SPIGELIAN HERNIA VARIOUS PRESENTATION AND MANAGEMENT- A CASE SERIES

2021 ◽  
pp. 6-8
Author(s):  
B. Santhi ◽  
M. Uma ◽  
Surya. R
Keyword(s):  
Computed Tomography ◽  
Surgical Technique ◽  
Clinical Presentation ◽  
Case Series ◽  
Spigelian Hernia ◽  
Operative Techniques ◽  
Radiological Investigation ◽  
Abdominal Hernias ◽  
Consistent Feature ◽  
High Index Of Suspicion

BACKGROUND: Spigelian hernia is rare and requires high index of suspicion. Given the case of inconsistent ndings and signs the diagnosis of spigelian hernia presents with great difculties than its treatment. Incidence of spigelian hernia ranges from 0.1% to 2% of all abdominal hernias AIM: Aim of this case series is to analyze epidemiological aspects, clinical presentation, challenges in diagnosis, surgical technique characteristics, morbidities and hospital stay MATERIALS AND METHODS: A total number of 4 patients who had undergone surgery for spigelian hernia for a period of 6 months from the month of Jan to June 2021 in the dept of general surgery in KMCH were studied. All 4 cases have been analyzed in this study period and followed up until discharge from the hospital. RESULTS: This case series consisted of 4 cases. All cases presented with pain. Only 2 among 4 cases presented with swelling. Denitive diagnosis of all cases could be done only by CT. Out of these 1 was taken up as emergency.Intraoperatively 3 cases were interstitial and 1 was subcutaneous type. All 4 cases were treated by open surgical technique and by placing mesh at different planes CONCLUSION: Diagnosis of spigelian hernia presents with great difculties and hence one must be aware of the clinical presentation. Pain is the consistent feature of all hernias and only occasionally swelling is present which may mislead easily. Computed tomography of abdomen and pelvis still prevails as the denitive radiological investigation in the diagnosis of spigelian hernia. There are many planes at which mesh can be placed for repair where the operative techniques vary. Though the outcome was good in all four cases discussed here, the post operative complication and duration of stay was considerably less when the mesh was placed in the intermuscular plane.

scholarly journals Vaping in today’s pandemic: E-cigarette, or vaping, product use–associated lung injury mimicking COVID-19 in teenagers presenting with respiratory distress

2020 ◽  
Vol 8 ◽  
pp. 2050313X2096959
Author(s):  
Daphne O Darmawan ◽  
Kriti Gwal ◽  
Brian D Goudy ◽  
Sanjay Jhawar ◽  
Kiran Nandalike
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Lung Injury ◽  
Respiratory Distress ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Case Series ◽  
Product Use ◽  
Abdominal Symptoms ◽  
History Of ◽  
High Index Of Suspicion

The clinical presentation of children and adolescents infected with severe acute respiratory syndrome coronavirus 2 can range from asymptomatic to mild or moderate manifestations. We present a case series of three adolescents who presented during the coronavirus disease 2019 (COVID-19) pandemic with symptoms concerning for COVID-19, including fever, abdominal symptoms, cough, respiratory distress, and hypoxemia. Their laboratory results showed elevated inflammatory markers that are also commonly seen in COVID-19. The chest imaging studies mimicked COVID-19 with non-specific ground glass opacities and interstitial prominence patterns. However, severe acute respiratory syndrome coronavirus 2 testing was negative and further questioning of these adolescents and their parents revealed a history of vaping marijuana-related products leading to the eventual diagnosis of e-cigarette, or vaping, product use–associated lung injury. Our patients were successfully treated with corticosteroids. The providers caring for pediatric patients, especially adolescents, should continue to have a high index of suspicion for e-cigarette, or vaping, product use–associated lung injury in patients presenting with unexplained respiratory failure, while ruling out COVID-19.

scholarly journals THE OBSERVATIONAL & CROSS-SECTIONAL STUDY OF CLINICAL PATTERN AND OUTCOME OF ORGANOPHOSPHORUS POISONING AT MGM MEDICAL COLLEGE AND HOSPITAL, JAMSHEDPUR, JHARKHAND

