ABSTRACT
Antiphospholipid Syndrome (APS) is an autoimmune disorder characterised by the association of thrombosis and obstetric complication. It is noted that the occurrence of haemolysis, elevated liver enzyme levels and low platelet count (HELLP) syndrome complicated with spontaneous rupture of liver is increased in APS associated pregnancy. We here report a case of a twenty six year old gravid female who developed foetal death and a subsequent spontaneous liver rupture due to HELLP syndrome and secondary APS. This report not only emphasises the prompt recognition of APS to pick up obstetrics and foetal complications early, but also points out the importance of the myriad presentations of APS.
ABSTRACT
The ileal diverticulum (Meckel's diverticulum) is a congenital out pouching located in the distal ileum which occurs due to the failure of obliteration of the yolk stalk. The peak age in which this anomaly is mostly found is the pediatric age especially below the age of two. Hence it is noted as an uncommon cause of intestinal obstruction and fatality in adult life. We present a case of a 26 year old man with abdominal pain and vomiting for 6 days associated fever for 3 days. Emergency laparotomy revealed ileal diverticulitis with small bowel obstruction. Ileal diverculectomy with ileal resection and ileoileal anastamosis was performed. However, the patient developed renal dysfunction leading to Multiorgan Dysfunction Syndrome and died on the fourth post operative day. This anatomic anomaly is rare in adult patients and is difficult to diagnose early due to its bizarre presentation resulting in high mortality in them. Hence we find this case of interest.
El divertículo de ileal o de Meckel es una evaginación congénita en el íleon distal, que se produce debido a la falta de obliteración del conducto vitelino. La edad en que esta anomalía frecuentemente se encuentra es la pediátrica, especialmente en menores de dos años. Por lo tanto, es una causa infrecuente de obstrucción intestinal y de escasa fatalidad en adultos. A continuación presentamos un caso de un hombre de 26 años, que presentaba un cuadro febril de 3 días y dolor abdominal y vómitos durante 6 días. Una laparotomía de emergencia reveló diverticulitis ileal, con obstrucción del intestino delgado. Fue realizada una diverculectomía ileal con resección ileal y anastomosis ileoileal. Sin embargo, el paciente desarrolló insuficiencia renal que condujo a una disfunción multiorgánica y síndrome de muerte al cuarto día postoperatorio. Esta anomalía anatómica es rara observarla en pacientes adultos y difícil de diagnosticar a tiempo, debido a su singular presentación y frecuentemente resulta en una alta mortalidad en estos pacientes.
Subject(s)
Humans , Male , Adult , Diverticulitis/surgery , Diverticulitis/pathology , Meckel Diverticulum/surgery , Meckel Diverticulum/pathology , Fatal Outcome , Intestinal Obstruction/etiologyABSTRACT
Giant cell rich malignant fibrous histiocytoma accounts for 3 -15% of all malignant fibrous histiocytomas. Currently, the nomenclature giant cell malignant fibrous histiocytoma is reserved for undifferentiated pleomorphic sarcomas with prominent osteoclastic giant cells. It is considered to be synonymous with malignant giant cell tumor of soft parts. We report a case of disseminated giant cell malignant fibrous histiocytoma involving the scalp, cervical node, lungs, spine, abdominal wall, base of penis, gluteal cleft, paraspinal region and back. The diagnosis was established after staining for a panel of immunohistochemical markers namely cytokeratin, vimentin, S100, desmin, CD68 and smooth muscle actin. CD68 positivity in tumor cells helped in arriving at the final diagnosis. It is essential to recognize this tumor as a giant cell rich distinct entity and differentiate from other giant cell rich pleomorphic sarcomas since therapeutic and prognostic differences are being appreciated currently.