We describe a case of a teenager who presented with palpitations and abnormal low atrial rhythm. Celiac Disease (CD) serology, sent due to low ferritin, was positive and gastroscopy confirmed CD diagnosis. Both palpitations and abnormal rhythm resolved after gluten-free diet with normalization of CD serology.
SARS-CoV 2 was designated a pandemic by WHO on March of 2019. There have been over 120 million confirmed cases of COVID-19 globally with greater than 4 million hospitalizations in the US alone. These cases can range from asymptomatic disease to multi-organ dysfunction resulting in death. The spectrums of complications stemming from COVID-19 are much broader and can include other autoimmune disorders. Here we present a case of a woman who developed autoimmune hemolytic anemia from COVID-19 infection and was successfully treated with high dose corticosteroids.
Successful treatment for bladder rupture after explosion during transurethral resection of prostate: a case report
Extra or intraperitoneal bladder explosion is a rare complication of transurethral resection of the prostate (TURP) or bladder tumor resection associated with high morbidity. There were just over 25 reports of bladder explosion described in the literature until 2015. We report the case of a 56-year-old black man, diagnosed with prostatic adenocarcinoma and scheduled for tunneling by transurethral resection of prostate (TURP). His medical history included diabetes mellitus, hypertension, retinopathy with bilateral amaurosis, ischemic stroke, and myocardial infarction. He was successfully submitted to a continuous spinal technique and sedation. During the hemostatic phase of the procedure, a loud “pop sound” was heard in the operating room and the patient presented sudden arterial hypotension and abdominal distention. An exploratory laparotomy was done to manage the bladder explosion. The adequate resolution of this adverse event requires awareness and high clinical suspicion for prompt intervention.
Acute limb ischemia(ALI) in a paediatric patient is a rare condition but may result in limb loss and life long complications. We present here a case of a 34 weeks premature infant, with birth weight 1530 grams, who was having respiratory distress at time of birth. Infant was referred to advanced pediatric center for further management, where he was kept in neonatal ICU. He was put on C-PAP and oxygen support and an infant feeding tube for feeding. On 21st day infant developed ischemia of the right upper limb. Color Doppler flow study was done which revealed thrombosed right radial and ulnar artery and biphasic flow in brachial artery. He was put on low molecular weight heparin and was advised referral to higher center for further management. Patient developed dry gangrene of right hand and wrist resulting in the autoamputation of the hand and wrist after a period of 15 day from development of gangrene. In order to prevent such complications there should well trained staff to detect early ischemic changes in the limb so that timely treatment can be started and the long term chronic complications can be prevented.
Successful treatment for intra-abdominal bleeding due to spontaneous rupture of huge liver cyst using transcatheter arterial embolization: a case report
Background: Non-parasitic simple liver cysts are one of the most common benign hepatic lesions. Although most liver cysts are asymptomatic and remain silent throughout the patient’s life, extremely large cysts can become symptomatic by direct compression to adjacent organs. Herein, we report a case of a spontaneously ruptured simple liver cyst, which is a rare presentation of a benign liver cyst. The patient’s liver cyst re-ruptured and was treated with transcatheter arterial embolization (TAE). Case report: A 62-year-old man presented to our hospital complaining of acute-onset lower abdominal pain. He had undergone laparoscopic fenestration of a huge liver cyst in another hospital 2 years prior. Computed tomography (CT) scan showed spontaneous rupture of a large liver cyst. Laparoscopic exploratory laparotomy showed no signs of ongoing intra-abdominal bleeding from the liver cyst; therefore, the operation was completed with peritoneal lavage. The patient was discharged from our hospital on postoperative day 5. Twelve days after the initial presentation, the patient was re-admitted to our hospital complaining of recurrence of lower abdominal pain. CT scan showed an enlargement of the previously ruptured liver cyst, with intra-abdominal bleeding and massive hematoma in the cyst. Extravasation of the cyst’s wall was also detected. Under the diagnosis of intra-abdominal bleeding from the artery in the wall of the huge cyst, emergent TAE was performed. Although the exact spot of extravasation was not detected, the anterior segment branch of the right hepatic artery, which corresponds to extravasation shown on the CT scan, was embolized. The patient was discharged from our hospital after 7 days, and the liver cyst remained stable without abdominal pain for more than 2 months. Conclusions: This case highlights a rare presentation of spontaneous rupture of a liver cyst with massive bleeding and the efficacy of TAE for the conservative treatment of ruptured liver…
Dislocation of the Mandible Condyle Towards the Middle Cranial Fossa: Case Report and Review of Literature
Introduction: Dislocation of the mandibular condyle into the middle cranial fossa is extremely rare in patients with craniofacial trauma. Methods: This report documents a case of an intact mandibular condyle intrusion into the middle cranial fossa in a 17-year-old woman following a traumatic incident treated by an intraoral approach that was performed to do an open reduction by condylectomy. Results: The causative mechanism, diagnostic features and a management option for reduction and treatment of these cases by performing a multidisciplinary approach involving neurosurgery and oral maxillofacial surgery are presented in this report. Conclusion: Adequate radiographic examination, including Tomography and Magnetic Resonance, is necessary to obtain the proper diagnosis and to determine an effective management.
