An unusual cause of severe cyanosis in infancy

An infant presented with cyanosis due to a diaphragmatic Morgagni hernia compromising right ventricular diastolic filling and resulting in right-to-left atrial-level shunting as demonstrated by contrast echocardiography. There was complete resolution of cyanosis after repair of the hernia.     

An unusual cause of severe dyspnea: A laryngeal live leech: Case report

IntroductionForeign bodies in the upper airways are one of the most challenging otolaryngology emergencies, leeches present a very rare cause of airway foreign bodies around the world.Case reportA 6-year-old girl was referred to our otolaryngology department at a tertiary university hospital with a severe dyspnea and hemoptysis. Nasofibroscopy revealed a dark living leech in the supraglottic area which extends to the glottis. The patient was urgently admitted to the operating room, the leech was grasped and removed with a foreign body forceps with a full length of more than 6 cm. All symptoms were relieved post operatively and she was discharged one day later.ConclusionLeeches should be suspected as an airway foreign body in patients with a recent history of drinking from stream water. Prevention remains the best treatment for such cases based simply on hygiene measures like not drinking stream water directly and filtering drinking water before it is used.     

An unusual cause of haematuria

We report an unusual cause of haematuria in a young male patient due to leech in urinary bladder. The patient presented with undiagnosed haematuria of 12 days duration. Sonography is a safe and noninvasive procedure for diagnosis. Most of the leeches are micturated out spontaneously.     

An unusual cause of dysuria

Laparoscopic adjustable gastric band (LAGB) insertion has become an increasingly common treatment for severe obesity worldwide. As a consequence, LAGB complications are reported in increasing numbers and usually present to acute surgical units. This report describes the development of lower abdominal pain and dysuria in a patient who had undergone LAGB surgery 20 months previously. Repeated symptomatic treatment for a possible urinary tract infection in the community setting had been unsuccessful. The cause was found to be a fracture in the tubing connecting the LAGB device with its subcutaneous adjusting port, which was causing persistent bladder irritation. It is recommended that when LAGB patients present with acute lower abdominal pain, consideration should be made as to whether a tubing disconnection has occurred. Such a complication may be visualised by abdominal radiography. Advice can be sought on this and other complications of bariatric surgery by contacting the regional bariatric surgical centre where definitive management would be undertaken.     

An unusual cause of renal colic: Hydatiduria

Hydatid disease of the urinary tract is seen rarely. Hydatiduria may be a finding of renal involvement, but it is a rare cause of renal colic. A case is reported of renal hydatid disease that was diagnosed during the investigation of renal colic. A 38-year-old woman presented with renal colic. She had a history of episodes of renal colic and occasional voiding of grape-like material. No calculus was found in the urinary tract by plain film or ultrasonographic examination. The histopathologic examination of this material revealed daughter cysts that are pathognomonic for hydatid disease. Ultrasound and computed tomography confirmed this diagnosis and right nephrectomy was performed without cyst perforation or any spilling of cyst content. Albendazole, 10 mg/kg per day, was given for 4 weeks (2 weeks preoperatively and 2 weeks postoperatively).     

An unusual cause of incontinence: urethral coitus

Megalourethra and incontinence due to urethral coitus are very rare phenomena in women. In this paper, we report two cases of urinary incontinence due to urethral coitus where there was no vaginal anomaly or dysfunction.     

Bezoar: An unusual cause of intestinal obstruction

Aim-Background

This article presents three cases of bezoar-induced small bowel obstruction (SBO). An uncommon entity, gastrointestinal bezoar (GIB) is reported to occur in 4% of all admissions for small bowel obstruction (SBO), with a prevalence in patients with a history of gastric surgery. Accurate preoperative diagnosis is notoriously difficult, and conventional management often necessitates laparotomy. Most bezoars are concretions of poorly digested food, which are usually formed in the stomach initially. Owing to their lack of diagnostic features, bezoars are often associated with delayed treatment and increased morbidity.

Case presentations

Herein, we describe three cases of SBO admitted to our department within the last 6 months. These patients initially presented with diffuse abdominal pain and abdominal distention. After undergoing the necessary laboratory and imaging investigation and failing to respond to conservative treatment, all three patients proceeded to surgery which revealed bezoar-induced SBO in all three cases. Two of the patients had a history of gastric surgery while the third had a bowel stenosis due to an adhesion band.

Conclusion

It is difficult to reach a preoperative diagnosis of bezoar-induced SBO based on clinical features. A GIB should be considered preoperatively as a cause of obstruction in patients with previous gastric surgery and digestive tract abnormalities such as adhesion bands. As yet, it remains a diagnostic and management challenge that usually demands early surgical intervention.