International Journal of Medicine and Medical Sciences, Jul 31, 2014
Meckel's diverticulum occurs around the fifth to seventh week of the embryological development. I... more Meckel's diverticulum occurs around the fifth to seventh week of the embryological development. It originates when the vitelline or omphalomesenteric duct which normally connects the primitive gut to the yolk sac fails to obliterate. Meckel's diverticulum may be symptomatic or remain silent throughout life time and incidentally discovered at autopsy. Symptoms primarily emanates from an array of complications which may include diverticulitis, haemorrhage, obstruction and intussusceptions. Diverticulitis predominately affects adults and remains exceedingly rare in infancy. However, Meckel's diverticulitis clinical symptoms are non-specific and frequently resemble other common acute surgical and inflammatory conditions of the abdomen. The infrequency and varied symptomatology make clearcut pre-operative diagnosis of diverticulitis extremely challenging. We hereby, report a case of a six month old infant with acute diverticulitis who present with brief history of vomiting, abdominal distension and fever. Basically, our report is aimed at forewarning clinicians to consider meckel's diverticulitis as a differential diagnosis when assessing children who present with acute abdominal pathologies.
International Journal of Case Reports and Images, May 9, 2013
Introduction: Urethrovesical foreign bodies have been fairly reported. However, hitherto their di... more Introduction: Urethrovesical foreign bodies have been fairly reported. However, hitherto their diagnosis and subsequent management still pose challenge to clinicians. Different types of urethrovesical foreign bodies have been described. Broadly, they can be categorized as inserted, iatrogenic and migratory foreign objects. Regardless of their diversity, nature and origin, they do often lead to similar presenting symptoms and beset by multitude of complications. Case Series: We hereby report two cases: first, being self inserted wire into the male urethra and urinary bladder. Second case is a foreign body iatrogenically introduced into urinary bladder of a 52yearold male during open prostate surgery. Conclusion: Patients with urethrovesical foreign bodies are highly susceptible to infections and other life threatening complications. Therefore, the use of broad spectrum antibiotics after culture and sensitivity studies coupled with safe removal of foreign bodies remains the mainstay of treatment. The precise modus operandi of retrieval always depends upon factors such as the type, size, shape and location of foreign object. Never the less, minimally invasive retrieval modalities are encouraged whenever deemed appropriately. Urethrovesical foreign bodies are frequently encountered in our clinical practice. It is therefore very essential to have high index of suspicion when reviewing patients with acute or chronic lower urinary symptoms.
International Journal of Case Reports and Images, 2013
Introduction: bezoars may be described as conglomerates of partially digested or indigestible org... more Introduction: bezoars may be described as conglomerates of partially digested or indigestible organic substances in the gastrointestinal tract. bezoars are classified based on their composition. there are four main categoriesphytobezoars, trichobezoars, pharmacobezoars, and lactobezoars. typically, bezoars are ingested and primarily conglomerate in the stomach over time. Occasionally, they may migrate distally and cause obstruction of small bowel. bezoar formation mainly occurs in patients with predisposing factors like altered gastrointestinal anatomy due previous surgery or impaired gastric motility. the presence of isolated bezoar in the small bowel without synchronous existence of primary gastric bezoar or any apparent predisposing factors for bezoar formation remains an exceedingly a rare presentation. case report: We hereby, report a case of isolated ileal bezoar causing acute small bowel obstruction in rather a healthy 15-year-old girl. conclusion: solitary bezoar induced ileal obstruction in a healthy teenager is a rarity occurrence. this report is, therefore, aimed at highlighting this atypical cause of small bowel obstruction in this age group and cautions clinicians in our environment that bezoars form an essential
Background: Despite the existing evidence, many physicians are reluctant to use opioid analgesia ... more Background: Despite the existing evidence, many physicians are reluctant to use opioid analgesia for acute abdominal pain. Methods: We performed updated conventional and network meta-analyses. For the first time to our knowledge, direct and indirect evidence of any type of opioid analgesia was estimated and compared using network meta-analysis. Results: There was no significant difference in the intensity of pain between the two cohorts (mean difference (MD) = 0.43 (-0.05 to 0.91), P = 0.08). In addition, no significant difference was detected in the rate of incorrect diagnoses between the opioid analgesia and the placebo cohorts (odds ratio (OR) = 0.79 (0.54 to 1.17), P = 0.24). Network meta-analysis demonstrated that the results of direct evidence of head-to-head comparisons of opioid analgesics with placebo were in accordance with the results of conventional metaanalysis. Moreover, estimation and comparison of the indirect evidence on the four opioid analgesics did not demonstrate significant differences in effect size. Conclusions: Any type of opioid analgesic can be used safely for acute abdominal pain without risk of impairment of diagnostic accuracy.
Rhinosporidiosis is a rare chronic granulomatous disease, characterised by polypous lesions of th... more Rhinosporidiosis is a rare chronic granulomatous disease, characterised by polypous lesions of the mucous membrane. Commonly affects the mucous membrane of the naso-pharynx, conjunctiva and palate. Its causative agent is Rhinosporidium seeberi. The disease is more prevalent in the Indian subcontinent, but remains quite rare in our environment. We hereby present a case description of a 70 year old native Malawian male with a polypoid nasal rhinosporidiosis. Patient presented with long standing history of nasal obstruction and intermittent epistaxis for three years. Diagnosis was confirmed by histopathological examination and he was successfully treated by complete surgical excision. This was a very unusual cause of nasal masses in our setting. Nasal rhinosporidioss lesions may largely mimic other ordinary nasal polyps, it is crucial therefore for clinicians in our region to consider rhinosporidiosis as a differential diagnosis when assessing patients presenting with nasal swellings.
