Open Access Case Report

Fireworks-Related Limb Injury in a Nigerian Neonate

O. J. Ogundele, K. I. Egbuchulem, O. A. Ifesanya

Asian Journal of Case Reports in Surgery, Page 1-5

Aims: We report an unusual case of firework blast injury to the trunk and left lower limb in a one-week-old neonate and reviewed relevant literatures.

Study Design: Case report.

Presentation of Case: Different types of injuries could be sustained following explosives used for fireworks during festivities. Fireworks-related blast injury to the limb in a neonate following accidental explosion is a rare finding in the literature and it can be associated with grave morbidity and mortality. Our index patient though survived but had accompanying morbidities.

Discussion: As fireworks-related limb injuries result in significant morbidity, public education regarding the proper use of fireworks would help in preventing the incidence of these injuries.

Conclusion: Advocacy for a strict legislation and enforcement to regulate its use in Nigeria would be the panacea.

Open Access Case Report

Acute Cardiac Herniation after Right Pleuropneumonectomy (Case Report and Review of Literature)

Nora Ismail Abbas

Asian Journal of Case Reports in Surgery, Page 1-7

Extra-pleural pneumonectomy (EPP) is an extensive surgery for management of pleural mesothelioma that is associated with perioperative morbidity of 60-63%. Extrapleural pneumonectomy (EPP) or pleuropneumonectomy for diffuse malignant pleural mesothelioma is a radical surgery which includes en bloc resection of the pleura, lung, ipsilateral hemidiaphragm and anterior pericardium. Acute cardiac herniation an extremely rare post-operative complication can cause immediate mortality in more than 50% of cases. Prevention and early recognition and management are necessary for favorable outcome. We report here the case of fatal acute cardiac herniation following right pleuropneumonectomy that caused sudden circulatory collapse upon patient manupalation shortly after admission. The patient died after futile cardiopulmonary resuscitation while preparing for emergency cardiothoracic surgery.

Prevention of acute cardiac herniation by adequate closure of the pericardial defect, avoiding excessive manupalation of the patient and Early recognition and management by emergency cardiothoracic surgery can leads to better outcome.

Open Access Case Study

Primary Supravesical Hernia Presented as Direct Inguinal Hernia with an Unusual Internal Opening – A Case Report

Devajit Chowlek Shyam

Asian Journal of Case Reports in Surgery, Page 1-4

Introduction: Supravesical hernia (SVH) or paravesical hernia is a rare condition and it is believed to be caused due to Weakness between the transversus abdominis aponeurosis and the transversalis fascia. They are mainly acquired and usually associated with inguinal hernia. The external and the internal variety of SVH is commonly presented as direct inguinal hernia and intestinal obstruction or undiagnosed abdominal pain respectively. 

Case Report: A 40 year old male was posted for TransAbdominal PrePeritoneal (TAPP) hernia repair for a direct inguinal hernia. Intraoperatively we diagnosed him with a supravesical hernia with an unusual internal opening over the medial umbilical ligament.

Discussion: SVH is a rare variety of pelvic hernia which protrudes through Supra Vesical or Paravesical Fossa (SVF). SVF is an area above the urinary bladder between the median umbilical ligament and medial umbilical ligament. CT/MRI sometimes helps in obtaining the diagnosis but mainly it was made intraoperatively. Simple closure of the internal opening is sufficed for treating this form of hernia.

Conclusion: Preoperative diagnosis of SVH is difficult to establish. CT/MRI can sometimes diagnose internal SVH but in majority, the diagnosis was made intraoperatively. Whenever we are dealing with direct inguinal hernia we should be aware of the possibility of this rare form of hernia especially if there is any difference in anatomical relation during surgery.

Open Access Case Study

Traumatic Left Hemi-Diaphragmatic Rupture with Intra-Thoracic Herniation of Abdominal Viscera with Iatrogenic Gastric Perforation – A Case Report

Ashish Vora

Asian Journal of Case Reports in Surgery, Page 1-5

Acute diaphragmatic injury (DI) is reported in less than 10% of all the patients with penetrating trauma to lower chest. Rupture of the diaphragm mostly occurs following major trauma (blunt or penetrating) or iatrogenic injury, the latter being infrequently diagnosed earlier. The presentation often masquerades as haemothorax and is misguiding and can lead to disastrous complications unless the surgeon has high index of suspicion.

Open Access Case Study

Necrotizing Fasciitis of the Breast: A Case Report and Review of Literature

Deepak Khatri, V. Shashikala, M. Mallikarjun, U. D. Manoranjan

Asian Journal of Case Reports in Surgery, Page 1-5

Necrotizing fasciitis of the breast is a rare entity in surgical practice. Since the first report by Shah et al in 2001, only a few cases have been reported worldwide. The rarity of this condition is attested by the fact that there is no definite approach to diagnosis and treatment till date. The etio-pathogenesis is found to be multifactorial. Clinical course in progressive with huge potential for morbidity and mortality due to sepsis.

A 35-years old housewife was referred to our center with 3-weeks history of a progressively enlarging swelling in her right breast. A breast abscess was clinically diagnosed, for which she underwent incision and drainage at a peripheral health center. However, she further developed a large chronic ulcer due to necrosis of the adjacent skin and was subsequently referred to our center. We managed our case through regular surgical debridement under antibiotic cover and successfully salvaged the breast. Delayed recognition, associated with massive local tissue destruction and systemic toxicity, remains a deadly pitfall in the management of necrotizing fasciitis. Various treatment modalities have been described for this condition, however, an early diagnosis is paramount and a timely aggressive intervention may save the patient’s life with good functional outcomes- a stitch in time saves nine.