: A range of peripheral nerve blocks is available to treat hip fracture pain, leaving clinicians confused on choice. No single block appears to be outstanding. The study described the relevant anatomy, technical approach, risk associated, and practicability to facilitate a better understanding of the various approaches available. The clinician should be able to make an informed decision based on local requirements and logistics.
Peritoneal tuberculosis (TB) is a rare extra-pulmonary presentation of TB, caused by strains of mycobacteria, usually Mycobacterium tuberculosis. The clinical presentation of peritoneal TB can be extremely varied, making it a huge diagnostic challenge. Herein, we report a case of a 62-year-old Chinese female with no previous exposure to TB, presenting with 1-day history of per-rectal bleeding and abdominal pain. The diagnosis was eventually made with a combination of blood investigations, computerized tomography scans and histological analysis of peritoneal nodules found on diagnostic laparoscopy, which confirmed necrotizing granulating inflammation. She was subsequently started on anti-TB medications promptly without any further complications and recovered uneventfully.
Background
Paramyotonia congenita is a rare autosomal dominant myopathy which presents with periodic weakness due to cold and exercise. It is caused by mutations of the SCN4 gene which encodes the sodium channel in skeletal muscles.
Case presentation
We report a full term obstetric patient with both paramyotonia congenita and terminal filum lipoma who presents for induction of labour followed by an emergency caesarean section performed under epidural anesthesia. Her recovery is subsequently complicated by a 3-day history of postpartum paraparesis attributed to hypokalemic periodic paralysis.
Conclusion
We describe the perioperative anesthesia considerations and challenges in this case with a review of the current literature. This case report highlights the importance of early proactive and collaborative multidisciplinary approach, maintaining normal temperature and electrolytes with a heightened vigilance for muscle-related perioperative complications.
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