Atypical presentation of catastophric spontaneous mesenteric bleeding

2021 ◽  
Vol 14 (8) ◽  
pp. e244051
Author(s):  
May Honey Ohn ◽  
Jun Rong Ng ◽  
Ng Pey Luen ◽  
Khin Maung Ohn
Keyword(s):  
Close Monitoring ◽  
Atypical Chest Pain ◽  
Mortality And Morbidity ◽  
Sudden Drop ◽  
Abdominal Bleeding ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Profound Hypotension ◽  
Early Imaging ◽  
High Index Of Suspicion

Spontaneous mesenteric bleeding is an exceptionally rare clinical condition and potentially lethal especially among elderly patients who are taking oral anticoagulant. We present a case of a 79-year-old woman who presented to the emergency department with atypical chest pain which was radiating to the back. She developed profound hypotension with a sudden drop of haemoglobin. Contrast-enhanced CT of the aorta showed active mesenteric bleeding with mesenteric haematoma. The early diagnosis relies solely on a high index of suspicion of occult bleeding in patients with unexplained hypotension with a sudden drop of haemoglobin. Troponin can be falsely positive in mesenteric bleeding. Close monitoring to detect any sign of deterioration and early imaging in diagnosing intra-abdominal bleeding can help to avoid delay in treatment which is essential to prevent mortality and morbidity.

Sinonasal polyposis complicated with extradural abscess and lateral rectus palsy

2021 ◽  
Vol 14 (5) ◽  
pp. e242667
Author(s):  
Aswin Chandran ◽  
Harithraa Cheniappangoundar Baskar ◽  
Anup Singh ◽  
Rajeev Kumar
Keyword(s):  
Nasal Polyposis ◽  
Early Recognition ◽  
Clinical Findings ◽  
Acute Onset ◽  
Mortality And Morbidity ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
High Index Of Suspicion ◽  
Orbital Complications

Sinogenic intracranial and orbital complications are infrequent complications of chronic rhinosinusitis with nasal polyposis (CRSwNP), leading to potentially fatal intracranial and orbital sequelae. The mortality and morbidity associated with these complications remain high despite the widespread use of antibiotics. We report a patient with CRSwNP presenting with acute onset extradural empyema and sixth nerve palsy in whom the diagnosis was delayed, necessitating early surgical intervention. Our case shows that delay in management and underdiagnosis of sinusitis with nasal polyposis can lead to devastating complications. A high index of suspicion, early recognition of the clinical findings and radiological evaluation with contrast-enhanced CT of paranasal sinuses, orbit and brain are essential to rule out fatal complications associated with CRSwNP. Timely endoscopic intervention and the use of antibiotics can lead to good outcomes, even in complicated cases.

scholarly journals Case Report: Seaweed Bezoar Masquerading as a Malignant Obstruction

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
E. C. Abboud ◽  
B. Babic
Keyword(s):  
Small Bowel ◽  
High Sensitivity ◽  
Bowel Loop ◽  
Asian Woman ◽  
Malignant Obstruction ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Risk Patients ◽  
High Index Of Suspicion

Bezoars represent a rare cause of small bowel obstruction (SBO). Nonoperative management of bezoars includes use of endoscopy with mechanical or chemical dissolution methods. When obstruction persists, surgical intervention becomes necessary. Here, we present the case of an Asian woman with a SBO secondary to a phytobezoar masquerading as a malignancy. She presented with two days of acute-on-chronic abdominal pain that started after eating seaweed. Initial computed tomography (CT) scan showed a SBO with a jejunal transition point and ill-defined liver lesions, worrisome for a malignant obstruction with liver metastases. Further imaging, however, showed the resolution of these artifacts. Subsequent laparotomy revealed a small bowel loop with copious obstructing seaweed. A distal stricture was palpated, and the involved segment was resected. Intraoperative liver ultrasound was negative, and final pathology revealed benign small intestine with a mild stricture. Given the rarity of bezoar-related obstructions, the diagnosis is often delayed particularly when confounding factors exist such as our patient’s concomitant hepatic findings. Contrast-enhanced CT has a high sensitivity but a lower specificity in identifying bezoars. A high index of suspicion is therefore necessary especially when managing higher risk patients.

