Stomach is a highly vascular organ in the gastrointestinal tract. It is very rare for a stomach to go in for gangrene even in cases of volvulus. Spontaneous gangrene due to acute necrotizing gastritis is a very rare and dreaded condition. This condition is usually not recognized preoperatively due to its rarity. Hence, early diagnosis and prompt expert management are necessary. Here, we present a case of acute necrotizing gastritis which was admitted in our emergency department which was diagnosed to be a case of gastric gangrene preoperatively with the help of radiological investigations.
Small bowel obstruction is a common surgical emergency. The common cause includes adhesions, malignancies and hernias which presents with abdominal pain. Small bowel obstruction needs to be evaluated and the cause should be found. Once the cause is established, appropriate management is to be carried out after initial resuscitation. Small bowel obstruction can be rarely managed conservatively. Ovarian cysts are commonly found in women. Most of them do not cause symptoms and resolve over one to two months with conservative management. Ovarian torsion refers to complete or partial rotation of adnexal supporting organ with ischemia. It can affect females of all ages. The most common symptom of ovarian torsion is acute onset of pelvic pain followed by nausea and vomiting. It can lead to gangrene of the ovarian cyst if left untreated. Once ovarian torsion is suspected and confirmed, surgery is the mainstay of treatment. Here we report a case of ovarian torsion presenting as intestinal obstruction.
Fournier’s gangrene is a rare, rapidly progressive, fulminant form of necrotizing fasciitis of the genital, perianal and perineal regions extending to the abdominal wall between the fascial planes. It is secondary to polymicrobial infection by aerobic and anaerobic bacteria with a synergistic action. A 42 year old male who is an alcoholic and diabetic on irregular treatment presented with scrotal swelling and pain for 5 days following a trauma. On examination, patient was febrile, tachypneic and had tachycardia. His scrotum was edematous and erythematous on right side with crepitus. Abdomen was warm on right side till umbilicus and had crepitus. He was in sepsis and had diabetic ketoacidosis, prerenal azotemia and mild impairment of liver function. A diagnosis of extensive Fournier gangrene with retroperitoneal involvement was made. Patient underwent scrotal exploration and aggressive debridement serially. Testis was spared. As patient improved with good wound care and glycemic control, wound was closed. Though our patient had retroperitoneal involvement without peritonitis, he was deferred laparotomy which significantly reduced the morbidity and mortality. It is one of the few reported case in the literature with retroperitoneal involvement.
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