2020 ◽  
pp. 62-63
Author(s):  
Sanjay Kumar Pandey ◽  
Mangesh Dorai ◽  
P. Sarkar ◽  
Debarshi Jana
Keyword(s):  
Clinical Presentation ◽  
Case Series ◽  
Cross Sectional Study ◽  
Acute Poisoning ◽  
Organophosphate Poisoning ◽  
Cross Sectional ◽  
Medical College ◽  
Organophosphorus Poisoning ◽  
Consistent Feature ◽  
Medical Wards

OBJECTIVES: To study the clinical presentation and outcome of acute organophosphorus(OP) poisoning. METHODS: This case series included 94 cases from medical wards/emergency/I.C.U. of MGM Medical College, Jamshedpur, Jharkhand from March 2019 to February 2020. all patients of organophosphorus poisoning showing either sign of muscarinic or nicotinic effects were included. We did exclude those patients with doubtful poisoning. RESULTS: Ninety-Four patients with organophosphate poisoning were admitted. Among these 61% were males and 39% were females. Modes of poisoning were suicidal in 61% of cases, accidental in 35%, and 4% were homicidal. The clinical presentation of acute poisoning was variable however the most consistent feature was miosis (98%). As per WHO classification for severity of organophosphorus poisoning; 57% of cases were moderate, 27% were severe, and 16% were mild. The mortality rate was 17% and mostly among patients who presented with severe symptoms and presented late. CONCLUSION: OPs are the main chemical threat to young people, depressed individuals, and farmworkers. so rapid diagnosis and early treatment is essential to save

scholarly journals Uncommon High Resolution Computed Tomography Features of Pulmonary Tuberculosis: A Case Series

2021 ◽  
Author(s):  
. Swarna ◽  
Anuradha Sharma ◽  
Reeta Kanaujia ◽  
Shalabh Jain ◽  
Rohit Sharma
Keyword(s):  
Computed Tomography ◽  
Pulmonary Tuberculosis ◽  
Case Series ◽  
Mediastinal Lymphadenopathy ◽  
High Resolution Computed Tomography ◽  
Diagnostic Dilemma ◽  
Pulmonary Tb ◽  
Cystic Lung ◽  
Normal Limits ◽  
High Index Of Suspicion

Classical imaging manifestations of pulmonary Tuberculosis (TB) include consolidation, cavitation, necrotic mediastinal lymphadenopathy and pleural effusions. On the other hand, atypical imaging findings of pulmonary TB are sometimes encountered which create a diagnostic dilemma; three such patients are reported here. The predominant finding in the first patient (24-year-old female) was diffuse cystic lung disease with associated bilateral secondary spontaneous pneumothoraces. The subacute onset of symptoms, associated nodules and ground glass opacities were a pointer towards an infective aetiology of the diffuse cysts in this case. The second patient (41-year-old female) presented with peribronchovascular and perifissural nodules with the galaxy or cluster sign leading to an erroneous diagnosis of sarcoidosis. However, the patient’s serum Angiotensin Converting Enzyme (ACE) levels were within normal limits; whereas her bronchial washings culture was positive for Mycobacterium TB. Therefore, this was actually a case of pulmonary TB with lymphatic involvement mimicking sarcoidosis. In the third patient (20-year-old female), there were pulmonary parenchymal lesions with the reversed halo sign classically described in cryptogenic organising pneumonia. Micronodularity in the wall and central part of the reversed halo lesion clinched the diagnosis of TB in this case. Laboratory investigations revealed acid fast bacilli or caseating granulomas consistent with TB in all these patients. Therefore, awareness regarding the atypical Computed tomography (CT) findings and a high index of suspicion is necessary to avoid delays in diagnosis and enable early institution of appropriate Antitubercular Therapy (ATT) in such cases.

scholarly journals Kawasaki disease among Egyptian children: A case series

2018 ◽  
Vol 2017 (3) ◽  
Author(s):  
Tarek Hamed Attia ◽  
Saed M Morsy ◽  
Bashier A Hassan ◽  
Al Shymaa A Ali
Keyword(s):  
Kawasaki Disease ◽  
Clinical Presentation ◽  
Case Series ◽  
The Other ◽  
Coronary Artery Aneurysms ◽  
Clinical Criteria ◽  
Egyptian Children ◽  
Criteria For Diagnosis ◽  
Atypical Presentations ◽  
High Index Of Suspicion

