Atypical Presentation of Gout: A Case Report.

Gout is the most common inflammatory arthritis which is caused by the buildup of uric acid crystals in the joints, that leads to severe pain, swelling, and stiffness. The condition typically affects the first metatarsophalangeal joint but it can impact other joints in the body. We present a case in which a 43-year-old male with a past medical history of obesity, hypertension, osteoarthritis, and gout presented with bilateral leg pain and the inability to walk for the last two years. Labs showed persistent leukocytosis, elevated ESR (erythrocyte sedimentation rate), normal uric acid levels, with physical exam findings of bilateral tender nodular leg lesions. Chest X-ray, head CT without contrast, left hip X-ray and ultrasound of left lower extremity were performed which were all negative. Biopsy of the tender skin nodules confirmed the diagnosis of tophaceous gout. Acute and prophylactic treatment of tophaceous gout resulted in resolved inflammation and leukocytosis without any complications.

Mesh for Hernia Repair as Cause of Bowel Obstruction.

Ventral hernia repairs are commonly treated by abdominal wall repair where a prosthetic mesh is placed over the hernia site, to prevent future hernia recurrences. Risks of a ventral hernia repair include urinary retention, seroma, recurrence, and in rare cases, bowel injury or obstruction. Our patient's clinical presentation and history, supported by an abdominal X-ray and CT findings, were consistent with the diagnosis of small bowel obstruction (SBO) due to adhesions between the patient's small bowel and the mesh used for abdominal wall hernia repair. Our patient underwent an exploratory laparotomy due to exquisite abdominal wall tenderness and evidence of SBO. Appropriate identification of the cause of our patient's SBO, careful and meticulous treatment, and appropriate inpatient monitoring all contributed to a successful outcome.