scholarly journals Acute and Massive Aortic Thrombosis and Embolic Occlusion in a Patient with COVID-19: A Case Report

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Seyedjavad Davarisani ◽  
Javad Koushki ◽  
Saeed Moghaddamzade ◽  
Hamzeh Sherafati ◽  
Mehdi Jamalinik ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Splenic Artery ◽  
Distal Part ◽  
Gastrointestinal Symptoms ◽  
High Resolution Computed Tomography ◽  
Aortic Thrombosis ◽  
Reactive Protein ◽  
Risk Patients ◽  
Life Threatening ◽  
History Of

: A 73-year-old man with a history of COVID-19 infection from two weeks ago was referred to the Emergency Department with a complaint of colicky and generalized abdominal pain in addition to prior respiratory symptoms. High-resolution Computed Tomography (HRCT) displayed the typical signs of COVID-19 pneumonia. Initially, laboratory tests showed increased C-reactive protein and severe leukocytosis. Because of generalized abdominal pain, spiral abdominal and pelvic CT scans were done, which showed massive irregular and free-floating aortic thrombosis from the carina site to the Superior Mesenteric Artery (SMA) detachment, indicative of acute and life-threatening thrombosis. Filling defects were seen in the middle and distal part of the splenic artery, indicating the embolic occlusion of the splenic artery. The patient was admitted to the Intensive Care Unit (ICU), and he became a candidate for conservative treatment because of the wide extension of thrombosis. Therefore, we should pay more attention to the indirect signs of thrombosis in patients with COVID-19 infection with gastrointestinal symptoms and consider anticoagulant therapy for high-risk patients with COVID-19. The unique feature of our case was acute and extensive arterial thrombosis.

929 Not Another Abscess - A Case of Streptococcal Myositis Misdiagnosed as a Right Axillary Abscess

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
O Oyende ◽  
J Jackman
Keyword(s):  
White Cell Count ◽  
General Surgeon ◽  
High Dose ◽  
General Anaesthetic ◽  
Microbiological Analysis ◽  
Reactive Protein ◽  
Affected Tissue ◽  
Life Threatening ◽  
History Of ◽  
High Degree

Abstract Introduction Streptococcal myositis is a rare form of infectious myositis caused by Lansfield A beta-haemolytic streptococci. It is characterised by rapidly spreading inflammation that can result in severe systemic toxicity and necrosis of the affected tissue if not diagnosed and aggressively treated. Presentation We report a case of a 42-year-old male who presented with a one-week history of worsening right axillary swelling that progressed to painful swelling of his arm. Inflammatory markers were significantly elevated with a white cell count of 17 ×109/L and C-reactive protein of 212 mg/L. On examination, a fluctuant axillary swelling was appreciated, and a decision was made for incision and drainage under general anaesthetic. Intraoperative aspiration of his arm revealed copious purulent fluid prompting intraoperative orthopaedic consult and exploration of the anterior compartment in which there was extensive involvement of the biceps muscle. The microbiological analysis revealed gram-positive cocci in chains, and microbiology advice sought for tailoring of antibiotic regimen. He has recovered well. Discussion Though uncommon, the emergency general surgeon should have a high degree of suspicion when evaluating soft tissue infections to avert potentially disastrous outcomes. Conclusion Early diagnosis, aggressive management with high-dose intravenous antibiotics, and surgical debridement are principles to treat this rare, life-threatening infection.

