Manju Paul

Successful medical management of emphysematous gastritis with concomitant portal venous air: a case report

IntroductionThe causes of diffuse abdominal pain following pelvic surgery are numerous. We present a rare case of acute abdominal pain in a woman in the post-partum period.Case presentationA 25-year-old Caucasian woman with neurofibromatosis type 1 presented to our hospital with diffuse abdominal pain immediately after a cesarean section. The patient was acutely ill and toxic with a fever of 38.8°C, a pulse of 120 beats per minute and a distended abdomen with absent bowel sounds. A computed tomography scan showed air in the wall of the stomach and portal venous system. The patient was successfully treated with intravenous antibiotics, bowel rest and total parenteral nutrition.ConclusionIt is rare for a case of emphysematous gastritis associated with portal venous air to be treated successfully without surgery. To the best of our knowledge, to date there has been no reported association of emphysematous gastritis with neurofibromatosis.

An Atypical Presentation of Neuroleptic Malignant Syndrome: Diagnostic Dilemma in a Critical Care Setting

Neuroleptic malignant syndrome (NMS) is a life-threatening condition associated with the use of neuroleptic agents and is characterized by a clinical syndrome of mental status change, muscle rigidity, fever, and autonomic instability.[1][1] We present a case of NMS in a patient on neuroleptic

An unusual presentation of cirrhotic pleural effusion in a patient with no ascites: a case report

Pleural effusion that develops in a patient with cirrhosis and portal hypertension, in the absence of cardiopulmonary disease, is termed hepatic hydrothorax. Hepatic hydrothorax very rarely presents in the absence of ascites. Although the exact mechanism is somewhat controversial, pleural effusion occurs when ascitic fluid moves through diaphragmatic defects which are opened up by increased intra-abdominal pressure. We report a case report of cirrhotic pleural effusion in a patient with no clinical or radiographic evidence of ascites and discuss the pathogenesis, diagnosis and management of this condition.

Unusual Case of Acute Intestinal Obstruction

Chronic NSAID use can cause diaphragm like strictures within the bowel leading to intestinal obstruction. This rare entity is called diaphragm disease. Preoperative diagnosis is extremely difficult. NSAID related injury should be considered in patient with intestinal obstruction of unclear etiology. We hereby present an interesting case of a 46 years old lady with significant history of long term naproxen use, who presented with nausea, vomiting and abdominal pain. She was diagnosed with acute intestinal obstruction. She received a trial of conservative management which was unsuccessful. Exploratory laparotomy with segmental resection of ileum was done subsequently. Histopathology showed mucosal ulceration, inflammation and focal sub mucosal fibrosis consistent with diaphragm disease. Patient recovered well in the post operative period. Keywords NSAIDS; Acute Intestinal Obstruction; Diaphragm Disease

Lung cancer or sarcoidosis: A diagnostic dilemma

Abstract Background: Small cell lung cancer is a neuroendocrine neoplasm representing about 15 percent of all lung cancers. Sarcoidosis is a multisystem granulomatous disease. The involvement of mediastinal lymph nodes

Gastroparesis as the initial presentation of pulmonary adenocarcinoma

Malignancy-associated gastroparesis is an under-reported entity and its diagnosis as a cause of cachexia or gastrointestinal symptoms is often missed in clinical practice. This case report highlights an unusual association of pulmonary adenocarcinoma with gastroparesis at presentation. Malignancy-associated gastroparesis should be added to the differential diagnosis in patients presenting with delayed gastric emptying of unknown aetiology and should prompt further radiological investigations. Early detection and treatment of underlying gastroparesis in patients with cancer is necessary to improve the quality of life and to avoid premature clinical deterioration due to intolerance to oral treatment.

A 77-year-old man with progressive dyspnea, lung fibrosis, and ossification.

SUMMARY : Diffuse pulmonary ossification is a rare clinical entity in which mature bone formation occurs within the pulmonary tissues. It has been associated with multiple pulmonary and systemic conditions and may be an indicator of disease severity and chronicity. It is often diagnosed only post mortem, because of its variable presentation with either very significant findings, mimicking other serious conditions, or very subtle onset unrecognized on imaging. In this report, we present the clinical presentation and findings in a case of diffuse pulmonary ossification diagnosed by transbronchial biopsy in a living patient.

Recurrent pneumonia in a 51-year-old woman due to congenital bronchoesophageal fistula.

Recurrent pneumonia in adults can be due to various etiologies. Congenital bronchoesophageal fistula may go undiagnosed in adult patients for many years. In cases of delayed recognition there is a long history of intermittent bouts of cough and choking after swallowing liquid, which may eventually