Spontaneous heterotopic pregnancy: a case report

Heterotopic pregnancy is defined as multiple gestation in which intrauterine and extrauterine gestational sacs co-exist. The extra uterine gestational sac is most commonly tubal ectopic pregnancy. We presented case of a 26 years old multigravida who presented to emergency with complaints of pain abdomen and giddiness for 2-3 days. She was at period of gestation (POG) 7 weeks and on clinical examination patient was anxious with mild pallor, mildly tachycardiac and blood pressure (BP) was 90/60 mm of Hg. After thorough clinical examination and sonography diagnosis of heterotopic pregnancy with ruptured tubal ectopic was made. She was taken up for Emergency laparotomy after investigations and consent. Left salpingectomy was done and she was discharged with a single intrauterine live pregnancy on 6th post op day. For early detection of cases of heterotopic pregnancy careful evaluation of adnexa is mandatory in early gestation scan.

Fatal catastrophic antiphospholipid syndrome at presentation of juvenile lupus

Catastrophic antiphospholipid syndrome (CAPS) is a severe and rare form of antiphospholipid syndrome, extremely uncommon inthe pediatric age group, characterized by multiple site thrombosis involving small, medium, and large blood vessels occurring over a short period of time (usually 1 week) causing multiorgan failure. We report the case of an 8-year-old girl presenting with fever, lymphadenopathy, and pain abdomen with refractory mitral regurgitation diagnosed as systemic lupus erythematosus with CAPS. All three antiphospholipid antibodies positivity in high titers further confirmed the diagnosis. In spite of the early initiation of adequate triple therapy (anticoagulation, steroids, and cyclophosphamide), our patient succumbed. The report aims to incorporate a greater awareness among clinicians for timely diagnosis and treatment of this condition and throws light on the varying ways in which lupus can present in children.

Acute ileocolitis as a presentation of Sars Cov-2 infection in children- A case report

As COVID-19 continues to spread in India and other countries, the impact of the disease among children, initially considered less important, is becoming more relevant. The extent of the diversity of clinical presentation of COVID-19 in children are still unclear. We have already seen a new clinical picture of SARS-CoV-2 in children manifesting as a hyper-inflammatory syndrome, with multi-organ involvement similar to Kawasaki Disease and with potential evolution to a shock syndrome. This represented a new phenomenon affecting previously asymptomatic children with SARS-CoV-2 infection. COVID-19 may also manifest as viral hepatitis, acute pancreatitis, acute liver injury, acute kidney injury, ARDS, Sepsis, septic shock and meningo-encephalitis and cerebellar ataxia. The Multisystem Inflammatory Syndrome in Children (MIS-C) associated with SARS-CoV-2 infection occurs weeks after infection and may evolve unnoticed. MIS-Cs pathophysiology remains unclear. However, it appears to be a postinfectious hyperimmune response that may occur during or following asymptomatic or symptomatic infection. COVID-19 infection in children may lead to a potentially life threatening condition that we may not be aware of. We are in need of reporting of the diverse presentation of SARS CoV-2 virus in children. Here we describe a case of a previously normal 14-year-old boy who manifested with severe pain abdomen after SARS CoV-2 infection and was diagnosed as Acute Ileocolitis secondary to COVID-19. Child improved with steroid therapy and was asymptomatic after 3 weeks of treatment.

Abnormal Ultrasonographic Findings among Referred Patients with Pain Abdomen in the Radiology Department of a Tertiary Care Center: A Descriptive Cross-sectional Study

