scholarly journals In trauma, expect the unexpected: a rare case of post-traumatic pancreatitis associated with salmonellosis and enterocolitis

2018 ◽  
pp. bcr-2018-226286
Author(s):  
Nadja Apelt ◽  
Emily Thompson ◽  
Erica Brown ◽  
David Schindel
Keyword(s):  
Rare Case ◽  
Gunshot Wound ◽  
Burst Fracture ◽  
Exploratory Laparotomy ◽  
Trauma Centre ◽  
Diaphragmatic Injury ◽  
Imaging Studies ◽  
Post Traumatic ◽  
Level I ◽  
Traumatic Pancreatitis

A 16-year-old Hispanic man was transferred to our level I paediatric trauma centre with pancreatitis. Ten days prior, he had sustained a gunshot wound to the abdomen requiring an exploratory laparotomy for repair of a traumatic left diaphragmatic injury. Additional injuries included gastric, renal, liver and pancreatic lacerations as well as a T12 burst fracture that resulted in paraplegia. Conservative management of pancreatitis was unsuccessful over the next 10 days, resulting in progressive symptoms of severe unresolved pain, nausea, emesis and rising lipase. Workup for post-traumatic, biliary and drug-associated causes of pancreatitis was negative, and no anatomical abnormalities were found on imaging. A fever workup on hospital day 10 revealed a urinary tract infection with non-typhoidSalmonellasp, and subsequent stool and imaging studies revealed salmonellosis associated with right-sided colitis andClostridium difficileinfection. Pancreatitis resolved within 48 hours following treatment of salmonellosis andClostridium.

scholarly journals Pedunculated Cecal Lipoma Causing Colo-Colonic Intussusception: A Rare Case Report

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Stefanos Atmatzidis ◽  
Grigoris Chatzimavroudis ◽  
Aristidis Patsas ◽  
Basilis Papaziogas ◽  
Spiros Kapoulas ◽  
...  
Keyword(s):  
Case Report ◽  
Preoperative Diagnosis ◽  
Rare Case ◽  
Histopathological Examination ◽  
Exploratory Laparotomy ◽  
Right Hemicolectomy ◽  
Resected Specimen ◽  
Ascending Colon ◽  
Imaging Studies ◽  
Rare Case Report

Colonic lipomas are uncommon nonepithelial neoplasms that are typically sessile, asymptomatic and incidentally found during endoscopy, surgery, or autopsy. We present a very rare case of a 34-year-old female patient with symptomatic pedunculated cecal lipoma causing intermittent colo-colonic intussusception. Despite adequate imaging studies, definite preoperative diagnosis was not established and the patient underwent exploratory laparotomy. Intraoperatively, intussusception of the cecum into the ascending colon was found and right hemicolectomy was performed. Macroscopic assessment of the resected specimen showed the presence of a giant cecal pedunculated polypoid tumor with features of lipoma, causing intussusception. Histopathological examination confirmed the diagnosis of pedunculated cecal lipoma.

scholarly journals Clinical Characterization of Traumatic Acute Interhemispheric Subdural Hematoma

2020 ◽  
Vol 47 (4) ◽  
pp. 504-510
Author(s):  
Etienne Léveillé ◽  
Solon Schur ◽  
Ahmed AlAzri ◽  
Charles Couturier ◽  
Mohamed Maleki ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Trauma Centre ◽  
Motor Deficits ◽  
Sagittal Sinus ◽  
Traumatic Amnesia ◽  
Close Proximity ◽  
Transient Loss ◽  
Bridging Veins ◽  
Post Traumatic ◽  
Level I

