Objective: To highlight the case of a patient with acute respiratory failure, whose diagnosis of Boerhaave’s syndrome only became apparent after a trial of non-invasive ventilation. Clinical Presentation and Intervention: A 68-year-old female presented with a clinical picture of community-acquired pneumonia and exacerbation of asthma that was supported by radiological evidence of a large left-sided pleural effusion. Within 20 h, she deteriorated and progressed to severe type 2 respiratory failure. After initiation of first non-invasive and then invasive ventilation, a tension pneumothorax developed. An emergency decompression of the chest revealed gastric contents in the left hemithorax. A diagnosis of Boerhaave’s syndrome was made. Subsequent management included a thoracotomy, defunctioning oesophagectomy, and gastrostomy with ventilatory and inotropic support. However, despite best efforts, the severe systemic inflammatory response resulted in death 3 weeks after initial presentation. Conclusion: It is important to have an open diagnostic mind with a thorough review of investigations and therapy as a patient deteriorates. This case illustrates the importance of considering the remote possibility of oesophageal rupture prior to commencing non-invasive ventilation, especially with regard to chest radiograph features.
Mesenteric cyst is presented as lump abdomen or detected incidentally in ultrasonography for other reason or when it becomes symptomatic due to complications. Spontaneous infection or rupture of the mesenteric cyst and disseminated infections are very rare complications in children. Expeditious diagnosis and surgical excision of the cyst are imperative for fruitful outcome. We report a case of a perforated mesenteric cyst with sepsis and intracerebral haemorrhage in a 9 month child who was managed successfully in our institute.
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