A rare case of cardiac tamponade masquerading as acute abdomen.

INTRODUCTION: Acute abdomen is any acute abdominal condition requiring a quick response. The incidence varies according to age and disease aetiology. The abdominal discomfort associated with extra-abdominal pathophysiology and thoracic conditions could mimic acute abdomen. In this case we report a rare case of a young patient with cardiac tamponade masquerading as acute abdomen. PRESENTATION OF CASE: A 25-years-old African man presented to the Emergency Department with abdominal pain. An EKG was performed, which revealed sinus tachycardia, with electrical alternans and borderline reduced voltage. At the time of the admission to our unit, he had a clinical worsening and a CT scan of abdomen was performed, which demonstrated hepatomegaly, abundant pericardial effusion and thin right pleural effusion at the lung bases. An echocardiogram confirmed a circumferential pericardial effusion with initial collapse of the right ventricular free wall. It was decided to immediately transport the patient to the Cardiosurgery Unit of another hospital to undergo pericardiocentesis. DISCUSSION: Our experience with this case underlines the important point that patients with a large pericardial effusion may present with the clinical features of acute abdomen and peritonitis. Abdominal pain was the primary symptom that prompted this patient to seek medical attention. CONCLUSION: Acute abdomen is any acute abdominal condition requiring a rapid, often surgical, treatment. Cardiac tamponade is a medical emergency. The differential diagnosis could be kept in mind by any emergency physician, surgeon and anaesthesiologist, because an incorrect diagnosis and therefore an incorrect treatment or a delay in pericardial evacuation can be life-threatening.

Gastrointestinal bleeding as a result of entero-iliac fistula due to intestinal foreign body.

Ingested toothpicks are a relatively rare event, but they may cause serious gut injuries and can be listed among rare causes of perforation, peritonitis, sepsis or death. Unless the foreign bodies were intentionally swallowed, many patients who ingested them fail to remember the event and they do not refer it during the medical history collection; this makes diagnosis problematic. In this work, a case of perforation of the sigmoid colon is described, caused by a toothpick ingestion. The patient had to be surgically treated because of a complication: the formation of an entero-iliac fistula with subsequent development of a pseudoaneurysm of the right external iliac artery. Vascular perforation due to toothpick ingestion has rarely been reported. In similar cases, it could be difficult to establishing the correct diagnosis because of the low sensitivity and accuracy rates of diagnostic investigations. The ingestion of foreign bodies should be kept in mind as an important differential diagnosis in patients with acute abdomen or chronic abdominal pain of unknown origin.

Relationship between haemorrhoidal grade and toilet habits.

PURPOSE: Haemorrhoids are defined as the distal displacement and venous distention of the normal hemorrhoidal cushions. Multiple factors have been claimed to be causes of hemorrhoidal development, but the exact pathophysiology is poorly understood. The objective of this study was to assess how common is the habit to spend a long time on the toilet in patients seen for hemorrhoidal disease. Our hypothesis is that haemorrhoids could be significantly associated with a long sitting time because this practice contributes to the weakening and then dilatation of the hemorrhoidal cushions. METHODS: The survey was conducted from April 2019 to June 2019. The study group consisted of 52 adult non-obese patients with diagnosed internal or external haemorrhoids. These patients have been asked to fill an anonymous short questionnaire. We divided the group into four classes and we calculated the mean time spent on the toilet for each group. Then we realized a plot to assess a relationship among these two variables. RESULTS: We found that the two studied variables (time spent on the toilet and degree of haemorrhoids) seemed to be linked by a linear association (R2=0.95). CONCLUSION: The results obtained in our preliminary study encourage us to continue this work, increasing the number of patients. If our supposition should be confirmed by further studies, we could say that toilet habits modification should be advised to any patients with any degree of haemorrhoids, as a part of treatment and as a preventive measure. KEY WORDS: Haemorrhoids, Goligher's classification, Constipation, Toilet habit.

Lymphangiomatosis of the ileum with perforation: A case report and review of the literature.

Lymphangiomatosis is a benign proliferation of lymph vessels. Lymphatic diseases can vary from small lymphangioma to generalized lymphangiomatosis, which is a rare condition and can have several clinical manifestations. The gastrointestinal tract may be affected, but the incidence in the intestinal wall is very low. We propose in our study a case of ileal lymphangiomatosis presenting with perforation, in which the diagnosis was made after the pathological analysis of the resected intestinal tract. Although rare and not described in the literature, intestinal lymphangiomatosis could manifest itself with acute abdomen and could be a surgical urgency. This disease should be considered when intestinal perforation is observed.