Chronic Nocturnal Abdominal Pain as the Presentation of Inverted Meckel Diverticulum: A Case Report

The common clinical manifestations of Meckel’s diverticulum include painless lower gastrointestinal bleeding and intestinal obstruction due to intussusception. Intussusception induced by inverted Meckel’s diverticulum has rarely been reported; furthermore, there is no report thus far of chronic nocturnal abdominal pain as a presenting symptom in children with Meckel’s diverticulum. A 4-year-and-10-month-old girl with no significant history of previous illness presented with the sole complaint of chronic nocturnal abdominal pain for 3 months. The patient was reported to be asymptomatic during the day. A provisional diagnosis of chronic ileoileal intussusception was already under consideration in her previous hospital visits elsewhere. Physical examination revealed a soft, non-distended abdomen without tenderness. Imaging studies revealed ileoileal intussusception. Exploratory laparotomy showed ileoileal intussusception induced by an inverted Meckel’s diverticulum with ulceration. The patient underwent successful surgery and made a full recovery. We report this case to remind physicians that Meckel’s diverticulum should be considered in differential diagnosis of children presenting with the isolated symptom of chronic nocturnal abdominal pain.

Congenital Pouch Colon in a Neonate

Congenital Pouch Colon (CPC) is a rare anorectal malformation (ARM) in which a part of or the entire colon is replaced by pouch-like dilatation. Males are more likely to be diagnosed with the condition compared to females. The highest incidence of the disease is in South Asia, with a significant number of cases reported from India. Early diagnosis can be made when there are hypoechogenic lesions on antenatal ultrasound scans. We report a case of a neonate with routine antenatal scans who presented with a distended abdomen and inability to pass feces. The diagnosis was made in the early neonatal period, followed by surgical management. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5771 How to cite this:Niaz S, Naz S, Raziq RA. Congenital Pouch Colon in a Neonate. Pak J Med Sci. 2022;38(2):426-429. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5771 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Huge subcutaneous extraperitoneal pseudocyst after migration of the ventriculoperitoneal shunt catheter

The formation of an intraperitoneal pseudocyst as a complication of ventriculoperitoneal shunts is well known. However, the formation of a pseudocyst at the subcutaneous extraperitoneal abdominal space is unusual and likely secondary to the migration of the peritoneal catheter. We present a 53-year-old male who had placement of a ventriculoperitoneal shunt for hydrocephalus secondary to a vestibular schwannoma. Five months later, he presented with an enormously distended abdomen. Investigations showed the peritoneal catheter in the extraperitoneal space within a large right lower quadrant abdominal wall pseudocyst. The patient was taken to the operating theatre, and the shunt was externalised at the original abdominal incision. Approximately 3 L of cerebrospinal fluid were aspirated from the distal peritoneal catheter. After negative cultures, a new peritoneal catheter was placed intraperitoneally at the contralateral lower abdominal quadrant. The contralateral quadrant was utilised to prevent fluid accumulation into the old extraperitoneal cavity.

Meckel’s Diverticulum, A Unique Presentation in the Neonate

Meckel’s diverticulum (MD) is the most prevalent gastrointestinal congenital malformation, occurring in 2% to 4% of all live births. Typical symptoms of MD include intestinal bleeding and bowel obstruction, but MD can also present with many atypical symptoms of varying severity, posing a diagnostic challenge with severe complications if left untreated. Neonates presenting with symptomatic MD are uncommon. In this report, we describe a neonatal case of MD in which the patient presented with atypical symptoms including distended abdomen and constipation mimick necrotizing enterocolitis. This case emphasizes the importance of clinically correlating a provisional diagnosis while maintaining a broad differential, including uncommon conditions in this age group such as MD.

Needle Decompression of Tension Pneumoperitoneum: A Case Report

Introduction: Tension pneumoperitoneum is rarely encountered in the emergency department but can have disastrous effects on the body when it is. However, an emergency physician has skills that can be readily applied to needle decompress the abdomen for rapid stabilization. Case Report: A 42-year-old male arrived via ambulance after a likely overdose with mental status improvement following naloxone administration. He was found to be in respiratory distress due to a rigid, distended abdomen that required intubation for stabilization. Computed tomography imaging showed significant pneumoperitoneum with tension physiology. Surgery consultation was unable to intervene immediately, and needle decompression with an angiocatheter was performed at the bedside with immediate ventilatory improvement. Conclusion: Tension pneumoperitoneum is a rare but potentially disastrous consequence of overdose secondary to emesis and rupture of the gastric wall. Needle decompression is a skillset already in the emergency physician’s toolbox and can be applied for emergency stabilization of a tension pneumoperitoneum with proper forethought and technique.

Clinical and Biological Characteristics of Congenital Hypothyroidism: A Family Case Study

Hypothyroidism is the condition of thyroid hormone deficiency. It can be primary or acquired. Primary hypothyroidism can be congenital or late onset. The symptoms of congenital hypothyroidism may go unnoticed in newborns if undiagnosed. Untreated, hypothyroidism can lead to poor mental and intellectual development in children. Hypothyroidism’s clinical manifestations are often subtle or not present at birth. Common symptoms include decreased activity and increased sleep, feeding difficulty, and constipation. On examination, common signs include myxoedematous facies, large fontanels, macroglossia, a distended abdomen with umbilical hernia, and hypotonia. Levothyroxine is the treatment of choice. In general, the prognosis is excellent when this condition is detected by screening and started on treatment early.

Adenomyomatous uterine polyp in a Miniature Pinscher: histologic, immunohistochemical, and clinical aspects

A 14-y-old Miniature Pinscher bitch was admitted to a veterinary clinic because of inappetence and a distended abdomen; ultrasound examination revealed a fluid-filled uterus with a single 1-cm hyperechoic nodule in its lumen. Ovariohysterectomy was performed. Grossly, the uterine horns were distended irregularly and asymmetrically, and the uterine lumen contained 200–300 mL of brown watery fluid. A single white polypoid 0.9-cm diameter nodule was present at the site of the distended uterine horn and arose from the endometrium with a narrow stalk. Histologically, the polyp consisted of dense, smooth muscle fascicles admixed with glandular components; its surface was covered by simple cuboidal epithelium with areas of squamous metaplasia. The myomatous cells expressed the myogenic markers smooth muscle actin and desmin. We interpreted the mass as an adenomyomatous uterine polyp, which is a rare variant of an endometrial polyp.