International Journal of Case Reports

  • A Case Report Highlighting Some of the Difficulties Faced Diagnosing Appendicitis in Children

    Introduction: In England 12,000 children are diagnosed with appendicitis each year. The diagnosis of appendicitis is difficult especially in children. There are many other diagnoses which mimic appendicitis including Meckel’s diverticulum, intussusception, gastroenteritis and mesenteric adenitis. Unfortunately there is no gold standard in the diagnosis of appendicitis and often clinicians are hesitant to submit a child to radiological investigations. Presentation of the case: An eleven year old boy, of Bangladeshi origin, presented to the Royal Gwent Hospital, South Wales, with an acute onset of centralised abdominal pain and vomiting. Following a period of observation and re-examination his pain had localised to the right iliac fossa and it was decided on clinical grounds to perform a laparoscopy for suspected appendicitis. Intra-operative findings showed an intussusception of the small bowel secondary to a mucosal lesion. Histology showed high grade non-Hodgkin’s lymphoma with a pattern suggestive of Burkitt’s lymphoma. Conclusion: The case highlights the importance of accurate diagnosis of appendicitis and the difficulties of managing abdominal pain in children. More needs to be done to develop a better criterion and judicial use of imaging to guide surgical intervention.

  • Intraventricular Tuberculoma : Single Case Report from Tertiary Care Centre in Eastern India

    Intraventricular tuberculomas as a manifestation of CNS tuberculosis is a rare finding.Suspicion for tuberculosis in these lesions is by the constitutional symptoms like low grade fever, weight loss, presence of tuberculosis elsewhere, contact with a TB patient, low socioeconomic status, occurrence in an endemic region, raised ESR, abnormal Chest X Ray findings, positive mantoux test. It is difficult to make a differential diagnosis from lesions if no systemic tuberculosis is present. Medical treatment is the preferred management method of this disease, and surgical intervention should be considered in certain situations. We report a case of an intraventricular tuberculoma in a 15- year-old girl and we discuss the pathogenesis and the radiological findings according this location.

  • Loading Doses of Bevacizumab in Branch Retinal Vein Occlusion (BRVO): a Case Report

    Background: Branch retinal vein occlusion (BRVO) is a sight threatening condition which may result well when promptly diagnosed and treated. Current trend of BRVO therapy uses anti-vascular endothelial growth factor (anti-VEGF) such as bevacizumab, ranibizumab and aflibercept as agents of choice. Previous studies have proven effectiveness of six monthly injections of anti-VEGF as loading doses before switching to pro-renata regimen in BRVO. We would like to report a case with lower frequency of bevacizumab injection as anti-VEGF in a case of BRVO with satisfactory outcome. Case presentation: A 52-year old male presented with sudden painless vision loss on right eye since 2 months prior to examination. Patient had been taking medications regularly for hypertension and dyslipidemia. Patient had also been previously diagnosed with peripheral artery disease. Patient came with BCVA of 0.1 and negative pinhole on right eye while BCVA for left eye was 1.0. Relative afferent pupillary defect was positive on the right eye. Intraocular pressure and anterior segment were within normal limits for both eyes. Upon fundus examination of the right eye, findings included 0.3 CDR, dilated and tortuous retinal veins, multiple scattered preretinal hemorrhages, and macular edema. Upon posterior segment evaluation of the left eye, no abnormalities was found. Patient was then diagnosed with BRVO of the right eye and received three monthly injections of bevacizumab. Patient’s BCVA and anatomic condition improved with final BCVA of 0.5 on the right eye. Patient was monitored monthly for the next six months and there was no deterioration on the anatomical and functional outcomes. Conclusion: Lower frequency of monthly bevacizumab injection could be beneficial in some cases of BRVO. Monthly monitoring is essential to maintain anatomical and functional outcomes.

  • Broncho-Oesophageal Fistula Complicating Carcinoma of the Oesophagus

    Broncho-oesophageal fistula refers to an abnormal communication between a bronchus and the oesophagus. Broncho-oesophageal fistula is rare and can be either congenital or acquired. Congenital fistulas are usually diagnosed in the neonatal period as they present with respiratory distress and cyanosis during feeding. Whereas developmental anomaly is the commonest cause in infancy and childhood, the aetiology in adults is most frequently secondary to an oesophageal malignancy1. Non-malignant causes of fistulae are rare. Diagnosis of a broncho-oesophageal fistula may sometimes be difficult because of an insidious and non-specific clinical course2. A rare case of broncho-oesophageal fistula due to carcinoma of the oesophagus, which was discovered incidentally during a barium swallow study is presented. SUMMARY A 68-year-old man with dysphagia who was diagnosed to have carcinoma of the oesophagus, which was complicated by broncho-oesophageal fistula is presented. The role of radiology in the management of this condition is discussed.

  • Chronic Lymphocytic Leukemia, a Case Report

    Purpose of the presentation. The case presentation has as aim to describe the onset and evolution of a case of Chronic Lymphocytic Leukemia, (CLL), less common, which does not fit into the standard treatment criteria for malignant hemopathies. Case description. The patient TA, female, 39 years of age, married, with 2 children, was admitted to the Emergency County Hospital of Targu Jiu in 2014, in the Internal Medicine Department for the Obstructive Chronic Bronchopathy with frequent coughing, night sweats, retrosternal pain. Clinical and ultrasound examination revealed splenomegaly, with spleen enlargement of 3 cm above normal diameters. The patient was also in the Endocrinology department with the diagnosis of Type II Diabetes and Grade III Obesity. Laboratory results. Hemogram in 3 Diff revealed Hb = 14g / dL, Ht = 45%, Nr. Platelets of 275,000 / mm cub, but an increased number of Leucocytes, 117,000 / mm cub, and in the leucocyte formula from peripheral blood, the lymphocyte count was 80%, the absolute value being 9360. All biochemistry assays were in normal values, inclusive LDH = 375 md / dL, (N = 200-400 mg / d L. In the cytological examination of the peripheral blood smear stained with My Grunwald-Giemsa staining in the LPF 100 microscopy, was described the lymphocytosis with very small lymphocytes in high percent. Conclusions; CLL onset occurs in a young female patient, contrary to the frequency of LLC in people over 65 years of age, especially in men. The normal baseline Hb, Ht%, Platelet counts in establishing the CLL diagnosis directly in stage I / II could be falsely positive due to the patient’s comorbidities with COPD and DZ type II and Obesity. Also low platelet counts in the final stage III / IV may be appropriate for the LLC disease stage or may be low due…

