ABSTRACT
Abdominal pain in pregnant individuals presents diagnostic challenges, especially when appendicitis is suspected. We report a rare case of a 26-year-old pregnant female with recurrent right lower quadrant (RLQ) abdominal pain initially misdiagnosed as a urinary tract infection. Diagnostic uncertainty led to a magnetic resonance imaging (MRI) scan, which revealed a right adnexal cystic structure and a thickened tubular structure adjacent to the cecal pole, raising concerns of complicated appendicitis. Subsequent diagnostic laparoscopy revealed a right-sided fallopian tube paratubal cyst with 360-degree torsion and associated fallopian tube torsion without the involvement of the ovary. The cyst was successfully excised, and the patient subsequently delivered a healthy baby via emergency lower section caesarean section. Abdominal pain during pregnancy has various causes. Diagnosing appendicitis during pregnancy is challenging due to anatomical and physiological changes. Ultrasound (US) is commonly used but has limited accuracy. Computed tomography (CT) is avoided due to radiation risks, while MRI is increasingly used and shows high diagnostic accuracy or aids in alternative diagnoses. Regardless of the diagnosis, the prompt recognition of intraabdominal pathology is crucial to prevent fetal morbidity. This case highlights the challenges in the accurate diagnosis of abdominal pain during pregnancy and emphasizes the importance of considering alternative pathologies to prevent delays in treatment and complications. Clinicians should consider diagnostic laparoscopy for pregnant patients with equivocal investigations and lower abdominal pain. The differential diagnosis may include both common and rare causes such as concomitant paratubal cyst and isolated fallopian tube torsion (IFTT), emphasizing a high index of suspicion and collaboration with obstetric colleagues to ensure optimal care.
ABSTRACT
Mucormycosis is a rare, life-threatening fungal infection. While typically affecting immunosuppressed individuals, cases in the immunocompetent have been reported, particularly secondary to trauma, and the subspecies Apophysomyces. These fungi are typically difficult to isolate. This case report describes cutaneous Mucormycosis caused by Apophysomyces complex at a vaccination site, given following a motor vehicle accident. This life-threatening infection occurred in an immunocompetent 17-year old girl, resulting in multiple hospital admissions and finally, radical surgical debridement of her left upper limb. This case highlights the aggressive nature of this infection and the importance of early clinical recognition as effective treatment requires aggressive debridement typically prior to microbiological confirmation.
ABSTRACT
OBJECTIVE: Emergency laparotomy (EL) is a major operation performed in critically unwell patients. The National Emergency Laparotomy Audit (NELA), undertaken in the UK since 2013 has shown progressive improvement in clinical outcomes, specifically reduced mortality, and length of stay (LOS) through the implementation of perioperative key performance indicators (KPIs) (ANZ J Surg. 2021;91:2575, Br J Surg. 2015;102:57, Br J Surg. 2017;104:463, JAMA Surg. 2019;154:e190145). The objective is to generate a rural hospital EL audit (MELA) to evaluate local outcomes and clinical standards of practice with regional, national, and international benchmarks. METHODS: A review of medical records between January 2014 and December 2021 of patients who undergo an EL. Data collected include patient demographics, clinical information, compliance to KPIs and the primary outcomes of 30-day mortality and LOS. DESIGN: This is a descriptive quantitative study. The inclusion and exclusion criteria were similar to those defined in NELA and ANZELA-QI. SETTING AND PARTICIPANTS: The general surgeons at the rural hospital provide emergency surgery services for the North-West Queensland community. MAIN OUTCOME MEASURES: To review local clinical outcomes of 30-day mortality, LOS, and adherence to perioperative KPIs. RESULTS: Overall, 84 patients met inclusion criteria. The median age (IQR) was 61 (48.8-70.3) years. The 30-day mortality was 3.6% and mean LOS was 12.8 (±13.4) days which was secondary to the low-risk patients within the data set. Compliance to KPIs (≥80%) was achieved in five of eight standards assessed. CONCLUSION: Local outcomes appear to be comparable to national and international benchmarks and a similar rural setting. The audited cohort outperformed the national standard in adherence to perioperative KPIs.
