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Search Results: 1 - 10 of 1873 matches for " Vijay Naraynsingh "
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Distended bladder presenting with constipation and venous obstruction: a case report
Anu Sharma, Vijay Naraynsingh
Journal of Medical Case Reports , 2012, DOI: 10.1186/1752-1947-6-34
Abstract: An 83-year-old man of African descent presented with constipation and bilateral lower limb edema. A huge abdominal mass was evident which was a large, distended urinary bladder confirmed by computed tomography. Promptly after urethral catheterization, both constipation and lower limb edema resolved.To the best of our knowledge distended urinary bladder causing both constipation and lower limb edema has never previously been reported. Analysis of the literature revealed several factors resulting in the patient's presentation. A high level of suspicion for urinary bladder distension must be maintained for prompt diagnosis and to avoid improper management.Chronically distended urinary bladder is diagnosed in only 0.8% [1] of elderly men annually. A distended urinary bladder causing inferior vena cava and external iliac venous obstruction has been commonly described [2] but is infrequently encountered. Its presentation with bilateral pedal edema poses a clinical dilemma as it can be easily misdiagnosed as deep venous thrombosis or congestive heart failure. Bladder distension causing constipation, however, is very rare with few reports in the literature. To the best of our knowledge and after extensive literature review, we present the first case of chronic bladder distension presenting with both constipation and bilateral pedal edema.An 83-year-old diabetic man of African descent presented with a four week history of constipation and a two week history of obstipation to our emergency department. He noticed painless increasing abdominal distension with concomitant leg edema. He denied any history of vomiting, fever or anorexia. He used several laxative concoctions with no relief. He revealed a long standing history of incontinence at night with hesitancy and poor stream but denied frequency and strangury. He had been diabetic and on treatment for 25 years with a history of diabetic retinopathy.On admission, he was tachycardic (pulse 102 beats per minute) with a blood pre
Adrenal insufficiency and bowel obstruction: An overlooked association  [PDF]
Ryan A. Kunjal, Ria R. Ramadoo, Surujpal Teelucksingh, Vijay Naraynsingh
Case Reports in Clinical Medicine (CRCM) , 2013, DOI: 10.4236/crcm.2013.22029

Bowel obstruction is a documented but rare presentation of adrenal insufficiency (AI). We report a case of acute AI manifesting as intestinal pseudo-obstruction (IPO) in a patient with underlying iatrogenic adrenal suppression. An 83 years old female was admitted for partial small bowel obstruction that failed to resolve with conservative management. She then underwent exploratory laparotomy where no mechanical obstruction was found and the small bowel was manually decompressed. Postoperatively she developed acute swelling of her right ankle which was similar to mono-articular attacks in the past. This was diagnosed clinically as gout. Her obstruction failed to settle and a second laparotomy was done which yielded the same as the first. Given her past account of arthritic pain, direct questioning of steroid use unearthed a history of multiple intra-articular corticosteroid injections for analgesia. She also described several short courses of high dose oral steroids for respiratory tract infections, including a recent course which was abruptly stopped two days prior to presentation. Clinical suspicion of AI was supported by biochemical testing of stress cortisol levels and change in the serum cortisol in response to 250 μg of synthetic adrenocorticotropic hormone. Moreover, her improvement following a therapeutic trial of steroid replacement was dramatic and strongly supports this diagnosis. It is therefore worthwhile to consider a diagnosis of AI in cases of bowel obstruction in patients with comorbidities that predispose to steroid use and especially in settings where steroid abuse is prevalent.