Adolescent with abdominal pain poorly responsive to analgesia

2020 ◽  
pp. edpract-2020-320772
Author(s):  
Neil Chanchlani ◽  
Philip Jarvis ◽  
James W Hart ◽  
Christine H McMillan ◽  
Christopher R Moudiotis
Keyword(s):  
Abdominal Pain ◽  
Ct Scan ◽  
White Cell Count ◽  
Autism Spectrum ◽  
Free Fluid ◽  
List Type ◽  
Reactive Protein ◽  
Normal Limits ◽  
History Of ◽  
Normal Gallbladder

Case presentationA 14-year-old boy, with autism spectrum disorder, presented with a 1-day history of colicky abdominal pain, non-bilious vomiting, anorexia and loose normal-coloured stool. Two days previously, he had a poorly reheated takeaway chicken.On examination, body mass index (BMI) was >99th centile. He had inconsistent epigastric, periumbilical and umbilical tenderness, and guarding, with normal bowel sounds. Observations were within normal limits, but his pain was poorly responsive to paracetamol, ibuprofen, hyoscine butylbromide, codeine and morphine.Investigations are in table 1. On day 3, his temperature increased to 38.5° and a CT scan was performed, which showed concerning features (figure 1).Table 1Serology and further investigations throughout admissionDay 1Day 2Day 3Day 4Serology White cell count (3.8–10.6×109/L)7.514.615.713.6 Neutrophils (1.8–8.0×109/L)5.312.312.85.3 C reactive protein (<5 mg/L)12010398 Bilirubin (0–21 μmol/L)812Further investigations Urine dipstickNegative UltrasoundSmall volume of free fluid, normal gallbladder, pancreas and appendix not visualisedFigure 1CT scan of the abdomen (A) and pelvis (B).QuestionsWhat is the diagnosis?Appendicitis.Pancreatitis.Cholecystitis.Gastroenteritis.Which serology would have been most helpful at presentation?Renal function.Coagulation.Amylase and lipase.Gamma glutamyltransferase.What are the acute treatment principles?What is the the most common cause?Idiopathic.Gallstones.Medications.Genetic.Answers can be found on page 2.

Possible GoLytely-Associated Cardiac Arrest: A Case Report and Literature Review

2019 ◽  
Vol 33 (3) ◽  
pp. 364-367 ◽  
Author(s):  
Yoonsun Mo ◽  
Shiv Gandhi ◽  
Jose Orsini
Keyword(s):  
Cardiac Arrest ◽  
Abdominal Pain ◽  
Sudden Cardiac Arrest ◽  
Lower Abdominal Pain ◽  
The Past ◽  
Life Threatening ◽  
History Of ◽  
Artery Disease ◽  
Possible Cause

Purpose: To report a case of sudden cardiac arrest possibly associated with the administration of GoLytely® (polyethylene glycol 3350 and electrolytes). Summary: A 60-year-old male with a history of hypertension, hyperlipidemia, type 2 diabetes, and coronary artery disease presented to the emergency department with complaints of constipation and lower abdominal pain over the past week, and the inability to urinate over the past day. The patient had received GoLytely as treatment to alleviate symptoms of constipation and abdominal pain. However, several hours after administration of the bowel prep solution, the patient suffered an episode of cardiac arrest. After ruling out other possible etiologies, GoLytely was suspected as a possible cause of cardiac arrest. The patient had suffered an anoxic brain injury and remained intubated and unconscious until he eventually expired, 20 days after the event. Conclusion: Although GoLytely appears to be a safe agent with fewer side effects, clinicians need to be mindful of potential life-threatening adverse events following GoLytely administration and monitor patients closely during and after administration.

scholarly journals Retrospective analysis of clinical characteristics of 405 patients with COVID-19

2020 ◽  
Vol 48 (8) ◽  
pp. 030006052094903 ◽  
Author(s):  
Ting Zhan ◽  
Meng Liu ◽  
Yalin Tang ◽  
Zheng Han ◽  
Xueting Cheng ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Severe Disease ◽  
Clinical Manifestations ◽  
Gastrointestinal Symptoms ◽  
Circulatory System ◽  
Respiratory Illnesses ◽  
Reactive Protein ◽  
Circulatory System Diseases ◽  
History Of ◽  
Abnormal Lymphocyte