ABSTRACT:Object:Interhemispheric subdural hematomas (IHSDHs) are thought to be rare. Surgical management of these lesions presents a challenge as they are in close proximity to the sagittal sinus and bridging veins. IHSDHs are poorly characterized clinically and their exact incidence is unknown. There are also no clear guidelines for the management of IHSDH.Methods:This is a retrospective review of all admitted patients with a diagnosis of traumatic brain injury over a 4-year period at a Level I trauma centre. Clinical characteristics of all patients with subdural hematoma (SDH) and IHSDH were collected.Results:Of 2165 admissions, 1182 patients had acute traumatic SDHs, 420 patients had IHSDHs (1.9% of admissions and 35.5% of SDH), 35 (8.3% of IHSDH) were ≥8 mm in width. IHSDH was isolated in 16 (3.8%) of the cases. Average age was 61.7 ± 21.5 years for all IHSDHs and 77.1 ± 10.4 for large IHSDH (p < 0.001). For large IHSDH, a transient loss of consciousness (LOC) occurred in 51.5% of individuals, post-traumatic amnesia (PTA) in 47.8% of cases, and motor weakness in 37.9% of patients. Five of the large IHSDH patients presented with motor deficits directly related to the IHSDH, and weakness resolved in four of these five individuals. None were treated surgically. Progression of IHSDH width occurred in one patient.Conclusion:IHSDHs are often referred to as rare entities. Our results show they are common. Conservative management is appropriate to manage most IHSDHs, as most resolve spontaneously, and their symptoms resolve as well.

scholarly journals Scoring systems for early prediction of tibial fracture non-union: an update

2021 ◽  
Author(s):  
George D. Chloros ◽  
Nikolaos K. Kanakaris ◽  
James S. H. Vun ◽  
Anthony Howard ◽  
Peter V. Giannoudis
Keyword(s):  
Tibial Fracture ◽  
Scoring Systems ◽  
Trauma Centre ◽  
Predictive Values ◽  
Non Union ◽  
Post Operative Period ◽  
Male Patients ◽  
Level I ◽  
Healing Score ◽  
Tibial Shaft Fractures

Abstract Purpose To evaluate the available tibial fracture non-union prediction scores and to analyse their strengths, weaknesses, and limitations. Methods The first part consisted of a systematic method of locating the currently available clinico-radiological non-union prediction scores. The second part of the investigation consisted of comparing the validity of the non-union prediction scores in 15 patients with tibial shaft fractures randomly selected from a Level I trauma centre prospectively collected database who were treated with intramedullary nailing. Results Four scoring systems identified: The Leeds-Genoa Non-Union Index (LEG-NUI), the Non-Union Determination Score (NURD), the FRACTING score, and the Tibial Fracture Healing Score (TFHS). Patients demographics: Non-union group: five male patients, mean age 36.4 years (18–50); Union group: ten patients (8 males) with mean age 39.8 years (20–66). The following score thresholds were used to calculate positive and negative predictive values for non-union: FRACTING score ≥ 7 at the immediate post-operative period, LEG-NUI score ≥ 5 within 12 weeks, NURD score ≥ 9 at the immediate post-operative period, and TFHS < 3 at 12 weeks. For the FRACTING, LEG-NUI and NURD scores, the positive predictive values for the development of non-union were 80, 100, 40% respectively, whereas the negative predictive values were 60, 90 and 90%. The TFHS could not be retrospectively calculated for robust accuracy. Conclusion The LEG-NUI had the best combination of positive and negative predictive values for early identification of non-union. Based on this study, all currently available scores have inherent strengths and limitations. Several recommendations to improve future score designs are outlined herein to better tackle this devastating, and yet, unsolved problem.

