Ischemic necrosis with sigma perforation in a patient with Systemic Lupus Erythematosus (SLE): case report

Systemic Lupus Erythematosus (SLE) is a chronic inflammatory rheumatic disease which affects the connective tissue. Its etiology is as yet unknown, while its pathogenesis involves the immune system. Both genetic and environmental and hormonal factors play a key role in the impaired immune regulation. A correlation with estrogens is demonstrated by the fact that the greatest incidence is found in young women, when estrogen secretion is at its highest. The disease is also reported to worsen in women taking oral contraceptives. It is therefore believed that the components of oral contraceptives, estrogens (ethinyl estradiol) and progestins, can affect the immune profile. Of the various complications attributed to systemic lupus erythematosus, gastrointestinal disorders are less common but potentially by far the most serious. We report a case of ischemic necrosis with sigma perforation in a patient with SLE. Signs and symptoms of acute abdomen in patients with SLE are rare (0.2%), but serious. Most patients require an exploratory laparotomy, as the causes are often linked with vasculitis.

Cecal volvulus during pregnancy. Case report

Introduction. Acute intestinal obstruction in pregnancy is a rare, but life-threatening complication associated with high fetal and maternal mortality. Case report. A 20-year old gravida presented with a 24 hour history of several episodes of vomiting, complete constipation and severe crampy abdominal pain. The patient was admitted with the diagnosis of acute abdomen associated with septic shock. On examination echography showed distended intestinal loops and presence of free peritoneal fluid. Abdominal X-ray with shielding of the fetus revealed colonic air-fluid levels. The obstetrician consult diagnosed dead fetus in utero and was decided to operate immediately. On laparotomy was found complete cecal volvulus with gangrene of cecum, part of ascending colon and terminal ileum. A right hemicolectomy was performed with side to side ileotransverse anastomosis. Afterwards a lower segment cesarean section was made and a stillborn fetus was delivered. The patient made an uneventful recovery and was discharged on 9th postoperative day. Conclusion. Cecal volvulus during pregnancy is a rare, but serious surgical problem. Correct diagnosis may be difficult until exploratory laparotomy is performed. Undue delay in diagnosis and surgical treatment can increase the maternal and fetal mortality.

On the need of standards for reporting on esophageal perforation

Esophageal perforation is associated with significant mortality and morbidity. Its etiology is as heterogenous as modalities currently employed for its treatment. There is no clear evidence which is the treatment of choice for esophageal perforation. This is partly due to the suboptimal quality of available studies and failure to accurately report on the characteristics, treatment and outcome of these patients. Indeed, baseline, operative and outcome data are important for a better evaluation of published data and possibly for including them in meta-analyses of aggregate or individual patient data. We propose a checklist for reporting data on esophageal perforation in order to standardize reporting of data of studies on this severe condition.

Simultaneous volvulus of the transverse and sigmoid colon. Case report

Introduction. Volvulus of transverse colon is rare when compared to cecal and sigmoid volvulus. Cases involving simultaneous volvulus of the transverse colon and another colonic segment are extremely rare. Case report. We report a rare case of simultaneous sigmoid and transverse colon volvulus in a 82-year-old Caucasian female Conclusion. Volvulus is a well recognized cause of large bowel obstruction. The development of transverse and sigmoid volvulus in the same patient is extremely rare. Though rare this possibility must always be considered in the differential diagnosis, when dealing with recurrent intermittent abdominal pain or acute intestinal obstruction.

Simultaneous Meckel’s diverticulitis and appendicitis: a rare complication in puerperium

We report a case of a 24-year-old woman who was delivered via cesarean section at 39 weeks and presented in the puerperium with symptoms of worsening abdominal pain and septicaemia. Preoperative ultrasonography suggested the presence of a pelvic collection. Explorative laparotomy revealed the simultaneous presence of Meckel's diverticulitis and appendicitis without bowel perforation. The patient made an uneventful recovery following small bowel resection with end to end reanastomosis and appendicectomy.

