scholarly journals UNUSUAL PRESENTATION OF REACTIVE ARTHRITIS AFTER SALMONELLA ENTERITIS IN A 6-YEAR-OLD BOY

2021 ◽  
Vol 32 (01) ◽  
pp. 48-51
Author(s):  
Samina Akhtar ◽  
Belqees Yawar Faiz ◽  
Khurram Khaliq Bhinder ◽  
Salma Gul ◽  
Ijaz A.Khan ◽  
...  
Keyword(s):  
Reactive Arthritis ◽  
Pediatric Population ◽  
Iliac Fossa ◽  
High Grade Fever ◽  
Potential Threat ◽  
Predisposing Factor ◽  
Abdomen Ct ◽  
Enteric Infections ◽  
The Right ◽  
Salmonella Enteritis

ABSTRACT: Reactive arthritis, formerly called Reiter’s syndrome is extra-articular oligoarthropathy, which can be due to bacterial infection or genetic predisposition. The infections are either urogenital (chlamydia being most notorious) or gastrointestinal (e.g. salmonella, yersinia, etc.). The human leukocyte antigen (HLA-B27) antigen has been implicated as the most common predisposing factor. Reactive arthritis often involves the joints of the lower limb. Bacterial enteric infections are a potential threat in a Pediatric population that can be due to an acute illness or its sequelae. Reactive arthritis following outbreaks of enteric infections with Salmonella is uncommon in the pediatric population. We report a rare case of a 6 years old boy who came to ER with high-grade fever and severe pain in the right iliac fossa. Clinical diagnosis of appendicitis was made by the physicians on physical exam but after radio-pathological investigation like CBC, ESR, CRP, Blood culture, USG abdomen, CT abdomen, and MRI, diagnosis of reactive arthritis secondary to salmonella enteritis was made and the patient underwent right hip arthrotomy after which he was discharged. Thus, imaging played a pivotal role in the right diagnosis of a patient with proper management guidelines. This also showed that salmonella enteritis can present atypically mimicking septic arthritis or acute appendicitis. Reactive arthritis after salmonella infection is a very rare and one of its kind case reported in Pakistan.

scholarly journals Disseminated Tuberculosis with Involvement of Appendix, Peritoneum and Right Knee Joint - A Case Report

2014 ◽  
Vol 15 (2) ◽  
pp. 153-155
Author(s):  
Mohammad Syedul Islam ◽  
Md. Abul Kalam Azad ◽  
Hanif Mohammad ◽  
Mohammad Mushahidul Islam ◽  
Md. Abdur Rahim
Keyword(s):  
Abdominal Pain ◽  
Knee Joint ◽  
Iliac Fossa ◽  
Joint Fluid ◽  
High Grade ◽  
High Grade Fever ◽  
Disseminated Tuberculosis ◽  
Initial Episode ◽  
The Right ◽  
Neutrophilic Leucocytosis

A 27 year old male presented with painful swelling of right knee joint for the last 6 months. Initially it was diagnosed as a case of reactive arthritis and was treated with NSAID with intraarticular steroids without significant improvement. Two months after the initial episode he again developed painful swelling of the right knee joint with severe abdominal pain and high grade fever. There was an ill defined ovoid mass in the right iliac fossa with generalized tenderness. ESR was raised and the ultrasonography revealed loculated ascites with appendicular lump. CT scan of the whole abdomen showed appendicular lump. FNAC from the lump showed tuberculosis. Joint fluid aspiration showed neutrophilic leucocytosis with the Total count 50,000/cmm. AFB was not found. So septic arthritis was  diagnosed, but as the patient was not improving we send the patient to orthopedic department for synovial biopsy but they refused as it was septic. So a diagnosis of disseminated Tuberculosis was made with the involvement of right knee joint, appendix and peritoneum. He was put on anti TB and well responded.DOI: http://dx.doi.org/10.3329/jom.v15i2.20702 J MEDICINE 2014; 15 : 153-155

SPONTANEOUS PERFORATION OF MECKEL'S DIVERTICULUM: A CASE REPORT AND REVIEW OF LITERATURE

2021 ◽  
pp. 50-51
Author(s):  
B. Santhi ◽  
Subhashini . A ◽  
Preethi. V
Keyword(s):  
Case Report ◽  
Unusual Case ◽  
Iliac Fossa ◽  
Meckel’S Diverticulum ◽  
Meckel's Diverticulum ◽  
Uneventful Recovery ◽  
Emergency Laparotomy ◽  
High Grade Fever ◽  
Meckels Diverticulum ◽  
The Right