The management of bite wounds in children—A retrospective analysis at a level I trauma centre

Injury ◽  
2012 ◽  
Vol 43 (12) ◽  
pp. 2117-2121 ◽  
Author(s):  
Manuela Jaindl ◽  
Judith Grünauer ◽  
Patrick Platzer ◽  
Georg Endler ◽  
Christiane Thallinger ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Trauma Centre ◽  
Level I ◽  
Bite Wounds

scholarly journals Paraneoplastic polymyositis presenting as a clinically occult breast cancer

2017 ◽  
Vol 99 (2) ◽  
pp. e40-e43 ◽  
Author(s):  
N Merali ◽  
M Yousuff ◽  
V Pronisceva ◽  
A Poddar
Keyword(s):  
Paraneoplastic Syndrome ◽  
Rare Case ◽  
Primary Tumour ◽  
Imaging Studies ◽  
Occult Breast Cancer ◽  
Symptom Stability ◽  
Underlying Malignancy ◽  
Neurological Presentation ◽  
Complete History ◽  
Metaplastic Breast Carcinoma

Paraneoplastic syndrome affects less than 1% of cancer patients. Diagnosis of paraneoplastic syndrome with neurological presentation requires screening for an underlying malignancy, including a complete history, physical examination and imaging studies. Treatment often results in symptom stability, rather than improvement. Paraneoplastic polymyositis can precede or instantaneously occur at diagnosis or treatment of a primary tumour, while neurological symptoms can persist even following cancer treatment. We report a rare case of metaplastic breast carcinoma with an unusual presentation of paraneoplastic polymyositis.

Features of the development of traumatic pancreatitis with gunshot wounds to the abdomen

2021 ◽  
Vol 23 (1) ◽  
pp. 101-108
Author(s):  
Nikita I. Myasnikov ◽  
Vyacheslav V. Panov ◽  
Mariyama R. Ba ◽  
Igor Y. Kim ◽  
Kazibek B. Chakalsky ◽  
...  
Keyword(s):  
High Probability ◽  
Gunshot Wound ◽  
Gunshot Wounds ◽  
Pancreatic Injury ◽  
Lateral Impact ◽  
Timely Manner ◽  
Military Conflict ◽  
Diagnostic Potential ◽  
Traumatic Pancreatitis ◽  
Diagnostic Capabilities

The features of the development of traumatic pancreatitis in gunshot wounds of the abdomen, which present difficulties in timely diagnosis, are considered, hypotheses are formulated for studying the problem. Two clinical cases of developing traumatic pancreatitis against the background of a gunshot wound to the abdomen with indirect damage to the pancreas are presented. Without taking into account the peculiarities of the formation of the wound canal relative to the organs of the abdomen, in conditions of limited diagnostic potential, there is a high probability of late diagnosis of traumatic pancreatitis, especially in indirect damage. Injuries to the organs of the upper half of the abdomen can be risk factors for indirect damage to the pancreas due to the effect of lateral impact energy and the formation of a temporary pulsating cavity. In general, the management of such wounded in a surgical hospital with limited diagnostic capabilities or with stage treatment in a local military conflict requires the surgeon to know the peculiarities of the course of traumatic pancreatitis, which make it possible to prevent the development of complications in a timely manner. The development of traumatic pancreatitis in penetrating gunshot wounds to the abdomen is not always a consequence of direct pancreatic injury. This circumstance must always be taken into account during a diagnostic laparotomy.

EP.FRI.543 A rare case of acute jejuno-jenual intussusception in a patient with Roux-en-Y bypass secondary to a benign polyp

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Armin Fardanesh ◽  
Jamie Powell ◽  
Maitham Al-Whouhayb
Keyword(s):  
Small Bowel ◽  
Rare Case ◽  
Exploratory Laparotomy ◽  
Lead Point ◽  
Benign Polyp ◽  
Small Bowel Intussusception ◽  
Pathological Lead Point ◽  
Malignant Lesions ◽  
Ectopic Pacemaker ◽  
Upper Abdominal

