Primary splenic lymphomas (PSL) constitute a rare variety of splenic neoplasms. As a secondary lymphoid organ, the spleen is usually involved by lymphomas as part of the systemic illness. However, rarely it can be the exclusive site of disease burden. An elderly lady presented with symptoms and signs of splenomegaly. After evaluation she was found to have a splenic tumor. Splenectomy was done which revealed primary splenic lymphoma. This case report highlights the evaluation and management of this illness.
Background: Surgical treatment for perforation peritonitis is still believed to be demanding and complex in spite of the advent of better surgical technique, antimicrobial therapy and intensive care support improving the outcome of such cases. However, the specific details of the pre-operative, intra-operative and post-operative management have always been very controversial and debatable. This study aims to evaluate the efficacy of peritoneal cavity irrigation with imipenem solution in patients with perforation peritonitis and compare it with standard saline wash.Methods: This study was conducted in a tertiary care teaching hospital from November 2015 to April 2017 and included 90 patients aged between 12 and 60 years who are operated for perforation peritonitis. Patients are divided into 3 groups and underwent post laparotomy irrigation as follows saline and fluid drained, saline and then imipenem wash at a concentration of 1mg/ml and fluid drained after 5 minutes, saline and then imipenem wash at a concentration of 1 mg/ml and drain was clamped for 1 hour. The patients were then observed for post-operative complications.Results: There was a statistically significant reduction in post-operative wound infection (33.33%), intra-abdominal abscess (23.33%) and sepsis (23.33%) in group 3 when compared to other two groups. Group 3 had a much lower mortality rate (3.33%) when compared to the other two (16.67% and 6.67% respectively.)Conclusions: Addition of Imipenem to normal saline for intraoperative peritoneal lavage has much satisfactory post-operative outcome. Further studies with larger sample size are needed to accurately assess the statistical significance of the same.
Introduction: Emphysematous pyelonephritis (EPN) may be defined as a severe infection of the kidney that leads to necrosis and the presence of gas in the renal parenchyma, surrounding tissue, and the pelvi-calyceal system. EPN occurs almost exclusively in diabetics, but may occasionally complicate obstructive uropathy in nondiabetic patients. Case Report: We present the case of a 45 year old male with uncontrolled diabetes mellitus who presented with acute abdominal pain and free intraperitoneal air on abdominal radiograph, initially suggestive of hollow viscus perforation. He was found to have EPN that had ruptured into the peritoneal cavity. Conclusion: Acute abdominal emergencies presenting with a pneumoperitoneum are not an uncommon occurrence in emergency centres throughout the world. However, rarely, patients present with the source of the pneumoperitoneum being an organ other than bowel. These patients need to be identified as soon as possible to prevent further morbidity and mortality arising from a delay in diagnosis.Introduction: La pye´lone´phrite emphyse´mateuse (PNE) peut se de´finir comme une infection grave du rein, entrainant une ne´crose et la pre´sence de gaz dans le parenchyme re´nal, les tissus pe´rire´naux et le syste`me pelvis-calices re´naux. La PNE survient presque exclusivement chez les personnes diabe´tiques, mais peut parfois entrainer une complication de l'uropathie obstructive chez les patients non diabe´tiques. É tude de cas: Nous pre´sentons dans cet article le cas d'un homme de 45 ans souffrant de diabe`te sucre´non controˆle´consultant pour des douleurs abdominales aigue¨s et la pre´sence d'air libre intra-pe´ritone´al apparaissant a`la radiographie abdominale, sugge´rant dans un premier temps une perforation des visce`res creux. Il souffrait en re´alite´d'une PNE avec rupture dans la cavite´pe´ritone´ale. Conclusion: Les urgences abdominales aigue¨s associe´es a`un pneumope´ritoine ne constituent pas un cas rare dans les centres d'urgences du monde entier. Cependant, il est rare que la source du pneumope´ritoine soit un organe autre que l'intestin chez les patients se pre´sentant. Ces patients doivent eˆtre identifie´s le plus rapidement possible afin d'e´viter une morbidite´et une mortalite´supple´mentaires associe´es a`un retard de diagnostic. African relevanceEmphysematous pyelonephritis is a very rare and late presentation of a common disease. It presents late due to lack of access to healthcare and poor patient education. It is more common in immunocompromised and diabetic patients with greater mortality and morbidity.
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