Acute Gastric Necrosis in a Teenager

Gastric infarction is a rare condition often associated with high mortality due to a delay in diagnosis. The stomach which has a rich supply of blood is a rare site for such a condition. Gastric infarction has a long list of etiological factors. We report a case of a patient who was managed successfully following gastric infarction from gastric dilatation. An 18-year-old female student presented with a three-day history of abdominal pain associated with abdominal distension of two days. The abdomen was distended with generalized tenderness, rebound tenderness, and guarding. Bowel sounds were absent. Digital rectal examination was unremarkable, and a pregnancy test was negative. Biochemical tests were all normal. Intraoperatively, two litres of serosanguinous fluid was suctioned from the abdomen. About 300 mL of pus was suctioned from the pelvis. The gangrenous portion was resected, and repair was done in two layers using Conell and Lambert suture techniques. Acute gastric necrosis is a rare surgical condition that requires a high index of suspicion and prompts aggressive resuscitation and surgical intervention to obviate the high mortality rate associated with the condition.

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Case Report: Pediatric pharmacobezoar with subacute intestinal obstruction

F1000Research ◽

10.12688/f1000research.25441.1 ◽

2020 ◽

Vol 9 ◽

pp. 1037

Author(s):

Mahnaz Hakeem ◽

Heeramani Lohana ◽

Sarwat Urooj ◽

Sheraz Ahmed

Keyword(s):

Case Report ◽

Intestinal Obstruction ◽

Abdominal Distension ◽

Acute Intestinal Obstruction ◽

Rare Entity ◽

Persistent Vomiting ◽

Delay In Diagnosis ◽

History Of ◽

Subacute Intestinal Obstruction ◽

High Index Of Suspicion

Bezoars are an undigested mass causing an intraluminal obstruction in children. Pharmacobezoars are formed from medicines or their vehicle, considered as a less frequent type observed in children. Our objective is to report a relatively rare entity as a potential cause of intestinal obstruction in children. Here we report a case of 13-year-old girl with a history of herbal medicine intake who presented with persistent vomiting and abdominal distension. She was diagnosed with acute intestinal obstruction and managed conservatively without any complications. The patient became stable within two days so was discharged home. We found that ineffective history could lead to a delay in diagnosis and management. Clinicians should have a high index of suspicion for pica and psychiatric disorders, especially in adolescent children.

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Intussusception in preterm neonates: A systematic review of a rare condition

BMC Pediatrics ◽

10.1186/s12887-021-03065-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Mostafa Kotb ◽

Mostafa Abdelatty ◽

Hayssam Rashwan ◽

Yasmine AbdelMeguid ◽

Ahmed Elrouby

Keyword(s):

Systematic Review ◽

Neonatal Intensive Care ◽

Case Reports ◽

Case Series ◽

Rare Condition ◽

Abdominal Distension ◽

Contrast Enema ◽

Preterm Neonates ◽

Lead Point ◽

High Index Of Suspicion

Abstract Background While necrotizing enterocolitis (NEC) is a prevalent condition in preterm neonates admitted to neonatal intensive care unit (NICU), intussusception is exceedingly uncommon and often overlooked. This is due to the fact that they share many clinical characteristics. The initial misdiagnosis of intussusception in preterm neonates (IPN) especially has led to a delay in their management, which increases the risk of developing compromised bowel. Additionally, it is difficult to reach a diagnosis as neonatal intussusception does not have any classical radiological signs even when contrast enema is used. This systematic review is based on the published literature including case reports and case series to review the clinical features of IPN and how to differentiate it from NEC in order to shed the light on this rare disease and how having a high index of suspicion would help practitioners to make an early and accurate diagnosis Methods A systematic literature search to report all cases of relevant articles that reported IPN till date. All cases that were born before 37 weeks gestational age, presented within the neonatal period and having well established documentation were included in the study. Any case that did not have these criteria was excluded from our study. Results Only 52 cases met these criteria during the period from 1963 till date. An average of 10 days had elapsed before the cases were confirmed to have IPN either clinically or intraoperatively. The most frequent manifestations were abdominal distension and bilious gastric residuals, occurring in 85% and 77% of the cases respectively, followed by bloody stools in 43% of cases. However, this triad was present only in approximately one-third of the cases. Only 13 cases were diagnosed as having intussusception preoperatively. About two thirds of the intussusception were located in the ileum. Pathological lead point was present in 7 cases only; 4 of them were due to Meckel’s diverticulum. Nine cases only out of the 52 cases with IPN died. Conclusion It is crucial to detect the clues for diagnosis of intussusception because in contrast to NEC, it is unresponsive to conservative management, affects the viability of the bowel and surgery is essential.

