The spleen is a rare location for hydatid cysts with the larvae reaching the site after escaping the hepatic and pulmonary filters. For most surgeons, splenectomy is the primary treatment in such cases which aims at eradicating the disease while decreasing the chances of recurrence by removing the intact cyst. While this is true, the risks of other two parasitic infections are increased, namely malaria and babesiosis. In the case presented here, the spleen was preserved after extirpating the cyst to keep the patient's immunity against malaria, which is endemic in our region. KeywordsSplenectomy, hydatid cyst, immune function * Corresponding author: ezzedien@hotmail.com Canines are the definitive hosts of the tapeworm Echinococcus granulosus. Humans are accidental intermediate hosts by consuming food or water contaminated by the eggs of the parasite. In the small intestine the eggs hatch and the released larvae penetrate the intestinal wall to gain access to the circulation and reside in different organs, primarily the liver, forming cysts. The disease is endemic in sheep and cattle rearing countries in both the developed and developing world (Bauman 2004).A 30-year-old female presented with pain in the left hypochondrium. On examination, she looked generally well; the vital signs were within normal and chest and heart examination showed no abnormality. The abdomen was soft with a palpable mobile mass in the left upper quadrant and bowel sounds were normal. Apart from a slightly raised white cell count (10.7 cell/cubic mm) there was no biochemical or haematological abnormalities.An ultrasound (US) and computerized axial tomography (CT) scan of the abdomen showed a large cystic lesion, 10 × 15 cm, occupying the upper half of the spleen with the characteristic appearance of hydatid cyst (Figs 1 and 2). The liver and kidneys were normal and no other lesions were detected. The diagnosis was splenic hydatid cyst and the patient was prepared for surgery.On call to surgery, intravenous Augmentin (amoxicillin and clavulanic acid) was given. Hydrocortisone was also given at the start of the operation and the abdomen was entered through a left subcostal incision. There were dense adhesions between the enlarged spleen and the anterior abdominal wall. At the medial aspect of the spleen, there was a fluctuant area marking the cyst. After isolation of the area with abdominal packs, aspiration and re-injection of the cyst cavity with 0.5% silver nitrate solution was done twice. The cyst was then opened and evacuated of the laminated membrane and all debris or membrane remnants were thoroughly removed (Fig. 3). A drain was inserted in the cyst cavity and the abdomen was closed.Oral feeding was started in the first postoperative day and the diet was gradually built up. The drain was removed on the fifth day when the drainage fluid became nil, and the patient was discharged on the 7th post-operative day.During her outpatient follow up three months later, she remained in good health and the cavity previously occupied by ...
Computed tomography (CT) has been regarded as the method of choice for detecting the presence, site and cause of gastrointestinal tract perforation. In addition to determining the presence of perforation, CT can also localise the perforation size and demonstrate direct and indirect findings relative to the perforation. In this case study, we report the CT results in a patient with perforated duodenal ulcer associated with anterior abdominal abscess, and highlight the diagnostic value of CT imaging.
New-onset DM or unmasking existing one, with or without metabolic complications, has been reported in SARS CoV-2 infection. New-onset DM in association with HHS alone or combination with DKA is uncommon but a possible manifestation of SARS CoV-2 infection that poses management challenges where the outcome may be worst.
The ongoing pandemic of COVID-19 that started in the Hubei province of China in late December 2019, caused by severe acute respiratory syndrome corona virus-2 (SARS CoV-2). Globally millions affected by the disease so far. The risk of COVID-19 severity and its complications increases with age and other comorbidities. The course of SARS-CoV-2 infection or its related complications has yet to be established in patients with sickle cell disease (SCD), once more evidence is available. It is clear from the available data that the course of COVID-19 in patients with SCD is mild to moderate, seldom severe, and rarely fatal. Herein we report three known cases of SCD with confirmed COVID-19, in whom the course of the disease was mild to moderate and uncomplicated with uneventful recoveries.
Severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) infection causes the disease known as coronavirus disease that started in Wuhan (China) in December 2019, leading to the current COVID-19 pandemic. The common presenting symptoms include fever, dry cough, shortness-of-breath, while sore throat, diarrhea, and abdominal and chest pain are the least. The atypical presentation of SARS CoV-2 infection poses a challenge for family physicians to screen and manage such patients for COVID-19 and specifically those at high risk with underlying disease such a sickle cell disease. Herein, we report a case of SARS CoV-2 infection in a known patient of sickle cell disease (SCD) with an atypical presentation, in whom the course of the disease was mild to moderate, uncomplicated, and the patient had an uneventful recovery. Primary care physicians should be vigilant to screen and manage such patients with established protocols, especially in the ongoing COVID-19 pandemic.
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