ABSTRACT
INTRODUCTION AND IMPORTANCE: Gastric volvulus is an abnormal rotation of all or part of the stomach around one of its axes. It is a rare clinical entity and a potentially life-threatening condition. Mesenteroaxial volvulus is a less commonly encountered variant of gastric volvulus. The objective of this study was to describe a rare case of Mesenteroaxial volvulus in a 12-year-old female child. CASE PRESENTATION: A 12-year-old female child presented with a complaint of severe abdominal pain of two days duration associated with abdominal distention, failure to pass faeces and flatus, difficulty of breathing, and bloating. The vital sign was blood pressure of 90/60 mmHg, pulse rate of 130 beats per minute, respiratory rate of 29 breaths per minute, and temperature 37.8 degree Celsius. On abdominal examination, there was distension, hyperactive bowel sound, tenderness, and splenomegaly. Exploratory laparotomy was done and the intraoperative finding was gastric volvulus with Mesentroaxial type which was slightly ischemic with poor ligamentous attachment. Decompression with a Nasogastric tube (NGT) and gastropexy was done. The child was discharged on the 6th postoperative day. CLINICAL DISCUSSION: Gastric volvulus is an abnormal rotation of the stomach on horizontal or vertical axes causing various degrees of obstruction. Mesenteroaxial volvulus is most commonly seen in young children and is associated with ligamentous laxity. CONCLUSION: Gastric volvulus causes grave complications and death if not recognized early or surgical intervention is taken timely. Though it is a rare clinical entity, the primary physician should be aware of the clinical presentation.
ABSTRACT
INTRODUCTION AND IMPORTANCE: Ascariasis is a helminthic infection of humans caused by Ascaris lumbricoides. Intestinal obstruction from ascariasis can result in a rare but severe and often fatal surgical emergency of intestinal perforation and peritonitis in endemic areas. There have been reports of ascariasis causing Small Bowel Obstruction (SBO) in children in endemic areas but this phenomenon has not been studied in adults. The objective of this study was to describe the case of ascariasis causing SBO in a 25-year-old female. CASE PRESENTATION: A 25-year-old female from southwest Ethiopia presented with a complaint of intermittent crampy abdominal pain of 02 days duration associated with vomiting of ingested matter of 02 to 03 episodes, progressive abdominal distension and failure to pass feces and flatus. On examination, she was acutely sick looking. She has mild abdominal distention and a hyperactive bowel sound. Subsequently, she was resuscitated, broad spectrum antibiotic started, consent taken & operated. Patient discharged on the 7th postoperative day. CLINICAL DISCUSSION: There have been reports of Ascariasis causing SBO in endemic areas of the tropics and sub-tropics. SBO secondary to the ascaris ball in an adult is very rare and is relevant to present as it adds key clinical lessons in the consideration as a differential diagnosis, investigation clues and patient management. CONCLUSION: In a patient presented with symptoms and signs suggestive of bowel obstruction, Ascariasis should be considered as a differential diagnosis for those from endemic areas. The treating physician should have a high index of suspicion.