Kawasaki disease is an acute vasculitis of early childhood. Its incidence varies among different ethnic groups with higher rates among Asians. In this case series, we presented four cases of Kawasaki disease with incomplete or atypical presentations in Egyptian children. Two cases presented with meningitis, which is not a criteria for the diagnosis of Kawasaki disease. The other two cases presented with pharyngitis and fever, which did not respond to antibiotics. The clinical criteria for diagnosis of Kawasaki disease were either incomplete or appeared sequentially. Coronary artery aneurysms were detected in one case, while the others had normal coronary by echocardiography. All cases were followed in our clinic, according to international guidelines. Early diagnosis and management of Kawasaki disease are important to ensure a good outcome and a high index of suspicion in febrile children is required irrespective of the clinical presentation. 

scholarly journals Gastrointestinal duplication cysts: experience from a tertiary care center in North India and review of literature

2020 ◽  
Vol 8 (1) ◽  
pp. 180
Author(s):  
Divya Aggarwal ◽  
Kim Vaiphei
Keyword(s):  
Congenital Malformations ◽  
Clinical Presentation ◽  
Care Center ◽  
Demographic Data ◽  
Tertiary Care ◽  
Case Series ◽  
North India ◽  
Male Predominance ◽  
High Index Of Suspicion ◽  
Age Range

Background: Duplication cysts (DC) are uncommon congenital malformations which predominantly present in infants and young children. Owing to their variable clinical presentation, radiology and/or histopathology are often required to clinch the diagnosis. We present a case series of 66 patients, which is the largest series reported so far.Methods: A search of prospectively maintained institutional database was carried out to identify patients who were diagnosed and operated for gastrointestinal DC between January 2013 and August 2018. For all cases, the demographic data, site of DC, details of clinical presentation, associated conditions and histopathology findings were recorded. The slides of all cases were retrieved and re-examined.Results: The age range was 1 day to 47 years, with a slight male predominance (1.3:1). Ileum was the most common site followed by jejunum. Ectopic mucosae noted were gastric, pancreatic, biliary and respiratory. One case showed glial heterotopia. Perforation, gangrene and intussusception were among the co-existing pathologies noted.Conclusions: Duplication cysts are rare congenital malformations. The variability in clinical presentation makes the diagnosis elusive. Timely diagnosis and appropriate management require a high index of suspicion and a holistic diagnostic approach with clinical, radiological and histopathological inputs. 

Mid-aortic syndrome: computed tomography angiography depicting extensive collateral circulation in an 11-year-old patient with thoracoabdominal aortic coarctation

VASA ◽  
2012 ◽  
Vol 41 (2) ◽  
pp. 132-135 ◽  
Author(s):  
Krohn ◽  
Gebauer ◽  
Hübler ◽  
Beck
Keyword(s):  
Computed Tomography ◽  
Computed Tomography Angiography ◽  
Collateral Circulation ◽  
Intestinal Ischemia ◽  
Clinical Presentation ◽  
Lower Limbs ◽  
Upper Body ◽  
Descending Aorta ◽  
Before And After ◽  
Blood Pressures

The mid-aortic syndrome is an uncommon clinical condition characterized by severe narrowing of the descending aorta, usually with involvement of its renal and visceral branches, presenting with uncontrollably elevated blood pressures of the upper body, renal and cardiac failure, intestinal ischemia, encephalopathy symptoms and claudication of the lower limbs, although clinical presentation is variable. In this article we report the case of an eleven-year-old patient with the initial diagnosis of a mid-aortic syndrome and present the computed tomography angiography pictures and reconstructions before and after surgical therapy.

