Cytomegalovirus (CMV) infection causes significant morbidty and mortality in immunopromised patients. Though it is usually silent in immunocompetent adults, rarely it can cause serious life-threatening complications. Gastrointestinal tract is one of the commonly involved organs, where it produces a spectrum of clinical manifestation ranging from mild non-specific abdominal pain and diarrhoea to severe infection with toxic megacolon and death. We present a 65-year-old immunocompetent male patient admitted with acute colonic obstruction secondary to CMV-induced colonic stricture, highlighting the importance of considering it as a differential diagnosis for colonic obstruction and reviewing its management.
Morgagni's hernia is an uncommon type of congenital diaphragmatic hernia. Large numbers are symptomatic but some may present in middle aged. Our patient was asymptomatic till 63 years of age. X-ray chest, for her recent onset exertional dyspne, was suspicious of right lung mass. CT thorax revealed right Morgagni's type of diaphragmatic hernia, a very rare diagnosis at that age.
failure (ALF). In India, an unusual but not an uncommon cause of ALF is the ingestion of rodenticides containing zinc phosphide (Ratol ®). Overall survival following Ratol ® poisoning is poor without LT. Aim: The aim of this study was to identify clinical predictors to distinguish patients most likely to require LT following Ratol ® ingestion. Method: Retrospective data analysis of 30 patients admitted between January 2006 and April 2011 following Ratol ingestion was performed. Nine underwent living donor liver transplant (LDLT) and 6 patients died without transplant (Group I). Fifteen patients who had very minimal exposure to the poison recovered without transplant (Group II). The 2 groups were compared with identify prognostic factors that could predict the need for LT. Result: The average time interval between consumption of the poison and ALF was 6.5 days. The average model for end stage liver disease (MELD) score for Group I was 38 compared with 18 in Group II. The median INR value (8 in Group I vs 3 in Group II) and the median total bilirubin value (13 in Group I vs 5 in Group II) were significantly lower in the group that recovered without transplant. All patients who developed encephalopathy either died or required LT. A MELD score of over 31 on day 6 and the onset of encephalopathy at any time following ingestion were the reliable predictors of the need for LT. Conclusion: MELD score of 31 on the sixth day or the presence of encephalopathy at any time after ingestion of Ratol ® is the strong predictor of mortality without LT.
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