Isolated perforation of fourth part of Duodenum following Blunt Abdominal Trauma

Introduction: Isolated duodenal injuries are rare in blunt abdominal trauma. These present a significant challenge for management because of the associated injuries and its difficult anatomical accessibility. Case presentation: A 20years male presented to the Emergency department following a bike accident sustaining injury over face, chest and abdomen, 6hours after the incident. His vitals were unstable so he was resuscitated and admitted in Intensive Care Unit. He had generalized abdominal tenderness without rigidity. Contrast enhanced computed tomography of abdomen and pelvis was suggestive of hollow viscus perforation. He underwent exploratory laparotomy and primary repair for isolated perforation at fourth part of duodenum. He was discharged on his ninth postoperative day. Conclusion: Rare injuries following blunt abdominal trauma should be considered and early intervention is necessary.

Double Magnet Ingestion Causing Intestinal Perforation with Peritonitis: Case Report and Review of the Literature

Introduction. Foreign body ingestion is a common pediatric complain, and most can be passed spontaneously; however, magnetic object ingestion is rather rare, and they can cause severe complications when multiple magnets are ingested, as they lead to entrapment of bowel walls between them, causing ischemia, pressure necrosis, perforation, and fistula formation. Case Presentation. Herein, we present a case of a 16-month-old female patient presented to our department complaining of continuous vomiting for two days along with fever and irritability. X-ray revealed dilated bowel loops with a radioopaque foreign body in the right lower quadrant. After discussing with the parents, exploratory laparotomy was done, showing two bowel perforations at the site of the magnets. Affected bowel was resected with anastomosis. The patient was discharged after 3 days with an uneventful recovery. Discussion. The diagnosis and management of magnet ingestion differ from those of small foreign bodies, which are usually managed conservatively by watchful waiting. Usually, the diagnosis is done due to complications such as peritonitis and death. On the other hand, management depends on the number, size, magnetic field, and shape of the magnet, and whether it has passed the pylorus or not. Conclusion. It is important to establish the diagnosis of this condition as early as possible to prevent complications. Despite the efforts that were made to try to prevent and minimize the risk of magnet ingestion, more investigations are required to reach a common and united strategy for management of such conditions.

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.

Radiological manifestations of benign mesenteric lipoma that presented with acute intestinal obstruction: A case report

Background Intestinal obstruction is a common surgical emergency that is presented to the hospital with various aetiologies. Among all, mesenteric lipoma is one of the uncommon extraluminal causes of intestinal obstruction. In such conditions, bowel volvulus, compression or even adhesion are the underlying pathologies. Case presentation We report a 69-year-old gentleman who presented with a triad of intestinal obstruction which required exploratory laparotomy. Preoperative computed tomography revealed multiple coalescing lobulated hypoattenuating lesions encircling part of a small bowel forming transitional zone. These lesions are comparatively more hypoattenuating in comparison with the surrounding mesenteric fat. Intraoperatively, a giant ileal mesenteric lipoma was identified causing compression and folding to the adjacent small bowel, leading to proximal bowel dilatation. Excision of the lipoma with a few mesenteric lymphadenectomy was done, revealing a benign mesenteric lipoma and reactive lymph nodes. Despite ileus, he made a good postoperative recovery and was discharged well. Conclusions Patients with recurrent abdominal pain must have a thorough endoscopic and imaging assessment. Besides common or malignant aetiology, rarities should be considered and actively sought. Mesenteric lipoma is a relatively indolent tumour for which early detection can alter clinical presentation.

Spontaneous vaginoperitoneal fistula as a rare complication of carcinoma ovary: a case report

Background Spontaneous vaginoperitoneal fistula formation in a case of carcinoma ovary is a very rare occurrence and has never been reported. Case presentation A 55-year-old postmenopausal lady presented with complaints of abdominal distention and mass coming out of the vagina for the last 10 days. On examination, she had tense ascites, uterovaginal prolapse and hard, fixed mass felt anteriorly on per-rectal examination. Biochemical investigations and radiological imaging suggested advanced stage ovarian neoplasm. She was planned for neoadjuvant chemotherapy. During the second cycle of chemotherapy, she developed spontaneous vaginoperitoneal fistula which was confirmed on exploratory laparotomy where interval debulking surgery was performed in collaboration with gastro-surgeons on a semi-emergency basis. The postoperative course was uneventful. Conclusion Spontaneous vaginoperitoneal fistula is a rare complication and should be kept in mind while managing advanced ovarian neoplasm.