Few cases of anal canal Merkel cell Carcinoma have been reported in the literature. Merkel Cell Carcinoma is rare neuroendocrine tumor which commonly found in sun-exposed areas such as extremities. We describe a case of 74-year-old male with anal canal Merkel Cell Carcinoma. He presented with peri-anal pain, tenesmus and itching. Besides, he was found to have chronic anemia. An anal nodule was found during per-rectum physical examination that was excised during endoscopy. Histological examination of the nodule confirmed the diagnosis of Merkel Cell Carcinoma. Thenceforward, patient died 7 months after diagnosis with marked metastatic disease despite initiation of Pembrolizumab therapy.
Burkitt Lymphoma of Central Nervous System in an elderly-patient: A new approach with a modified classic regimen
Burkitt’s lymphoma (BL) is one of the high-grade lymphomas, characterized by a rapid growth. They are usually treated with intensive chemotherapy regimens, being normally chemo-sensitive, but at the expense of high toxicity secondary to treatment. Additionally, the compromise of the central nervous system (CNS) implies a major risk as well as greater toxicity, taking into account a worse clinical prognosis with a requirement of more intensive schemes to achieve control of the disease. This implies doubts in the management of older patients with BL with CNS compromise, in whom toxicity is a limitation to these therapies, and there are no other alternatives that offer better benefit in terms of less frequent or severe adverse events, with similar outcomes in terms of progression-free survival (PFS) or overall survival (OS). Therefore, clarifying cases such as the one we report below allows us to provide a therapeutic alternative for older or unfit patients, in whom the intention of treatment should be to seek a good tumor response, but without ignoring the potential toxicity of chemotherapy.
Introduction: This manuscript will dealt with the outcome of emergency surgeries in COVID19 positive individuals. We are under the second wave of COVID pandemic. The research is ongoing regarding the outcome of patients who are undergoing, surgical treatment with COVID Rt-PCR positivity or become COVID positive during early postoperative period. Materials and Methods: All the patients who attended the emergency department of a tertiary care centre were screened for COVID -19 by RT-pcR and the patients who are COVID positive but needed emergency surgical procedure were included in the study. A cohort of 49 patients who were COVID positive and needed emergency surgical procedure due to various causes were included in the study. Results:The causes of acute surgical emergencies were acute appendicitis, appendicular perforation, perforative peritonitis, obstructed/ strangulated inguinal hernia, intestinal obstruction, diabetic foot and perianal abscess. Most of the patients belong to the age group between 40 – 70 years. 63.8% were males. The mortality rate was 12.8%. More than one co-morbid condition was present in 8.5% of individuals. Most of the patients got discharged in 10 – 12 days. 40.4% have co morbid conditions like diabetes or hypertension. 8.5% had more than one co morbid conditions. Diabetes was present in 27.7% of cases Conclusion: The mortality was high during the postoperative period of COVID positive cases, extreme care and precaution should be taken to avoid pulmonary complications
Laparoscopic approach for pancreato-splenic abscess from disseminated melioidosis: Surgical outcome and review of literature
Melioidosis is a severe systemic infection caused by Burkholderia pseudomallei. It commonly affects the lungs, liver and kidneys. Pancreatic and splenic abscess from melioidosis is rare, with few reports in the literature. We present a series of 4 patients with disseminated melioidosis of pancreas and spleen who required surgical intervention. A MEDLINE database review was conducted. Relevant publications were evaluated and demographic data, clinical, radiological findings as well as management options were collected. We found 10 case reports describing this clinical condition. In our series, median age was 57. Median operative time 260 minutes. All four patients failed trial of antibiotic therapy and required surgery. Three underwent distal pancreatosplenectomy and one underwent splenectomy alone. Laparoscopic distal pancreatosplenectomy was successful in two patients. Median length of stay 11.5 days. No post-operative complications and mortality reported. Surgery is indicated in failed medical therapy and laparoscopic approach is safe and feasible.