Open Access Case Study

Abdominal Tuberculosis Presenting as Acquired Megacolon

V. I. C. Nwagbara, M. E. Asuquo

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

Background: Tuberculosis is a chronic granulomatous infection caused by the bacilli Mycobacterium tuberculosis. Decades after the discovery of effective treatment, the infection persists till date as a re-emerging communicable disease. It is preventable by childhood vaccination. Its presentation may be protean and mimic many other conditions. Abdominal tuberculosis presents a diagnostic challenge hence the need to expose the various shades of presentation to aid prompt diagnosis and proper management to reduce attributable morbidity and mortality. We report a case of abdominal tuberculosis presenting as acquired Megacolon

Case Report: A 28-year-old mother of three presented with six months history of recurrent constipation, marked weight loss, gross abdominal distension and colicky abdominal pain. She was evaluated and a clinical impression of acquired Megacolon was made but at laparotomy features of abdominal tuberculosis were found and confirmed by histopathologic examination of biopsied granulomatous lesions on the colon and lymph nodes. A temporary loop colostomy was fashioned and later closed after six-month successful treatment with antituberculosis drugs.

Conclusion: Abdominal tuberculosis should be considered in the differential diagnosis of adult patients presenting with chronic constipation and distension.

Open Access Case Study

Delayed Small Bowel Perforation Following Blunt Abdominal Trauma as a Rare Cause of Acute Abdomen: A Case Report

Bhuban Mohan Das, Srikant Patro, Suraj Ethiraj, Ramapada Mohapatra

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

We present a case of delayed small bowel perforation occurring 3 months after a blunt abdominal trauma. A 36 year old male sustained a steering wheel injury 3 months back. Computed tomography of the abdomen done after the trauma revealed only a mild peritoneal collection with a small non expanding mesenteric hematoma. He was managed conservatively. He now presented with features of acute abdomen since 2 days. Clinical and radiological investigations revealed a perforated viscous. He underwent exploratory laparotomy to reveal a phlegmon with multiple adhesions in the ileal loops with an underlying ileal perforation. The pathophysiological mechanism of such injuries causing a delayed presentation is unclear with only a few cases reported in the literature. We propose that delayed small bowel perforation following blunt abdominal trauma should be considered as a rare cause of acute abdomen.

Open Access Case Study

A Tale of Two Neck Cysts

Anupam Lahiri, Ashwani Kumar Malhotra

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

We present a case of 2 neck cysts in the same patient which were clinically diagnosed as plunging ranula and an uncomplicated thyroglossal cyst. This was supported by radiological imaging as well. But it is sought to share that sometimes clinical evaluation and imaging may not be as reliable, as intraoperatively we found it to be a right submandibular epidermoid cyst coexisting with an infected thyroglossal cyst. This was confirmed subsequently on histopathology. Thus we must always consider differentials before embarking on any surgery despite all preoperative investigations, lest we be found at a loss intraoperatively.

Open Access Case Study

Solitary Neurofibroma of the Lateral Canthal Region of the Face Masquerading as a Lipoma – A Case Report

Karishma Motwani, Shreyas Gupte, Thomson Mariadasan Dcruz

Asian Journal of Case Reports in Surgery, Page 17-23

Background: Solitary neurofibromas of the maxillofacial region are extremely rare and there are no cases reported in literature so far, overlying the lateral canthus region of the face. This case report aimed to evaluate the clinical and radiological presentation of this lesion and our experience in its management.

Methods: We illustrate a rare solitary neurofibroma in a 50 year old female overlying the left lateral canthus region of her face. A computed tomography described the lesion to be well-circumscribed without causing any bony changes, suggestive of a benign soft tissue pathology. The lesion was enucleated in toto under local anesthesia.

Results: Histopathological analysis revealed interlacing bundles of elongated cells with wavy and dark-stained nuclei, wire-like strands of collagen and immuno-histochemical positivity with S-100 protein, which are the hallmarks of a neurofibroma.

Conclusions: Based on our experience, the importance of a thorough clinical and radiological investigation in the management of such lesions cannot be over-emphasized. The patient remained free of recurrence on a one year follow up period.

Open Access Case Study

Postoperative Idiopathic Posterior Reversible Encephalopathy Syndrome- A Rare Case Report

Dharmendra Dugar, Debajyoti Mohanty, Arijit Saha, Hari S. Mahobia, R. Manju

Asian Journal of Case Reports in Surgery, Page 24-27

Background: Posterior reversible encephalopathy syndrome (PRES) is characterized by headache, altered mental functioning, seizures and loss of vision associated with posterior leukoencephalopathy on the imaging studies. The clinical symptom complex as well as the abnormalities in imaging usually resolves within a week with effective management. We report a case of PRES in an operated case of gastric malignancy with no major recognized risk factors other than one episode of mild hypertension and incidentally detected supracardiac partial anomalous venous return.

Case Presentation: A 55-year-old lady underwent D2 subtotal gastrectomy under general anesthesia and epidural analgesia for gastric outlet obstruction secondary to a poorly differentiated gastric adeno-carcinoma. On the first postoperative day she reported sudden loss of vision. Clinical examination revealed presence of bilateral light reflex with absence of visual perception in both the eyes. All necessary examinations and investigations including MRI performed. She was able to regain light perception in the right eye on the 5th postoperative day which was followed by successful finger counting and face recognition within the next couple of days. The patient was well with normal visual acuity in both eyes on follow up at 10 months after discharge.

Conclusion: Sudden development of neurological manifestations in the immediate postoperative period should alert the surgeon regarding PRES. Classical clinical history, detail neurological examination supported by neuroimaging clinches the diagnosis of PRES. Prompt and effective treatment results in excellent prognosis in this serious and treatable disease.