Whipple’s disease infection surgical treatment: presentation of a rare case and literature review

The Whipple’ Disease (W.D.) is a very rare disease with an incidence of 1 per 1.000.000 inhabitants; it is a systemic infection that may mimic a wide spectrum of clinical disorders, which may have a fatal outcome and affects mainly male 40-50 years old. The infective agent is an actinomycete, Tropheryma Whipplei (T.W.) that was isolated 100 years after first description by Wipple, and identified in macrophages of mucosa of the small intestine by biopsy which is characterized by periodic acid-Schiff-positive, products of the inner membrane of his polysaccharide bacterial cell wall. The multisystemic clinical manifestations evolve rapidly towards an organic decay characterized by weight loss, malabsorption, diarrhea, polyathralgia, opthalmoplegia, neuro-psychiatric disorders and sometimes associated to endocarditis. Early antibiotic treatment with trimethoprim and sulfometathaxazole reduces the fatal evolution of the disease. The authors present a rare experience about a female subject in which the clinical gastrointestinal signs were preceded by neuro-psychiatric disorders, and evolved into obstruction and intestinal perforation which required an emergency surgery with temporary ileostomy, recanalized only after adequate medical treatment with a full dose of antibiotic and resolution of clinical disease for the high risks of fistulae for the edema and lymphadenopathy of mucosa. The diagnosis was histologically examined by intestinal biopsy performed during surgery, which showed PAS-positive histiocytes, while PRC polymerase RNA was negative, which confirms the high sensibility of PAS positive and low specificity of RNA polymerase for T.W.

Delayed presentation of blunt duodenal injuries in children. Case report and review of literature

Background. Duodenal injuries are rare in children and classically present following a fall over the handle bar. Retroperitoneal location of the duodenum may lead to delay in diagnosis, and missed injuries are associated with increased morbidity and mortality. Case report. A 5-year-old child was admitted to the National Trauma Center, in Tirana (Albania), 28 hours after a Motor Vehicle Crash (MVC), complaining of mild abdominal pain. He was febrile (39°C) and had a white blood cells count of 18,000 mm3. On physical exam he had mild tenderness. Plain abdominal X-rays and Focused Abdominal Sonography for Trauma (FAST) were negative for free air or free fluid. The CT scan of the abdomen demonstrated free air and fluid in the retroperitoneal space. At laparatomy, a perforation of the second portion of the duodenum was found. A single layer suture repair of the duodenum with wide drainage was performed. The patient was discharged from the hospital tolerating oral feeding 8 days later. Conclusion. Duodenal injuries in children are rare. Most duodenal hematomas are managed non-operatively. This is a case of MCV with delayed presentation that was treated surgically for perforation successfully.

A Rare Manifestation of Crohn's Disease: Sinonasal Granulomatosis. Report of a Case and Review of Literature

Crohn’s disease is a granulomatous inflammatory bowel disease. Its pathologic findings include non-contiguous chronic inflammation and non-caseating granulomas, sometimes with extra-intestinal localizations. Sinonasal manifestations of Crohn’s disease are quite rare and only a few cases have been reported up to date in the worldwide literature. They are characterized by chronic mucosal inflammation, obstruction, bleeding and occasionally septal perforation. We report a case of sinonasal granulomatosis revealing Crohn’s disease in a 22-year-old woman and go over the available literature on sinonasal involvement in Crohn’s disease.

Gallbladder Perforation with Postoperative Preservation of Peritoneal Dialysis Catheter

A patient undergoing peritoneal dialysis was admitted with acute peritoneal dialysis-related peritonitis. On the 10th day of intraperitoneal antibacterial therapy, the patient’s dialysate developed a green color. Gallbladder perforation was revealed. The patient underwent a conventional cholecystectomy with a preserved peritoneal catheter. There are few cases in the medical literature about green dialysate. In all of them, peritoneal dialysis catheters were removed after cholecystectomy. The present case report shows a patient with an intact peritoneal catheter and with no further complications.