Meckel's diverticulum is the commonest congenital abnormality of the gastrointestinal tract. Hemorrhage obstruction and inammation are the three main categories of complications resulting from Meckel's diverticulum. Spontaneously perforation of Meckel's diverticulum is very rare and mimics acute appendicitis. We report a case of 65 year-old female, who presented since 2 days worsening abdominal pain predominantly in the right iliac fossa associated with high grade fever and nausea. On physical examination her abdomen revealed diffuse tenderness, more over the right iliac fossa and the hypogastric region with guarding in the right iliac fossa. A provisional diagnosis of appendicular perforation was made. Our patient had an emergency laparotomy, where a perforated Meckel's diverticulum and advanced peritonitis were discovered. A resection of ileum with meckels diverticulum with end to end anastomosis of ileal loops were performed. Heterotopic mucosa of diverticulitis was conrmed on histopathology. The patient made an uneventful recovery postoperatively . This case report is an interesting and unusual case of Meckel's diverticulum complications and highlights the importance of considering Meckel's diverticulum as a differential diagnosis in every patient presenting with acute abdomen.

scholarly journals A Retrospective Analysis of Acute Appendicitis in Children Treated with Laparoscopic Appendectomies at a Single Center in Dubai, UAE

2021 ◽  
pp. 1-6
Author(s):  
Saad Syed ◽  
Hussein Naji
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Ct Scan ◽  
Laparoscopic Appendectomy ◽  
Pediatric Population ◽  
Iliac Fossa ◽  
Demographic Data ◽  
Free Fluid ◽  
Rebound Tenderness ◽  
The Right

<b><i>Background:</i></b> Appendicitis is one of the most common emergency conditions that occur in the pediatric population. The condition is usually suspected clinically, and the diagnosis is confirmed by radiological investigations such as ultrasound, CT scan, or MRI. This study was conducted to contribute to global databases by presenting data from the Middle East with an objective of identifying the clinical characteristics of children who were diagnosed with acute appendicitis and underwent laparoscopic appendectomy at a single pediatric surgery center in Dubai. <b><i>Methods:</i></b> A 2-year hospital-based retrospective cohort study was conducted at Mediclinic Parkview Hospital, Dubai, enrolling all patients younger than 14 years who were diagnosed with acute appendicitis and who underwent laparoscopic appendectomy. Demographic data, clinical presentation, laboratory, radiological and pathology findings, postoperative complications, and readmission rates were analyzed. <b><i>Results:</i></b> Fifty-six patients were operated on and enrolled in this study. All patients (56/56) presented with abdominal pain, while an associated fever was present in 44.6% (25/56); 78.5% (44/56) of the patients had nausea but 64.3% (36/56) had vomiting. On examination, all patients had abdominal tenderness, while rebound tenderness in the right iliac fossa (RIF) was found in 92.8% (52/56) of the patients. Laboratory investigations showed elevated leukocyte count in 76.7% (43/56) of patients. Appendicitis was diagnosed on ultrasound in 57.4% (31/54) of the patients, and free fluid was visualized in 40.7% (22/54) of the patients. Appendicitis was diagnosed on CT scan in all 25 patients, and free fluid was visualized in 64% (16/25) of the patients. The number of admission days ranged from 1 to 5 days, with a median of 2 days. And 62.5% (35/56) of patients were discharged in the first 2 days from admission. Major and minor complications after surgery were documented in 4 and 14 patients, respectively. Pathology reports showed features of acute appendicitis in all the resected appendices. <b><i>Conclusions:</i></b> Acute appendicitis in children should be suspected in all children with acute abdominal pain. This study can help guide the management of pediatric appendicitis and allow proper and standardized documentation of findings and judicious use of laboratory and radiological investigations.

scholarly journals Spontaneous Splenic Rupture Four Days after an Open Appendicectomy

2015 ◽  
Vol 97 (2) ◽  
pp. e23-e24
Author(s):  
R Parker ◽  
G Gravante ◽  
M Elshaer ◽  
N Humayun ◽  
H Ebdewi
Keyword(s):  
Splenic Rupture ◽  
Case Reports ◽  
Iliac Fossa ◽  
Postoperative Bleeding ◽  
Haemorrhagic Shock ◽  
Spontaneous Splenic Rupture ◽  
Open Appendicectomy ◽  
Predisposing Factor ◽  
Midline Laparotomy ◽  
The Right

