Muhammad Faisal Khilji

Primary Peritonitis—A Forgotten Entity

Primary peritonitis is a rare phenomenon in modern antibiotic era. A case of pediatric primary peritonitis is presented here, in which a child presented with complaints of abdominal pain, vomiting for one day. Abdominal examination showed marked tenderness and guarding, diagnosis of appendicitis was made and laparoscopic appendectomy done. Later, ascitic fluid analysis and appendix histopathology proved it to be a case of primary peritonitis.

Takotsubo cardiomyopathy presenting as pulseless electrical activity

Introduction: Takotsubo cardiomyopathy (TCM) is a rare condition, clinically presenting as myocardial infarction with normal coronaries and characterized by reversible apical ballooning of the left ventricle. Case Report: We present a case of a 40-year-old female presenting to the Emergency department (ED) of a tertiary care hospital after she collapsed suddenly and became unresponsive at the triage. She was having central chest pain before her collapse. Immediate Cardiopulmonary Resuscitation (CPR) was provided. Her rhythm was pulseless electrical activity (PEA) during the CPR. After two cycles of CPR she achieved ROSC (Return of Spontaneous Circulation) with electrocardiograph (ECG) showing ST elevation in lateral and inferior lead. She was taken to the catheterization laboratory immediately where her coronary arteries were found normal on coronary angiography with left ventricular apical hypokinesis in the shape of takotsubo (a Japanese octopus trapping fishing pot). Patient was discharged after one week of uneventful hospital stay. Her subsequent echocardiography after two months showed Muhammad Faisal Khilji1, Muhammad Mujtaba Shaikh2 Affiliations: 1Sultan Qaboos University Hospital, Specialist, Emergency Medicine, P. O. Box 38, P.C. 123, AL-Khod, Muscat, Sultanate of Oman; 2Sultan Qaboos University Hospital, Senior Specialist, Department of Medicine(Cardiology), P. O. Box 38, P.C. 123, AL-Khod, Muscat, Sultanate of Oman. Corresponding Author: Muhammad Faisal Khilji, Sultan Qaboos University Hospital, Specialist, Emergency Medicine, P. O. Box 38, P.C. 123, AL-Khod, Muscat, Sultanate of Oman; Email: faisalkhilji@yahoo.com Received: 19 April 2018 Accepted: 21 May 2018 Published: 12 June 2018 almost complete recovery of left ventricular function proving it to be a case of Takotsubo cardiomyopathy. Conclusion: TCM should be suspected in all females with acute myocardial infarction.

Seat Belt Compression Appendicitis following Motor Vehicle Collision

Appendicitis and trauma both present in emergency department commonly but their presentation together in the same patient is unusual. We present a case of a middle-aged man brought by emergency medical services (EMS) to the emergency department with complaints of abdominal pain after he was involved in motor vehicle collision. He was perfectly fine before the accident. His primary survey was normal. Secondary survey revealed tenderness in right iliac fossa with seat belt mark overlying it. Computerized tomography (CT) of the abdomen and pelvis was performed which showed 8 mm thickening of appendix with minimal adjacent fat stranding. There is also subcutaneous fat stranding of anterior lower abdominal wall possibly due to bruising. Impression of posttraumatic seat belt compression appendicitis was made. Laparoscopic appendectomy was done and patient recovered uneventfully. Histopathology showed inflamed appendix, proving it to be a case of seat belt compression appendicitis.

Spontaneous Arachnoid Cyst Rupture with Subdural Hygroma in a Child

Arachnoid cyst of the brain is common in children but its association with spontaneous subdural hygroma is rare. A case of a nine-year-old boy, without any preceding history of trauma, is presented here who came to the emergency department of a tertiary care hospital with complaints of headache, nausea, and vomiting for the last two weeks but more for the last two days. Examination showed a young, fully conscious oriented boy with positive Cushings reflex and papilledema of left eye. MRI (magnetic resonance imaging) of the brain showed left temporal extra-axial cystic lesion of 5.40 × 4.10 cm in size, representing arachnoid cyst, with bilateral frontoparietal subdural hygromas. Cyst was partially drained through left temporal craniectomy and subdural hygromas were drained through bilateral frontal burr holes. Postoperatively the child recovered uneventfully and was discharged on the seventh postoperative day. Histopathology proves it to be arachnoid cyst of the brain with subdural CSF (cerebrospinal fluid) collection or hygroma.

Supratentorial extraventricular anaplastic ependymoma in a child

A young child presented to the emergency department of a tertiary care hospital with on and off headache, focal seizures involving the left side of the body, weakness of left upper and lower limbs and vomiting for 2 weeks. Examination showed an alert child with grade 4/5 powers in left upper and lower limbs. Blood investigations were normal. An urgent CT of the brain showed intra-axial mass in the right frontal cerebral cortex, superolateral to the right lateral ventricle. MRI of the brain showed supratentorial extraventricular mass of 5.20×3.70×3.80 cm, in the right frontal cortex, emitting heterogeneous signals on T1, T2 and fluid-attenuated inversion recovery sequences and impression of astrocytoma, ependymoma or choroid plexus papilloma was made. Complete surgical resection of mass was performed. Histopathology of the mass proved it as WHO grade III anaplastic ependymoma. The child made an uneventful postoperative recovery and radiotherapy was followed.