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Extensive gastric necrosis in an infant

International Surgery Journal ◽

10.18203/2349-2902.isj20213625 ◽

2021 ◽

Vol 8 (9) ◽

pp. 2816

Author(s):

Suraj R. Gandhi ◽

Neha S. Shenoy ◽

Vini Joseph ◽

Apoorva P. Makan ◽

Syamantak Basu ◽

...

Keyword(s):

Gastric Wall ◽

Fatal Outcome ◽

Gastric Volvulus ◽

Rare Condition ◽

Abdominal Distension ◽

Feeding Tube ◽

Gastric Necrosis ◽

History Of ◽

Anterior Gastric Wall ◽

Upper Abdominal

Gastric necrosis is a rare condition, more so in children and can be potentially fatal. The sloughing of the necrosed wall results in perforations or large defects in the gastric wall. We report a rare case of extensive gastric necrosis in a 2 months old female infant, managed successfully. Child presented with non-bilious vomiting and excessive cry. There was history of recurrent upper abdominal distension. X-ray of abdomen showed massive pneumoperitoneum. Intra operatively, posterior gastric wall was sloughed off and lower end of feeding tube was lying in the peritoneal cavity. Necrotic wall was debrided and stomach tube was created from remaining anterior gastric wall. Gastrostomy and jejunostomy was done. Post-operative period was uneventful. Dye study at three months showed good gastric capacity. Stomach being a well vascularised organ, necrosis is rare. There is varied etiology of gastric necrosis, volvulus being one of them. Gastric volvulus might be associated with other congenital anomalies like eventration, asplenia, wandering spleen. The incidence of perforation in gastric volvulus with necrosis is 5-28% and a mortality of 50% is reported with such perforations. Vigilant clinical observation in pediatric patients with upper abdominal distension and pain can point the diagnosis and prevent fatal outcome.

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Bone marrow necrosis and fat embolism syndrome: a near fatal complication in previously undiagnosed sickle beta + thalassaemia

BMJ Case Reports ◽

10.1136/bcr-2020-238317 ◽

2021 ◽

Vol 14 (1) ◽

pp. e238317

Author(s):

Nibash Budhathoki ◽

Sunita Timilsina ◽

Bebu Ram ◽

Douglas Marks

Keyword(s):

Bone Marrow ◽

Multiorgan Failure ◽

Rare Condition ◽

Altered Mental Status ◽

Fat Embolism ◽

Bone Marrow Necrosis ◽

Embolism Syndrome ◽

Hb S ◽

High Index Of Suspicion ◽

Specific Symptoms

Prevalence of haemoglobin sickle-β+ thalassaemia (Hb S/β+thal) is variable with geography ranging from 0.2% to 10% among sickle cell patients. Clinical presentation of Hb S/β+thal patients depends on HbA level, with milder disease often going undiagnosed. However, rarely these patients can present with a fulminant vaso-occlusive crisis (VOC). Given VOC can present with non-specific symptoms, the diagnosis and treatment is often delayed. Here, we present a patient who initially developed altered mental status, pancytopenia and multiorgan failure due a critical VOC resulting in bone marrow necrosis and fat embolism. Subsequent workup confirmed that our patient had Sickle-β+ thalassaemia, which had gone undiagnosed, despite subclinical evidence of haemolysis on routine lab work for years. Following diagnosis and initiation of RBC exchange, he improved significantly and was discharged home. High index of suspicion and bone marrow biopsy is vital for early diagnosis and management of this rare condition.

