Total Gastric Necrosis as a Presentation of Aluminum Phosphide Poisoning: A Case Report

Background: Rice pill poisoning is among the most frequent causes of death among poisoners. Despite advances in the treatment of this poisoning, its mortality rate remains high. The symptoms of Aluminum Phosphide (AlP) poisoning are varied and progressive. One of the essential foundations of diagnosis is based on the history of swallowing the pill by the patient or their companions.Case Report: A 20-year-old woman with generalized abdominal pain and a diagnosis of peritonitis was operated. The operative finding was total gastric necrosis. After the operation, the patient’s husband claimed that she had consumed some rice pills, intending to commit suicide. Despite all efforts, she remained in persistent septic shock and multi-organ failure and passed away after surgery.Conclusion: Total gastric necrosis could be among the lethal complications of rice tablet (AlP) poisoning

Can Heroin Poisoning Lead To Stomach Necrosis? A Case Report

Introduction: Opiate (including heroin) use prevalence is 1.2% of the world population according to the last report of UNOCD. In Iran about 2 million people of population are drug abusers..Heroin reduces gastric motility and prolongs gastric emptying time and it can cause gastric dilation which can be a reason for gastric ischemia . Gastric ischemia is an uncommon condition do to the rich gastric blood perfusion and collateral arteries . As some of studies show, gastric dilation can be a cause for gastric necrosis. Case presentation: A 22-year-old woman who presented to our hospital with severe abdominal pain and several episodes of vomiting. The patient declared that she had a history of addiction to methamphetamine and heroin. In abdominal examination, a soft and non-distended abdomen with generalized tenderness, mostly in hypogastric region without rebound tenderness was revealed.Abdominal radiograph revealed a much distended stomach. A non-contrast CT abdomen confirmed severe gastric dilatation. On endoscopy, multiple necrotic lesions were seen throughout the stomach and mostly in the proximal part. Our finding in the laparotomy was gastric necrosis in the proximal part, which resulted in a total gastrectomy. esophagojejunostomy with roux en y reconstruction was done after total gastrectomy. Conclusion: Opioids can increase the risk of GI dysfunction and they can increase risk of infection in GI tract. In our case ,abuse of heroin caused a gastric dilation and massive gastric necrosis

Review of Unusual Presentations of COVID-19

The world has faced the coronavirus disease 2019 (COVID-19) pandemic since the H1N1 influenza pandemic in 1918. The symptoms of this disease are spreading rapidly and affect almost all systems of the body. In addition to the common symptoms of the virus, numerous reports of rare symptoms of the virus have also been published. These atypical presentations can result in difficulty in diagnosing the disease. The aim of this work is to summarize “uncommon atypical presentations”, which have not received enough attention in descriptions of the disease presentation to date and the authors specifically discuss the important uncommon atypical presentations of COVID-19

A Case Report of death from retroperitoneal hematoma following femoral vein Catheterization

کاتتریزاسیون ورید فمورال برای انجام دیالیز یکی از شایع ترین دسترسی های وریدی است. عوارض مختلفی از جمله خونریزی و آسیب های شریانی و فیستول شریانی وریدی برای این روش گزارش شده است. یکی از عوارض نادر ولی کشنده این روش هماتوم رتروپریتونئال ناشی از آسیب دیواره ورید است. مهمترین نکته در پیشگیری از ایجاد این عوارض تکنیک مناسب قرار دادن کاتتر است. در این مطالعه ما به معرفی یک مورد مرگ ناشی از عارضه بسیار نادر و بالقوه کشنده این تکنیک یعنی هماتوم رتروپریتونال می پردازیم.  Femoral vein catheterization is one of the most common venous accesses for dialysis. Various complications such as bleeding and arterial damage and arterio venous fistula have been reported for this procedure. One of the rare but fatal complications of this procedure is retroperitoneal hematoma due to damage to the vein wall. The most important point  in preventing these complications is the proper technique in  placement of the catheter. In this study, we introduce a case of death from a very rare and potentially fatal complication of this technique, retroperitoneal hematoma

