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Delayed post-traumatic spinal cord infarction in an adult after minor head and neck trauma: a case report  [cached]
Bartanusz Viktor,Ziu Mateo,Wood Leisha E,Caron Jean-Louis
Journal of Medical Case Reports , 2012, DOI: 10.1186/1752-1947-6-314
Abstract: Introduction Delayed post-traumatic spinal cord infarction is a devastating complication described in children. In adults, spinal cord ischemia after cardiovascular interventions, scoliosis correction, or profound hypotension has been reported in the literature. However, delayed spinal cord infarction after minor head trauma has not been described yet. Case presentation We report the case of a 45-year-old Hispanic man who had a minor head trauma. He was admitted to our hospital because of paresthesias in his hands and neck pain. A radiological workup showed cervical spinal canal stenosis and chronic cervical spondylotic myelopathy. Twelve hours after admission, our patient became unresponsive and, despite full resuscitation efforts, died. The autopsy revealed spinal cord necrosis involving the entire cervical spinal cord and upper thoracic region. Conclusions This case illustrates the extreme fragility of spinal cord hemodynamics in patients with chronic cervical spinal canal stenosis, in which any further perturbations, such as cervical hyperflexion related to a minor head injury, can have catastrophic consequences. Furthermore, the delayed onset of spinal cord infarction in this case shows that meticulous maintenance of blood pressure in the acute post-traumatic period is of paramount importance, even in patients with minimal post-traumatic symptoms.
Delayed Presentation of Renocolic Fistula at 4 Months after Blunt Abdominal Trauma
Sang Don Lee,Tae Nam Kim,Hong Koo Ha
Case Reports in Medicine , 2011, DOI: 10.1155/2011/103497
Abstract: Causes of previously reported reno-colic fistulas included primary renal and colonic pathologic states involving infectious, malignant or other inflammatory processes. However, reno-colic fistula after renal injury is extremely uncommon. We report an unusual delayed presentation of reno-colic fistula that occurred at 4 months later after blunt abdominal trauma.
Delayed Presentation of Intussusception with Perforation after Splenectomy in Patient with Blunt Abdominal Trauma  [PDF]
Ibrahim Afifi,Hassan Al-Thani,Sajid Attique,Sherwan Khoschnau,Ayman El-Menyar,Rifat Latifi
Case Reports in Surgery , 2013, DOI: 10.1155/2013/510701
Abstract: Adult intussusception (AI) following blunt abdominal trauma (BAT) is a rare surgical condition. We present a case of delayed diagnosis of ileocecal junction intussusception with a perforation of small bowel in a 34-year-old male with a history of fall from height. Initial exploratory laparotomy revealed shattered spleen requiring splenectomy. Initial abdominal computerized tomography scanning (CT) scan showed dilated small bowel with no organic obstruction. Patient started to improve with partial distention and was shifted to rehabilitation unit. On the next day, he experienced severe abdominal distention and vomiting. Abdominal CT showed characteristic intussusception at the distal ileum. Secondary exploratory laparotomy revealed severe adhesions of stomach and small bowel to the anterior abdominal wall with dilated small bowel loops and intussusception near the ileocecal junction with perforation of small bowel. The affected area was resected and side-to-side stapled anastomosis was performed. Though small bowel intussusception is a rare event, BAT patients with delayed symptoms of bowel obstruction should be carefully evaluated for missed intussusception. 