A rare cause of acute abdomen – Spontaneous rectus sheath hematoma

Spontaneous rectus sheath hematoma (SRSH) is a rare entity that mimics acute abdomen. Rectus sheath hematoma is the accumulation of blood in rectus sheath due to muscle or epigastric vessel injury. However, SRSH without a trauma or anticoagulation is rare. It frequently mimics acute abdomen and it may lead to misdiagnosis and unnecessary laparotomy. In this article, we described two cases of SRSH with their diagnostic and therapeutic strategy. Both of our patients in report were neither consumed antiplatelet nor coagulopathy. They both had abdominal muscle straining before their symptoms presentation. We hypothesized that the SRSH may be induced by rectus muscle injury secondary to inappropriate straining or posture. To diagnose SRSH, clinical findings are important but radiologic imaging such as computed tomography, can be diagnostic. In expanding SRSH, percutaneous arterial embolization of epigastric artery is useful to secure the bleeding. If embolization is not feasible, surgical exploration hemostasis is curative. In non-expanding SRSH, it can be managed nonoperatively. SRSH is an important initial differential for acute abdomen. Radiologic imaging helps in diagnosis. Stable SRSH can be managed conservatively with good outcome.

Management and Prevention of Recurrent Paratesticular Liposarcoma

Paratesticular liposarcoma is a rare entity. Compared to other genitourinary sarcoma, it is usually detected earlier and is easily resectable, resulting in an excellent prognosis. The recurrence of well-differentiated paratesticular liposarcoma after complete resection is extremely rare. Optimal management of the tumour recurrence includes complete re-excision and radiotherapy to the area of recurrence. Here, we describe a 48-year-old man with a recurrent left paratesticular well-differentiated liposarcoma, six years after its complete excision. Our discussion focused on the therapeutic strategy to prevent tumour recurrence. It is hoped that this case discussion can increase the awareness of this condition and assist in its management.

Massive hemothorax following administration of intrapleural streptokinase

The administration of intrapleural streptokinase [IPSK] is widely practiced in the management of loculated empyema thoracis. To our knowledge, there have been only 4 cases of hemorrhagic complications attributed to the administration of IPSK reported in the literature. In this article, we report a case of a 17-year-old girl who received IPSK and developed shock, anemia, coagulopathy and massive hemothorax. Our discussion focuses on the hemorrhagic complication of chest tube insertion and the role of IPSK in blood clot lysis and inhibition of local hemostasis

BCG Adenitis—Need for Increased Awareness

Bacille Calmette–Guerin (BCG) vaccination for protection against tuberculosis has been in use for long. Although the vaccine is safe, its administration can result in complications such as BCG adenitis. We report here a series of children with BCG adenitis with a view to recognise and manage this condition. It is hoped that this case series would encourage the increased identification of this condition.