Introduction: Correct and prompt diagnosis is essential for the appropriate management of patients. Often, children and their caretakers cannot provide a reliable history to allow clinicians to determine the cause of the pain. This study's objective was to find out the prevalence of abnormal ultrasonographic findings among referred patients with pain abdomen in the radiology department of a tertiary care center of Nepal. Methods: A descriptive cross-sectional study was conducted among patients in the out-patient and emergency department with complaints of abdominal pain from 2021 April 5 to August 30 in a tertiary care hospital. Ethical clearance was taken from IRC (registration no: 423/2021). The convenience sampling method was used. Written informed consent was taken from each study participant. Collected data were entered and analyzed on Statistical Package for the Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data. Results: Among 250 patients with pain abdomen referred to the department of radiology, 169 (67.6%) (61.80-73.40 at 95% Confidence Interval) had abnormal ultrasonographic findings. Mean age of the patients was 39.4±17.9 years. Initial clinical diagnosis was in agreement with the abdominal ultrasound diagnosis in 57 (22.8%) patients. For the remaining 193 patients, the diagnosis obtained from abdominal ultrasound differed from the initial clinical diagnosis. Conclusions: Most of the cases of pain abdomen showed abnormalities in ultrasound. Clinical evaluation should be used together with ultrasound abdomen in order to arrive at a correct diagnosis.

A RARE CASE OF MUCINOUS CYSTADENOCARCINOMA OF LIVER PRESENTING AS HYDATID CYST

Hepatobiliary cystadenocarcinoma is a very rare cystic tumor that arises in the liver or, less frequently, in the extrahepatic biliary system mostly seen in elderly patients. It has been shown to arise in congenital liver cysts, bile ducts, biliary cystadenoma, in the context of bro- polycystic disease and in the hepatoduodenal ligament. In the present case report, we describe a case of rare entity of hepatobiliary cystadenocarcinoma presented in a 36 year old male patient presented to opd with complaints of pain abdomen in right side of upper abdomen since 2 months. Main concern of this case report is preoperative imaging is imprecise and frequently misdiagnosed as benign cystic lesions and delays in treatment.

Atypical ectopic pregnancy: a nightmare for the gynaecologist

Ectopic pregnancy is one of the leading causes of maternal morbidity and mortality in early pregnancy. Incidence of ectopic pregnancy is 2% of total reported pregnancies and is rising in the recent past due to increase in RTIs and STIs and even early diagnosis due to advancing technology. Classical triad of pain abdomen, bleeding p/v and amenorrhea is not present in all the cases which add to confusion in diagnosing these atypical presentations. A meticulous history and clinical examination along with combination of transvaginal ultrasound (TVS) and serum beta HCG levels (discriminatory zone) can aid in picking up these atypical cases as depicted in our study. Here, we discussed 7 cases of atypical presentations of ectopic pregnancy which reported to gynaecology OPD of a service hospital of armed forces in a span of 3 months. One patient had pregnancy test negative, one patient was repeatedly treated as a case of AUB, 2 cases of heterotopic pregnancies, 1 case of elderly cornual ectopic and 2 young cases reporting one with repeated episodes of gastritis and other with post tubectomy status. The cases were managed accordingly using surgical methods. Ectopic pregnancy is like a tornado which if not diagnosed in time may prove fatal. Atypical presentation of ectopic pregnancies not fitting into the well-known triad of ectopic pregnancies these days add to confusion. One really needs to be ectopic minded if we actually want to avoid this catastrophe & save these young mothers.

Challenge in challenging times: a case report of ruptured isthmic ectopic pregnancy in an asymptomatic COVID-19 positive patient

Emergency surgical management of patients who are COVID-19 positive is extremely challenging for the treating doctors as there is a need to keep the balance between delivering optimal medical care to the patient, preventing spread to others and protecting ourselves. COVID-19 manifestations in pregnant women are similar to non-pregnant patients. The patient may be asymptomatic or may present with symptoms like cough, cold, fever and shortness of breath. In obstetric emergencies like ruptured ectopic pregnancy, when a patient presents in casualty with history of amenorrhea, pain abdomen and features of shock, main priority for the clinician is to stabilize them and treat the underlying cause so as to save their life. We report the emergency management of a hemodynamically unstable ruptured ectopic pregnancy at 9 weeks of gestation in a COVID-19 positive patient. It was stressful for the treating doctors because of high infectivity of the disease, scarcity of resources during the pandemic and precarious condition of the patient.