Abstract Introduction Roux-en-Y Gastric bypass (REYGB) amounts for a third of surgical bariatric interventions. Small bowel obstruction (SBO) is a long-term complication in REYGB and can be caused by intussusception of bowel, in approximately 0.5% of procedures.  Intussusception in REYBG is mostly attributed to dysmotility. This report demonstrates a rare case of intussusception in REYGB secondary to a benign polyp.  Case description A 45 year old female, three years post REYGB, presented to A&E with acute, extreme upper abdominal pain, with three days absolute constipation. She was tender on examination with normal blood tests. CT scan demonstrated small bowel intussusception. Initial concerns were of intussusception of the jejuno-jejunostomy anastomosis causing SBO.  She had an exploratory laparotomy, which confirmed intussusception, however this was 20cm distal to the jejuno-jejunostomy. Bowel was gently reduced, and deemed viable. On thorough run-through, a small segment at the transition point, was considered abnormal on palpation. This region was resected and a 1x1cm intraluminal polyp was identified as the causative lead point. The patient did well postoperatively.  Discussion Small bowel intussusception in adults is typically attributed to pathological lead point, such as benign or malignant lesions. Intussusception in REYBG is a rare but well-documented cause of intestinal obstruction, usually attributed to dysmotility, secondary to ectopic pacemaker cells particularly around anastomoses. In this case, the intussusception was caused by an unusual pathology separate from the jejuno-jejunal anastomosis. We recommend thorough examination of all adjacent bowel to exclude lesions, in this case a polyp, which could result in recurrence. 

scholarly journals Spinal intraosseous epidural arteriovenous fistula with perimedullary drainage obliterated with Onyx embolization: case report

2015 ◽  
Vol 23 (2) ◽  
pp. 250-253 ◽  
Author(s):  
Chang-Hsien Ou ◽  
Hao-Kuang Wang ◽  
Tzu-Hsien Yang ◽  
Cheng-Loong Liang ◽  
Ho-Fai Wong
Keyword(s):  
Case Report ◽  
Arteriovenous Fistula ◽  
Rare Case ◽  
Direct Evidence ◽  
Embolic Agent ◽  
Imaging Studies ◽  
Disease Evolution ◽  
Compressive Fracture ◽  
Rare Location ◽  
Vein Reflux

The authors report an extremely rare case of spinal intraosseous epidural arteriovenous fistula (AVF) with perimedullary vein reflux causing symptoms of myelopathy. The intraosseous fistula tracts were completely obliterated with Onyx embolic agent, resulting in a total resolution of symptoms. The unique features of this case include the rare location of the fistula in the vertebral body and the association of the fistula with a compressive fracture. Imaging studies confirmed these hemodynamic findings and provided clarity and direct evidence regarding the association of epidural AVF formation with the vertebral compressive fracture. The authors also propose a possible disease evolution based on the previously adduced reflux-impending mechanism.

scholarly journals A rare clinical case: schwannoma of tongue

2019 ◽  
Vol 5 (3) ◽  
pp. 789
Author(s):  
Chandra Veer Singh ◽  
Sheetal Radia ◽  
Saalim Sheikh ◽  
Vijay Haribhakti
Keyword(s):  
Head And Neck ◽  
Rare Case ◽  
Neck Region ◽  
Surgical Excision ◽  
Imaging Studies ◽  
Head And Neck Tumours ◽  
Head And Neck Region ◽  
Complete Surgical Excision ◽  
Slow Growing ◽  
Rule Out

<p class="abstract">Schwannoma are slow growing tumours, which can arise from any peripheral nerve. 10% of schwannomas that occur in the head and neck region mostly originate from the vagus or sympathetic nervous system. Extracranial schwannomas in the head and neck region are rare neoplasm. Intraoral schwannoma are only 1% of the all head and neck tumours. Diagnosis is established by imaging studies such as magnetic resonance imaging or computed tomography, while FNAC is used to rule out other conditions. We report a rare case of lingual schwannomas generally present as a painless lump schwannoma of the tongue in a 27-year-old male complaining of asymptomatic swelling over a posterolateral surface of the tongue, treated by complete surgical excision. The diagnosis was established on the basis of clinical, histopathological, and immunohistochemical examination. We report a rare case of schwannoma over the posterolateral surface of tongue. Prognosis is good for the patient when this condition is correctly diagnosed as the condition rarely recurs after complete resection.</p>

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