ABSTRACT
Blue rubber bleb nevus syndrome (BRBNS) is a rare congenital condition, characterized by multiple venous malformations that may involve any organ system, most commonly the skin or the gastrointestinal tract. These lesions are often responsible for chronic blood loss and secondary anemia, and in rare situations may cause severe complications such as intussusception, volvulus, and intestinal infarction. Intussusception as a complication of BRBNS, although a known complication of the disease, has rarely been reported, especially in the Philippines. In the Philippine Society for Orphan Disorders, only 2 cases of BRBNS are currently included in the organization, including the patient presented in the case report. The treatment of BRBNS that involves the gastrointestinal tract depends on the extent of intestinal involvement and severity of the disease. The treatment aims to preserve the GI tract as much as possible due to the high recurrence in the disease. In this case report, we present a 13 year-old male with BRBNS with previous history of intussusception, successfully managed conservatively;however, upon recurrence, underwent exploratory laparotomy wherein a subcentimeter perforation in the antimesenteric border of the proximal ileum was noted, together with a gangrenous intussuscipiens, and multiple mulberry-like formations on the antimesenteric border of the small bowels. Histopathological findings of the resected bowels showed multiple cavernous hemangiomas consistent with BRBNS. The postoperative course of the patient was unremarkable.Copyright © 2023 The Authors
ABSTRACT
Hollow viscous perforation is one of the most common emergency dealt by general surgeons worldwide. A high degree of suspicion is required and prompt management is warranted to reduce morbidity and mortality. Here we present a study of perforative peritonitis in our medical college at the outskirt of Udaipur city in the state of Rajasthan, India during the Covid-19 pandemic. During the one year study period from September 2020 to August 2021, a total of 16 cases of hollow viscous perforation admitted and treated. The number is relatively low because of the pandemic and there was a period of total lockdown with negligible patient footfall. All patient had free gas under diaphragm in plain x-ray and all of them were scheduled for emergency laparotomy after adequate resuscitation. Emphasis given on the location of perforation, etiology, organism on culture of peritoneal fluid and procedure undertaken. Copyright © 2022, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.
ABSTRACT
Children with prior coronavirus disease 2019 (COVID-19) infection display an increased systemic inflammation causing multiorgan dysfunctions in the cardiovascular, respiratory, central nervous system, and gastrointestinal (GI) systems, known as MIS-C, that is, multisystem inflammatory syndrome in children. Most of the MIS-C cases have GI manifestations like pain abdomen, loose motion, vomiting or nausea, elevated liver enzymes, ileus, and bleeding. Angiotensin-converting enzyme 2 (ACE2) receptors in the terminal ileum and colon are responsible for the majority of ACE2-induced damage to these tissues. In the pandemic's second wave, a significant number of MIS-C patients with predominantly GI symptoms (around 80%) were reported. Although different molecular inflammatory mechanisms are involved, there is a significant overlap of the children's GI symptoms with those of MIS-C and other conditions of the abdomen caused by infection or inflammation, thus resulting in a diagnostic dilemma. Here, we report two cases of MIS-C with acute appendicular perforation and ileal perforation needing both medical management and surgical intervention. © 2022 Medical Journal of Dr. D.Y. Patil Vidyapeeth ;Published by Wolters Kluwer - Medknow.