Silent perforation and migration of IUCD: A diagnostic challenge in patients with pain abdomen: A case report

Secondary perforations of intrauterine contraceptive devices (IUCD) may be clinically silent. The patient may not report the missing threads due to a lack of acute symptoms or under the impression that the device could have been expelled. We present a case of a 42-year-old lady treated for renal cell carcinoma and presenting with recurrent right lower quadrant abdominal pain for 2 years. Ultrasound scans did not reveal any abnormality. A plain computed tomography (CT) revealed a migrated IUCD embedded in the omentum with adjacent inflammation. Although CT is not the modality of choice in the diagnosis of migrated IUCD, it proved helpful in diagnosing this case as history was not forthcoming. This case highlights the diagnostic dilemma faced in cases of silent IUCD migration presenting with pain abdomen. It is important to counsel the patient at the time of IUCD insertion for the early recognition of missing devices and prompt diagnosis of complications.

INCIDENCE OF ABDOMINAL TUBERCULOSIS IN PATIENTS PRESENTING WITH PAIN ABDOMEN

Tuberculosis is a major health problem worldwide and in India continues to be responsible for considerable morbidity and mortality despite tremendous effort made in diagnosis, prophylaxis and therapy. The disease may involve any system of body but abdomen is one of the commonest site of involvement after lungs. This study is carrying to nd out Incidence of Abdominal Tuberculosis in patients of pain abdomen presenting as acute/chronic cases. The present study was carried out in the Department of Surgery, Rajendra Institute of Medical Sciences, Ranchi, from April 2018 to September 2019. The total number of cases selected disease remains early detection. A continual awareness on the part of the clinician of the possibility of abdominal Tuberculosis in many patients with obscure abdominal symptoms should avoid errors and aid in the detection of a condition, which if treated early, not only produces remarkable remission and relief on the part of for this study was 1800. According to the presentation, the patients were clinically divided into 2 broad groups: those who were admitted as acute emergencies and those who came with a chronic presentation. From these two groups 100 cases were fall in our inclusion criteria. Of these 100 patients, most were in their third or fourth decades of life, and females were approx two times more commonly affected as their male counterparts, maintaining an approximate ratio of 1.86:1. Thus we had a 5.55 % incidence of abdominal Tuberculosis in this series. The development of cheap and efcient procedures for early diagnosis remains one of the practical problems to battle this disease, because the only way to decrease morbidity and mortality of this the patients but also takes unnecessary burden off the health care services.

Is endoscopy a must before laparoscopic cholecystectomy?

Background: Laparoscopic cholecystectomy is common surgery performed for gall stone diseases and the gold standard procedure nowadays. But it is sometimes challenging to distinguish whether pain abdomen is due to gallstones or other UGI (upper gastro-intestinal) pathologies. Present study was conducted to rule out UGI pathologies in the patients undergoing cholecystectomy by performing UGI endoscopy as routine for effective management of the cases. The aims and objectives were to study the role of preoperative UGI endoscopy as an investigative modality to rule out UGI disorders in patients with gall stone disease.Methods: The study population consisted of 100 patients admitted for the management of gall stone diseases in KIMS hospital Bengaluru between January 2018 to July 2019. UGI endoscopy was done in all the patients routinely and to look for significant pathologies and patients with upper GI pathologies were adequately treated and later laparoscopic cholecystectomy was done. Postoperative events of pain abdomen were assessed on POD (postoperative day) 7, 14, 30, 60 days.Results: Out of the 100 patients in the study 55 patients (55%) had UGI pathologies on endoscopy and 30 patients (54.5%) are positive for H. pylori, 29 patients (52%) had persistent pain abdomen on POD 60 with p value of 0.001 which is statistically significant and 19 patients (34%) had persistent pain abdomen on POD 30 with p value <0.001 which is statistically significant.Conclusions: Beside its cost effectiveness, UGI endoscopy may potentially help in reducing the incidence of postoperative persistence of symptoms. UGI endoscopy has a vital role in the initial evaluation and investigation of patients with symptomatic gall stones.