BMJ case reports
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Acute genital ulcers, also known as acute vulvar ulcers, ulcus vulvae acutum or Lipschütz ulcers, refer to an ulceration of the vulva or lower vagina of non-venereal origin that usually presents in young women, predominantly virgins. Although its incidence is unknown, it seems a rare entity, with few cases reported in the literature. Their aetiology and pathogenesis are still unknown. ⋯ Diagnosis is mainly clinical, after exclusion of other causes of vulvar ulcers. The treatment is mainly symptomatic, with spontaneous resolution in 2 weeks and without recurrences in most cases. We present a case report of a 13-year-old girl with two episodes of acute ulcers that fit the clinical criteria for Lipschütz ulcers.
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Case Reports
Inferolateral ST-segment elevation associated with a gastric variceal bleed and the use of a Minnesota tube.
The use of Minnesota and modified Sengstaken-Blakemore tubes for balloon tamponade in acute variceal haemorrhage has declined with the availability of modern endoscopic techniques. However, in massive uncontrolled haemorrhage their use may still be required. ⋯ The patient developed inferolateral ST-segment elevation on a 12-lead ECG which resolved rapidly following aspiration of 2000 mL of blood from the gastric port of the Minnesota tube. It was thought that the distension of the stomach, along with the traction applied to the Minnesota tube, resulted in external compression of the diaphragmatic surface of the heart and the observed ECG changes.
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A 57-year-old man with no medical history and comorbidities presented to the outpatient clinic with a 2-week history of increasing cough and shortness of breath following a recent viral upper respiratory tract infection. Chest X-ray showed increased mediastinal opacity. A CT scan of the thorax was performed which revealed a large right-sided diaphragmatic hernia extending across the mediastinum to the left side of the chest. Repair was performed via combined transthoracic and transabdominal approaches.
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Uterine torsion is defined as a rotation of the uterus of more than 45° along its long axis. It is a rare complication during pregnancy; a common cause of torsion can be uterine myoma. ⋯ On lapratomy she was diagnosed as a case of complete axial torsion of pregnant uterus with fundal myoma with massive abruption. Early diagnosis and timely intervention would help in improving both maternal and fetal outcome.
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Acute comparment syndrome (ACS) is a surgical emergency, in which tissue pressure becomes greater than perfusion pressure leading to tissue ischaemia. It is typically a consequence of trauma. We present a case in which a patient suffers blunt trauma to the thigh, but develops ACS 2 years after this injury and consequently endures 10-episodes of ACS (no perciptating event or cause) in the same thigh over 10 years. ⋯ A thorough literature search deemed this case to be the first reported recurrent spontaneous ACS of the thigh. Prompt recognition and treatment of ACS is vital. Clinicians should thoroughly investigate such patients postoperatively and involve vascular/plastic surgeons and interventianal radiologist to provide optimum care and prevent recurrence.