Operative Management Considerations in a Patient With Multiple Occult Penetrating Cardiac Injuries

Penetrating cardiac injury remains one of the deadliest traumatic injuries. Early identification and definitive operative management are critical tenets for patient survival; however, variable clinical presentations can obscure the diagnosis. Here, we present the case of a 58-year-old obese man who presented to an urban level 1 trauma center with multiple stab wounds to the epigastrium and lateral left chest in the axillary line with an unknown weapon. The patient was taken emergently to the operating room for exploratory laparotomy, median sternotomy, and attempted repair of multiple full-thickness lacerations of the right ventricle and left and right atrium. This case demonstrates several instructive points. First, a high index of suspicion for penetrating cardiac injury is needed, especially during triage of multiple injuries. Second, careful release of cardiac tamponade is critical. Finally, there are several indications for cardiopulmonary bypass, which include multichambered injuries, uncontrollable hemorrhage, and concern for intracardiac injury.

Giant Fibrothecoma of the Ovary in a Young Patient a Case Report

Fibrothecomas are benign ovarian stromal tumors, they are rare tumors of gonadal stromal cell origin that represent 3-4% of all ovarian tumors. It commonly occurs in post-menopausal women. The clinical presentation is often nonspecific, whereas patients more frequently present with a pelvic mass, metrorrhagia, and pelvic pain. We present a 35-year-old patient, nulli-pregnant, with no personal or family pathological history, who attended a medical consultation for presenting progressive abdominal distention of 6 months of evolution in addition to abdominal pain in the last 2 months type colic which increased during her menstrual periods concomitantly alteration in your defecatory habits. Abdominal ultrasound was performed, finding a solid intrapelvic mass of approximately 14x10x10 cm in diameter of probable left ovarian origin, free fluid in the Douglas space, compression and displacement of intestinal loops and bladder. The patient underwent surgery and an exploratory laparotomy was performed, finding a pelvic tumor adhered to the tube and left ovary, in addition to ascites fluid in the abdominal cavity, complete resection of the tumor, ovary and left salpingue was performed.

Ocorrência de Lesão Pulmonar Aguda relacionada à Transfusão em Hospital de Referência do Ceará: Relato de Caso / Occurrence of Transfusion-related Acute Lung Injury in a Reference Hospital of Ceará: Case Report

Lesão pulmonar aguda relacionada à transfusão (TRALI –Transfusion Related Acute Lung Injury) é uma complicação grave da transfusão sanguínea que cursa essencialmente com desconforto respiratório durante ou dentro de 6 horas depois de completada a transfusão. Apesar de ser considerada rara e a lesão pulmonar ser geralmente transitória, traz preocupação aos profissionais da área da saúde, visto que está associada à alta morbidade dos pacientes que necessitaram de suporte ventilatório, assim como a alta mortalidade. Sua incidência não está bem estabelecida, muito devido à falta de preparo para identificar os casos suspeitos. Assim, os relatos de casos ganham relevância tanto para contribuir que o diagnóstico desta patologia seja alcançado com mais facilidade quanto para estimular que os casos sejam notificados. O presente relato descreve a ocorrência de TRALI em paciente no segundo dia de pós-operatório de cesárea por pré- eclâmpsia e síndrome Hellp que evoluiu com suspeita de hemoperitônio sendo submetida a laparotomia exploratória (LE).---Transfusion related acute lung injury (TRALI) is a serious complication of blood transfusion that evolves mainly with respiratory distress during or within 6 hours after transfusion. Although considered rare and is usually transient lung injury, she brings concern to health professionals, as it is associated with high morbidity of patients requiring ventilatory support, as well as the high mortality. Its incidence is not well established, much due to lack of preparation to identify suspected cases. Thus, case reports gain relevance to contribute to the diagnosis of this condition is more easily achieved as to stimulate the cases are reported. This report describes the occurrence of TRALI in a patient on the second day after surgery by cesarean preeclampsia and HELLP syndrome who developed suspected hemoperitoneum and underwent exploratory laparotomy (LE).

African traditional abdominal massage in pregnancy resulting in antepartum uterine rupture, abruptio placenta and foetal demise – a case report

The practice of abdominal massage dates to years ago and associated with foetal and maternal morbidity and mortality when undertaken by untrained traditional birth attendants in our setting. We present a 30-year old G3P2+0 with uterine rupture and intra-uterine foetal death following abdominal massage. She was resuscitated and had emergency exploratory laparotomy and repair of uterine rupture.