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Case Reports in Pediatrics 2020Congenital duodenal web causing proximal duodenal obstruction leading to gastroduodenal emphysema is a very rare presentation in infancy. Due to persistent...
Congenital duodenal web causing proximal duodenal obstruction leading to gastroduodenal emphysema is a very rare presentation in infancy. Due to persistent peristalsis against the duodenal membrane, there is progressive stretching of the duodenal web leading to windsock deformity. We describe a rare case of a child with gastroduodenal emphysema and portal venous air due to duodenal obstruction secondary to a duodenal web. An eighteen-month-old male child, who was under investigation for failure to thrive, presented with a history of persistent projectile vomiting and progressive abdominal distension for two days. The abdominal ultrasound scan revealed air within the portal vein and in the wall of the stomach. Plain X-ray abdomen confirmed the presence of gas in the gastric wall and in the proximal duodenal wall. Upper gastrointestinal contrast study revealed complete obstruction at the second part of the duodenum. The child underwent emergency laparotomy, which revealed a duodenal web as the cause of the duodenal obstruction. During the surgery, windsock deformity was noted. This case illustrates that although rare, proximal duodenal obstruction due to duodenal web may present in early childhood and that alarming imaging features such as gastric emphysema and portal venous air could be associated with benign conditions.
PubMed: 32015925
DOI: 10.1155/2020/9897208 -
Biomedical Journal Oct 2019Severe headaches, projectile vomiting, focal neurological deficits and early onset seizure are regarded as early warning symptoms of subarachnoid hemorrhage (SAH)....
BACKGROUND
Severe headaches, projectile vomiting, focal neurological deficits and early onset seizure are regarded as early warning symptoms of subarachnoid hemorrhage (SAH). Earlier diagnosis based on such warning symptoms theoretically would improve the clinical prognosis. However, it is still not clear whether the prognosis is correlated with early warning symptoms. Here, we reviewed warning symptoms and other predictive factors in the emergency room (ER) setting and examined their correlations with mortality.
METHODS
Ninety saccular aneurysmal SAH cases were reviewed in a single medical center between January 2011 and December 2013. We examined differences in mortality rate related to warning symptoms, SAH scales, onset-to-ER time, hydrocephalus, and aneurysm size, location, and complexity. Logistic regression analyses were performed to determine the correlations of warning symptoms and other predictive factors with mortality. Receiver operating characteristic (ROC) curve analysis was used to calculate the area the under curve (AUC) of SAH mortality prediction tools.
RESULTS
Warning headache, projectile vomiting, the Hunt and Hess scale, Fisher scale, World Federation of Neurological Surgeons (WFNS) grading scale, and modified WFNS (m-WFNS) scale, body mass index, aneurysm complexity and hydrocephalus were significantly different between the survivors and the decedents. The warning headache and WFNS grade were strongly correlated with mortality. The rate of prognostic prediction improved from 90.4% to 94.6% when warning headache was additionally evaluated.
CONCLUSIONS
With growing healthcare costs and recognition of the value of palliative care, early identification via warning headache and a detailed clinical history review is necessary for cases of aSAH.
Topics: Adult; Aged; Area Under Curve; Female; Headache; Humans; Male; Middle Aged; Prognosis; ROC Curve; Retrospective Studies; Risk Assessment; Subarachnoid Hemorrhage; Survival Rate
PubMed: 31783996
DOI: 10.1016/j.bj.2019.04.006