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BMJ Case Reports Jan 2016A 64-year-old woman with a previous right colectomy presented with severe epigastric abdominal pain and nausea of several weeks' duration, which then escalated to...
A 64-year-old woman with a previous right colectomy presented with severe epigastric abdominal pain and nausea of several weeks' duration, which then escalated to projectile faeculent emesis. During her clinical course, she remained afebrile with normal vital signs. Physical examination revealed abdominal distension, moderate tenderness in the bilateral upper quadrants and provoked voluntary abdominal wall guarding. Haematology and laboratory chemistries were only notable for a mild (14.6 K/μL) leucocytosis. Acute abdominal plain radiological series revealed dilated small bowel loops and possible pneumoperitoneum. Abdominal CT demonstrated a mechanical small bowel obstruction and no extraluminal air. An exploratory laparotomy was performed, revealing an obstructing enterolith related to actively inflamed jejunal diverticulitis (complicated JD). This case report aims to describe the non-specific presentation of a poorly understood disease entity that presents a diagnostic and therapeutic challenge for the medical community.
Topics: Abdominal Pain; Colectomy; Diverticulitis; Female; Humans; Intestinal Obstruction; Jejunal Diseases; Laparotomy; Middle Aged; Tomography, X-Ray Computed; Vomiting
PubMed: 26729826
DOI: 10.1136/bcr-2015-212826 -
Journal of Medical Case Reports Feb 2014A malignant fibrous histiocytoma occurring on the scalp near a primary operation site is extremely rare.
INTRODUCTION
A malignant fibrous histiocytoma occurring on the scalp near a primary operation site is extremely rare.
CASE PRESENTATION
A 74-year-old Chinese man presented with a one-month history of recurrent headaches, vomiting and left limb atony. He had undergone a successful clipping operation through the pterional approach for an anterior communicating aneurysm five years previously. One month before presentation, he developed a headache without apparent cause that was especially severe in the right frontal region. He also had a small tumor on the right side of his forehead at the original incision site. The tumor had gradually increased from soybean size to egg size in one month; this growth was accompanied by nausea, projectile vomiting of gastric contents and left limb atony. The subcutaneous tumor was totally resected along with some affected cranial tissues. Our patient's postoperative recovery was good, and he was safely discharged 20 days after the surgery. He was free of recurrence over two years of follow-up.
CONCLUSIONS
Dissection of the temporal muscles and deep fascia using electric resection and electrocoagulation through the pterional approach may cause tissue degeneration, which may in turn lead to cancer development. In our patient's case, the reason for the development of the tumor five years after his surgical aneurysm repair was unclear; it may have represented a primary malignant fibrous histiocytoma of the scalp that had no relationship to the operation. We followed up our patient for two years and he had no tumor recurrence. Because malignant fibrous histiocytoma of the scalp has a high degree of malignancy and readily recurs in situ, early diagnosis and radical surgical resection are key to a successful outcome.
PubMed: 24524377
DOI: 10.1186/1752-1947-8-50 -
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 -
Oman Medical Journal Jul 2014An adolescent presented with headache and projectile vomiting and showed ataxia, dysarthia and nystagmus with normal cognition. A diagnosis of acute cerebellitis was...
An adolescent presented with headache and projectile vomiting and showed ataxia, dysarthia and nystagmus with normal cognition. A diagnosis of acute cerebellitis was made on the basis of computed tomography and magnetic resonance imaging findings. He developed seizures and had a rapid downhill course with death at 48 hours after admission. Clinically, patients of acute cerebellitis present with fever, nausea, headache and altered sensorium with cerebellar symptoms. Inflammation of the cerebellum compresses the brain stem and induces mental alterations. It is a rare pathology developing due to an infectitious cause, post-infectitious or post vaccination etiology. Many times it is not possible to identify the causative agent. Cerebellitis can be mild where recovery occurs in few weeks and no abnormalities are seen on diagnostic imaging studies. On the other end, severe cases have focal neurological deficits, altered consciousness, raised intracranial pressure and abnormal neuroimaging. Treatment should be tailored to individual needs according to presentation, severity, and etiology. We discuss clinical features, diagnosis and management of acute cerebellitis which is an important cause of acute cerebellar functional disorder in childhood.
PubMed: 30996818
DOI: 10.5001/omj.2014.84 -
Indian Pediatrics Jul 2014Small bowel volvulus caused by a jejunal trichobezoar is an extremely rare and life-threatening emergency in children.
BACKGROUND
Small bowel volvulus caused by a jejunal trichobezoar is an extremely rare and life-threatening emergency in children.
CASE CHARACTERISTICS
An 8-year-old girl with abdominal pain and persistent bilious vomiting.
OBSERVATION
The abdominal computed tomography scan showed a solitary intraluminal mass and a whirl sign, suggesting the small bowel volvulus. Emergency laparoscopic exploration revealed the rotated segment of small bowel loops by a jejunal trichobezoar.
OUTCOME
Satisfactory recovery after surgery.
MESSAGE
Trichobezoars should be considered in the differential diagnosis of abdominal pain and projectile vomiting in children.
Topics: Bezoars; Child; Female; Humans; Intestinal Volvulus; Jejunal Diseases; Jejunum; Radiography
PubMed: 25031141
DOI: 10.1007/s13312-014-0451-7 -
The Canadian Veterinary Journal = La... Sep 2000Eosinophilic gastroenteritis without peripheral eosinophilia was diagnosed histologically in a 5-year-old neutered male ferret showing acute signs of projectile...