International Journal of Medicine and Medical Sciences, Jul 31, 2014
Meckel's diverticulum occurs around the fifth to seventh week of the embryological development. I... more Meckel's diverticulum occurs around the fifth to seventh week of the embryological development. It originates when the vitelline or omphalomesenteric duct which normally connects the primitive gut to the yolk sac fails to obliterate. Meckel's diverticulum may be symptomatic or remain silent throughout life time and incidentally discovered at autopsy. Symptoms primarily emanates from an array of complications which may include diverticulitis, haemorrhage, obstruction and intussusceptions. Diverticulitis predominately affects adults and remains exceedingly rare in infancy. However, Meckel's diverticulitis clinical symptoms are non-specific and frequently resemble other common acute surgical and inflammatory conditions of the abdomen. The infrequency and varied symptomatology make clearcut pre-operative diagnosis of diverticulitis extremely challenging. We hereby, report a case of a six month old infant with acute diverticulitis who present with brief history of vomiting, abdominal distension and fever. Basically, our report is aimed at forewarning clinicians to consider meckel's diverticulitis as a differential diagnosis when assessing children who present with acute abdominal pathologies.
International Journal of Case Reports and Images, May 9, 2013
Introduction: Urethrovesical foreign bodies have been fairly reported. However, hitherto their di... more Introduction: Urethrovesical foreign bodies have been fairly reported. However, hitherto their diagnosis and subsequent management still pose challenge to clinicians. Different types of urethrovesical foreign bodies have been described. Broadly, they can be categorized as inserted, iatrogenic and migratory foreign objects. Regardless of their diversity, nature and origin, they do often lead to similar presenting symptoms and beset by multitude of complications. Case Series: We hereby report two cases: first, being self inserted wire into the male urethra and urinary bladder. Second case is a foreign body iatrogenically introduced into urinary bladder of a 52yearold male during open prostate surgery. Conclusion: Patients with urethrovesical foreign bodies are highly susceptible to infections and other life threatening complications. Therefore, the use of broad spectrum antibiotics after culture and sensitivity studies coupled with safe removal of foreign bodies remains the mainstay of treatment. The precise modus operandi of retrieval always depends upon factors such as the type, size, shape and location of foreign object. Never the less, minimally invasive retrieval modalities are encouraged whenever deemed appropriately. Urethrovesical foreign bodies are frequently encountered in our clinical practice. It is therefore very essential to have high index of suspicion when reviewing patients with acute or chronic lower urinary symptoms.
International Journal of Case Reports and Images, 2013
Introduction: bezoars may be described as conglomerates of partially digested or indigestible org... more Introduction: bezoars may be described as conglomerates of partially digested or indigestible organic substances in the gastrointestinal tract. bezoars are classified based on their composition. there are four main categoriesphytobezoars, trichobezoars, pharmacobezoars, and lactobezoars. typically, bezoars are ingested and primarily conglomerate in the stomach over time. Occasionally, they may migrate distally and cause obstruction of small bowel. bezoar formation mainly occurs in patients with predisposing factors like altered gastrointestinal anatomy due previous surgery or impaired gastric motility. the presence of isolated bezoar in the small bowel without synchronous existence of primary gastric bezoar or any apparent predisposing factors for bezoar formation remains an exceedingly a rare presentation. case report: We hereby, report a case of isolated ileal bezoar causing acute small bowel obstruction in rather a healthy 15-year-old girl. conclusion: solitary bezoar induced ileal obstruction in a healthy teenager is a rarity occurrence. this report is, therefore, aimed at highlighting this atypical cause of small bowel obstruction in this age group and cautions clinicians in our environment that bezoars form an essential
Background: Despite the existing evidence, many physicians are reluctant to use opioid analgesia ... more Background: Despite the existing evidence, many physicians are reluctant to use opioid analgesia for acute abdominal pain. Methods: We performed updated conventional and network meta-analyses. For the first time to our knowledge, direct and indirect evidence of any type of opioid analgesia was estimated and compared using network meta-analysis. Results: There was no significant difference in the intensity of pain between the two cohorts (mean difference (MD) = 0.43 (-0.05 to 0.91), P = 0.08). In addition, no significant difference was detected in the rate of incorrect diagnoses between the opioid analgesia and the placebo cohorts (odds ratio (OR) = 0.79 (0.54 to 1.17), P = 0.24). Network meta-analysis demonstrated that the results of direct evidence of head-to-head comparisons of opioid analgesics with placebo were in accordance with the results of conventional metaanalysis. Moreover, estimation and comparison of the indirect evidence on the four opioid analgesics did not demonstrate significant differences in effect size. Conclusions: Any type of opioid analgesic can be used safely for acute abdominal pain without risk of impairment of diagnostic accuracy.
Rhinosporidiosis is a rare chronic granulomatous disease, characterised by polypous lesions of th... more Rhinosporidiosis is a rare chronic granulomatous disease, characterised by polypous lesions of the mucous membrane. Commonly affects the mucous membrane of the naso-pharynx, conjunctiva and palate. Its causative agent is Rhinosporidium seeberi. The disease is more prevalent in the Indian subcontinent, but remains quite rare in our environment. We hereby present a case description of a 70 year old native Malawian male with a polypoid nasal rhinosporidiosis. Patient presented with long standing history of nasal obstruction and intermittent epistaxis for three years. Diagnosis was confirmed by histopathological examination and he was successfully treated by complete surgical excision. This was a very unusual cause of nasal masses in our setting. Nasal rhinosporidioss lesions may largely mimic other ordinary nasal polyps, it is crucial therefore for clinicians in our region to consider rhinosporidiosis as a differential diagnosis when assessing patients presenting with nasal swellings.
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