Malignant peritoneal mesothelioma presenting as recurrent adhesion obstruction in general surgery: a case report
Vijay Naraynsingh, Michael J Ramdass, Crystal Lum
Journal of Medical Case Reports , 2011, DOI: 10.1186/1752-1947-5-420
Abstract: A 49-year-old man of African descent presented to our hospital with a three-month history of weight loss, anorexia, abdominal distension, and general signs of cachexia and ascites on second presentation. At first presentation one year prior to this, he had undergone a laparotomy at our institution by a different team for intestinal obstruction secondary to adhesions with no biopsy taken. The patient's condition subsequently progressively deteriorated, and investigations including upper and lower gastrointestinal endoscopies and computed tomography of the abdomen were inconclusive, except for some free fluid in the peritoneal cavity and diffuse, mild thickening of the gut wall and mesentery. A second-look exploratory laparotomy revealed widespread nodular thickening of the visceral peritoneum with a striking, uniformly diffuse, erythematous, and velvety appearance. The peritoneal biopsy histology showed that the patient had malignant peritoneal mesothelioma. His condition deteriorated rapidly, and he died eight weeks after surgery.Our report aims to increase the diagnosing clinician's awareness of the cardinal features of malignant peritoneal mesothelioma and thus reduce diagnostic errors and delays in treatment.We present the case of a 49-year-old man with asbestos exposure to illustrate the rarity and difficulty of the diagnosis of malignant peritoneal mesothelioma (MPM). This case report focuses on the clinical appearance of the condition during exploratory laparotomy and demonstrates the striking, uniformly diffuse, erythematous, and velvety aspect of the tumor as it infiltrates the peritoneal surface. This presentation has not been described previously in the literature, and we hope that this information assists clinicians and surgeons in recognizing the condition, should they confront it in the future.At first presentation, a 49-year-old man of African descent who was a non-smoker presented with sudden onset of vomiting and abdominal distension. A clinical diag
Benign cervical multi-nodular goiter presenting with acute airway obstruction: a case report
Anu Sharma, Vijay Naraynsingh, Surujpaul Teelucksingh
Journal of Medical Case Reports , 2010, DOI: 10.1186/1752-1947-4-258
Abstract: We report the case of a 64-year-old woman of African descent who presented with acute shortness of breath. She required immediate intubation and later a total thyroidectomy for a benign cervical multi-nodular goiter with no retrosternal tracheal compression.Benign multi-nodular goiters are commonly left untreated once euthyroid. Peak inspiratory flow rates should be measured via spirometry in all goiters to assess the degree of tracheal compression. Once tracheal compression is identified, an elective total thyroidectomy should be performed to prevent morbidity and mortality from acute airway obstruction.Benign multi-nodular goiter is a common problem affecting 5% of the general population in non-endemic and 15% [1] in endemic areas. However, the incidence of benign goiter causing acute airway obstruction is as low as 0.6% [2]. Retrosternal goiters account for most of these cases, as growth of the thyroid into the bony rigid thoracic inlet can cause tracheal compression. When a goiter is purely cervical, however, it rarely compresses the trachea to cause obstruction [3]. On review of the literature, only eight reports of cervical goiters causing airway obstruction were found [3-6]. Here, we present the case of a patient with recurrent benign cervical multi-nodular goiter presenting with acute airway obstruction.A 64-year-old hypertensive woman of African descent presented to our emergency room with a two-day history of worsening shortness of breath and stridor. She had been aware of a recurrent goiter for over 15 years, having had a partial thyroidectomy 35 years ago for benign multi-nodular disease. Over the past year, she had been experiencing shortness of breath on exertion, generally relieved by rest. However, the period of rest needed to relieve her dyspnea had been increasing in duration. She did not have any hyperthyroid or hypothyroid symptoms and there was no history of fever, dysphagia, pain or hoarseness.On presentation to our emergency department she had
A Safe Surgical Approach to a Giant Intrarenal Arteriovenous Fistula and Aneurysm
Vijay Naraynsingh,Patrick Harnarayan,Seetharaman Hariharan
Urology Journal , 2009,
Gossypiboma Presenting as an Atypical Intra-Abdominal Cyst: A Case Report  [PDF]
Dilip Dan, P. Ramraj, Viren Solomon, Olivier Leron, Malini Ramnarine, Kavita Deonarine, Vijay Naraynsingh, Nigel Bascombe
Health (Health) , 2014, DOI: 10.4236/health.2014.618287
Abstract: Gossypibomas are generally retained surgical sponges, and are usually a rare occurrence. They are diagnostic dilemmas with an incidence ranging from 1 in 8000 to 1 in 18,000 surgeries. However the incidence of this problem is on the rise and the clinician needs to have a high index of suspicion to make an accurate diagnosis. We reported the case of a 50-year-old male patient who presented with a 6-month history of vague epigastric discomfort, early satiety and nausea. Further investigation revealed an intra-abdominal cyst that proved to be secondary to a retained laparotomy sponge and was treated laparoscopically. This is usually an unanticipated surgical misadventure which is often preventable, with significant associated stigma for the surgical professional involved. Unfortunately it leads to extensive and often unnecessary surgical intervention. The condition can be managed conservatively or surgically. Our case report demonstrates the use of laparoscopy for the successful management of intra-abdominal gossypibomas and represents the first reported case of laparoscopic management of a gossypiboma in the Caribbean setting. It also demonstrates both the acute and delayed presentations of gossypibomas in the same patient.