Long-term outcomes of lumbar microdiscectomy in the pediatric population: a large single-institution case series

2019 ◽  
Vol 24 (5) ◽  
pp. 549-557
Author(s):  
Malia McAvoy ◽  
Heather J. McCrea ◽  
Vamsidhar Chavakula ◽  
Hoon Choi ◽  
Wenya Linda Bi ◽  
...  
Keyword(s):  
Conservative Management ◽  
Functional Outcomes ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Case Series ◽  
Csf Leak ◽  
Single Institution ◽  
The Mean

OBJECTIVEFew studies describe long-term functional outcomes of pediatric patients who have undergone lumbar microdiscectomy (LMD) because of the rarity of pediatric disc herniation and the short follow-up periods. The authors analyzed risk factors, clinical presentation, complications, and functional outcomes of a single-institution series of LMD patients over a 19-year period.METHODSA retrospective case series was conducted of pediatric LMD patients at a large pediatric academic hospital from 1998 to 2017. The authors examined premorbid risk factors, clinical presentation, physical examination findings, type and duration of conservative management, indications for surgical intervention, complications, and postoperative outcomes.RESULTSOver the 19-year study period, 199 patients underwent LMD at the authors’ institution. The mean age at presentation was 16.0 years (range 12–18 years), and 55.8% were female. Of these patients, 70.9% participated in competitive sports, and among those who did not play sports, 65.0% had a body mass index greater than 25 kg/m2. Prior to surgery, conservative management had failed in 98.0% of the patients. Only 3 patients (1.5%) presented with cauda equina syndrome requiring emergent microdiscectomy. Complications included 4 cases of postoperative CSF leak (2.0%), 1 case of a noted intraoperative CSF leak, and 3 cases of wound infection (1.5%). At the first postoperative follow-up appointment, minimal or no pain was reported by 93.3% of patients. The mean time to return to sports was 9.8 weeks. During a mean follow-up duration of 8.2 years, 72.9% of patients did not present again after routine postoperative appointments. The total risk of reoperation was a rate of 7.5% (3.5% of patients underwent reoperation for the same level; 4.5% underwent adjacent-level decompression, and one patient [0.5%] ultimately underwent a fusion).CONCLUSIONSMicrodiscectomy is a safe and effective treatment for long-term relief of pain and return to daily activities among pediatric patients with symptomatic lumbar disc disease in whom conservative management has failed.

scholarly journals Pancreatico‑pleural Fistula: Case Series

2018 ◽  
Vol 09 (01) ◽  
pp. 026-031 ◽  
Author(s):  
Manoj Munirathinam ◽  
Pugazhendhi Thangavelu ◽  
Ratnakar Kini
Keyword(s):  
Magnetic Resonance ◽  
Pleural Effusion ◽  
Pleural Fluid ◽  
Case Series ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Fluid Analysis ◽  
High Index Of Suspicion ◽  
Enhanced Computed Tomography ◽  
Acute And Chronic Pancreatitis ◽  
Pancreatic Pathology

ABSTRACTPancreatico‑pleural fistula is a rare but serious complication of acute and chronic pancreatitis. The pleural effusion caused by pancreatico‑pleural fistula is usually massive and recurrent. It is predominately left‑sided but right‑sided and bilateral effusion does occur. We report four cases of pancreatico‑pleural fistula admitted to our hospital. Their clinical presentation and management aspects are discussed. Two patients were managed by pancreatic endotherapy and two patients were managed conservatively. All four patients improved symptomatically and were discharged and are on regular follow‑up. Most of these patients would be evaluated for their breathlessness and pleural effusion delaying the diagnosis of pancreatic pathology and management. Hence, earlier recognition and prompt treatment would help the patients to recover from their illnesses. Pancreatic pleural fistula diagnosis requires a high index of suspicion in patients presenting with chest symptoms or pleural effusion. Extremely high pleural fluid amylase levels are usual but not universally present. A chest X‑ray, pleural fluid analysis, and abdominal imaging (magnetic resonance cholangiopancreatography/magnetic resonance imaging abdomen more useful than contrast‑enhanced computed tomography abdomen) would clinch the diagnosis. Endoscopic retrograde cholangiopancreatography with stent or sphincterotomy should be considered when pancreatic duct (PD) reveals a stricture or when medical management fails in patients with dilated or irregular PD. Surgical intervention may be indicated in patients with complete disruption of PD or multiple strictures.

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