Open Access Case Report

Management of Xipho-Omphalopagus Conjoint Twins in North Central Nigeria: A Case Report and Discussion of Our Experience

Samson Olori, Philip M. Mshelbwala, Olabisi O. Osagie, Y. John Chinda, Babatunde Odeyemi, A. M. Mustapha, Alfa Yakubu, Ndubisi Mbajiekwe, Joshua Aiyekomogbon, Kudirat E. Olateju, Stella Omokaro

Asian Journal of Case Reports in Surgery, Page 11-16

This case report describes the management of Xipho-omphalopagus conjoint twins in North central Nigeria. Conjoint twins have been reported in literature and they present very enigmatic and grotesque appearances. The aim of management of most cases is to separate them into two independent persons, but in case of parasitic twins, is to remove the parasite from the autosite. On the 11th of June 2018, a set of conjoint twins were referred to the Paediatric Surgery Division of our Hospital. The patients were delivered by a caesarian section after a prolonged labour at St Mary’s Hospital in Gwagwalada. Two operation teams were constituted which undertook six sessions of conference discussions and several drills on how to mobilize, position, transport, intubate and monitor these patients through the course of operation and in the post-operative care. The management of conjoint twins is multidisciplinary and requires that the managing team, the parents and community have a common understanding with a view of the successful separation of the babies. The society is very limited in the knowledge of the requirements for care, yet put so much pressure on the doctors and the health care institutions to deliver on the separation of conjoint twins, it would be appropriate as was done in this case to constitute a media team of the hospital to respond to concerns from media houses and interested parties so as to allow the managing team concentrate on their professional duties.

Open Access Case Report

Colorectal Foreign Body: Series of Three Case Reports

Amritanshu Saurabh, Tayod Kumar Choudhary, Rohit Chauhan, Udit Khurana

Asian Journal of Case Reports in Surgery, Page 23-28

Introduction: Although patients presenting with retained colorectal foreign bodies are uncommon, yet various incidences of it are well documented in the literature. The reasons related to it are homosexual practices, anal autoerotism, physical assault or can be a result of body packing. The patients may have minimal symptoms, or entirely asymptomatic or can develop complications like abdominal pain, sepsis, bleeding, or perforation leading to death. Delayed presentation due to social embarrassment is the most often reason for worsened results. Management and approach depends on the presentation of patient. In this article, we report a series of three cases, with distinct presentation and highlight the approaches taken to remove the foreign bodies.

Case Presentation: In the first two cases, transanal extraction with sedation or spinal anaesthesia was done to remove the foreign body. In the third case, laparotomy with an enterotomy and primary repair of sigmoid was done to remove the foreign body.

Open Access Case Study

Successful Retrieval of a Partially Cut and Embolized Peripheral Intravenous Catheter from Cephalic Vein

Manoj Ravi, C. K. Prasanna Kumar, T. P. Rakesh

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

Placements of peripheral intravenous (IV) catheters are very common in hospital admitted patients. Rarely, fracture or accidental cutting can lead to embolization of the distal segment. Difficult decision-making situations can arise while considering between open surgical or interventional procedures for retrieval, which, largely depends on the position, physical features of the embolized segment, and morbidity of the procedure. We report a case of successful retrieval of an embolized fragment of an IV catheter lodged in the cephalic vein with an interventional procedure. We illustrate detailed step-wise techniques applied for percutaneous retrieval of foreign body, using simplified tool with different interventional possibilities. All procedures were performed safely and without difficulty. No complication was noted during or after these procedures.

Open Access Case Study

Atypical Presentation of Appendicitis Revealing a COVID-19 Infection

Fakhar Shahid, Khalid Ahmed, Zubair Shahid, . Inamullah, Syed Muhammad Ali, Zia Aftab

Asian Journal of Case Reports in Surgery, Page 6-10

COVID-19 can present in many ways that need to be recognized early, to protect the medical staff from exposure/infection, by isolation of affected patients. We report a case, who presented with acute abdominal pain and on investigations was found to have features of acute appendicitis, without any pulmonary symptoms, and tested positive for COVID-19. He was treated conservatively for appendicitis with antibiotics and recovered well but developed full blown COVID-19 pneumonia after three days. This report signifies that COVID-19 infections may present as acute abdominal pain and appendicitis, in our case, the screening protocol helped us to identify this patient and helped to avoid exposure and possible infection to healthcare staff and avoidance of presumably unnecessary appendectomy. 

Open Access Case Study

A Rare Case of Hyena Bite - Reconstruction of Complex Central Face Defect with Folding Free Radial Forearm Flap: A Case Report

Pradeep Goil, Saket Srivastava

Asian Journal of Case Reports in Surgery, Page 17-22

Background: A hyena bite to the face of a live adult human is one of the rarest cases and is hardly reported in India. The central face is an intricate 3-Dimensional structure and is a dominant feature of a human being. A complex central facial defect can severely affect a person’s appearance and function; and poses a substantial challenge for reconstructive surgeons. The aim and principles of central facial reconstruction are to achieve adequate function and aesthetics.

Case Report: This report describes a very rare case of a 43-year-old man, resident of a rural part of Rajasthan state of India, who sustained a massive injury in the central face after getting bitten by a hyena. A free radial forearm flap was designed as a multiple folding, double paddle flap that was divided into several portions. The folded portions of the flap were used to reconstruct the nose, oral mucosa and the upper lip defects and while a downturned forehead flap provided the lining for nasal mucosa reconstruction. The patient achieved a good functional recovery and had a good aesthetic outcome.

Conclusion: One of the rarest cases reported in the literature, where timely intervention was done is nothing short of a miracle. Meticulous preoperative planning and harvesting of flaps enabled the achievement of good aesthetic and functional results in the present patient.