by Ognyan Georgiev Milev and Lyudmil Lyubenov Milanov
Case Report
Isolated cecal necrosis is a rare surgical emergency. In most cases the clinical picture resembles an acute appendicitis, usually occurring in elderly patients who have associated diseases. We believe that this is the first published case of isolated cecal gangrene, mimicking a perforated ulcer. A previously healthy 82-year-old male presented with abdominal pain, stabbing in nature, and of 12-hours duration. The clinical signs and symptoms were consistent with a perforated peptic ulcer. A plain abdominal X-ray disclosed a significant pneumoperitoneum. An emergency laparotomy released a gas under pressure revealing an isolated gangrenous cecum. Perforation of the cecum and fecal soiling were not present. A right hemicolectomy was performed. An intra-operative hemodynamic instability precluded primary anastomosis and a double barrel ileocolostomy was created. The patient was discharged in good health on the 8th postoperative day. This paper presents an original case of isolated cecal necrosis. A high index of suspicion should be maintained and the condition promptly addressed. Any delay is associated with high mortality rate. The procedure of choice is ileocecal resection or right hemicolectomy. The intestinal continuity should be restored through a primary anastomosis unless stump blood supply or peritoneal contamination, or patient’s overall condition are specific concerns.
American Journal of Medical Case Reports. 2016, 4(10), 349-353. DOI: 10.12691/ajmcr-4-10-6
Pub. Date: November 17, 2016
10755 Views2268 Downloads
by Tarik Zahouani, Claudia Lopez, Liliana Burdea, Anyelina De LaCruz, Patrick Polonio, Catalina Marino and Yekaterina Sitnitskaya
Case Report
Human bite wounds are the third leading cause of bite wounds seen in the emergency departments. Osteomyelitis due to animal bite is well known. However there are very few reports of osteomyelitis secondary to human bite. We present a case of osteomyelitis of the fifth toe due to a human bite. A 13 year old previously healthy Male developed severe pain, redness and swelling with oozing from the wound, 2 days after sustaining a human bite to the right foot. The Magnetic Resonance Imaging (MRI) showed a mild T2 prolongation and enhancement within the proximal phalanx of the fifth digit consistent with osteomyelitis. He was treated for 4 weeks: Ampicillin/Sulbactam for 5 days followed by 11 days of Amoxicillin/Clavulanic and Clindamycin for 25 days. Human bite wounds are a source of serious morbidity with hand and foot wounds due to higher risk of infection. The oral cavity harbors more than 300 different bacterial species. The most common bacteria isolated from bite wounds are Streptococcus sp., Staphylococcal epidermis and Staphylococcus aureus. Anaerobes such as Eikenella, Fusobacterium, Peptostreptococcus, Prevotella and Porphyromonas species are also common. The teeth can cause a deep laceration implanting oral and skin organisms into the joint capsules causing septic arthritis or osteomyelitis with signs and symptoms appearing within 24 to 72 hours. The absence of fever or laboratory evidence of serious bacterial infection in our patient is due to non-hematogenous, contiguous nature of spread of infection. Without imaging by MRI, osteomyelitis would have been missed in this case. Though rare, human bites to the distal extremities should be suspected and assessed for underlying osteomyelitis using MRI to guide appropriate length of antibiotic treatment.
American Journal of Medical Case Reports. 2016, 4(10), 346-348. DOI: 10.12691/ajmcr-4-10-5
Pub. Date: November 14, 2016
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by Gao Chuanping and Wang Hexiang
Case Report
Intramedullary cavernous angioma (ImCA), which was originally thought to be an uncommon vascular lesion, has shown an increased incidence since the advent of magnetic resonance imaging. We present a case of multiple ImCAs in the cervicothoracic region. The patient presented with slow, progressive motor weakness in the upper and lower limbs. Surgical intervention was performed because of misdiagnosis as a spinal cord tumor. The patient underwent decompression surgery because no neoplasm was noted in the course of the operation. The angioma regressed on follow-up magnetic resonance images 3 months later.
