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Journal of the ASEAN Federation of... 2022A 35-year-old female presented with abdominal pain, fever, projectile vomiting, and a diffuse tender epigastric mass. She was diagnosed to have acute persistent...
A 35-year-old female presented with abdominal pain, fever, projectile vomiting, and a diffuse tender epigastric mass. She was diagnosed to have acute persistent pancreatitis with a pancreatic pseudocyst. Elevated serum calcium levels provided an etiologic link between hypercalcemia and pancreatitis. On examination, a nodule was found in the left side of her neck which was later diagnosed as a giant left inferior parathyroid adenoma. This report highlights the critical analysis of history, examination, and investigations to reach an ultimate diagnosis. Pseudocyst drainage and parathyroidectomy resolved her symptoms.
Topics: Female; Humans; Adult; Parathyroid Neoplasms; Adenoma; Neck; Pancreatitis, Chronic; Hypercalcemia; Gastric Outlet Obstruction
PubMed: 35800590
DOI: 10.15605/jafes.037.01.11 -
Journal of Medical Case Reports Apr 2021Although central nervous system tumors are the most common etiology of malignancies in the pediatric age group, choroid plexus carcinomas are rare, with an annual...
INTRODUCTION/BACKGROUND
Although central nervous system tumors are the most common etiology of malignancies in the pediatric age group, choroid plexus carcinomas are rare, with an annual incidence rate of 0.10 per 100,000 children.
CASE PRESENTATION
We report the case of an adolescent male belonging to central India who had presented with a history of persistent headache, projectile vomiting, neck stiffness, and an episode of generalized tonic-clonic seizure. Neurological examination was suggestive of a space-occupying lesion. Further neuroimaging was suggestive of a large left-sided choroid plexus carcinoma, later confirmed on pathological examination. Gross total resection was achieved and followed by radiation therapy. His recovery was satisfactory without any major events despite suffering from such a malignancy with a poor prognosis.
CONCLUSION
In the absence of a global consensus on choroid plexus carcinoma management, our patient underwent a successful gross total resection and received postoperative radiotherapy. He made a satisfactory recovery with a further plan to review with gadolinium-enhanced neuroimaging at a later date. We conclude that, when possible, achieving gross total resection is of utmost importance.
Topics: Adolescent; Carcinoma; Choroid Plexus Neoplasms; Headache; Humans; India; Male; Neuroimaging; Radiotherapy, Adjuvant; Treatment Outcome; Vomiting
PubMed: 33879216
DOI: 10.1186/s13256-021-02801-w -
International Journal of Surgery Case... Nov 2023A volvulus is a serious surgical emergency caused by torsion or hyper-flexion of the bowel loop and its mesentery on a fixed point. Cecal volvulus is an uncommon cause...
INTRODUCTION
A volvulus is a serious surgical emergency caused by torsion or hyper-flexion of the bowel loop and its mesentery on a fixed point. Cecal volvulus is an uncommon cause of intestinal obstruction, accounting for just 1-1.5 % of all cases of bowel obstruction.
CASE PRESENTATION
A 33-year-old intellectually disabled male presented to the emergency department with complaints of generalized abdominal pain, absolute constipation, and non-projectile vomiting. He had a grossly distended and rigid abdomen with generalized tenderness and guarding. The abdomen was hyper-resonant. Bowel sounds were hypoactive. Digital rectal examination revealed an empty and collapsed rectum with no stool staining of the finger. Laboratory reports showed leukocytosis and neutrophilia. Radiographic imaging was consistent with acute intestinal obstruction. Laparotomy was performed, and cecal volvulus with viable bowel and acute appendicitis was diagnosed intra-operatively. Manual detorsion, cecopexy, and appendectomy were performed. The patient had an uneventful postoperative course. The patient is still on follow-up since June 2023, and no complication has occurred.
CLINICAL DISCUSSION
Cecal volvulus is an uncommon cause of intestinal obstruction with multiple etiologies. The annual incidence of cecal volvulus is estimated to be between 2.8 and 7.1 cases per million. Cecal volvulus may lead to life-threatening complications such as bowel ischemia and perforation.
CONCLUSION
Diagnosis of cecal volvulus must be made promptly to prevent bowel gangrene and perforation. In this case, manual detorsion and cecopexy were performed as the bowel was viable per-operatively due to early surgical intervention.
PubMed: 37844385
DOI: 10.1016/j.ijscr.2023.108904 -
Annals of Medicine and Surgery (2012) Mar 2022and importance:Bilateral extradural hematomas account for less than 5% of all entities of extradural hematomas. The condition is generally caused by traumatic brain...
INTRODUCTION
and importance:Bilateral extradural hematomas account for less than 5% of all entities of extradural hematomas. The condition is generally caused by traumatic brain injury, which can form separate hematomas contralaterally or joint bilateral extradural hematomas commonly owing to superior sagittal sinus injury. In light of the above, this is the first case of such a condition to be reported from Sudan in the literature.
