Not Everything Is Cordless Today—Case Report of Acute Intestinal Obstruction in a Neonate Due to Cord Clamping

We report a case of a 2-day-old neonate with bilious vomiting and abdominal distension. A small bowel obstruction with ileal perforation due to a misplaced clamping of the umbilical cord was apparent before laparotomy. This complication was a sequala after clamping the cord too close to the abdominal wall in a case where there was a hernia into the cord with intestinal content. A herniation of abdominal contents due to an omphalocele minor or a hernia must be taken into consideration during the inspection of the umbilical cord before clamping.

CONGENITAL COLONIC ATRESIA PRESENTING AS PNEUMOPERITONEUM: A RARE CLINICAL ENTITY

Introduction:Colonic Atresia is the least common type of Intestinal Atresia which occurs as a result of ischemic necrosis of a segment of large intestine.It presents with abdominal distention,bilious vomiting and failure to pass meconium.Perforation leads to peritonitis and sepsis Case Report:We describe a 3 day old male baby presenting with Colonic Atresia type IIIa and pneumoperitoneum and his surgical management Conclusion:In conclusion, Colonic Atresia is managed by either by colostomy or primary anastomosis.Terminal ileostomy,as in this case is done when there is Ascending Colon atresia with distal ileal perforation.

A Rare Case of Pneumoperitoneum in Pregnancy: Perforation of Tubercular ileal Ulcer

The incidence of tuberculosis (TB) is rising worldwide, despite the efficacy of the BCG vaccination. Populations at greatest risk of contracting TB are migrant communities, as well as immunocompromised individuals. The diagnosis of intestinal tuberculosis can often present as a diagnostic conundrum, due to its nonspecific and varied presentation, often mimicking inflammatory bowel disease or malignancy. Free perforation is one of the most feared complications of the intestinal tuberculosis. The terminal ileum is the most common site of perforation, while the majority of (90%) perforations are solitary. We present a 25 year old 17 weeks primi presented with peritonitis with solitary perforation of terminal ileum with miscarriage of fetus and subsequent surgical wedge resection of ileum and ileo-ileal anastomosis. Histology revealed presence of Langerhan’s cell with caseating granulomatous inflammation. There was no radiological evidence of pulmonary tuberculosis. Patient was started on anti-tubercular therapy and responded well. This present case underscores the importance of biopsy specimens taken from the margins of patients with ileal perforation to avoid the misdiagnosis of such condition.

THE WANDERING INTRA UTERINE DEVICE: A RARE CASE REPORT

Intra Uterine Device (IUD) is one of the widely used reversible methods of female contraception. There are many complications reported with IUD insertion, among which device migration and delayed perforation of viscera like small bowel is one of the rare and serious complication. Here we report a case of 29 year old female who presented with sudden onset of abdominal pain associated with vomiting. Her Computed Tomography (CT) scan of abdomen revealed IUD lying within peritoneal cavity causing terminal ileal perforation. She was treated surgically and she recovered well. Extra uterine visceral organ injury many months or years following IUD insertion is rare and should be considered as a differential in any female with IUD presenting with abdominal symptoms.

Intrauterine Intussusception Presenting as Fetal Ascites and Meconium Peritonitis

Intussusception is a well-known cause of intestinal obstruction in children. Its occurrence in fetus as an intrauterine incidence is extremely rare and poses a diagnostic difficulty. Intrauterine intussusception may result in intestinal atresia once the gangrenous segment resorbed. However, a very late occurrence of intussusception just prior to delivery may present as meconium peritonitis. We are reporting a case of premature baby who was born at 35 weeks gestation via emergency caesarean for breech in labour. Routine scan 4 days prior to the delivery showed evidence of fetal ascites. She was born with good Apgar Score and weighed 2.5kg. Subsequently she developed respiratory distress syndrome requiring mechanical ventilation. She passed minimal meconium once after birth then developed progressive abdominal distension and vomiting. Abdominal radiograph on day 4 of life revealed gross pneumoperitoneum and bedside percutaneous drain was inserted to ease the ventilation. Upon exploratory laparotomy, a single ileal perforation was seen 20cm from ileocecal junction with an intussusceptum was seen in the distal bowel. Gross meconium contamination and bowel edema did not favour the option of primary anastomosis, thus stoma was created. Reversal of stoma was performed a month later and she recovered well. Fetus with a complicated intrauterine intussusception may present with fetal ascites and their postnatal clinical and radiological findings need to be carefully assessed for evidence of meconium peritonitis; in which a timely surgical intervention is required to prevent the sequelae of prolonged intraabdominal sepsis in this premature baby.International Journal of Human and Health Sciences Supplementary Issue-2: 2021 Page: S18

Diabetic Ketoacidosis Misdiagnosed and Managed as Typhoid Ileal Perforation in a Ghanaian Child: A Case Report

We report on a 15-year-old Ghanaian boy, who presented to a district hospital with diabetic ketoacidosis (DKA) but was diagnosed wrongly as a small bowel perforation due to typhoid fever. He presented with weakness, poor feeding, vomiting, and severe abdominal pain. General examination revealed a lethargic, drowsy, and severely dehydrated patient. His abdomen was diffusely tender more in the right ileac fossa. Investigations including complete blood count, blood smear for malaria parasites, urinalysis, and abdominal ultrasound yielded unremarkable results. Hemoglobin level was 12.4 grams per decilitre. He was diagnosed as typhoid ileal perforation and laparotomy was done, but the bowels and all other intra-abdominal organs were found to be normal. A blood glucose test was done intraoperatively, and it found very high hyperglycaemia. This led to the suspicion of DKA, which was confirmed through urine dipstick testing for high urine ketones and a high glycated hemoglobin (HbA1C) test result. He was then treated for DKA, which resolved on the second day of admission, but the surgical wound healed after twelve days.Our account emphasizes the need for testing for blood glucose in critically ill children and adolescents with suspected severe infections or acute medical conditions that require admission or surgical intervention. This owes to the fact that the clinical features of undiagnosed diabetes, especially if it progresses to DKA, are similar to those of infections and disorders managed via surgical treatment, which are rather more common in Ghana and Africa.