Deep-tissue extension of perianal and perirectal abscesses, while rare, requires timely diagnosis and emergent surgical intervention to prevent serious secondary complications. This report evaluates a case of intra-abdominal and extraperitoneal extension of a persistent perirectal abscess that required comprehensive irrigation, drainage, and debridement of multiple abscess-associated cavities. This report follows the case of a 24-year-old African-American female presenting to the ED with mild fevers, nausea, abdominal distension, and lower abdominal pain following a persistent perirectal abscess that had not resolved following conservative outpatient antibiotic management one week prior. Clinical examination revealed abdominal guarding with CT imaging demonstrating extraluminal air pockets in multiple intra-abdominal and extraperitoneal compartments. The patient underwent emergent surgical irrigation, drainage, and debridement of multiple abscess cavities extending from the original perirectal abscess. This report provides a comprehensive overview of the diagnosis, surgical approach, and postoperative management in a patient presenting with a complex tunneling perirectal abscess forming intra-abdominal and extraperitoneal abscesses.
Percutaneous tracheostomy (PT) is a commonly performed procedure in ICUs as a safe and cost-effective alternative to surgical tracheostomy (ST). Bronchoscopy is frequently used during PT for real-time confirmation of needle placement and tube positioning. We present a case of a 42-year-old female with a complex medical history who underwent PT and experienced acute airway loss due to endotracheal tube obstruction caused by accumulated secretions. To prevent such complications, vigilance regarding airway obstruction, cautious bronchoscope advancement, avoiding endotracheal tube puncture, and readiness to abort the procedure and replace the tube are crucial.
Neoplastic polycythemia is a condition in which high hematocrit levels result from a neoplastic lesion in the body. It is a rare condition and occur because of excess erythropoietin or androgen production by the neoplastic cells. Steroid cell tumours of the ovary though notorious for producing endocrine changes in the body have rarely been associated with polycythemia. We present the case of a post menopausal lady who developed polycythemia and features of virilisation. Further investigations revealed that she had steroid cell tumour of the left ovary. Her signs and symptoms resolved after surgical removal of the tumour.