Introduction Spontaneous splenic rupture is a rare but dangerous event that requires prompt diagnosis and frequently an emergency splenectomy. Previous case reports have described the occurrence in patients with medical conditions, anticoagulant treatments, endoscopic procedures, laparoscopic surgery or no particular predisposing factor. Our report is the first to describe the occurrence of spontaneous spleen rupture following a laparotomy conducted in the lower abdomen. Case History A 62-year-old woman presented with a 10-day history of right iliac fossa pain radiating to the right leg and associated vomiting. Following a routine blood check and computed tomography (CT), she underwent an open appendicectomy through a lower midline laparotomy for an appendicular abscess. Four days later, she experienced haemorrhagic shock and a second CT scan diagnosed a spontaneous splenic rupture that required a prompt splenectomy. Conclusions Our case is the first that describes the spontaneous rupture of the spleen following an open procedure conducted in the lower quadrants. This entity must still be considered as a rare but potential cause for postoperative bleeding when no other obvious sources are identified.

scholarly journals Late presentation of extrauterine adenomyomas after laparoscopic morcellation at hysterectomy: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mohammed Nagdi Zaki ◽  
Aafia Mohammed Farooq Gheewale ◽  
Nada Ibrahim ◽  
Ibrahim Abd Elrahman
Keyword(s):  
Case Report ◽  
Transvaginal Ultrasound ◽  
Iliac Fossa ◽  
Abdominal Cavity ◽  
Laparoscopic Hysterectomy ◽  
Pathology Report ◽  
Presacral Space ◽  
Gnrh Analogue ◽  
Power Morcellation ◽  
The Right

Abstract Background An adenomyoma is a well circumscribed form of adenomyosis and can be located within the myometrium, in the endometrium as a polyp, or extrauterine with the last being the rarest presentation amongst the three. With the ongoing advancement in gynecological surgery, the use of electromechanical morcellators have made the removal of large and dense specimens possible with minimally invasive techniques. However, it has also caused an increase in complications which were previously rare. Whilst the tissue is being grinded within the abdominal cavity, residual tissue can spread and remain inside, allowing for implantation to occur and thereby giving rise to recurrence of uterine tissue as a new late postoperative complication. Case presentation A 45-year-old woman presented with worsening constipation and right iliac fossa pain. Her past surgical history consists of laparoscopic supra-cervical hysterectomy that was indicated due to uterine fibroids. Computerized tomography and magnetic resonance imaging were done, which showed an irregular lobulated heterogeneous mass seen in the presacral space to the right, located on the right lateral aspect of the recto-sigmoid, measuring 4.5 × 4.3 × 4.3 cm in size. A transvaginal ultrasound revealed a cyst in the left ovary. The patient had a treatment course over several months that included Dienogest (progestin) and Goserelin (GnRH analogue) with add-back therapy. In line with the declining response to medications, the patient was advised for a laparoscopic ovarian cystectomy. During the surgery, an additional lesion was found as a suspected fibroid and the left ovarian cyst was identified as pockets of peritoneal fluid which was sent for cytology. The surgical pathology report confirmed adenomyosis in both specimens, namely the right mass and the initially suspected fibroid. Conclusion In this case report, we showcase a rare occurrence of an extrauterine adenomyoma presenting two years post laparoscopic morcellation at hysterectomy. This poses questions regarding the benefits versus risks of power morcellation in laparoscopic hysterectomy.

scholarly journals A very persistent chicken bone: two separate perforations from the same foreign object 2 months apart

2019 ◽  
Vol 12 (5) ◽  
pp. e228050
Author(s):  
Andrew James Brown ◽  
Thomas Whitehead-Clarke ◽  
Vera Tudyka
Keyword(s):  
Small Bowel ◽  
Bowel Perforation ◽  
Linear Structure ◽  
Small Bowel Resection ◽  
Emergency Laparotomy ◽  
Small Bowel Perforation ◽  
Chicken Bone ◽  
Abdomen Ct ◽  
Distal Migration ◽  
The Right

A 56-year-old man presented acutely with abdominal pain and raised inflammatory markers. Initial CT images demonstrated acute inflammation in the right upper quadrant surrounding a high-density linear structure. The appearance was of a chicken bone causing a contained small bowel perforation. This was managed conservatively with intravenous antibiotics and the patient was discharged 10 days later. The same patient returned to the hospital 2 months later, once again with an acute abdomen. CT imaging on this occasion showed distal migration of the chicken bone as well as free gas and fluid indicative of a new small bowel perforation. The patient underwent an emergency laparotomy, washout and small bowel resection. No foreign body was found at laparotomy or in the histopathology specimen. The postoperative course was complicated by an anastomotic leak. A further CT on that admission demonstrated that the chicken bone had migrated to the rectum!

