RESUMO
Necrotising fasciitis (NF) resulting from sigmoid perforation is rare, but none the less remains life threatening. Early surgical intervention and empiric broad-spectrum antibiotic remains the standard of care. A 65-year-old man with history of stage 4 rectal cancer presented with bilateral hip pain. An X-ray of the hip and pelvis to rule out fracture revealed abnormal gas pattern overlying the right hip. CT imaging revealed distal sigmoid perforation with air extending from the pelvis to posterior aspect of the right hip and thigh. Aggressive surgical intervention and antibiotic initiation was associated with successful outcomes in our patient. Although less common, sigmoid perforation leading to NF in posterior thigh is a reminder of a potentially lethal complication.
Assuntos
Artralgia/etiologia , Colo Sigmoide/patologia , Fasciite Necrosante/etiologia , Perfuração Intestinal/complicações , Idoso , Artralgia/diagnóstico , Bacteroides fragilis , Colostomia/métodos , Desbridamento/métodos , Diagnóstico Diferencial , Fasciite Necrosante/diagnóstico , Fasciite Necrosante/microbiologia , Quadril/patologia , Humanos , Perfuração Intestinal/diagnóstico por imagem , Perfuração Intestinal/tratamento farmacológico , Perfuração Intestinal/cirurgia , Masculino , Infecção da Ferida Cirúrgica/complicações , Infecção da Ferida Cirúrgica/microbiologia , Resultado do TratamentoAssuntos
Asma/complicações , Enfisema Mediastínico/diagnóstico por imagem , Enfisema Subcutâneo/diagnóstico , Administração Intravenosa , Broncodilatadores/administração & dosagem , Broncodilatadores/uso terapêutico , Progressão da Doença , Humanos , Masculino , Enfisema Mediastínico/etiologia , Nebulizadores e Vaporizadores , Oxigênio/administração & dosagem , Oxigênio/uso terapêutico , Radiografia Torácica/métodos , Esteroides/administração & dosagem , Esteroides/uso terapêutico , Resultado do Tratamento , Adulto JovemRESUMO
Thiamine is an important coenzyme, which is essential for metabolism and maintaining cellular osmotic gradient. Thiamine deficiency can cause focal lactic acidosis, alteration of the blood-brain barrier and the production of free radicals through cell death by necrosis and apoptosis. Wernicke encephalopathy (WE) is a clinical diagnosis. Cytotoxic and vasogenic oedema are the most typical neuroimaging findings of WE, presenting as bilateral symmetrical hyperintense signals on T2-weighted MR images. MRI is not necessary for the diagnosis of WE, but it can be helpful in ruling out alternative diagnosis. We present the case of an 61-year-old man with the history of class II obesity presenting with diplopia, dysarthria and vertigo, confirmed to be non-alcoholic WE. We aim to highlight the occurrence of WE in patients with large bowel resection though. Delay in diagnosis, particularly in obese individuals due to lack of suspicion, can lead to grim prognosis.