Eosinophilic gastroenteritis without peripheral eosinophilia was diagnosed histologically in a 5-year-old neutered male ferret showing acute signs of projectile vomiting, dark mucoid diarrhea, and chronic weight loss for 2 mo. The ferret was clinically normal after 4 days of treatment with parenteral fluids, antibiotics, and corticosteroids.
Topics: Adrenal Cortex Hormones; Animals; Anti-Bacterial Agents; Diarrhea; Ferrets; Gastroenteritis; Male; Vomiting; Weight Loss
PubMed: 10992990
DOI: No ID Found -
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 -
Oncology Letters Sep 2015Atypical teratoid/rhabdoid tumor (AT/RT) is an aggressive embryonic brain tumor that is predominantly found in young children. The present study reports the unusual case...
Atypical teratoid/rhabdoid tumor (AT/RT) is an aggressive embryonic brain tumor that is predominantly found in young children. The present study reports the unusual case of an adult male AT/RT patient with a history of another type of tumor, hereditary multiple exostoses (EXT or HME), who survived for 18 years. The patient's first and chief complaint was a 1-month history of progressive projectile vomiting. The patient was admitted twice for treatment, and on the second admission, a craniotomy was performed to remove a intracranial mass. However, no radiotherapy or chemotherapy treatment was administered. Pathology revealed monotonous medium- to large-sized neoplastic cells. The patient succumbed to a pulmonary infection and respiratory failure 14 days after the initial treatment. The prognosis for AT/RT is extremely poor; furthermore, the patient presented with another tumor. There may have been an association between the two tumors that worsened the clinical phenotype and prognosis of this patient. Additionally, symptomatic treatment for this condition is insufficient; early surgery and radiotherapy may be more useful for preventing the aggressive progression of these tumors.
PubMed: 26622709
DOI: 10.3892/ol.2015.3389 -
Brain Pathology (Zurich, Switzerland) Apr 2009We report a case of a 2 year-old girl who presented with three weeks' history of deterioration of walking, then became unable to walk and later she developed projectile...
We report a case of a 2 year-old girl who presented with three weeks' history of deterioration of walking, then became unable to walk and later she developed projectile vomiting. Neurological examination revealed bilateral papilledema, nystagmus, and truncal ataxia with intention tremor. Radiological studies showed an enhancing mass in the posterior fossa extending from the cerebellum to the roof of the fourth ventricle. The tumor was diagnosed as an embryonal tumor with abundant neuropil and true rosettes (ETANTR). The tumor cells in the neuroblastic component were diffusely positive for synaptophysin and CD56, with scattered positive cells for glial fibrillary acidic protein. The true rosettes were only positive for vimentin. Ki67 showed high index (over 90%) in the true rosettes, while the neuroblastic areas were up to 15%. Our patient developed recurrent disease 6 months after resection and chemotherapy. ETANTR is a very rare aggressive embryonal CNS tumor that combines features of neuroblastoma and ependymoblastoma. We review the thirteen cases reported in the literatures. This case represents the second report of an ETANTR arising in the cerebellum.
Topics: Child, Preschool; Female; Humans; Infratentorial Neoplasms; Magnetic Resonance Imaging; Neoplasms, Germ Cell and Embryonal
PubMed: 19291003
DOI: 10.1111/j.1750-3639.2009.00279.x -
Brazilian Journal of Anesthesiology... 2015Hypertrophic pyloric stenosis is a relatively common affection of gastrointestinal tract in childhood that results in symptoms, such as projectile vomiting and metabolic...
BACKGROUND AND OBJECTIVES
Hypertrophic pyloric stenosis is a relatively common affection of gastrointestinal tract in childhood that results in symptoms, such as projectile vomiting and metabolic disorders that imply a high risk of aspiration during anesthetic induction. In this way, the carrying out of a technique with general anesthesia and intravenous rapid sequence induction, preoxygenation and cricoid pressure are recommended. After the correction of systemic metabolic alkalosis and pH normalization, cerebrospinal fluid can keep a state of metabolic alkalosis. This circumstance, in addition to the residual effect of neuromuscular blocking agents, inhalant anesthetics and opioids could increase the risk of postoperative apnea after a general anesthesia.
CASE REPORT
We present the successful management in 3 neonates in those a pyloromyotomy was carried out because they had presented congenital hypertrophic pyloric stenosis. This procedure was done under general anesthesia with orotracheal intubation and rapid sequence induction. Then, ultrasound-guided paravertebral block was performed as analgesic method without the need for administrating opioids within intraoperative period and keeping an appropriate analgesic level.
CONCLUSIONS
Local anesthesia has demonstrated to be safe and effective in pediatric practice. We consider the ultrasound-guided paravertebral block with one dose as a possible alternative for other local techniques described, avoiding the use of opioids and neuromuscular blocking agents during general anesthesia, and reducing the risk of central apnea within postoperative period.
Topics: Anesthesia, General; Anesthetics, Local; Humans; Infant, Newborn; Intubation, Intratracheal; Nerve Block; Pyloric Stenosis, Hypertrophic; Ultrasonography, Interventional
PubMed: 26123148
DOI: 10.1016/j.bjane.2014.03.012