1. Introduction Intussusception is the telescoping of one segment of the gastrointestinal tract into an adjacent one and usually occurs in children [1]. John Hunter was the first to describe the clinical and pathological characteristics of intussusceptions. Sir Fredrick Treves proposed the first management plan for intussusception which is being practiced to date [2]. Unlike children in whom most cases are idiopathic, the majority (80%) of adult intussusception (AI) cases have an underlying cause which could be due to development of tumors, fibrosis after surgery, and Meckel’s diverticula. Cases following blunt abdominal trauma are rare [3]. AI is relatively uncommon with different clinical presentation, diagnosis, and management compared to childhood intussusception [4]. AI is often diagnosed late during emergency laparotomy and the delayed diagnosis may be attributed to nonspecific presentation such as chronic colicky pain and intermittent partial intestinal obstruction associated with nausea and vomiting [5]. AI mainly needs surgical treatment which includes bowel resection with prior reduction of intussusception [4]. The increased utility of computerized tomography scanning (CT) helps in early evaluation of patients with abdominal pain and confirms the diagnosis for the possible AI without subsequent delay [1]. Definitive diagnosis of intussusception is possible due to its marked diagnostic
Delayed presentation of an isolated gallbladder rupture following blunt abdominal trauma: a case report
Jonathan Bainbridge, Hossam Shaaban, Nick Kenefick, Christopher P Armstrong
Journal of Medical Case Reports , 2007, DOI: 10.1186/1752-1947-1-52
Abstract: A 65 year old lady presented through the Emergency Department with a 1 week history of blunt trauma to her abdomen. She complained of continued epigastric pain which radiated through to her back and right upper quadrant. On presentation, the patient had a low grade temperature, hypotension and mild tachycardia. Abdominal examination revealed right upper quadrant tenderness with no localised peritonism. C-reactive protein was 451. An abdominal CT showed a moderate amount of ascitic fluid in the perihepatic space. The patient underwent a laparotomy, which revealed a ruptured gallbladder with free bile. There was no evidence of any associated injuries to the surrounding organs. Partial cholecystectomy was done in view of the friable nature of the gallbladder. Post operatively, a persistent bile leak was managed successfully with endoscopic sphincterotomy and stenting.Rupture of the gallbladder due to blunt injuries to the abdomen occurs from time to time and may constitute a diagnostic challenge especially with delayed presentation. Partial cholecystectomy is a safe option in cases where friability of the wall renders formal cholecystectomy inadvisable. Endoscopic sphincterotomy and stenting is a safe and effective treatment for persistent post operative bile leaks.Blunt injuries to the gallbladder occur rarely, and the incidence of isolated damage to the gallbladder is even smaller [1-3]. The delay in presentation of the injury is not unusual. Significant morbidity or even mortality can result from delay in diagnosis, which can easily occur due to both rarity of the condition and low amplitude of symptoms. It is very important to bear in mind the possibility of such injury when confronted with a case of upper abdominal pain following blunt abdominal trauma. We report a case of delayed presentation of isolated rupture of the gallbladder following blunt trauma to the abdomen. A literature review on this subject is also provided.A 65 year old lady presented through the E
A rare and an unusually delayed presentation of orbital actinomycosis following avulsion injury of the scalp  [cached]
Hegde Vidya,Puthran Neelam,Mahesha S,Anupama B
Indian Journal of Ophthalmology , 2010,
Abstract: We report a rare case of orbital swelling presenting one year after head trauma. An initial fine needle aspiration cytology revealed it to be an infected organizing hematoma. However, broad-spectrum antibiotics did not resolve the infection and the orbital lesion continued to grow in size, as evaluated by magnetic resonance imaging. Incisional biopsies were done, which were reported as orbital actinomycosis. Patient has responded well to treatment with penicillin. This case is of interest due to the delayed presentation of an orbital complication of head trauma and the rare infection with actinomyces. It also highlights the importance of using appropriate antibiotics, as well as the need for long-term treatment.
