Extensive fournier gangrene with retroperitoneal involvement in a diabetic patient

Fournier’s gangrene is a rare, rapidly progressive, fulminant form of necrotizing fasciitis of the genital, perianal and perineal regions extending to the abdominal wall between the fascial planes. It is secondary to polymicrobial infection by aerobic and anaerobic bacteria with a synergistic action. A 42 year old male who is an alcoholic and diabetic on irregular treatment presented with scrotal swelling and pain for 5 days following a trauma. On examination, patient was febrile, tachypneic and had tachycardia. His scrotum was edematous and erythematous on right side with crepitus. Abdomen was warm on right side till umbilicus and had crepitus. He was in sepsis and had diabetic ketoacidosis, prerenal azotemia and mild impairment of liver function. A diagnosis of extensive Fournier gangrene with retroperitoneal involvement was made. Patient underwent scrotal exploration and aggressive debridement serially. Testis was spared. As patient improved with good wound care and glycemic control, wound was closed. Though our patient had retroperitoneal involvement without peritonitis, he was deferred laparotomy which significantly reduced the morbidity and mortality. It is one of the few reported case in the literature with retroperitoneal involvement.

Eccrine porocarcinoma from the abdominal wall in an elderly female: a case report

Eccrine porocarcinoma (EPC) is a rare malignancy arising from the sweat gland. It is commonly seen in elderly female patients. There is no characteristic appearance for this malignancy and so making a clinical diagnosis is difficult. The diagnosis is confirmed by histopathological examination (HPE). Authors present a case of a 53-year-old female who presented with an ulceroproliferative lesion on the left side of the abdominal wall. After the lesion was radiologically ascertained to be localized and having a diagnosis of porocarcinoma from wedge biopsy, a wide local excision was done.  The HPE confirmed the diagnosis of EPC.

Spontaneous rupture of neurogenic bladder

Pneumoperitoneum is abnormal presence of air or any other gas in the peritoneal cavity. This finding can be both benign or a sign of a grave underlying pathology and a wide spectrum of clinical conditions can attribute to the finding. Prompt clinical examination of a case of abdominal pain can identify findings of peritonitis. We are reporting an interesting case report about a patient of acute abdomen with pneumoperitoneum and peritonitis which was caused by spontaneous rupture of urinary bladder. A 36-year-old male, came with complaints of abdominal pain for one day, two episodes of non-bilious vomiting. He was a known case of neurogenic bladder on continuous bladder drainage. Systemic examination of the abdomen showed warmth, diffuse tenderness, guarding and absent bowel sounds. Bladder catheterisation showed clear urine. On investigation, He had pneumoperitoneum in chest X-ray and free fluid in ultrasonography. A clinical diagnosis of hollow viscus perforation was made and emergency laparotomy was done in view of signs of peritonitis. There was rupture of the dome of urinary bladder with necrosis of the bladder wall and extravasation of urine into the peritoneal cavity. This rare presentation should remind us to keep all the differential diagnoses in mind while opening a case of perforation peritonitis as timely intervention can well and truly be the difference between life and death.

A rare case of iliopsoas hematoma in a patient with von Willebrand disease

Iliopsoas hematoma is a serious complication that can occur in bleeding disorders, most commonly hemophillia but it can also be seen in von Willebrand disease (vWD) in less frequency. This can cause muscle pain, muscle dysfunction and sometimes even femoral nerve palsy. Iliopsoas hematomas can be diagnosed by the usage of ultrasonography, computed tomography (CT) or magnetic resonance imaging (MRI). Here we report a case of a 20-year-old boy who presented to us with complaints of pain in the right lower quadrant, flank, and inguinal region for a week. He was diagnosed with vWD type 3 when he was 10 years old. The symptoms started after he had tried to kick start his motorbike vigorously. Clinical examination revealed the patient to be in an anti-pain posture and to have tenderness at sites where he complained of pain. A subsequent CT scan showed that there was an iliopsoas hematoma of size 10×6 cm. The patient was managed conservatively with factor replacement and physiotherapy following which there was amelioration in the symptoms and the patient recovered well.

Midline cervical cleft: a case report

A 14-year-old boy presented with complaints of a sinus in the middle of neck, with mucoid discharge present since birth. MRI sinogram along with MRI neck was taken which revealed a sinus tract opening in midline, extending posteriorly and traversing inferiorly to end blindly above sternum. Patient was planned for an elective excision of sinus tract, with z-plasty for decreased scarring. Congenital midline cervical cleft is a rare entity that was first described in 1924. Subsequently there have been fewer than 100 cases reported in medical literature. It typically manifests at birth as a cleft at level of suprasternal notch with a pseudonipple above it. Pathogenesis of congenital midline cervical clefts remains speculative. Differential diagnosis includes thyroglossal duct cysts or branchial cleft anomalies.