Acute intestinal obstruction due to extrinsic compression by previa myoma and ectopic pregnancy: a case report

Abstract

BackgroundAcute intestinal obstruction during pregnancy is a rare digestive surgical emergency with significant maternal and fetal mortality. Diagnosis is difficult, often delaying the management. Here, we report an exceptional association of mechanical acute intestinal obstruction due to compression by previa uterine leiomyoma, and a ruptured ectopic pregnancy.Case presentationThis is the case report of a 43-year-old primiparous black woman from a rural area, who was admitted to the surgical emergency department for acute intestinal obstruction.At examination on admittance, our patient had a bad general condition with clinical anemia. She had an occlusive syndrome that had been evolving for 3 days. A physical examination of her abdomen showed a widespread distension with an irregular and polylobed solid mass occupying the whole of the lower-umbilical and hypogastric area. A rectal examination found an empty rectum, and the mass was perceptible in Douglas’s pouch. At the vaginal examination, we found the same mass and a finger holster was clean. The diagnosis of intestinal occlusion by a tumor was retained. The laparotomy revealed a distended intestine, a ruptured right tubal ectopic pregnancy and a polymyomatous uterus. The most massive previa leiomyoma was adhering and compressing the rectal and sigmoidal hinge. A total hysterectomy was performed and histopathological examination of specimens confirmed myoma and ectopic pregnancy. The surgical follow-up was uneventful, and our patient was discharged on postoperative day 12.ConclusionsThe etiological diagnosis of acute intestinal obstruction during pregnancy is not easy, especially in the context of a low-income country where the means of biological and radiological diagnosis are lacking. A laparotomy is required before diagnosis of acute surgical abdomen and its management will depend on the intraoperative findings and the condition of the patient.

Traumatic sacralization of L5 vertebra with severe extension type spinopelvic dissociation: A case report

“…In regard to the mechanism of injury, Nonne et al [ 3 ] reported a case series of 5 patients who had similar mechanism of injury as our patient; however, there was no traumatic L5 sacralization. The fractures were classified as type III and VI as per Roy's classification, with all of the patients experiencing severe neurological deficit; only two patients had definitive management with spinopelvic fixation.…”

“…Sacral fractures and lumbosacral dissociation are serious injuries that result in tremendous instability and a high rate of neurologic deficit in the majority of cases [ 3 ]. The gold standard treatment consists of posterior spinopelvic fixation - with or without decompression - and anterior pelvic stabilization [ 3 ]. Early surgical treatment for such injuries reduces complications related to immobilization and improves patient quality of life.…”

Pharmacokinetic Monitoring of Levetiracetam in Portuguese Refractory Epileptic Patients: Effect of Gender, Weight and Concomitant Therapy

“…However, in addition to gender and weight, we also demonstrated that co-medication with carbamazepine determines the Vd/F. We suggest that hyponatremia, a well-known adverse effect of carbamazepine [ 54 , 55 , 56 , 57 , 58 , 59 ], may be involved in this drug–drug interaction. Briefly, the increased secretion of the antidiuretic hormone due to carbamazepine stimulation may lead to the syndrome of inappropriate antidiuretic hormone secretion.…”

A Case of Cutaneous Larva Migrans in a Child from Vinces, Ecuador

“…It may be uncommon to detect any pathology caused by the parasite in CLM, because it may be found in places that are not visible [5,8]. Intense pruritus can be associated with a strong inflammatory reaction to hyaluronidases and other enzymes secreted by the larvae as these enzymes facilitate penetration of the skin [9]. Dermatoscopy can be helpful in the clinical diagnosis of CLM but may fail to detect the larvae in some patients.…”