Relationship Between Body Mass Index and Chronic Periodontitis

2021 ◽  
Vol 5 (1) ◽  
pp. 7-10
Author(s):  
Shreeya Aryal ◽  
Ameena Pradhan ◽  
Shilu Shrestha ◽  
Surendra Man Shrestha
Keyword(s):  
Body Mass Index ◽  
Periodontal Disease ◽  
Body Mass ◽  
Disease Status ◽  
Periodontal Pocket ◽  
Potential Threat ◽  
Predisposing Factor ◽  
Clinical Attachment Loss ◽  
Cross Sectional ◽  
Attachment Loss

Introduction: Obesity is regarded as unnecessary body fat in ratio to lean body mass. Besides being an established risk factor for cardiovascular and other systemic diseases, obesity has been suggested to be a potential threat for periodontitis as well. Objective: The objective of the study was to learn relationship between body mass index (BMI) and periodontal disease. Methods: This analytical cross-sectional study was conducted at People’s Dental College from February 16 to April 15, 2021 after ethical approval. Seventy-two participants were selected conveniently who, on the basis of calculation of weight and height were allocated into two groups: Group A: participants with normal BMI, Group B: Obese/ overweight individuals. Plaque index, gingival index, periodontal pocket, and clinical attachment loss were recorded in both the groups to assess the periodontal disease status. On basis of findings, the two groups were statistically compared. Results: The result showed clinical attachment loss was significantly higher (P <0.001) in overweight/obese group than in normal BMI group (P =0 .001). Conclusion: The findings of this study suggest that obesity and overweight can be a possible predisposing factor for periodontal disease.

scholarly journals Pure laparoscopic unilateral nephrectomy for a patient with a polycystic horseshoe kidney

2014 ◽  
Vol 8 (11-12) ◽  
pp. 881 ◽  
Author(s):  
Shawn Dason ◽  
Christopher B Allard ◽  
Bobby Shayegan ◽  
Kevin Piercey
Keyword(s):  
Renal Transplantation ◽  
Autosomal Dominant ◽  
Iliac Fossa ◽  
Laparoscopic Approach ◽  
Horseshoe Kidney ◽  
Laparoscopic Nephrectomy ◽  
Polycystic Kidney ◽  
Large Size ◽  
Autosomal Dominant Polycystic Kidney ◽  
The Right

A 45-year-old female patient with autosomal dominant polycystic kidney disease (ADPKD) and a horseshoe kidney underwent right laparoscopic nephrectomy. The indication for nephrectomy was to create space within the right iliac fossa for renal transplantation. The operation proceeded as routine for laparoscopic nephrectomy for ADPKD, but was uniquely challenging due to the large size and extensive vasculature of the polycystic horseshoe kidney. In addition to documenting the feasibility of the pure laparoscopic approach for nephrectomy in patients with ADPKD and horseshoe kidney, this case highlights the abnormal location and vasculature encountered when operating on horseshoe kidneys.

scholarly journals Stiffness of the Masseter Muscle in Children—Establishing the Reference Values in the Pediatric Population Using Shear-Wave Elastography

2021 ◽  
Vol 18 (18) ◽  
pp. 9619
Author(s):  
Cyprian Olchowy ◽  
Anna Olchowy ◽  
Aleksander Pawluś ◽  
Mieszko Więckiewicz ◽  
Luca Maria Sconfienza
Keyword(s):  
Shear Wave ◽  
Masseter Muscle ◽  
Pediatric Population ◽  
Shear Wave Elastography ◽  
Total Sample ◽  
Healthy Children ◽  
Significant Difference ◽  
The Right ◽  
The Impact ◽  
Masseter Muscles

In children, the quality and muscle function are altered in many pathologic conditions, including temporomandibular disorders. Although several methods have been used to evaluate muscle tonus, none became a golden standard. Moreover, the masseter muscle characteristics in children have not been investigated to date. This study aimed to measure the stiffness of the masseter muscle using shear-wave elastography in healthy children. We enrolled 30 healthy children (mean age 10.87 ± 3.38 years). The stiffness of masseter muscles was measured with shear wave elastography. Stiffness for the total sample was 6.37 ± 0.77 kPa. A comparison of the measurements did not show significant differences between the right and the left masseter muscles (left—6.47 ± 0.78 kPa; right—6.24 ± 0.76 kPa; p = 0.3546). A significant difference was seen between boys and girls (boys—5.94 ± 0.50 kPa; girls—6.63 ± 0.80; p = 0.0006). Shear-wave elastography is a promising diagnostic tool. It may help to detect changes in the stiffness of the masseter muscle and draw attention to pathological processes within the jaw muscles. Directions for further research shall include determining stiffness values in pathological conditions and the impact of biological and functional factors on the stiffness of the masseter muscle.

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