Spontaneous cecal perforation secondary to acute fulminant gastroenteritis: report of a rare case

Acute gastroenteritis and food poisoning are the two common diagnoses considered when two or more family members present with vomiting, diarrhea, and abdominal pain. Acute fulminant gastroenteritis is usually seen in immunocompromised patients and is associated with significant morbidity and mortality. We report a 15-year-old boy who presented with acute onset abdominal pain, vomiting, and diarrhea, along with three other family members. He developed abdominal distension and signs of hollow viscus perforation after 3 days; by that time he had developed  respiratory distress requiring ventilatory assistance. During laparotomy, a 1-cm cecal perforation with feculent peritoneal contamination was noted. Limited ileocolic resection and ileostomy was performed and ileostomy closure was carried out at 6 weeks. This case is being reported to highlight the unusual presentation of fulminant gastroenteritis, leading to spontaneous cecal perforation.Keywords: acute gastroenteritis, fulminant gastroenteritis, spontaneous cecal perforatio

Nonspecific Cecal Ulcer: An Obsolete Jargon

Non specific cecal ulcer (NSCU) is a rare entity described by Cruveilhier in 1832. NSCU has no specific presenting features and it can mimic a host of conditions like appendicitis, diverticulosis and colonic carcinoma. Earlier, this terminology was used to depict those ulcers where it was not possible to make the exact diagnosis. There are only a few cases where a specific preoperative diagnosis was made. The number of NSCUs being reported recently is less. This is due to the advent of newer diagnostic techniques to identify the etiology of these ulcers. Hence the term NSCU is no longer employed in current literature because a specific diagnosis is attained in most ulcers. Therefore the term NSCU is no longer valid and its use should be largely restricted to those cases where a specific diagnosis is not possible even after exhausting the currently available investigative techniques. This article provides an overview of this outdated term and outlines how to proceed when NSCU is encountered in clinical practice. [J Interdiscipl Histopathol 2013; 1(2.000): 85-88

Subclavian carotid transposition: A single-center experience

Objective: Subclavian carotid transposition (SCT) is generally performed for stenoocclusive disease of the proximal subclavian artery. This study was undertaken to analyze the results of SCT at our center and also highlight the usefulness of this procedure in varied pathologies involving the proximal subclavian artery. Patients and Methods: This retrospective study included 16 consecutive patients from 2011 to 2016 who presented to our department. The study was carried following approval by the Institute Research Committee and the Institute Ethics Committee. The data were collected from the departmental database, and the patients were followed up prospectively and the data were analyzed. Results: The mean age of the patients at presentation was 46.6 years with standard deviation of 11.48. Eleven patients (78%) had total occlusion of the proximal subclavian artery. About 81% of the patients had left-sided SCT. The etiology for SCT was varied with ten patients (62.5%) having proximal subclavian artery occlusion with chronic upper-limb ischemia, three patients (18.75%) with acute subclavian artery occlusion, one patient with bilateral cervical ribs, one patient with dysphagia lusoria with aberrant right subclavian artery (ARSA), and one patient with right common carotid aneurysm. The mean follow-up duration was 64 months. The patency rate was 100% in the study population. There were no immediate occlusions or stenosis noted in our series. Conclusion: SCT is a safe, effective, and durable procedure with long-term patency rates with less morbidity and reintervention rates. It can be safely done for both acute and chronic subclavian artery occlusions and various other conditions too such as dysphagia lusoria due to ARSA and cervical rib with subclavian artery occlusion. Hence, a vascular surgeon should master the art of doing SCT for its good results and for its being effective for varied pathologies

Surgical management of acute aortic occlusion: A single-center experience

Objective: Acute aortic occlusion (AAO) is an uncommon vascular emergency with a high mortality rate of 25%–80%. The management relies heavily on the timely presentation, early recognition, and prompt institution of appropriate treatment to decrease the morbidity and mortality. The objective of this study was to analyze the results of aortic thrombectomy for AAO in our center. Patients and Methods: This retrospective study included ten consecutive patients from November 2014 to July 2015 who presented to the Emergency Department of our hospital with features of AAO. The intraoperative and postoperative data were recorded, and the patients were followed up for 30 months. Results: Of the total of 10 patients, 6 were male. The age range was between 21 and 60 years. Three patients had an identifiable embolic source. The shortest duration of presentation was 12 h while the longest duration was 1 week. Only one patient presented with pain abdomen and vomiting whereas the rest presented with features suggestive of lower-limb ischemia. The mean duration of ischemia and presentation to hospital was 3.33 days in case of embolic etiology while it was 2.64 days in case of thrombotic etiology. We had two postoperative mortalities. Conclusion: AAO though rare has a favorable prognosis irrespective of the duration of presentation depending on the severity of ischemia and end-organ dysfunction at the time of presentation. It also has decreased morbidity and mortality with appropriate and timely treatment. Aortic thrombectomy (infrarenal, suprarenal, or thoracic aorta) is a safe and cost-effective management with less morbidity and mortality

Atlantoaxial dislocation in a patient with nonsyndromic symmetrical dwarfism: Report of a rare case

Congenital anomalies of the craniovertebral junction (CVJ) are complex developmental defects. We describe a patient with atlantoaxial dislocation (AAD) and short stature whose morphopathologydid not fit into any of the previously described syndromic constellations. The patient underwent a reduction of the AAD followed by fixation with C1-C2 transarticular screws. Although numerous syndromes have been linked to both dwarfism and craniovertebral junction anomalies, this patient did not fit into any of these patterns. It is possible that this may be one of the many as yet unrecognized patterns of congenital anomalies