American Journal of Medical Case Reports. 2016, 4(10), 343-345. DOI: 10.12691/ajmcr-4-10-4
Pub. Date: November 07, 2016
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by Imene Boukhris, Hana Zoubaidi, Ines Kechaou, Eya Cherif, Nadia Znaidi, Aicha Ben Miled and Narjes Khalfallah
Case Report
Castleman disease (CD) is an uncommon lymphoproliferative disorder occurring mostly in patients presenting with mediastinal lymphadenopathy. Predominant phenotypes are categorized as localized hyaline vascular or multicentric plasma cell variants. Localized form of CD is usually asymptomatic and rarely associated with deep venous thrombosis. We report an exceptional case of mediastinal CD, which presented as retrosternal chest pain, in a 42-year old man. Imaging and pathological examination showed an atypical, mixed and localized form of CD. Thoracic CT scan revealed brachiocephalic vein thrombosis. Investigations didn’t reveal other risk factors for deep venous thrombosis. Deep venous thrombosis is an exceptional complication of localized variants of CD. Therefore, it seems worth looking carefully for this last type of benign lymphopathy when an unusual thrombosis is found.
American Journal of Medical Case Reports. 2016, 4(10), 339-342. DOI: 10.12691/ajmcr-4-10-3
Pub. Date: November 01, 2016
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by Amal A M Al-Shukaili, Khoula M S AL-Mandhari, Basman Younis, Shobha Lad, Awadh Othman and Sachin Jose
Original Research
In this prospective, randomized, double-blind study, we evaluated the effect of ultra-low dose of naloxone on duration of supraclavicular brachial plexus block. It was hypothesized that naloxone can prolong the duration of sensory block. Following approval by Hospital Ethical Issues Committee, eighty patients scheduled for upper limb surgery under supraclavicular brachial plexus block were randomly allocated into control group who received 20ml bupivacaine with 3 ml normal saline (Group B) or study group that received 20ml bupivacaine with 100 mcg. of naloxone in 3 ml saline, (Group BN). Onsets of sensory and motor blockade were assessed at an interval of 3 min following the block. Duration of sensory and motor block was considered to be the time interval between the complete block and the first post operative pain reported by patient and complete recovery of motor functions respectively. The difference in onset time for sensory and motor block was statistically significant between two groups but clinically it may be considered insignificant. The recovery of sensory block was slower in group BN (15.6 ± 3.2 hr) compared to group B (13.3 ± 2.4 hr) [p=0.0001]. The recovery of motor block was slower in group B (13.3 ± 2.5 hr) compared to group BN (11.6 ± 4.3) [P=0.03]. In conclusion, addition of ultra-low dose of naloxone to bupivacaine in supraclavicular block prolongs the duration of sensory block and reduces duration of motor block significantly as compared to bupivacaine alone.
American Journal of Medical Case Reports. 2016, 4(10), 336-338. DOI: 10.12691/ajmcr-4-10-2
Pub. Date: October 29, 2016
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by Sumith Gunawardane, Kanchana Kapugama and Vishaka Senevirathne
Case Report
Craniofacial osteosarcoma is a relatively rare entity comprising about 6.5–7% of all osteosarcomas, whereas it is reported to be one of the most common malignancies of long bones. Osteosarcoma (OS) is a malignant mesenchymal tumor whose cancerous cells produce osteoid matrix. Jaw lesions are diagnosed on average two decades later than sarcomas of long bone, with a peak incidence between 20 and 40 years. Considerable histopathologic variability is seen in jaw OS, which includes osteoblastic, chondroblastic and fibroblastic types. Head and neck OS is associated with a lower metastatic rate than long bone OS, and they have a better 5-year survival rate. Here we present a case of chondroblastic variant of osteosarcoma (COS) of the mandible in a 23 year-old-boy.
American Journal of Medical Case Reports. 2016, 4(10), 332-335. DOI: 10.12691/ajmcr-4-10-1
Pub. Date: October 28, 2016
1739 Views761 Downloads