CONTEXT: Rapunzel syndrome is a rare form of gastric trichobezoar that develops through outstretching of the bezoar from the stomach to the intestine. CASE REPORT: A 12-year-old girl who had been diagnosed with celiac disease six years earlier was brought to the department of pediatric gastroenterology because of abdominal distension. A palpable mass was detected. A trichobezoar that stretched to the small intestine was removed surgically. The patient was diagnosed as having anxiety and depressive disorder, and treatment started. Following the treatment, her previous trichophagia completely disappeared. CONCLUSION: Presence of trichobezoar should be kept in mind, especially when young girls who have psychiatric problems suffer from gastrointestinal symptoms.
ÖZGram-negatif bakteri ilişkili peritonitler, kronik periton diyalizi hastalarının izleminde güçlük yaratmaktadır. Özellikle pseudomonas türleri ile ilişkili perionitlerde tedavi güçleşmekte, kateter kaybı söz konusu olabilmektedir. Ancak, bazı suşlar farklılık gösterebilmektedir. Burada, Ailesel Akdeniz Ateşi (AAA) ilişkili amiloidoz nedeniyle son dönem böbrek yetmezliği gelişerek aletli periton diyalizi programına alınan ve P. putida peritoniti geçiren 14 yaşında bir çocuk olgu sunulmuştur. Başvurusundan bir gün önce başlayan karın ağrısı, ateş yüksekliği, kusma ve periton sıvısında bulanıklaşma şikayetleri olup, kabulünde periton sıvısında silme lökositi ve %100 polimorf nüveli lökosit hücresi olan olguya peritonit tanısı konuldu. Periton sıvısı kültürü alınarak ampirik sefepim tedavisi başlanan olgunun kültüründe sefepime duyarlı P. putida üredi. Kateter disfonksiyonu gelişmesi üzerine üç gün süre ile sistemik olarak da sefepim verildi ve intraperitoneal tedavisi ikinci haftanın sonunda kesildi. Olgunun izleminde peritonit tekrarı ya da teknik bir sağ kalım sorununun olmadığı görülmüştür. Virulansı düşük, antibiyotik tedavisine yanıtı yüksek olan ve immünsüpresif hastalarda görülen fırsatçı bir patojen olduğu düşünülen P. putida'nın olgumuzun kullanmakta olduğu kanakinumab ile ilişkili olabileceği düşünülmüştür. Olgu, pseudomonal bir peritonit olmasına rağmen, P. putida peritonitinde iki haftalık sefepim monoterapisinin yeterli olduğuna dikkat çekmek amacı ile sunulmuştur.ANAHTAR SÖZCÜKLER: Çocuk, Peritonit, Periton diyalizi, Pseudomonas putida ABSTRACTPeritonitis associated with gram-negative bacteria presents difficulties in the follow-up of patients with chronic peritoneal dialysis. Especially in perionitis related to Pseudomonas spp., treatment becomes difficult and may lead to catheter removal. However, some strains may differ. Here, we present a 14-year-old girl with P. putida peritonitis while on automated peritoneal dialysis due to familial Mediterranean fever (FMF)-related amyloidosis and end-stage renal failure. The patient was admitted with abdominal pain, fever, vomiting and cloudy peritoneal fluid starting one day before the admission. She was diagnosed with peritonitis when additional large amounts of leukocytes with 100% polymorphic nucleated cells were found in the peritoneal fluid. Intraperitoneal cefepime treatment was instituted empirically and systemic cefepime was added for up to three days when catheter dysfunction developed. The peritoneal fluid culture yielded cefepime sensitive P. putida and the treatment was stopped at the end of two weeks. No peritonitis recurrence or technical survival problem was found in the follow-up period. It was thought that infection with P. putida, which is thought to be an opportunistic pathogen with low virulence and high response to antibiotic therapy seen in immunosuppressive patients, may be related to canakinumab, which was being used by our case. The case was presented with the aim of drawing attention to the fact that although a pseudomonal periton...
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