degeneration and herniation risk. The review culminates with the presentation of the current limitations and future research directions, including opportunities for integration with multi-omics analysis, highlighting radiomics' potential for enhanced diagnostic accuracy and more personalized patient care. The application of radiomics in spinal imaging offers a promising avenue for improving non-invasive image early detection, risk stratification, and personalized management of spinal pathology, paving the way for more effective interventions and improved patient outcomes.

Uretero-sciatic herniation is an exceptionally rare cause of ureteric obstruction, resulting from herniation of the ureter via the sciatic foramen. A 66-year-old woman presented with left flank pain and deteriorating renal function. Computed tomography intravenous pyelogram (CT IVP) demonstrated severe left hydronephrosis secondary to herniation of the ureter through the left sciatic foramen. The patient then underwent successful renal decompression with an endoscopic retrograde ureteric stent placed. Subsequent trial of stent removal failed, with left uretero-sciatic herniation and renal obstruction recurring shortly after stent removal. Multidisciplinary review led to further evaluation for potential underlying pathology and subsequent definitive open ureterolysis, ureteric reduction and omental wrapping being performed. This case report highlights the pertinent clinical, radiological and management principles underlying such rare pathology. The possible association of piriformal atrophy as an underlying precipitant is discussed along with the key radiological findings of such rare pathology. Within the literature, evidence-based definitive management options are limited and currently require multidisciplinary discussion with invasive surgical correction to be considered following failure of more minimally invasive endoscopic management. In this case, given the success of open ureterolysis and omental wrapping, it is hoped future cases may benefit from this knowledge and consider similar surgical approaches to achieve definitive management.

Encapsulating peritonitis (EP), also known as abdominal cocoon syndrome, and internal hernia are uncommon yet important causes of small bowel obstruction (SBO). Their true coexistence is exceedingly rare and presents a unique diagnostic challenge. Despite their distinct pathogenesis, both entities can rarely share considerable clinical and radiological overlap. We report the case of a 29-year-old man who presented with acute abdominal pain and multiple episodes of non-projectile, non-bilious, non-blood-stained vomiting. Contrast-enhanced computed tomography demonstrated clustered dilated small bowel loops enclosed within an enhancing fibro-collagenous membrane, consistent with EP. In addition, mesenteric vascular convergence and a focal transition point within the transverse mesocolon raised suspicion for a concomitant internal hernia. Emergency exploratory laparotomy confirmed a dense fibro-collagenous membrane encasing the small bowel, together with a transmesocolic internal hernia through a defect in the transverse mesocolon. Complete excision of the encapsulating membrane, meticulous adhesiolysis, reduction of the herniated bowel, and closure of the mesocolic defect resulted in complete resolution of the obstruction and an uneventful postoperative recovery. This case highlights the exceptionally rare coexistence of EP and a transmesocolic internal hernia, two entities that have traditionally been described as radiological mimics rather than concurrent pathologies. Previous case reports have primarily described EP and internal hernia as independent causes of SBO, rarely also highlighting one entity as a radiological mimic of the other; however, their concurrent occurrence in the same patient is extremely rare. This case highlights the importance of a systematic computed tomography evaluation, as recognition of one diagnosis should not preclude careful assessment for the other, with direct implications for surgical planning and optimal patient management.

Iatrogenic diaphragmatic hernia is a rare complication following pedicled omentoplasty for post-cardiac surgery mediastinitis. No standardized repair technique has been established for this condition. We report the case of a 79-year-old man who developed an iatrogenic diaphragmatic hernia with transverse colon herniation into the mediastinum following omentoplasty after aortic arch replacement. We successfully performed a totally laparoscopic repair using a modified Sugarbaker technique with reinforcement of the peri-pedicle area using the round ligament of the liver. At 2-year follow-up, no recurrence was observed. The proposed modifications-dorsal pedicle lateralization and round ligament reinforcement of the peri-pedicle area-may improve mesh stability and reduce recurrence risk in iatrogenic diaphragmatic hernia repair while preserving the omental vascular pedicle.

