An Anterior Abdominal Abscess as the Initial Presentation of a Perforated Duodenal Ulcer: A Case Report.

Duodenal perforation most commonly presents with life-threatening symptoms of acute abdomen. However, in rare cases, a perforation may have an indolent course due to subclinical progression, and the patient may present with complications at the first visit. We present a case of an anterior abdominal abscess as the initial presentation of a duodenal perforation in a 65-year-old female with no pre-morbidities. The patient presented with a painful mass in the right upper quadrant associated with fever. Physical examination revealed a tender, erythematous swelling in the right hypochondrium and lumbar regions with no signs of peritonitis. Contrast-enhanced CT (CECT) of the abdomen showed a subcapsular hepatic abscess with parietal extension, but no signs of hollow viscus perforation were visible. Empirical antibiotics were given, and incision and drainage (I&D) were performed to drain around 100 mL of pus. However, drain on postop day one demonstrated bile suggesting a hollow viscus perforation, which was confirmed by a Gastrografin study.

Leukocytoclastic Vasculitis: A peculiar presentation of scrub typhus.

Scrub typhus is a disease endemic to the Indian subcontinent caused by the obligate intracellular pleomorphic organism, Orientia tsutsugamushi. Scrub typhus, among other acute febrile illnesses, manifests as prodromal symptoms of fever, malaise, myalgia and anorexia followed by a distinct maculopapular rash, hepatosplenomegaly and lymphadenopathy. We report the case of a patient presenting to tertiary care hospital in southern India in 2021 who developed a rare cutaneous vasculitis secondary to infection with Orientia tsutsugamushi. After performing the Weil-Felix test, a diagnostic titre of >1:640 against OXK was obtained. Furthermore, a skin biopsy was carried out which confirmed the diagnosis of leukocytoclastic vasculitis. The patient was treated with doxycycline and showed drastic improvement in his symptoms.

Stuck pericardial pigtail catheter in purulent pericarditis: early surgery?

Pyopericardium is rare in the modern antibiotic era but is still infrequently seen in the setting of immunosuppression, recent thoracic surgery and sepsis. Although classically an extension of a thoracic gram-positive bacterial infection, gram-negative bacterial purulent pericarditis may be encountered in the setting of nosocomial infections. Emergent pericardial drainage allows for prompt definitive management and planning for further intervention. Early surgery should be the priority after a failed retrieval of the catheter. Appropriate surgical methods should be employed to minimize complications associated with stuck catheters. We report a case of pyopericardium secondary to a clinically silent lung abscess in an immunocompetent 49-year-old patient. This was treated by standard pericardial drainage via a pigtail catheter. Multiple failed attempts in removal warranted a surgical approach to remove the coiled catheter. The catheter was found to be coiled around the heart with presence of clots in the pericardium.

Acute myocardial infarction in a young adult with hyperhomocysteinaemia secondary to tropical sprue.

Coronary heart disease and its complications remain the most common cause of morbidity and mortality throughout the world. In addition, its incidence among adults <45 years of age has also been steadily increasing in the past few decades. Besides the typical aetiology such as coronary artery abnormalities or autoimmune disorders, increasing rates can be attributed to escalating trends of obesity, type 2 diabetes mellitus, and illicit abuse of drugs such as cocaine and amphetamines in the younger population.1 Every cardiovascular event in a young adult must be thoroughly investigated as the aetiology is typically unconventional. Our case reports a young man who developed an acute inferior wall myocardial infarction (IWMI) in the setting of hyperhomocysteinaemia secondary to vitamin B12-folate deficiency itself due to tropical sprue.

Mycobacterium tuberculosis infection of an intralobar pulmonary sequestration.

Pulmonary sequestration is a rare bronchopulmonary foregut anomaly that occurs when a portion of the lung derives its blood supply from an aberrant vessel rather than the customary tracheobronchial supply. The sequestration can be classified as intralobar or extralobar. Most patients with intralobar sequestration are asymptomatic. Among symptomatic patients, presentations vary greatly, from fever, cough with expectoration, exertional dyspnea, pleuritic chest pain, and hemoptysis to eventual lung abscess or empyema. Contrast-enhanced computed tomography/computed tomography angiography is performed to determine the origin of the anomalous blood supply as well as the pathological manifestations involving the lobes. We present a patient with diagnosed intralobar sequestration who developed pulmonary tuberculosis of the sequestered lung tissue. The patient was successfully managed with long-term antitubercular therapy and left lower lobectomy with ligation of the anomalous vessel.

Asymptomatic Giant Aneurysm of the Arteria Lusoria Treated by Debranching and Aneurysmal Resection.

The aberrant right subclavian artery (ARSA, arteria lusoria) is the most common intrathoracic vascular anomaly, affecting up to 2% of the population. However, aneurysms of congenital anomalies are extremely unusual and often present with dysphagia, dysphonia, or dyspnea due to compression of the surrounding structures. We report a case of an asymptomatic 57-year-old male with chronic kidney disease who was incidentally found to have a large aneurysm of the ARSA on preoperative computed tomography for laparoscopic nephrectomy. Surgery is unequivocally warranted as these aneurysms are associated with a high risk of complications, including thrombosis, embolism, and rupture. We debranched the ARSA, followed by anastomosis to the right carotid artery through a right neck incision. Subsequently, aneurysmal resection was performed through left thoracotomy. The patient had an uneventful postoperative recovery and was asymptomatic during the follow-up.