No abstract

Ileosigmoid knot (ISK) is an unusual and serious condition that is known to pose a diagnostic dilemma due to overlapping features of acute closed-loop intestinal obstruction. Early diagnosis and intervention are of immense importance in this condition because they can prove life threatening with rapid progression to gangrene of both the ileum and sigmoid colon. We report a case of a 27-year-old man who presented 2 days post-appendicectomy procedure with acute abdominal pain, abdominal distention, and hypovolemic shock. Initial evaluation with ultrasonography (USG) and abdominal X-ray was performed, which revealed pleural effusion, ascites, and an ahaustral dilated large bowel loop in the right upper abdomen with convergence in the left lower abdomen. Further imaging with computed tomography revealed closed-loop obstruction of the sigmoid colon with beaked appearance of its afferent and efferent limbs in the pelvis. There was associated whirling or knotting of the ileum around the sigmoid pedicle along with features of mesenteric ischemia. Emergency laparotomy was performed, which revealed ISK with gangrene of the ileal and large bowel loops.

Aim: This retrospective study was undertaken to determine incidence of different clinical presentations in pediatric malaria and its correlation with parasitology of disease. Methods: Case records of 100 children admitted in pediatric ward of a tertiary care hospital from June 2010 to September 2011were studied. All children below 12 years of age with any of the following diagnosis based on peripheral smear examination were included: a) P. vivax malaria, b) P. falciparum malaria, c) Mixed infection (both vivax and falciparum) and d) Those who responded only to antimalarials despite their peripheral smears being negative for malarial parasite. Complete history, clinical examination, relevant investigations and treatment given were recorded and findings were analyzed using statistical tests. Results: Out of 100 cases reviewed, 53 had P.vivax malaria, 20 had P.falciparum, 1 had mixed infection (both vivax and falciparum) and 26 patients had clinical features suggestive of malaria (fever with chills, malaise, pallor, hepatosplenomegaly) with their peripheral smears being negative for malarial parasite but responded only to single dose of antimalarials. The average age of presentation of vivax malaria was 6.9 + 3.6 years and of falciparum was 7.0+ 3.5 years. The average duration of hospital stay was 5.3 + 3.6 days for P.vivax and 5.4 + 2.9 days for P.falciparum. Cerebral malaria, splenomegaly were seen more in falciparum; whereas respiratory problems, severe anemia, thrombocytopenia and low blood pressure were similar in both vivax and falciparum malaria. Seventy five percent of children with vivax and 55% of children with falciparum malaria responded to single dose of chloroquine only. Conclusion: P. Vivax can also lead to unusual and serious complications thus defying its stereotype as a benign disease. Most of the prevalent strains of plasmodia are still sensitive to chloroquine monotherapy.

Meningiomas are the most common intracranial extra-axial neoplasms with mostly straightforward radiological diagnosis; however, they can have unusual clinical and imaging manifestations posing diagnostic dilemma for radiologists and clinicians. The objective of this case report is to highlight the infrequent and misleading presentations of meningiomas to make an accurate diagnosis. A 65-year-old male patient presented with complaints of left recurrent otitis media and facial nerve palsy for past 6 months. On imaging, an aggressive predominantly cystic intracranial neoplasm was found in the left temporal fossa extending into the middle and external ear. Histopathological examination of the excised tumor revealed WHO grade I meningothelial meningioma. Meningiomas can show atypical imaging features such as large meningeal cysts, heterogenous or ring enhancement and aggressive features such as bone erosion. They can invade the middle ear and should be thought of while dealing with nonresponsive cases of otitis media.