  • Novel Technique In Strangulated Para-Umbilical Hernia Repair Under Local Anaesthesia Block For High-Risk Patient : Case Report

    Background: Strangulated hernia is one of the most emergency cases that require surgery under general anaesthesia. Here, we present a rare case of strangulated PUH repair done under rectus sheath block (RSB). Case Presentation: We report here a case of a 74-year-old male with diabetes mellitus, hypertension, ischemic heart disease with ejection fraction 20% who presented to our ER with peri-umbilical hernia (PUH) swelling and constipation. On examination, incarcerated PUH was found with massive ascites. Under local anaesthesia, rectus sheet block was performed. During midline laparotomy, there was a supra-umbilical hernia defect of about 3 cm narrow neck containing bowel loop about 5-7cm in length, initially appeared ischemic then regain Its normal colour, primary repair done for the defect. No complication was observed in the post-operative period. Discussion: Strangulated hernia is an emergency case that requires surgical intervention, hernia reduction and resection of necrotic tissue if needed. PUH repair as a day case by using local anaesthesia is a good option as it has advantages of low recurrence and infection rate. For patients with 3 to 4 ASA class, general or spinal anaesthesia is risky, and RSB is the best alternative option in such high-risk patients. Conclusion: Rectus sheath block is a good option for strangulated PUH patients.

  • A Rare Case of Adrenaline- Induced Kounis Syndrome presenting to the Emergency department

    Introduction: Kounis syndrome is the concurrent occurrence of acute coronary syndromes with hypersensitivity reactions [4] [3]. It has been established as a hypersensitivity coronary disorder induced by various conditions, drugs, environmental exposures, foods and coronary stents. Allergic, hypersensitivity, anaphylactic and anaphylactoid reactions are associated with this syndrome. Vasospastic allergic angina, allergic myocardial infarction and stent thrombosis with occluding thrombus infiltrated by eosinophils and/or mast cells. There are three principal variants of the syndrome: type 1 is allergy – related angina due to coronary spasm, whereas, type 2 is allergy related myocardial infarction due to plaque rupture or erosion and type 3 is allergy – related stent thrombosis with re – infraction. Case summary: A young healthy male with no significant risk factors for coronary artery disease developed ventricular tachycardia and myocardial infarction following therapeutic dose of intramuscular administration of adrenaline for an anaphylactic reaction to the ED.

  • A Rare Case of Pantoprazole Induced Anaphylactic Shock

    INTRODUCTION: Pantoprazole,a drug from the proton pump inhibitors group (PPI), is widely used for gastroesophageal disease and peptic ulcer . PPI’s act on H+/K+-ATPase pump,the process needed for gastric acid secretion 1. Drug induced hypersensitivity is an immune mediated reaction. Drug hypersensitivity reactions are commonly encountered in clinical practice1. OBJECTIVE: The objective of reporting this case is to show that anaphylaxis reaction may occur with tablet pantoprazole. CASE SUMMARY: A 40 year old female reported to emergency department in hemodynamically unstable condition, with a history of loose stool, vomiting, spasmodic abdomen pain, redness all over the body after approximate 1 and half hour back after ingestion of tablet pantoprazole 40mg .

  • Role of Aspirin on Keloid : a Case Report

    A keloid is a cutaneous mass that characteristically develops following dermal injury. Keloids extend beyond the borders of the original wound invading normal skin. Usually appear as firm nodules, often pruritic and painful, and generally do not regress spontaneously. Most often occur on the chest, shoulders, upper back, back of the neck, and earlobe. We report a case of excessive keloid formation in a 40 years old female following itching in which no other aetiology could be found after detailed history, examination and investigation. Because of the rapid and extensive nature of the disease it is a matter of further research.

  • Natural orifice endoscopic drainage of a perforated duodenal ulcer

    Posterior perforation of gastric and duodenal ulcers is uncommon and frequently misdiagnosed due to nonspecific clinical exam findings. The need for surgical treatment has recently been questioned in patients with contained perforations due to the success of nonoperative management and the morbidity and mortality associated with surgical intervention. We present a clinically stable 65-year-old morbidly obese female transferred to our institution with radiographic evidence of posterior perforation of a duodenal ulcer with a large associated abscess cavity. A fenestrated 9.5 French nasal feeding tube was directed over a guide-wire into the abscess cavity under endoscopic/fluoroscopic guidance and used for decompression. The patient was managed conservatively and repeat computed tomography (CT) demonstrated resolution of the cavity. She was discharged to home after an uncomplicated 10-day hospital course. Contained posterior peptic/duodenal ulcer perforations associated with an abscess cavity can be successfully managed conservatively in patients that are hemodynamically stable and without overt signs of peritonitis. Natural orifice drainage of the cavity, gastric decompression, antibiotics, PPI administration, and nutritional support can avoid the morbidity and mortality associated with traditional surgical management.