Objective This study was performed to investigate the clinical characteristics of patients with coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods We analyzed the electronic medical records of 405 hospitalized patients with laboratory-confirmed COVID-19 in the Third Hospital of Wuhan. Results The patients’ median age was 56 years, 54.1% were female, 11.4% had a history of smoking, and 10.6% had a history of drinking. All cases of COVID-19 were community-acquired. Fever (76.8%) and cough (53.3%) were the most common clinical manifestations, and circulatory system diseases were the most common comorbidities. Gastrointestinal symptoms were present in 61.2% of the patients, and 2.9% of the patients were asymptomatic. Computed tomography showed ground-glass opacities in most patients (72.6%) and consolidation in 30.9%. Lymphopenia (72.3%) and hypoproteinemia (71.6%) were observed in most patients. About 20% of patients had abnormal liver function. Patients with severe disease had significantly more prominent laboratory abnormalities, including an abnormal lymphocyte count and abnormal C-reactive protein, procalcitonin, alanine aminotransferase, aspartate aminotransferase, D-dimer, and albumin levels. Conclusion SARS-CoV-2 causes a variety of severe respiratory illnesses similar to those caused by SARS-CoV-1. Older age, chronic comorbidities, and laboratory abnormalities are associated with disease severity.

Management of Life-Threatening Hemorrhages and Unsafe Interventions in Nonhemophiliac Children by Recombinant Factor VIIa

2008 ◽  
Vol 16 (1) ◽  
pp. 77-82 ◽  
Author(s):  
Göksel Leblebisatan ◽  
Ilgen Sasmaz ◽  
Bulent Antmen ◽  
Dincer Yildizdas ◽  
Yurdanur Kilinc
Keyword(s):  
Intracranial Hemorrhage ◽  
Recombinant Factor Viia ◽  
Factor Viia ◽  
Liver Disorder ◽  
Recurrent Hemorrhage ◽  
Leukemia Patient ◽  
Risk Patients ◽  
Life Threatening ◽  
History Of ◽  
Hemorrhage Risk

The literature on the use of recombinant factor VIIa (rFVIIa), which was initially used in hemophiliac patients with inhibitors, for hemorrhages that cannot be managed with conventional methods or operations that cannot be performed safely is increasingly growing. This study presents a group of nonhemophiliac patients with hemorrhagic problems or hemorrhage risk for some interventions that were successfully resolved with the use of rFVIIa. The patient group was composed of 20 patients with different disorders resulting in similar results as hemorrhage or hemorrhage risk. Most of the patients were diagnosed with liver disorders primary or secondary to other diseases. The remaining cases were patients with leukemia, sepsis, intracranial hemorrhage, and burn. Some of the patients had multiple problems like a patient with liver disorder and intracranial hemorrhage or a leukemia patient with sepsis and disseminated intravascular coagulation. rFVIIa had been administered to the patients at dosages between 70 and 150 μg/kg up to 6 doses with 2-hour to 3-hour intervals. All the patients had benefited from the use of rFVIIa even though some of them died because of primary disease. This study shows that rFVIIa can be safely used in high-risk patients with a history of recurrent hemorrhage, for whom no improvement can be achieved in the hemostasis tests.

scholarly journals A rare cause of neutropenic enterocolitis: Propylthiouracil-induced agranulocytosis

2018 ◽  
Vol 25 (5) ◽  
pp. 286-289 ◽  
Author(s):  
Vermi Degerli ◽  
Fulya Yilmaz Duran ◽  
Mustafa Kucuk ◽  
Ibrahim Atasoy
Keyword(s):  
Abdominal Pain ◽  
Complete Blood Count ◽  
Multiple Organ ◽  
Antithyroid Drugs ◽  
Gastrointestinal Complication ◽  
Emergency Physicians ◽  
Neutropenic Enterocolitis ◽  
High Clinical Suspicion ◽  
Life Threatening ◽  
History Of

