ABSTRACT
INTRODUCTION: Intramural jejunal hematoma is a very rare condition with only few cases reported in the literature. It rarely occurs spontaneously, and is mostly seen in hemophiliac patients and is also associated with abdominal trauma. It occurs more commonly in children than in adults and can present with features of intestinal obstruction. CASE PRESENTATION: A 10year old boy presented with features of intestinal obstruction. He sustained a blunt abdominal trauma two days prior to presentation. Abdominal computed tomography (CT) revealed jejunal hematoma with signs of complete obstruction. A trial of non-operative management failed and eventually he was managed surgically. DISCUSSION: Blunt trauma to the abdomen is the principle cause of jejunal hematoma. The trauma in majority of cases is trivial and usually the patients present late. The symptoms range from mild abdominal pain to intestinal obstruction with acute abdomen. A trial of conservative management is justifiable in stable patient. If no clinical improvement surgical intervention is indicated. CONCLUSION: Intramural jejunal hematoma after blunt abdominal trauma is seen predominately in pediatric age group and can present as intestinal obstruction. It should be suspected when a child presents with intestinal obstruction and a concurrent history of blunt abdominal trauma. The mainstay of treatment is surgical intervention. Because of the rarity of this disease, the role of conservative therapy is undefined.
ABSTRACT
INTRODUCTION: Seat belt injuries are not uncommon. The use of seat belts is associated with a unique injury profile collectively termed "the seat belt syndrome". The aim is to aid in the early diagnosis of seat belt injuries. CASE PRESENTATION: Two different patients presented to the emergency after sustaining a motor vehicle accident. Both were the drivers, restrained and had a frontal impact. On presentation they were hemodynamically stable with mild tenderness on the abdomen and the abdominal computed tomography (CT) did not show any signs of bowel or mesenteric injuries. The signs of peritonitis became obvious after 24h in one case and after 3 days in the other. DISCUSSION: Early diagnosis provides better outcomes for patients with seat belt injuries, but this remains a challenge to trauma surgeons. The typical findings of peritonitis might not be present initially. The presence of abdominal wall ecchymosis (seat belt sign) increases the chance of intraabdominal injuries by eight folds. CONCLUSION: Clinical signs of intestinal injuries might not be obvious on presentation. In the presence of seat belt sign the possibility of bowl injury must be suspected. Admit the patient for observation even if no clinical or radiological findings are present at presentation.
ABSTRACT
INTRODUCTION: The Gatekeeper™ is the most recent bulking agent used in the treatment of fecal incontinence with no reported complications. This case reports side effects similar to other bulking agents, namely migration of the prosthesis and perianal abscess. PRESENTATION OF CASE: A 52 year old gentleman presented with a history of fecal soiling. He underwent uncomplicated surgery in 2012 for 6 Gatekeeper™ implantations with only temporary improvements. In 2013, endorectal ultrasound revealed prosthesis migration. In 2014, he presented with a perianal abscess which contained one of the prosthesis. DISCUSSION: The Gatekeeper™, made of the inert Hyexpan, typically implanted in the intersphincteric region, has been used for the treatment of fecal incontinence since its discontinuation in the treatment of gastroesophageal reflux disease.(5) The Gatekeeper™ was implemented on a small number of subjects for which the typical side effects of bulking agents were not seen. CONCLUSION: Larger studies need to be conducted to investigate the advantages or perhaps disadvantages of the Gatekeeper™ over other bulking agents.