Early presentation of traumatic pseudoaneurysm of deep lingual artery as a massive oral bleed

2021 ◽  
Vol 14 (4) ◽  
pp. e240928
Author(s):  
Ramya Rathod ◽  
Neha Choudhary ◽  
Bharat Hosur ◽  
Sandeep Bansal
Keyword(s):  
Successful Outcome ◽  
Lingual Artery ◽  
Early Presentation ◽  
Artery Pseudoaneurysm ◽  
Pseudoaneurysm Formation ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Traumatic Pseudoaneurysm ◽  
Secondary Haemorrhage ◽  
High Index Of Suspicion

Tongue trauma with active bleed is most commonly due to the ruptured lingual artery and its branches, whereas delayed haemorrhage is usually secondary to pseudoaneurysm formation. This case is a unique presentation of traumatic tongue bleeds with early formation of pseudoaneurysm of a lingual artery branch. We present our experience in its management. A contrast-enhanced CT (CECT) with angiography detected right deep lingual artery pseudoaneurysm, which was managed by endovascular gelfoam embolisation followed by tongue laceration repair. Tongue bleed stopped immediately post embolisation; tongue viability and functions restored on postoperative day 1 of repair. No complications like secondary haemorrhage or tongue necrosis were noted at 1-month follow-up. High index of suspicion for lingual artery and/or its branch pseudoaneurysm is crucial in acute and uncontrollable traumatic tongue bleed. A CECT is a minimum norm in early diagnosis. Choice of management is the cornerstone of a successful outcome.

scholarly journals Asymptomatic gossypiboma with complete intramural migration and ileoileal fistula

2019 ◽  
Vol 12 (6) ◽  
pp. e228587
Author(s):  
Pranav Mohan Singhal ◽  
Manu Vats ◽  
Sushanto Neogi ◽  
Mehul Agarwal
Keyword(s):  
Asymptomatic Patient ◽  
Exploratory Laparotomy ◽  
Surgical Sponge ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Complication Of Surgery ◽  
High Index Of Suspicion ◽  
Upper Abdomen ◽  
Resection And Anastomosis

Retained gossypiboma is a rare and under-reported complication of surgery, which can present in a variety of ways. Thus, a very high index of suspicion is required by the clinician to clinch the diagnosis in a postoperative patient. A 45-year-old woman, who was otherwise asymptomatic, presented to the General Surgery outpatient department (OPD) with a contrast-enhanced CT suggestive of a retained intra-abdominal foreign body from previous surgery. An exploratory laparotomy was planned on elective basis. Intraoperatively, dense inter-bowel adhesions were found in the upper abdomen. After a meticulous adhesiolysis, an ileoileal fistula and an intraluminal surgical sponge were discovered. Resection and anastomosis of the involved ileal segment was done. An asymptomatic patient with a migrated intramural gossypiboma with an ileoileal fistula is an extremely rare occurrence. In these circumstances, it becomes almost impossible for the surgeon to clinch the diagnosis of a gossypiboma in an otherwise asymptomatic patient, without the aid of radiological investigations.

scholarly journals Hollow viscus injury due to blunt abdominal trauma

2017 ◽  
Vol 4 (3) ◽  
pp. 861 ◽  
Author(s):  
Surya Ramachandra Varma Gunturi ◽  
Venu Madhav Thumma ◽  
Jagan Mohan Reddy Bathalapalli ◽  
Nava Kishore Kunduru ◽  
Kamal Kishore Bishnoi ◽  
...  
Keyword(s):  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Close Monitoring ◽  
Medical Sciences ◽  
Hollow Viscus ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Hollow Viscus Injury ◽  
Time Of Presentation

Background: Management of hollow viscus injury (HVI) due to blunt abdominal trauma (BAT) is a challenge to the clinicians even in the era of advanced imaging and enhanced critical care. Repeated clinical examination with appropriate imaging with multidisciplinary teamwork is the key for timely intervention in equivocal cases for successful outcomes. Aim of the study was to present our experience over last 4½ years.Methods: This is a retrospective study of prospectively collected data of patients treated at surgical gastroenterology department, Nizam’s Institute of Medical Sciences, Hyderabad, India over a period of 4½ years (2012-2016).Results: A total of 126 BAT Patients were treated in our unit as inpatients during the last 4½ years. Out of 126, twenty patients (15.87%) with HVI in whom surgical intervention was done formed the study group. Contrast enhanced CT Scan abdomen and chest was done in stable patients (13/20), in rest of the patients (7/20) the decision to operate was taken more on clinical grounds along with X-ray abdomen and USG abdomen features. 12 (60%) had jejunal and ileal injuries, 5 (25%) patients had colonic injuries (sigmoid 4, caecum 1). One (5%) patient had extra peritoneal rectal perforation with ascending retroperitoneal fascitis and 2 (10%) had duodenal injury. Two (10%)patients required relaparotomy. We had mortality in 3 (15%) patients and 17 (85%) patients had complete recovery.Conclusions: Hollow viscus injury should be suspected in all cases of blunt abdominal trauma. In equivocal cases careful repeat clinical examinations with close monitoring and repeat imaging is highly essential to prevent delay in intervention. Type of procedure is based on time of presentation, degree of contamination, associated injuries and general condition of the patient.

Early diagnosis of poststernotomy mediastinitis: Are there typical findings in contrast-enhanced CT?

2009 ◽  
Vol 56 (S 01) ◽  
Author(s):  
C Schimmer ◽  
M Weininger ◽  
K Hamouda ◽  
C Ritter ◽  
SP Sommer ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct
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