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Intraorbital Abscess: A Rare Cause of Orbit Compression

FACE ◽

10.1177/27325016211005062 ◽

2021 ◽

pp. 273250162110050

Author(s):

Samuel Ruiz ◽

Rizal Lim

Keyword(s):

Pediatric Population ◽

Rare Complication ◽

Disease Process ◽

Rare Condition ◽

External Drainage ◽

Direct Extension ◽

Life Threatening ◽

History Of ◽

High Index Of Suspicion ◽

Prompt Diagnosis

Introduction: Intraorbital abscess is a rare complication of rhinosinusitis that affects most commonly the pediatric population. It is thought to be caused by direct extension or venous spread of infections from contiguous sites and can lead to life-threatening complications, like permanent visual loss and cerebral abscesses. Objectives: Intraorbital abscess is a rare condition that requires prompt diagnosis and treatment to avoid serious complications. Our objectives are to provide an overview of this rare disease process and its management including our successful treatment experience. Case Description: We present a 2 case report of a 13-year-old pediatric male and a 66-year-old male with history of chronic sinusitis who presented with a right intraorbital abscess successfully treated with external drainage with decompression of the orbit. Conclusion: When intraorbital abscess is encountered, a high index of suspicion is needed to allow prompt and accurate diagnosis for this infrequent condition. Timely surgical drainage of the abscess is needed to prevent the development of fatal complications.

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Tracheoinnominate fistula: surgical management of an iatrogenic disaster

The Journal of Laryngology & Otology ◽

10.1017/s0022215106001514 ◽

2006 ◽

Vol 120 (8) ◽

pp. 676-680 ◽

Cited By ~ 26

Author(s):

R W Ridley ◽

J B Zwischenberger

Keyword(s):

Operating Room ◽

Surgical Management ◽

Surgical Repair ◽

Surgical Intervention ◽

Pectoralis Major Muscle ◽

Muscle Flap ◽

Rare Condition ◽

Innominate Artery ◽

Significant Potential ◽

High Index Of Suspicion

Tracheoinnominate fistula (TIF) is a rare condition with significant potential for mortality if surgical intervention is not immediate. We present two cases of successfully managed TIF. Both cases involve ligation and resection of the innominate artery at the TIF followed by a pectoralis major muscle flap. In both cases, success was largely due to a high index of suspicion and immediate control of the bleeding with transport to the operating room for surgical repair. The history, aetiology, and pathogenesis of TIF are reviewed, yielding an algorithm for recommended management of TIF.

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Unusual Nasogastric Tube Position Leading to Delay in Diagnosis of Tracheoesophageal Fistula

Journal of Neonatology ◽

10.1177/09732179211036778 ◽

2021 ◽

pp. 097321792110367

Author(s):

Monika Kaushal ◽

Saima Asghar ◽

Ayush Kaushal

Keyword(s):

Early Diagnosis ◽

Nasogastric Tube ◽

Common Type ◽

X Ray ◽

Delay In Diagnosis ◽

Atypical Symptoms ◽

Tube Position ◽

Esophageal Pouch ◽

High Index Of Suspicion ◽

Surgical Unit

Aim: This case highlights the importance of high index of suspicion for early diagnosis and thorough clinical examination of a newborn with tracheoesophageal atresia and fistula. Case Report: We report a case of most common type of tracheoesophageal atresia with fistula where diagnosis was missed due to unusual gastric position of nasogastric tube. Nasogastric tube reached stomach in esophageal atresia with fistula, delaying the diagnosis and management of condition. After accidental removal of tube and failure to pass again raised suspicion and was confirmed with coiled tube in esophageal pouch in X-Ray chest. Baby shifted to surgical unit for treatment, fortunately baby recovered and discharged home after surgical correction. Conclusion: Tracheoesophageal atresia with fistula can present with atypical symptoms and unusual events, challenging the early diagnosis and treatment of common types of conditions. Other association like VACTERL should be looked for, in patients.

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Subungual Glomus Tumor- Clinical Presentation And Treatment

Bangladesh Journal of Plastic Surgery ◽

10.3329/bdjps.v3i2.18250 ◽

2014 ◽

Vol 3 (2) ◽

pp. 45-48 ◽

Cited By ~ 1

Author(s):

Shyamal Chandra Debnath ◽

Suman Kumar Roy ◽

RR Kairy

Keyword(s):

Soft Tissue ◽

Soft Tissue Tumor ◽

Clinical Presentation ◽

Glomus Tumor ◽

Rare Condition ◽

Surgical Excision ◽

Tissue Mass ◽

Delay In Diagnosis ◽

Nail Deformity

Glomus tumor is a rare condition and constitutes only 1 % of all soft tissue tumor of body. Glomus tumor is familiar for its unusual presentation and long standing symptoms due to delay in diagnosis. Authors have presented the clinical behavior and treatment of 7 patients with subungual soft tissue mass. Following surgical excision, all patients cured of symptoms, at the end of follow up, no recurrence occurred; post operative nail deformity was insignificant. DOI: http://dx.doi.org/10.3329/bdjps.v3i2.18250 Bangladesh Journal of Plastic Surgery July 2012, 3(2): 45-48

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Challenges in the Diagnosis of Giant Cell Arteritis Before Visual Loss

Neurology and Neurobiology ◽

10.31487/j.nnb.2020.03.06 ◽

2020 ◽

pp. 1-5

Author(s):

Purnima Mehta ◽

Faaiq Hassan ◽

Muhammed Omar Qadir ◽

Shirish Dubey ◽

Sergio Pagliarini ◽

...