CASE PRESENTATION
A 31-years-old male presented with headache, confusion, and 4 episodes of non-projectile vomiting with a GCS score of 14, after being assaulted by direct blunt head trauma. CT brain showed acute extradural hematoma on the right frontotemporal part compared to a parietal extradural hematoma on the contralateral side. The patient underwent bilateral craniotomy with a wide question mark-like skin flap on the right temporoparietal side followed by 5 burr holes. On the left side, parietal craniotomy was made with an inverted U-shaped skin flap and 4 burr holes on the left parietal side, after that two surgical drains were inserted bilaterally. The patient was discharged on the third postoperative day with a GCS of 15.
DISCUSSION
Although bilateral extradural hematomas are rare and grave conditions, prompt surgical intervention has shown low morbidity and mortality rate with markedly favorable postoperative outcomes.
CONCLUSION
Bilateral extradural hematomas can be attributed to extended linear fracture caused by superior sagittal sinus injury. CT scan is the gold standard imaging. However, MRI and MRV can be used to demonstrate injury or occlusion of the Superior sagittal sinus.
PubMed: 35198197
DOI: 10.1016/j.amsu.2022.103377 -
International Journal of Surgery Case... May 2024Gastric Outlet Obstruction (GOO) is a clinical syndrome due to mechanical obstruction of the gastric outlet near the antrum. The incidence of GOO is not known...
INTRODUCTION AND IMPORTANCE
Gastric Outlet Obstruction (GOO) is a clinical syndrome due to mechanical obstruction of the gastric outlet near the antrum. The incidence of GOO is not known adequately; however, it is estimated that its incidence has declined in recent years as the incidence of peptic ulcer disease, which is the common cause of GOO, has been declining recently due to the use of proton pump inhibitor (PPI). The objective of this case report to highlight the importance of consideration of TB as a cause of GOO by affecting the duodenal wall and nearby lymph node enlargement.
CASE PRESENTATION
The case was a 31-year-old man who presented to the surgical referral clinic with a complaint of non-projectile vomiting of ingested matter. The patient also had a significant amount of weight loss. Laparotomy was done and displayed multiple enlarged pyloric and duodenal lymph nodes with a thickened duodenal wall. The patient was discharged from the ward after one week of hospital stay. For diagnosing the disease and relieving obstruction, laparotomy is usually required.
CLINICAL DISCUSSION
Generally, gastric outlet obstruction is a common and early complication associated with duodenal ulcers. However, cases of gastric outlet obstruction caused by other factors are rare.
CONCLUSION
In a patient presented with symptoms and signs suggestive of GOO with symptom complex of TB (tuberculosis). Early identification and appropriate management can lead to improved outcomes for patients with this rare form of tuberculosis.
PubMed: 38626640
DOI: 10.1016/j.ijscr.2024.109618 -
Archives of Physical Medicine and... Jan 2024To investigate if preschool children differ to school age children with mild traumatic brain injury (TBI) with respect to injury causes, clinical presentation, and... (Observational Study)
Observational Study
OBJECTIVE
To investigate if preschool children differ to school age children with mild traumatic brain injury (TBI) with respect to injury causes, clinical presentation, and medical management.
DESIGN
A secondary analysis of a dataset from a large, prospective and multisite cohort study on TBI in children aged 0-18 years, the Australian Paediatric Head Injury Rules Study.
SETTING
Nine pediatric emergency departments (ED) and 1 combined adult and pediatric ED located across Australia and New Zealand.
PARTICIPANTS
7080 preschool aged children (2-5 years) were compared with 5251 school-age children (6-12 years) with mild TBI (N= (N=12,331) MAIN OUTCOME MEASURES: Clinical report form on medical symptoms, injury causes, and management.
RESULTS
Preschool children were less likely to be injured with a projectile than school age children (P<.001). Preschool children presented with less: loss of consciousness (P<.001), vomiting (P<.001), drowsiness (P=.002), and headache (P<.001), and more irritability and agitation (P=.003), than school-age children in the acute period after mild TBI. Preschool children were less likely to have neuroimaging of any kind (P<.001) or to be admitted for observation than school age children (P<.001).
CONCLUSIONS
Our large prospective study has demonstrated that preschool children with mild TBI experience a different acute symptom profile to older children. There are significant clinical implications with symptoms post-TBI used in medical management to aid decisions on neuroimaging and post-acute intervention.
Topics: Adult; Child; Child, Preschool; Humans; Australia; Brain Concussion; Brain Injuries, Traumatic; Cohort Studies; Emergency Service, Hospital; Prospective Studies
PubMed: 37715760
DOI: 10.1016/j.apmr.2023.08.008 -
International Journal of Surgery Case... May 2024Ilea caecum Intussusception protruding to the level of anus is a rare manifestation and potentially serious condition in infants.
INTRODUCTION AND IMPORTANCE
Ilea caecum Intussusception protruding to the level of anus is a rare manifestation and potentially serious condition in infants.