A Delayed and Rather Unusual Presentation of a Bladder Injury after Pelvic Trauma: 5 Years after a Road Traffic Accident  [PDF]
Nikolaos Davarinos,John Thornhill,JP McElwain,David Moore
Case Reports in Orthopedics , 2014, DOI: 10.1155/2014/873079
Abstract: Associated injuries frequently occur in patients who sustain fractures of the pelvis. Specifically, high-energy trauma resulting in pelvic fractures places the bladder and urethra at risk for injury, often resulting in significant complications. Timely identification and management of genitourinary injuries minimize associated morbidity. Prompt injury identification depends upon a systematic evaluation with careful consideration of the mechanism of injury. Physical examination is pertinent as well as analysis of the urine and appropriate diagnostic imaging. Despite such increased vigilance genitourinary injuries get missed and delayed presentations in the order of a few weeks have been well documented. To our knowledge, this is the first report of its kind in the literature showing such a particularly delayed (5 years) and rather unusual presentation of a bladder injury after pelvic trauma. 1. Introduction Pelvic fractures are usually the result of high-energy trauma and may have associated soft tissue and organ damage resulting in significant morbidity and mortality in these patients. The typical profile of such patient depicts a young male individual in his 30s involved in a high-energy road traffic accident (RTA) [1]. There may be multiple-system involvement following injury. Injuries to the lower genitourinary (GU) tract alone are not life threatening, but their association with other potentially more significant injuries necessitates an organized approach to diagnosis and management. Other injuries often take priority over injuries to the GU system and may initially interfere or postpone a complete urologic assessment. Coordinated efforts between various services caring for the patient are crucial to ensure comprehensive care [2, 3]. Initial evaluation of the injured patient should follow the protocols of the Advanced Trauma Life Support program of the American College of Surgeons [4]. The lower GU tract comprises the urinary bladder, urethra, and external genitalia. Most bladder injuries occur in association with blunt trauma. Eighty-five percent of these injuries occur with pelvic fractures, with the remaining 15% occurring with penetrating trauma and blunt mechanism not associated with a pelvic fracture (i.e., full bladder blowout) [5]. Bladder injuries are best classified as intraperitoneal and extraperitoneal. Extraperitoneal bladder injuries account for 65–85% of bladder injuries and are usually associated with pelvic fractures, especially pubic ramus fractures (95%). Intraperitoneal bladder injuries account for 15–35% of bladder injuries and
Delayed presentation of a sigmoid colon injury following blunt abdominal trauma: a case report  [cached]
Ertugrul Gokhan,Coskun Murat,Sevinc Mahsuni,Ertugrul Fisun
Journal of Medical Case Reports , 2012, DOI: 10.1186/1752-1947-6-247
Abstract: Introduction The low incidence of colon injury due to blunt abdominal trauma and the lack of a definitive diagnostic method for the same can lead to delays in diagnosis and treatment, subsequently resulting in high morbidity and mortality. Case presentation A 66-year-old woman with sigmoid colon injury was admitted to our emergency department after sustaining blunt abdominal trauma. Her physical examination findings and laboratory results led to a decision to perform a laparotomy; exploration revealed a sigmoid colon injury that was treated by sigmoid loop colostomy. Conclusions Surgical abdominal exploration revealed gross fecal contamination and a perforation site. Intra-abdominal irrigation and a sigmoid loop colostomy were performed. Our patient was discharged on post-operative day six without any problems. Closure of the sigmoid loop colostomy was performed three months after the initial surgery.
A Case Presentation of a Large Rhinolith
Fahim Ahmed Shah,Sunil George,Nair Reghunanden
Oman Medical Journal , 2010,
Abstract: Rhinolith is like a stone formation within the nasal cavity. Although stones rarely form in the nasal cavity, the findings of calcified objects or stones anywhere within the body has long been a subject of interest. Though infrequently observed, nasal concretions can be the source of bad smell from the nose and therefore a social concern for the patient. The salient features of such Rhinoliths and their relevance to clinical practice are discussed and a case of a large Rhinolith is presented in this article. So as to enable the attending clinician to be aware of this forgotten entity, which requires a high index of suspicion.
Rhinolith  [cached]
Patil Karthikeya,Guledgud Mahima,Malleshi Suchetha
Indian Journal of Dental Research , 2009,
Abstract: Rhinoliths are rare entities encountered in clinical practice. They are calcified masses found within the nasal cavity. Which lesions can be encountered incidentally upon a routine dental radiograph. This article reports a case of such an incidental finding of rhinolith on a dental radiograph.
Delayed presentation of ventricular septal defect secondary to penetrating cardiac trauma following stab wound to the chest  [cached]
Omid Aghadavoudi,Mohsen Mirmohamadsadeghi,Mahmoud Saeidi
Journal of Research in Medical Sciences , 2008,
Abstract: Ventricular septal defect represents an uncommon sequel of penetrating cardiac trauma. A high index of suspicion, follow- up, and a complete evaluation of the patient who survives a penetrating heart injury is required. We report an unusual case of posttraumatic ventricular septal defect in a patient who had a stab injury to the chest requiring emergency operation. After the first surgery, the patient presented with dyspnea and signs of heart failure. Intraoperative assessment revealed ventricular septal defect. KEY WORDS: Heart injuries, diagnosis, ventricular septal defect, penetrating wounds.
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