Introduction: Neutropenic enterocolitis is a life-threatening gastrointestinal complication of neutropenia that is rarely seen in adults. Neutropenic enterocolitis is more common in oncology patients, especially in those with leukemia. Antithyroid drugs are widely used to treat hyperthyroidism, but they can rarely cause agranulocytosis. Although the pathophysiology is not well understood, high clinical suspicion and immediate and appropriate treatment responses are essential to reduce the mortality rate of neutropenic enterocolitis. Case presentation: We present a case of a 57-year-old male patient who developed neutropenic enterocolitis as a result of agranulocytosis caused by the use of propylthiouracil. He had history of hyperthyroidism and was on propylthiouracil. He presented to the emergency department with abdominal pain but eventually died due to rapid deterioration of sepsis and multiple organ failure despite medical and surgical treatment. Discussion: Thioamides can cause agranulocytosis which can result in serious complication including neutropenic enterocolitis. Complete blood count must be monitored in patients receiving thioamides, and these patients should be educated on symptoms of agranulocytosis. Conclusion: Since patients with neutropenic enterocolitis are often evaluated first by emergency physicians, emergency physicians must be vigilant for neutropenic enterocolitis in patients with neutropenia and abdominal pain.

scholarly journals Amiodarone and its Pulmonal Toxicity

2014 ◽  
pp. 113-25
Author(s):  
Kemalasari Nas Darisan ◽  
Jamal Zaini ◽  
Yoga Yuniadi
Keyword(s):  
Pulmonary Toxicity ◽  
Ventricular Arrhythmias ◽  
Treatment Guidelines ◽  
High Resolution Computed Tomography ◽  
X Ray ◽  
Risk Patients ◽  
Life Threatening ◽  
Amiodarone Treatment ◽  
Chest X Ray ◽  
Modest Reduction

Amiodarone is an antiarrhythmic agent commonly used to treat supraventricular and ventricular arrhythmias. The drug prevents the recurrence of life-threatening ventricular arrhythmias and produces a modest reduction of sudden deaths in high-risk patients. This drug is an iodine-containing compound that tends to accumulate in several organs, including the lungs. It has been associated with a variety of adverse events. Of these events, the most serious is amiodarone pulmonary toxicity. Although the incidence of this complication has decreased with the use of lower doses of amiodarone, it can occur with any dose. Because amiodarone is widely used, all clinicians should be vigilant of this possibility. Pulmonary toxicity usually manifests as an acute or subacute pneumonitis, typically with diffuse infiltrates on chest x-ray and high-resolution computed tomography. Other, more localized, forms of pulmonary toxicity may occur, including pleural disease, migratory infiltrates, and single or multiple nodules. With early detection, the prognosis is good. Most patients diagnosed promptly respond well to the withdrawal of amiodarone and the administration of corticosteroids, which are usually given for four to 12 months. It is important that physicians be familiar with amiodarone treatment guidelines and follow published recommendations for the monitoring of pulmonary as well as extrapulmonary adverse effects.

scholarly journals PICA LEADING TO LITHOBEZOAR AND TRICHOBEZOAR IN ADULT MALE: A CASE REPORT

2020 ◽  
pp. 1-3
Author(s):  
Bhuvana Lakshmi Sundararajan ◽  
Siddartha Gowthaman ◽  
Arul Kumar ◽  
Ramanathan M
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
Developmental Disabilities ◽  
Adult Male ◽  
Conservative Management ◽  
Foreign Bodies ◽  
Exploratory Laparotomy ◽  
Life Threatening ◽  
History Of

INTRODUCTION: Pica is common in patients with developmental disabilities and can be life-threatening. It is important to identify pica and manage it appropriately. CASE REPORT:A 19-year-old male presented with history of abdominal pain and vomiting for two days.On imaging he was found to have multiple foreign bodies within the small and large bowel.After trial of conservative management,he was taken up for exploratory laparotomy. He was found to have trichobezoar and lithobezoar obstructing the bowel at terminal ileum.Bezoars when removed via enterotomy. DISCUSSION: Bezoars are conglomerates of non-absorbable food or fibre formed in the alimentary tract.Trichobezoar forms following ingestion of hair and usually leads to gastric outlet obstruction.Lithobezoar refers to the accumulation of stones in the GIT. Reports of colonic lithobezoar are rare. Pica is the persistent ingestion of non-nutritive substances beyond a developmentally inappropriate age. Patients should be referred to a psychologist/behaviour analyst and caregivers should also be educated

scholarly journals A multisystem inflammatory syndrome in children associated with COVID-19 in a 11-years-old girl

