RESUMO
BACKGROUND: Cases of a case of situs inversus totalis are very rare and therefore when encountered, they are likely to be missed or poorly managed. OBJECTIVE: To present a case of situs inversus totalis with a view to creating more awareness about this rare clinical entity. PATIENT AND METHOD: The patient, a 22 year old boy was referred from a private clinic after a failed and complicated attempted appendicectomy carried out by a general medical practitioner. The patient was admitted, resuscitated and had investigations done. Some of the investigations done were abdominal ultrasound scan, computerized axial tomography scan, a chest x ray, complete blood count, urinalysis and electrolyte and urea. RESULTS: Investigations showed features of situs inversus totalis. There was also bilateral hydronephrosis, worse on the right side. The patient also had features of renal failure. He died after three days on admission. Autopsy finding confirmed bilateral pyonephrosis which was worse on the right side. There was associated urethral fibrosis. Cause of death was urethral fibrosis resulting in obstructive uropathy, pyonephrosis and renal failure. CONCLUSION: Situs inverses totalis is rare but can psented in diverse ways and thus the diagnosis may be missed and the patient wrongly managed. A high index of clinical suspicion is required if we the diagnosis is to be made early and wrong treatments avoided.
Assuntos
Fibrose/diagnóstico , Pionefrose/diagnóstico , Situs Inversus/diagnóstico , Doenças Uretrais/diagnóstico , Adulto , Apêndice , Evolução Fatal , Fibrose/etiologia , Humanos , Masculino , Pionefrose/etiologia , Situs Inversus/complicações , Situs Inversus/fisiopatologia , Doenças Uretrais/etiologiaRESUMO
Carcinoma of the gallbladder is a rare and often over looked cause of right upper abdominal quadrant pain. Diagnostic delay is common as the clinical features are confused with those of chronic cholecystitis. We report two cases of gallbladder carcinoma not associated with gallstones occurring in two middle-aged women. To our knowledge this is the first report in Nigeria of gallbladder carcinoma unassociated with cholelithiasis. We conclude that there should be a high index of suspicion in patients presenting with weight loss and chronic cholecystitis syndrome