CASE PRESENTATION
A four-month-old infant presented with a one-day history of non-projectile vomiting, three episodes, food contents, worsened by feeding, accompanied by intermittent low-grade fever, and one instance of passing black tarry stool. After outpatient treatment, the infant showed improvement for three days, but later the mother noticed a protruding, self-reducing anal mass, hence the suspected rectal prolapse, which was then Referred for further management.
CLINICAL DISCUSSION
Intussusception, the most frequent surgical emergency in infants and young children aged 3 to 6 months, is primarily idiopathic, with the ileocecal region being the most commonly affected (90 % of cases). However, when the intussusceptum advances to the anus, it's rare, often leading to misdiagnosis and mismanagement.
CONCLUSION
Intussusception of the colon should be added to the differential diagnosis of symptoms and the clinical picture of rectal prolapse.
PubMed: 38579601
DOI: 10.1016/j.ijscr.2024.109572 -
Current Medical Mycology 2020Rhinocerebral mycosis is a rapidly invasive infection in diabetic patients with an unfavorable course. Herein, we report a rare case of orbital cellulitis caused by...
BACKGROUND AND PURPOSE
Rhinocerebral mycosis is a rapidly invasive infection in diabetic patients with an unfavorable course. Herein, we report a rare case of orbital cellulitis caused by following fungal rhinosinusitis in a diabetic male patient.
CASE REPORT
A 35-year-old male with uncontrolled diabetes presented to the emergency department of our center with high-grade fever accompanied by chills and rigors, severe diffuse headache, and projectile vomiting with swelling and loss of vision in the right eye. The tissue sample from surgical debridement showed pigmented hyphae; in addition, was isolated in culture. Imaging was indicative of orbital extension. Therefore, the patient was diagnosed with fungal rhinosinusitis with orbital cellulitis. The patient was subjected to extensive surgical debridement, along with antifungals. Rhinosinusitis resolved; however, the loss of vision was irreversible.
CONCLUSION
Orbital cellulitis is a very rare but life-threatening complication of fungal rhinosinusitis. Very few cases of orbital cellulitis following fungal rhinosinusitis have been reported in the literature. Early and prompt diagnosis can save the life of a patient.
PubMed: 32420509
DOI: 10.18502/cmm.6.1.2510 -
Cureus May 2024The report explores a case of cerebral sinus venous thrombosis associated with hypereosinophilia, presenting a unique clinical scenario. A 22-year-old male presented...
The report explores a case of cerebral sinus venous thrombosis associated with hypereosinophilia, presenting a unique clinical scenario. A 22-year-old male presented with persistent headache for eight days, escalating in intensity, along with projectile vomiting and blurred vision. Despite the absence of typical indicators such as fever or respiratory symptoms, comprehensive evaluations revealed hypereosinophilia in the complete blood count. Imaging studies, including magnetic resonance angiography and venography, confirmed cerebral sinus venous thrombosis. The patient was successfully treated with a multidimensional approach, including anticoagulation therapy, corticosteroids, and supportive measures. This report highlights the concealed nature of hypereosinophilia in the context of cerebral sinus venous thrombosis and underscores the importance of a vigilant diagnostic approach in unravelling this silent association.
PubMed: 38854235
DOI: 10.7759/cureus.60012 -
International Journal of Surgery Case... Jul 2023Intestinal obstruction due to external compression is a rare condition, and those caused by appendiceal neoplasms like low-grade appendiceal mucinous neoplasms are...
INTRODUCTION
Intestinal obstruction due to external compression is a rare condition, and those caused by appendiceal neoplasms like low-grade appendiceal mucinous neoplasms are extremely rare.
PRESENTATION OF CASE
A 67-year-old post-menopausal female, with no history of prior abdominal surgery, presented to the emergency room with constipation for 2 days, and peri-umbilical pain and non-projectile bilious vomiting for 19 h. There was mild abdominal distension and diffuse tenderness. After ultrasonography and Computed Tomography (CT) of the abdomen and pelvis, a provisional diagnosis of complete small bowel obstruction secondary to perforated mucinous neoplasm of the appendix was made. An emergency exploratory laparotomy was performed followed by ileo-cecal resection and ileocolic anastomosis. Intraoperative findings revealed bands extending from the appendix to the ileum forming a closed loop with gangrenous spots in the distal ileum and ascitic fluid with mucin. Later, histopathological examination findings were consistent with low-grade appendiceal mucinous neoplasm (LAMN).
DISCUSSION
We reviewed three cases of intestinal obstruction, caused by compression from a LAMN, including the presented case. Preoperative diagnosis of the cause of small intestinal obstruction on CT is sometimes challenging. Hence, in patients with intestinal obstruction with a transition point in the right lower quadrant of the abdomen on CT, a high index of suspicion for an appendiceal etiology is required.
CONCLUSION
LAMN with an associated band should be considered as one of the differential diagnoses in the patient presenting with symptoms of complete small intestinal obstruction without prior abdominal surgery.
PubMed: 37348199
DOI: 10.1016/j.ijscr.2023.108422