Common sleep problems reduce quality of life and increase chronic disease risk. The relationship between sleep-related disorders and thyroid function is unclear. This study examines the relationship between sleep-related disorders and thyroid disease using the National Health and Nutrition Examination Survey (NHANES) data and Mendelian randomization (MR) analysis. Data from NHANES 2007 to 2012 were used to assess the relationship between sleep-related disorders and thyroid function using weighted multivariable-adjusted logistic regression. A two-sample MR study was conducted using genome-wide association study summary statistics, and methods such as inverse variance weighted were used to explore the causal relationship between sleep-related disorders and thyroid disease. Sensitivity analysis ensured robustness. The study included 6919 NHANES participants. Logistic regression analysis revealed higher thyroid-stimulating hormone levels in the long sleep group (P < .0001, β = 0.85, 95% confidence interval [CI]: 0.54, 1.15). Lower free triiodothyronine levels were found in the normal sleep group (P = .0030, β = -0.06, 95% CI: -0.06, 0.00). Total T4 levels were lower in those with sleep disorders (P = .0157, β = -0.11, 95% CI: -0.20, -0.02). Long sleep was positively associated with thyroglobulin antibodies (TGAb) positivity (P = .0288, odds ratio [OR] = 1.81, 95% CI: 1.06, 3.07), while sleep disorders were negatively associated with TGAb positivity (P = .0176, OR = 0.72, 95% CI: 0.56, 0.95). MR analysis indicated a positive association between long sleep and Graves disease risk (P = .0240, OR = 99.98, 95% CI: 1.83, 5453.63), and a negative association between sleep duration and Hashimoto's thyroiditis risk (P = .0294, OR = 0.72, 95% CI: 0.54, 0.97). Sleep duration is associated with thyroid hormone levels and autoimmunity. Long sleep is linked to higher thyroid-stimulating hormone levels, lower free triiodothyronine levels, and increased TGAb positivity risk, while sleep disorders are linked to lower total T4 levels and decreased TGAb positivity risk. MR studies suggest long sleep may increase Graves disease risk, while shorter sleep may decrease Hashimoto's thyroiditis risk.

Bladder retroflexion associated with perineal hernia may cause urinary dysfunction, and surgical correction can be challenging after repeated procedures because of extensive adhesions and altered anatomy. An 11-year-old, 7.5 kg, castrated male Pomeranian was referred for recurrent bilateral perineal hernia, bladder retroflexion, and persistent urinary dysfunction after multiple perineal and abdominal surgeries. A previous attempt at abdominal bladder reduction and cystopexy had failed because adhesions prevented adequate mobilization of the bladder. During salvage surgery, bilateral perineal adhesiolysis was performed first to release the displaced urinary tract structures, followed by an abdominal approach to restore the bladder to its normal intra-abdominal position. Modified bilateral vas deferens pexy was then performed by fixing the residual vasa deferentia to the rectal wall, and each side of the pelvic diaphragm was reconstructed according to the available tissues and defect configuration. Retrograde urethrocystography performed 8 days postoperatively demonstrated short-term anatomical correction, with restoration of the normal positions of the bladder, bladder neck, and urethra. Urinary function gradually improved but had not completely normalized by 150 days. Without further objective imaging, long-term mechanical stability and prevention of recurrence could not be established. This case describes a multimodal salvage strategy for recurrent bilateral perineal hernia with markedly altered anatomy after repeated surgery.

Background and Objectives: Severe chronic postoperative inguinal pain (CPIP) affects 2-5% of patients after hernia repair, yet most published explanations remain neuropathic. The pubic periosteum, including the tubercle and adjacent symphyseal zone, lies within the operative field and may be engaged by medial mesh fixation. Its contribution to CPIP has not been tested. This narrative review brings together anatomical, imaging and clinical evidence and defines a hypothesis that can be examined prospectively. Materials and Methods: PubMed/MEDLINE, Embase and the Cochrane Library were searched without date restriction, with the final search run in April 2026. Thirty-three publications met the eligibility criteria. Evidence was classified using the 2011 OCEBM Levels of Evidence, with indirectness recorded when the population, exposure or outcome did not match the review question. The review was narrative, so no PRISMA flow diagram or formal risk-of-bias assessment was undertaken. Results: Direct evidence is limited. Among 1633 patients in one retrospective study, six underwent reoperation for severe late pain, and two had a staple placed in the periosteum. Pain resolved after staple removal. Two further cases of MRI-confirmed osteitis pubis followed laparoscopic repair with a titanium tacker. CT found pubic spurs in 17 of 20 patients, although their clinical meaning was uncertain. Fixation trials, CPIP reviews and groin-pain imaging studies repeatedly examined adjacent outcomes but did not define a periosteal endpoint. Conclusions: Pubic periosteal pathology is a plausible and testable pain generator, not an established cause of CPIP. Prospective studies should pair preoperative MRI and standardised pain mapping with explicit recording of fixation at the pubic tubercle. This design would show whether periosteal findings identify a distinct pain phenotype and whether penetrating fixation modifies its course.

