Spontaneous gastric perforation complicating acute laryngotracheobronchitis in an infant: a novel case report from Nepal.

Pediatric spontaneous gastric perforation is a rarely encountered condition with poorly understood causal mechanisms. We present a novel case of a two-month-old female infant from Nepal who previously experienced Croup and subsequently developed severe abdominal distention and vomiting. Abdominal X-ray findings confirmed pneumoperitoneum, prompting immediate laparotomy. Intraoperative examination revealed a substantial perforation along the posterior stomach wall, specifically along the lesser curvature. The surgical intervention involved gastrorrhaphy and omentopexy using 3-0 Vicryl sutures, leading to an uneventful postoperative recovery. This case report highlights the critical importance of early and efficient management of spontaneous gastric perforations in infants, emphasizing the need for timely intervention to achieve favorable outcomes. Pediatric spontaneous gastric perforation remains a rare condition, and reporting such cases contributes to our understanding and management of this unusual pathology.

Role of Conservative Management in Stump Appendicitis: A Case Series.

Stump appendicitis is a rare, delayed complication of appendectomy. It is seen following both open and laparoscopic appendectomy and may occur weeks to years following the initial appendectomy. We report two cases of stump appendicitis seen at our hospital. Both cases were diagnosed based on radiological findings and successfully managed conservatively with antibiotics. Although the usually recommended treatment for stump appendicitis is completion appendectomy, conservative management may be suitable for some patients. This report highlights the possibility of utilizing a conservative approach in the management of stump appendicitis compared to the recommended operative intervention. Awareness of the possibility of stump appendicitis is crucial for early diagnosis and treatment, to prevent potentially catastrophic complications.

Incisional hernia appendicitis: A unique case report.

INTRODUCTION AND IMPORTANCE: Incisional hernia appendicitis is very rare. Very few papers have been published reporting about Pfannenstiel incision hernia with appendicitis. Here we report one such case of Pfannenstiel hernia with appendicitis. CASE PRESENTATION: A 20 years old lady presented with a tender mass in the right iliac fossa after Pfannenstiel incision. Ultra-sonography showed an incisional hernia with a 12.1 mm defect at the site of the incision. A provisional diagnosis of strangulated hernia was made. Acute appendicitis was diagnosed intra-operatively. Appendectomy followed by primary repair of the hernia was done. The patient had an uneventful recovery postoperatively and was discharged on the third day without any complications. Histopathology confirmed appendicitis. CLINICAL DISCUSSION: Amyand originally documented the presence of appendix within external hernias. The presence of appendicitis within an incisional hernia is even rarer. Hypermobility of the cecum, inflammatory adhesions from surgery and defects created during surgery have been considered as the pathological basis of such incisional hernias. A classic presentation of appendicitis may be absent in cases of incisional hernia appendicitis. Deviation from usual clinical symptoms often deviates from treating surgeons to assume it as strangulated/incarcerated hernia. Incisional hernia appendicitis management consists of appendectomy followed by subsequent primary hernia repair. The use of mesh for repair is not preferred. CONCLUSION: Incisional hernia appendicitis diagnosis is almost always intraoperative. As the incidence of incisional hernia appendicitis is low, awareness about the possibility of its occurrence is essential to formulate a well-planned intra-operative strategy.

Major Spinal Surgery Between Two Documented COVID-19 Infections in an Elderly Female: A Case Report.

Documented re-infection of COVID-19 is uncommon and doing a major spinal surgery in an elderly patient right after the recovery from the first event is itself a major undertaking. Re-infection after successful surgery points to the possibility of COVID-19 infection being a post-surgical complication. Here, we report a case of a 72-years-old elderly female who had presented to us with features of COVID-19 infection confirmed by reverse transcription polymerase chain reaction assay and unstable spinal fracture who underwent a pedicle screw fixation for the fracture of the third and fourth thoracic vertebrae after two consecutive negative serology assays. A month after discharge from the hospital, she presented with severe symptoms of COVID-19 again confirmed by two consecutive polymerase chain reaction assays. She was managed conservatively and was discharged without significant respiratory and neurological complications. We described this case in detail in addition to reviewing the pertinent literature.