انسداد روده ناشی از بزوار، بررسی 19 مورد

مقدمه: بزوار مواد هضم نشده ای هستند که به علل مختلف در دستگاه گوارش باقی مانده اند و باعث بروز علائم و عوارض متنوع می شوند. یکی از عوارض نادر بزوار انسداد روده است که در این مطالعه بررسی شده است. روش کار: این مطالعه بصورت بررسی موارد(case series) در بازه زمانی 2 ساله از سال 1395 الی 1397 کلیه بیمارانی که با تشخیص انسداد روده باریک در بیمارستان امام حسین (ع) تحت عمل جراحی قرار گرفته بودند و پاتولوژی نهایی بزوار بوده است وارد مطالعه شدند. اطلاعات دموگرافیک و آزمایشگاهی و یافته های حین عمل در این بیماران مورد ارزیابی و تجزیه و تحلیل قرار گرفت. یافته ها: از تعداد 19 بیمار، 12 بیمار (63%) زن و 7 بیمار (37 %) مرد بودند. میانگین سنی بیماران2± 84/63 سال بود.15 بیمار در فصل زمستان و پاییز و 4 بیمار در بهار و تابستان مراجعه کرده بودند.بیماری های همراه شامل دیابت (42%)،سابقه جراحی معده (15%)،کم کاری تیروئید (5%) بود.مواد خارج شده شامل خرمالو (47%)، مواد نامعلوم (38%)، انار(10%)،مو (5%)بود شایع ترین علائم بالینی شامل درد شکم (87%)، تهوع و استفراغ (80%)، عدم دفع گاز و مدفوع (60%) بود. در معاینه بالینی یافته ها شامل دیستانسیون شکم(85%)، صداهای روده ای کاهش یافته (52%) تندرنس شکمی(48%) وDRE رکتوم خالی (45%).در آزمایشات یافته ها شامل لکوسیتوز(78%)، اسیدوز متابولیک (42%)، ازتمی پره رنال (32%) بود. شایع ترین محل های انسداد شامل 100 سانتی متری انتهایی ایلئوم 68.42% (13 بیمار)، ژژنوم 21% (4 بیمار)، معده و روده باریک همزمان 10.52%(2 بیمار).از این تعداد 13 بیمار(68 %) تحت انتروتومی برای خارج سازی بزوار و6 بیمار(31%) تحت دوشیدن بزوار قرار گرفتند. تمامی بیماران پس از طی سیر بهبودی از بیمارستان مرخص شدند. نتیجه گیری: بزوار یکی از علل نسبتا نادر انسداد روده باریک میباشد. در بیمارن مسن و دارای فاکتورهای زمینه ای برای بزوار و همچنین شرح حال مصرف اخیر میوه های با پتانسیل تشکیل بزوار در فصول پاییز و زمستان میتواند در تشخیص انسداد ناشی از بزوار کمک کننده باشد

Subcutaneous Emphysema as an Ominous Side Effect in COVID-19 Patients under Mechanical Ventilation, Report of 7 Cases

Today, due to the pandemic of novel coronavirus 2019 (COVID-19), extensive information over all parts of the world is spreading rapidly. We present seven cases of COVID-19 patients with pneumothorax as one of the ominous side effects of the disease and a strong predictor of death which is a new challenge in controlling the transmission and distribution of the disease

A case report of primary isolated extrahepatic hydatid cyst of the soft tissues of the breast and thigh.

INTRODUCTION: Hydatid Disease (HD), or hydatidosis or echinococcosis, is an endemic infection and a major public health concern in the Mediterranean region. At times it involves the primary soft tissues, such as in the breast and muscle, though this is quite uncommon even in endemic areas. PRESENTATION OF CASES: A. A 31 year-old woman complained of a gradual progressive, painless lump in the left axillary tail of spence for two years. Examination revealed a firm lump measuring 5cm × 5cm, non-mobile, in the left axillary tail of Spence. B. A 32 year-old woman presented with mild and continuous pain in lateral aspect of left thigh. On examination, there was a round, non-tender, non-mobile mass in the lateral aspect of her left thigh. Preoperative imaging studies in both patients revealed evidence of HD. Both of the patients underwent surgery and received Albendazole twice per day for 10 days, before and three months after surgery. DISCUSSION: The disease can be diagnosed by serological and radiological modalities, both of which are not definitive. Ultrasonography should be the first diagnostic modality of soft tissue HD, however, MRI can be used to understand clearly the surgical involvements of structures. The standard treatment of soft tissue HD is surgery using pericystectomy techniques, as well as anthelmintic therapy. CONCLUSION: HD should be suggestive in soft tissues if mass is slowly developing and presenting with local extension, particularly in endemic countries. Excision of HD using pericystectomy technique is the first choice of intervention for HD of soft tissues

کرونا ویروس و درد شکم،گزارش 3 مورد لاپاراتومی منفی

The global spread of coronavirus 2019 (SARS-CoV-2) and various reports indicate a change in the symptoms caused by the virus and gastrointestinal symptoms becoming an important part of the diagnostic symptoms of the virus. The most common gastrointestinal symptoms include anorexia, nausea, vomiting, and abdominal pain. The probable cause of abdominal symptoms in these patients is the presence of the virus in the digestive system and stimulation of the immune system, followed by the release of inflammatory mediators leading to manifestation of symptoms in this part of the body, causing symptoms of peritoneal irritation. Due to the high physiological stress of surgery, deciding on surgery in patients infected with the virus, who have abdominal pain and a positive abdominal examination is a new challenge for physicians and medical staff. In this study, we introduce three patients with COVID-19 who underwent surgery due to abdominal pain and a positive abdominal examination for peritonitis but had normal findings in surgery, and surgery increased mortality.    گسترش جهانی کرونا ویروس و گزارش های متعدد نشان دهنده تغییر در علائم این ویروس و اضافه شدن علائم گوارشی به بخش مهمی از علائم تشخیصی این ویروس شده است.شایع ترین علائم گوارشی شامل بی اشتهایی و تهوع و استفراغ و درد شکم میباشد. با توجه به استرس فیزیولوژیک بسیار زیاد جراحی، تصمیم گیری در مورد انجام عمل جراحی در بیماران مبتلا به این ویروس با درد شکم و معاینه شکمی مثبت چالش جدیدی برای پزشکان و کادر درمانی است.در این مطالعه ما به معرفی 3 بیمار مبتلا به کرونا ویروس که با علائم درد شکم و معاینه شکمی مثبت از نظر پریتونیت تحت عمل جراحی قرار گرفتند و یافته های نرمال در عمل جراحی داشتند و عمل جراحی باعث افزایش مرگ و میر شد،میپردازی