Background/Objectives: Dysplastic spondylolisthesis is associated with developmental abnormalities of the lumbosacral junction, but the contribution of extremely sagittal L5-S1 facet orientation in an adolescent with an intact pars interarticularis remains incompletely characterized. We aimed to describe this unusual quantitative morphologic phenotype and discuss its possible biomechanical implications. Methods: Clinical records and serial imaging of a 14-year-old girl with symptomatic low-grade L5-S1 dysplastic spondylolisthesis were reviewed. Standing radiographs, flexion-extension radiographs, computed tomography (CT), magnetic resonance imaging (MRI), quantitative spinopelvic parameters, intraoperative findings, treatment, and 12-month follow-up were assessed. Results: The patient had approximately one year of progressively worsening low back pain and occasional transient right-leg numbness despite more than 8 months of lumbosacral bracing and more than 6 months of supervised physical therapy. Standing radiographs showed Meyerding grade I L5-S1 anterolisthesis and mild thoracolumbar scoliosis. Quantitative spinopelvic assessment showed a pelvic incidence (PI) of 76.63°, pelvic tilt of 22.21°, sacral slope of 54.42°, lumbar lordosis of 59.5°, sagittal vertical axis of 2.67 cm, and a Dubousset lumbosacral angle of 109°. CT demonstrated an intact pars interarticularis, bilateral facet subluxation, and L5-S1 facet angles of 6° on the left and 3° on the right relative to the sagittal plane. Flexion-extension radiographs showed measurable L5-S1 angular motion from -6.7° to +3.5°, while MRI showed no major central canal stenosis, focal disc herniation, or definite neural compression. Posterior reduction and L5-S1 fusion were performed after individualized counseling, and facet subluxation was confirmed intraoperatively. At 6 and 12 months, the patient remained free of recurrent pain or numbness and radiographs showed maintained lumbosacral alignment. Conclusions: Quantitatively extreme L5-S1 facet sagittalization accompanied by bilateral facet subluxation, an intact pars, and high-PI low-grade spondylolisthesis represents a distinctive morphologic phenotype. This configuration is biomechanically compatible with reduced resistance to anterior shear, although a single case cannot establish independent causality or justify a general indication for early surgery. Comparative quantitative imaging and longitudinal studies are required.

Introduction: Ventral incisional hernia repair remains a significant surgical challenge, with ongoing debate regarding the optimal approach. While laparoscopic intraperitoneal onlay mesh (IPOM+) and open Rives-Stoppa techniques are widely utilized, a comprehensive understanding integrating perioperative clinical outcomes, patient-reported quality of life, and the systemic stress response is lacking. This study aimed to compare these two surgical techniques across these multifaceted domains. Methods: This prospective non-randomized comparative study enrolled 96 adult patients (n = 48 per group) undergoing elective ventral incisional hernia repair via either laparoscopic IPOM+ or open Rives-Stoppa techniques. Perioperative clinical outcomes (operative time, hospital stay, bowel function, pain, analgesic use, complications, self-reported return to daily activities) and EuraHS-QoL scores were assessed. A comprehensive panel of endocrine (cortisol, ACTH, prolactin), inflammatory (IL-6, CRP, presepsin, procalcitonin), and coagulation (D-dimer) biomarkers were measured preoperatively and on the first postoperative day. Results: Laparoscopic IPOM+ repair was associated with more favorable postoperative recovery compared to open repair, characterized by reduced pain, shorter hospital stay, faster return to daily activities and better patient-reported quality of life (all p < 0.001). No significant time-by-group interactions were observed for endocrine or coagulation markers, indicating comparable perioperative trajectories (p > 0.05), while the inflammatory response (IL-6, C-reactive protein, presepsin, and procalcitonin) differed between the two approaches. Significant time-by-group interactions were found for IL-6 (p = 0.005), C-reactive protein (p = 0.015), presepsin (p = 0.040) and procalcitonin (p = 0.006). These associations remained after adjustment for baseline age, BMI, employment status and ASA classification. However, following Bonferroni's adjustment for multiple comparisons, the observed associations between the biomarkers and the outcome did not remain statistically significant. Conclusions: Laparoscopic IPOM+ was associated with more favorable postoperative recovery and lower one-month EuraHS-QoL scores compared to the open Rives-Stoppa repair. Although some biomarkers suggested a possible difference in the postoperative inflammatory response between the two groups, further studies are needed to determine whether these findings reflect true biological differences between the surgical techniques.