Portal vein thrombosis following laparoscopic cholecystectomy complicated by dengue viral infection: a case report
Dilip Dan, Kevin King, Shiva Seetahal, Vijay Naraynsingh, Seetharaman Hariharan
Journal of Medical Case Reports , 2011, DOI: 10.1186/1752-1947-5-126
Abstract: We report a case of a 63-year-old woman of Asian Indian ethnicity who developed portal vein thrombosis following an uneventful laparoscopic cholecystectomy for symptomatic gallstones. Her condition was further complicated by dengue viral infection in the post-operative period, with thrombocytopenia immediately preceding the diagnosis of portal vein thrombosis. The etiological connections between dengue viral infection with thrombocytopenia, laparoscopic cholecystectomy, portal vein thrombosis as well as the treatment dilemmas posed in treating a patient with portal vein thrombosis with a bleeding diathesis are discussed.When portal vein thrombosis occurs in patients with contraindications to anticoagulation, there is a role for initial conservative management without aggressive anticoagulation therapy and such patients must be approached on an individualized basis.Portal vein thrombosis (PVT) is one of the recognized complications in the post-operative period following abdominal surgeries, although it is uncommonly reported in the literature. PVT may usually manifest in a patient who is in a hypercoagulable state, but to the best of our knowledge, has never been reported in a patient with thrombocytopenic hemorrhagic disorder. We report a patient who presented with PVT, five days after an uneventful laparoscopic cholecystectomy. She was simultaneously diagnosed with thrombocytopenia secondary to dengue virus infection. This case is noteworthy in that it represents an unusual constellation of diseases and poses interesting challenges regarding the seemingly contradictory fundamentals of management.A 63-year-old woman of Asian Indian ethnicity presented with complaints of biliary colic, which was worsening over a period of six months. She denied jaundice, fevers or weight loss. She had a past medical history of hypertension, diabetes mellitus and ischemic heart disease; she had received coronary angioplasty and stenting two years prior to the presentation. She was on
Inguinal Hernia and Airport Scanners: An Emerging Indication for Repair?
Vijay Naraynsingh,Shamir O. Cawich,Ravi Maharaj,Dilip Dan
Case Reports in Medicine , 2013, DOI: 10.1155/2013/952835
Abstract: The use of advanced imaging technology at international airports is increasing in popularity as a corollary to heightened security concerns across the globe. Operators of airport scanners should be educated about common medical disorders such as inguinal herniae in order to avoid unnecessary harassment of travelers since they will encounter these with increasing frequency. 1. Introduction Inguinal herniae are common clinical findings in modern surgical practice. Many patients choose to undergo inguinal herniorrhaphy when the minor risks associated with repair are weighed against the potential for the hernia to become complicated. More recently, conservative management has become an accepted therapeutic option for patients with asymptomatic inguinal herniae that are unlikely to strangulate [1, 2]. We report our experience managing a patient with an asymptomatic inguinal hernia who opted for herniorrhaphy with an unusual indication. 2. Case Presentation A 68-year-old man had a left inguinoscrotal hernia that was asymptomatic and easily reducible (Figure 1). Despite the hernia, he was active and comfortably managed his retired lifestyle. At surgical consultation, he was advised with his options and chose not to have surgery. He was content managing the hernia conservatively for five years. Figure 1: Clinical image of the left inguinoscrotal hernia mistakenly thought to be a bulge from contraband substances implanted subcutaneous by TSA security personnel after backscatter scanning. While traveling on holiday, he made an in-transit stop in a United States airport where he was required to enter a security scanner. Immediately upon exiting the scanner, he was approached by security personnel and rigorously questioned about the presence of a concealed item in his under garments. His explanation that he had an inguinal hernia was not accepted. In the presence of many onlookers at the busy airport, he was separated from his wife and escorted away in the custody of two armed airport security personnel. After another elaborate round of questioning in an interrogation room, two additional officers were summoned, and the patient was subjected to a humiliating examination of the genitalia. Only after this prolonged exercise was he released back into the airport, resulting in a delay in his travels and ruining his vacation. Frustrated, embarrassed, and inconvenienced, the patient returned home and immediately sought surgical consultation for inguinal herniorrhaphy. Although he managed his hernia conservatively for five years without event, he was now fearful of a
Bariatric Surgery in the Caribbean: Is It Safe in a Low-Volume, Third World Setting?
