ABSTRACT
Colloid cysts (CCs) of third ventricle are rare benign lesions. They present with acute hydrocephalus and its sequalae like brain herniation, infarcts resulting even death in otherwise healthy individual. We present a case of an acute hydrocephalus caused by CC of third ventricle. A middle age male was airlifted from a remote district of Nepal to our hospital with no accompanying doctor. The patient had headache, multiple episodes of vomiting, abnormal body movement, and loss of consciousness for 24 hours. On examination, vitals were stable; the Glasgow Coma Scale (GCS) score was 7. The patient was intubated in emergency and an MRI brain was done. MRI showed an obstructive lesion in third ventricle with features consistent with CC and an active hydrocephalus. There were multifocal infarcts in the bilateral cerebrum, left part of mid brain and pons, left thalamus and left superior cerebellum. We inserted external ventricular drainage in emergency operation theatre within hours and endoscopic excision of the lesion was done on the next day. In histopathology, the lesion was confirmed to be a CC.
ABSTRACT
Mesenteric ischemia is a surgical emergency. The presence of hepatic portal venous gas and pneumatosis intestinalis is a frequent finding in computed tomography. Not all hepatic portal venous gas and pneumatosis intestinalis are due to mesenteric ischemia. A 70-year-old female, with a known case of diabetes mellitus, rheumatic heart disease and atrial fibrillation under warfarin presented with diffuse abdominal pain, multiple episodes of vomiting and ecchymosis in bilateral flanks. Evaluation of the coagulation profile suggested warfarin-induced coagulopathy. Portal venous gas was detected during an ultrasound examination. Subsequent contrast-enhanced computed tomography abdomen showed hepatic portal venous gas, pneumatosis intestinalis, paucity of branches of the ileocolic artery, and reduced enhancement of caecum and ascending colon. Mild ascites were present in the pelvis. Arterial blood gas analysis revealed compensated metabolic acidosis. The patient was managed conservatively and discharged after nine days of hospital admission. Conservative approach can be considered for suspected mesenteric ischemia in surgically unfit candidates. Keywords: case reports; mesenteric ischemia; portal vein; rheumatic heart disease; warfarin.
