Using fresh frozen plasma as an emergency treatment modality for hypertriglyceridaemic acute pancreatitis in a resource-constrained environment: A case report and review of literature.

Hypertriglyceridaemia is associated with severe disease such as coronary disease, cerebral vascular accidents and acute pancreatitis. Severe hypertriglyceridaemia is defined as a serum triglyceride value of >55 mmol/L. Hypertriglyceridaemic acute pancreatitis, often found in pregnancy, has a higher mortality rate than the other causes of acute pancreatitis. The cornerstone of treatment is to lower the triglyceride level as quickly as possible. In a resource-constrained environment, plasma exchange is not a viable option. Therefore, exploring the possible efficacity of directly infusing fresh frozen plasma is applicable to rural emergency medicine and may lead to more definitive research. In our case study, we used fresh frozen plasma to enhance the removal of triglyceride because it contains lipoprotein lipase.

Symptomatic hepatothorax presenting 25 years after penetrating thoracoabdominal injury.

Hepatic herniation through the diaphragm is a rare finding. It generally occurs due to a congenital diaphragmatic abnormality or blunt trauma resulting in a diaphragmatic defect. Making the diagnosis is difficult, as there are few definitive clinical signs and chest radiograph (CXR) findings may be non-specific. To our knowledge, only a single case report exists of penetrating right diaphragm injury leading to hepatic herniation. A 42-year-old man presented to the emergency department of a regional hospital with hyperglycaemia and exertional dyspnoea. He was diagnosed with diabetes mellitus type 2. He gave a history of smoking for 15 pack-years, was negative for retroviral disease and had no history of pulmonary tuberculosis. He had no significant surgical history but reported being stabbed with a knife in 1995. The point of entry was below the level of the nipple in the right anterior axillary line. At the time, he was treated with an intercostal drain and discharged home. CXR showed a right-sided chest mass. We considered a differential diagnosis of pulmonary consolidation, diaphragm eventration or hepatothorax. Computerized tomography of the chest and abdomen demonstrated apparent intrathoracic extension of the right liver lobe and partial attenuation of the superior vena cava and right atrium due to a mass effect. The upper border of the liver abutted the aortic arch. Surgical treatment options were discussed. The patient declined surgery and will be followed up as an outpatient.