2021 ◽  
pp. 78-78
Author(s):  
Milena Bjelica ◽  
Gordana Vilotijevic-Dautovic ◽  
Andrea Djuretic ◽  
Slobodan Spasojevic
Keyword(s):  
Gastrointestinal Symptoms ◽  
World Health ◽  
Nasopharyngeal Swab ◽  
First Case ◽  
Control And Prevention ◽  
Inflammatory State ◽  
Life Threatening ◽  
History Of ◽  
Health Organization ◽  
Inflammatory Syndrome

Introduction. Multisystem inflammatory syndrome in children (MIS-C) is a post-viral, life-threatening, inflammatory state with multisystem involvement that typically manifests 3-4 weeks after SARS-CoV-2 infection. In this article, we present the first case of MIS-C in the Institute for Child and Youth Health Care of Vojvodina at the beginning of the COVID-19 pandemic. Case outline. A previously 11-years-old healthy girl got sick two days before admission to the hospital with a fever, headache, vomiting, abdominal pain, and fatigue. She was tested positive for COVID-19 by nasopharyngeal swab PCR with positive IgM and IgG antibodies. In the further course the illness presented with prolonged fever, laboratory evidence of inflammation, multiorgan involvement such as respiratory, gastrointestinal, cardiovascular, and dermatologic. Based on Centers for Disease Control and Prevention and World Health Organization criteria the diagnosis of MIS-C was made and IVIG and methylprednisolone were introduced with favorable clinical course. Conclusion. Every prolonged and unusual febrile state, especially if it is accompanied by gastrointestinal symptoms, in a school-age child, should be investigated in the direction of recent COVID-19 infection or exposure. In a case of a positive COVID-19 history or history of exposure, the MIS-C diagnosis should be considered.

scholarly journals Clinico-radiological profile of COVID-19 in a tertiary care hospital of western Rajasthan

2021 ◽  
Vol 6 (3) ◽  
pp. 152-155
Author(s):  
Priyanka Soni ◽  
Laxman Kumar Soni ◽  
K.C Agarwal
Keyword(s):  
Tertiary Care ◽  
Left Lung ◽  
Care Hospital ◽  
Lung Involvement ◽  
Laboratory Findings ◽  
Reactive Protein ◽  
Radiological Data ◽  
Life Threatening ◽  
History Of ◽  
Novel Coronavirus

Coronavirus disease 2019 (COVID-19) is a pandemic infectious disease caused by a novel coronavirus, known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Infection by COVID-19 can result in a range of clinical outcomes, from asymptomatic to severe life-threatening course or death. The purpose of our research was to evaluate the presentation of COVID19 disease based on the clinical and radiological characteristics of our population. 100 COVID19 patients recorded by RTPCR. Clinical, biochemical and radiological data from April-May, 2021. Of the 100 patients, in our study 66% were males and 26% patients had history of recent travel. Majority of patients were asymptomatic and don’t have comorbid illness. Thrombocytopenia and lymphopenia, increased levels of lactate dehydrogenase (LDH) and serum ferritin and C-reactive protein were common in these patients. CT finding were 63% had normal CT chest. Among the 37% patients who had CT chest findings, 25% had bilateral diseases, 8% patients had right lung involvement while 4% patients have left lung involvement.  COVID-19 disease has a relatively mild course in this part of the subcontinent. Clinical and laboratory findings are similar to those found in viral diseases. Studies involving larger sample size and interventional trials are need of the hour.

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