Acute hemorrhagic pancreatitis following influenza infection: a case report.

BACKGROUND: Acute hemorrhagic pancreatitis is a life-threatening condition leading to shock and multiorgan failure. Although prevalent in the general population, the incidence during pregnancy is low, with a high maternal and fetal mortality rate. The highest incidence is in the third trimester/early postpartum period. Infectious etiology for acute hemorrhagic pancreatitis is rare with only a handful of cases following influenza infection being documented in the literature. CASE PRESENTATION: A 29-year-old Sinhalese pregnant lady in the third trimester presented with an upper respiratory tract infection and abdominal pain, for which she was managed with oral antibiotics. An elective caesarean section was done at 37 weeks gestation due to a past section. On postoperative day 3 she developed a fever with difficulty in breathing. Despite treatment, she succumbed to death on the sixth postoperative day. The autopsy revealed extensive fat necrosis with saponification. The pancreas was necrosed and hemorrhagic. The lungs showed features of adult respiratory distress syndrome and necrosis was observed in the liver and kidneys. Polymerase chain reaction of lungs detected influenza A virus (subtype H3). CONCLUSION: Although rare, acute hemorrhagic pancreatitis from an infectious etiology carries risk of morbidity and mortality. Therefore, a high level of clinical suspicion must be upheld among clinicians to minimize adverse outcomes.

A fatal muzzle/barrel injury by home-made firearm-an unusual mechanism.

INTRODUCTION: Trap guns are a type of home-made firearms common to Sri Lanka. Prevalent in the rural regions of the country, their main purpose is to protect crops from wild animals. It consists of a long metal pipe with a basic firing mechanism which is activated by a trip wire. Although the firing range and capacity to injure are low, they have a high propensity for causing accidental injury to unintended targets. CASE REPORT: A 42- year-old female was brought to the emergency department with the metal pipe of a trap gun penetrating through her head. According to eyewitnesses, she had thrown the trap gun, which upon impact with the floor fired in the direction of the floor. The force of fire energized the body of the trap gun to rebound with massive force. It impacted the victim's forehead and penetrated through the skull. Shortly after admission, she was pronounced dead and an autopsy was conducted. Autopsy revealed entry and exit wounds at the left supra-orbital ridge and right parietal bone respectively, with significant laceration of the brain matter. The trajectory of the metal pipe was further confirmed by antemortem computed tomography (CT) imaging. CONCLUSION: This highlights the first reported case where accidental activation of a trap gun from direct force, caused the body of the trap gun to rebound and inflict fatal injuries on a distant, unintended individual.