An Interesting Case of Isolated Pancreatic Transection Following Blunt Abdominal Trauma in Emergency Department

Introduction: Traumatic injury to the pancreas is not common, but if the diagnosis is delayed or misdiagnosed in the emergency department (ED), the condition is associated with high morbidity and mortality and raises a question about the quality of emergency care. Here, we describe a rare case of blunt abdominal trauma resulted in isolated pancreas injury. Case presentation: A 25-year-old young male came to our emergency room (ER) in a conscious, anxious state from a nearby town with a history of roadside trauma. Further investigations revealed an isolated pancreatic injury due to trauma with no other major injuries, which occurred due to a sudden high-speed impact of the steering wheel to the epigastrium of a driver while driving the car, severely compressing the pancreas between the backbone and steering wheel. The patient was admitted to the intensive care unit for close observation and monitoring. He was managed conservatively on intravenous fluids, antibiotics, analgesics, and vasopressors. He was discharged after five days in a hemodynamically stable and afebrile condition, on a normal diet. Conclusion: Isolated pancreatic injury following blunt abdominal trauma is rare, and the symptoms are difficult to analyze early due to its retroperitoneal anatomy. Early detection and early intervention are important in the ED, and if left unrecognized, could result in a poor outcome

Central retinal artery occlusion presenting with headache and sudden painless blurring of vision

The patient was a 61-year-old smoker male, who presented to emergency department (ED) with complaints of sudden onset of headache followed by painless blurring of vision of the right eye that was started 10 hours prior to the admission. Due to blood pressure of 190/104 mmHg at home, the patient had taken amlodipine 10mg orally. The patient reported some episodes of transient ischemic attacks in his past medical history, for which he did not take any advice from physicians. The patient was also found to be hypertensive with deranged cholesterol. On examination in ED, the patient was afebrile, and had pulse rate= 88/min, blood pressure (BP)= 130/90 mmHg, respiratory rate=22/min, and O2 Saturation=99% in room air. There was not any positive finding in systemic examination. Patient was admitted for further evaluation and management. Paraclinical lab tests were all reported in normal range. Echocardiography revealed left ventricular ejection fraction (LVEF) of 60%, with no regional wall motion abnormality (RWMA), mild concentric left ventricular hypertrophy (LVH) and normal cardiac chambers. In view of Headache, brain computed tomography (CT) scan was performed, in which, there was prominence of sulci, basal cistern, sylvian fissure and ventricular system suggestive of age-related diffuse cerebral atrophy. Ill-defined hypodensities were seen in bilateral periventricular white matter, suggestive of chronic ischemic changes. Later, brain magnetic resonance imaging (MRI) was also performed, which revealed multiple discrete and confluent areas of hyperintensity scattered in subcortical deep and periventricular white matter of both cerebral hemispheres, suggestive of nonspecific small vessel ischemic changes, likely a combination of ischemic demyelination chronic lacunar infarcts and prominent perivascular space. The ventricular system and subarachnoid space were prominent, suggestive of age-related cerebral atrophy. In the next step, cervical and brain MRI angiography was performed, which revealed 100% occlusion of right internal carotid artery at its origin, with no distal reformation of the artery in the neck and intracranial part. The right middle and anterior cerebral artery were filling via circle of Willis and were severely diffusely narrowed in calibre. There were mild atheromatous changes in the left common carotid artery and carotid bulb causing mild narrowing. Bilateral vertebral arteries were normal. There was evidence of diffuse severe narrowing and poor visualization of entire left anterior cerebral artery. Ophthalmology reference was taken and fundus examination was done. On examination, the patient was found to have finger counting close to face with no improvement with glasses. In the right eye, anterior segment examination showed relative afferent pupillary defect (RAPD), while fundus examination revealed retinal background pale white with cherry red spot in macula and absent venous pulsation in the right eye, suggestive of Central Artery Retinal Obstruction (CRAO), and thread like blood vessels and Grade II Hypertensive retinopathy. After starting the low molecular weight heparin, antiplatelet and steroid, vision improved from finger counting close to face to finger counting at 3 feet distance. Patient was later discharged under follow-up for further recovery

Blunt, Penetrating and Strangulating; Suicidal, Homicidal, Accidental and Sport-Related Neck Injuries: a Case Series and Literature Review

Introduction: Presentation of neck injuries in ER can be with or without neurological deficit. Trauma victims with multiple injuries should be examined for neck injuries as these injuries are potentially life threatening. Further neck movement should be restricted by applying the cervical collar until further radiological investigations rule out the spine injury. Early identification and treatment of neck injuries whether spine, vascular, or muscular injury improve the morbidity and mortality in polytrauma patients. Case presentation: In a series of case presentations of neck injuries through various modes, the first case of neck injury was related to road traffic accident presented with neck pain and paraplegia. In the second case, neck injury was due to suicidal hanging presented with ligature mark over the neck. Third case was related to Indian traditional sport-related neck injury presented with severe neck pain stiffness. In the fourth case, neck injury was due to gunshot and presented with bullet entry wound and quadriparesis. Conclusion: Neck injury in the absence of associated injuries is rarely seen after blunt and penetrating trauma, but can result in devastating outcomes if left unrecognized. A high index of suspicion and early intervention are critical