Keyword(s):

Giant Cell Arteritis ◽

Giant Cell ◽

Visual Loss ◽

Systemic Vasculitis ◽

The Elderly ◽

Common Type ◽

Atypical Presentation ◽

Delay In Diagnosis ◽

Atypical Presentations ◽

High Index Of Suspicion

Background: Giant cell arteritis (GCA) is the most common type of systemic vasculitis affecting the elderly. Ophthalmic presentations of GCA in particular can be difficult to identify prior to permanent visual loss occurring. Methods: Here, we present 3 challenging cases as a retrospective series to highlight the variable presentations of GCA with ophthalmic involvement, but GCA was not suspected due to atypical presentation. Results: Unfortunately, all 3 cases went on to develop visual loss in the affected eye due to a delay in diagnosis or treatment. The authors wish to highlight the challenges posed to the referring clinicians, when patients had systemic/ocular co-morbidities, which delayed the suspicion of GCA Conclusion with a Practical Point: Our cases highlight the variable presentations of this condition as well as the devastating ophthalmic implications that GCA can have. A high index of suspicion must be maintained; particularly in elderly patients with atypical presentations.

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Perforated diverticulitis in a patient with very proximal jejunal diverticula

Journal of Gastric Surgery ◽

10.36159/jgs.v2i3.49 ◽

2020 ◽

Vol 2 (3) ◽

Author(s):

Constantinos Avgoustou ◽

Dimitrios Velecheris

Keyword(s):

Abdominal Distension ◽

Perforated Diverticulitis ◽

Jejunal Loop ◽

Emergency Laparotomy ◽

Rebound Tenderness ◽

Cardiac Arrythmias ◽

Cardiopulmonary Support ◽

Abdomen Ct ◽

Fluid Levels ◽

Jejunal Diverticulitis

Background: We report a case of an elderly with peritonitis due to perforated jejunal diverticulitis, and we highlight the diagnostic evaluation and treatment alternatives. Case presentation: A 92-year-old woman was transferred to the Emergency Dept. with abdominal pain and vomiting for the past 12 hours. Physical examination revealed diffuse pain, abdominal distension, rebound tenderness and bowel silence. She was febrile, tachycardic, tachypneic, hypotensive and anuric. Blood gas estimation showed metabolic acidosis. She fulfilled the criteria of septic shock. At presentation, she was mildly malnourished. From her medical history, she had cardiac arrythmias, hypertension and diabetes mellitus under proper medication, and laparoscopic cholecystectomy. Laboratory investigations revealed Hct 44.6%, WBC 12.500/dL, glucose 300 mg/dL, creatinine 2.8 mg/dL, CRP 405 mg/L, and electrolyte deficit. Abdominal X-ray showed gastric, small intestinal and colonic gas, with no pneumoperitoneum or air-fluid levels. Chest/abdomen CT showed thickening of proximal jejunal loop and adjacent mesentery, and an extraluminal air bubble, suggesting possible perforation. The patient was given intense resuscitation and broad-spectrum antibiotics and underwent emergency laparotomy. Results: Four jejunal diverticula, sized 1-3 cm, were confined to a segment 12 cm long, located 6 cm from the Treitz ligament; the proximal diverticula was inflamed and perforated. The adjacent mesentery was inflamed and thickened; the bowel lumen remained open. We performed one-layer full-thickness suturing of the perforated diverticulum and omental patch closure. The patient was transferred intubated to ICU. E. Coli was isolated from peritoneal fluid cultures and antibiotic therapy was adjusted to antibiogram. The patient had a first bowel movement at day 5 and was extubated at day 21. She needed mild cardiopulmonary support and was discharged at day 30. Conclusions: Jejunal diverticulitis is a challenging disorder since its rarity makes diagnosis difficult and, thus delayed. The perforation of jejunal diverticulitis requires emergent surgery and poses technical dilemmas.

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