BMJ case reports
-
A man in his mid-50s presented with a painful and swollen right thigh and buttock. This was accompanied by a month long history of flank pain, back pain, vague abdominal pain, limp, fever and weight loss. On examination, there was extensive erythaema, heat, tenderness, oedema and crepitus over his right buttock and thigh. ⋯ After CT imaging, a psoas abscess (PA) and caecal mass were identified. Subsequent right hemicolectomy, PA drainage and debridement of his right thigh were performed. This case reminds clinicians of the many non-specific ways a PA can present and that a high level of suspicion assists in making a timely diagnosis.
-
A 74-year-old morbidly obese man was scheduled for surgical repair of an incisional ventral hernia. Anaesthesia was induced with propofol and fentanyl, and maintained with desflurane. A second dose of fentanyl 0.2 mg, given before starting surgery, resulted in sinus bradycardia and mild decrease of arterial blood pressure. ⋯ The surgical procedure and the recovery from anaesthesia were uneventful. The patient was discharged from the hospital on the fifth postoperative day. For the treatment of bradycardia atropine sulfate should be adjusted at least to lean body weight in order to avoid paradoxical heart rate response in patients with obesity.
-
We report a case of a 64-year-old man presented to A&E with a 2-week to 4-month history of right hip pain, right leg weakness and fasciculations, extensive bruising and a vesicular skin rash. He had a CT of the chest/abdomen/pelvis, which revealed multiple extensive haematomas including an iliopsoas haematoma causing a lumbar plexopathy and resulting in the right hip and leg symptoms. ⋯ Haematology review together with mixing studies suggested a diagnosis of acquired haemophilia A. He was treated at the local tertiary centre with activated prothrombin complex concentrate and steroids and made a full recovery.
-
An 18-year-old young man presented with an ankle injury, after landing on a supinated right foot following jumping while playing football. A plain X-ray revealed a medial subtalar dislocation. Despite obvious ankle deformity, the surrounding skin remained intact. ⋯ A CT of the ankle, after reduction, demonstrated a non-displaced fracture of the neck of the talus; no osteochondral defect was observed. This was successfully managed conservatively, with immobilisation of the ankle, in a non-weight bearing cast for 6 weeks. This case highlights that subtalar dislocation may follow a low-energy mechanism and that such injuries can be managed without open reduction.
-
The median arcuate ligament passes the truncus coeliacus superior to its ostium. If it is thickened and located too low, it can cause external compression and stenosis of the truncus coeliacus, leading to postprandial abdominal pain and vomiting. This combination of symptoms is called median arcuate ligament syndrome. ⋯ The patient underwent laparoscopic release of the median arcuate ligament, which resulted in relief of his symptoms. The median arcuate ligament syndrome should be considered in patients with epigastric stress-induced pain. Further underlying pathologies, especially coronary artery disease, as life-threatening diagnosis have to be initially excluded.