Dilip Dan,Yardesh Singh,Vijay Naraynsingh,Seetharaman Hariharan,Ravi Maharaj,Surujpal Teelucksingh
Minimally Invasive Surgery , 2012, DOI: 10.1155/2012/427803
Abstract: Bariatric surgery is a well-recognized modality of management of obesity. In addition to obesity, it effectively controls diabetes mellitus, and hypertension. It has been recommended that bariatric surgery should be done in “designated centers” of excellence where there is a high volume of case turnover. Caribbean nations are not spared from the global spread of the obesity epidemic; however, not many patients get the benefits of bariatric surgery. This study aimed to establish that bariatric surgery could be safely and efficiently undertaken in a low-volume center outside the “designated centers” with comparable patient outcomes even in a third world setting. Though “patient numbers” generally imply better outcome, in an environment where these numbers cannot be achieved, patients should not be denied the access to surgery once good outcomes are achieved. 1. Introduction Obesity has reached epidemic levels in many countries around the world [1]. The prevalence of obesity has steadily increased over the years irrespective of demographic factors such as age, sex, race, ethnicity, or educational level [2]. It is also increasing rapidly in both industrialized and developing countries [3]. Worldwide, nearly 250 million people are obese, and the WHO has estimated that in 2025, 300 million people will be obese [4]. It is a well-known fact that obesity is associated with increased morbidity and mortality. There have been many published reports from several Caribbean nations such as Jamaica, Barbados, Trinidad & Tobago, and St. Lucia concerning the steady rise in the prevalence of obesity from primary school age through adolescence and adulthood [5–8]. A recent PAHO/WHO report suggests that more than half of the population in Trinidad & Tobago fall within the parameters of being either overweight or obese, which is indeed quite alarming [9]. The medical management of obesity has a poor track record, but bariatric surgery has demonstrated superior weight loss and dramatic improvement in comorbidities in the postoperative period. In the developed world, bariatric surgery is usually performed at designated centers of excellence on the basis that this leads to better outcomes. However, it is debatable if bariatric surgery should be limited to such high-volume centers [10]. In addition to control of obesity, bariatric surgery is also very effective in the management of diabetes mellitus and hypertension, which commonly afflicts this population. Since the prevalence of diabetes mellitus and hypertension is also very high in the Caribbean nations, it may well be
Extrauterine leiomyomata presenting with sepsis requiring hemicolectomy
Dan, Dilip;Harnanan, Dave;Hariharan, Seetharaman;Maharaj, Ravi;Hosein, Ian;Naraynsingh, Vijay;
Revista Brasileira de Ginecologia e Obstetrícia , 2012, DOI: 10.1590/S0100-72032012000600008
Abstract: extrauterine leiomyomas are rare, benign, and may arise in any anatomic sites. their unusual growth pattern may even mimic malignancy and can result in a clinical dilemma. occasionally, uterine leiomyomas become adherent to surrounding structures. they also develop an auxiliary blood supply, and lose their original attachment to the uterus, thus becoming 'parasitic'. parasitic myomas may also be iatrogenically created after uterine fibroid surgery, particularly if morcellation is used. this report presented two cases of parasitic myomas with sepsis, both requiring right hemicolectomy. it reviewed the pertinent literature.
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