Bowel obstruction in body-packing: A case report and literature review.

INTRODUCTION AND IMPORTANCE: The body packer swallows or embeds drugs in body cavities in a purposeful way. Packets usually contain of opium, cocaine, cannabis and amphetamines. The significant complications of body packing usually are symptoms of drug toxicity due to leaking or ruptured packets or symptoms of ingesting relatively large foreign bodies. Herein, we present a case of heroin body-packing that resulted in subsequent bowel obstruction. CASE PRESENTATION: A 30-year-old male, who was brought from the prison to the emergency department, complained of abdominal pain. After the absence of intoxication symptoms and insignificant plain abdominal radiograph results, abdominal computed tomography (CT) scan revealed the presence of ingested packets in the stomach as well as in the patient's small intestine. Therefore, the decision of surgery was immediately made for the patient, and during the surgery, the drug packets were entirely removed. The patient was discharged in good general condition three days after his surgery. CLINICAL DISCUSSION: Body packers are in considerable risk as rupture of packet inside the body and risk of obstruction that both of them may be fatal. Patients should be monitored for complications, possible early treatment, and removal or assistance in expulsion drug packets from the body. Initially on plain abdominal radiographs, classic findings suggest the presence of drug packets. CONCLUSION: In case of an inconclusive plain abdominal radiograph, further investigation with CT is indicated, with an almost 100 % sensitivity. For symptomatic patients, bowel obstruction and acute drug toxicity are the two most common indications for surgical intervention.

The efficacy of local dexmedetomidine during fiberoptic nasotracheal intubation: A randomized clinical trial.

BACKGROUND AND AIMS: The present study was designed and carried out aiming to evaluate the effects of local dexmedetomidine (Dex) on sedation rate and hemodynamic changes in candidate patients for fiberoptic nasotracheal intubation. MATERIAL AND METHODS: Candidate patients for fiberoptic nasotracheal intubation were randomly divided into three groups including intravenous (IV) Dex group, local Dex group, and control group. Local anesthesia using lidocaine was performed in all patients. After performing the intubation, propofol infusion was used to keep the patients on predetermined cerebral state index (CSI). Hemodynamic parameters, arterial blood O2 saturation (SpO2), and CSI were monitored in all patients before, during, and after the procedure. Coughing score, intubation score, and patient tolerance score during and after nasotracheal intubation were assessed. Propofol consumption was also measured. RESULTS: A total of 95 patients with the mean age of 45.4 ± 6.7 years were evaluated (54.2% of females). Hemodynamic parameters and SpO2 were significantly different between the three groups (P < 0.001). The dose of propofol used for reaching proper CSI was significantly higher in the control group compared to IV and local Dex groups (P < 0.001). There is no significant statistical difference in propofol consumption between local and IV Dex groups. The number of patients who were cooperative during intubation was higher in local Dex group compared to IV Dex and control groups; however, the difference was not statistically significant. CONCLUSION: It is likely that using local Dex during fiberoptic bronchoscopy decreases sudden changes in hemodynamic values and decreases coughing and improves patient tolerance and intubation scores. Local Dex can be useful as IV form with the aim of propofol dose saving.

Comparing the efficacy of preoperative magnetic resonance cholangiopancreatography with intra-operative cholangiography in patients suspicious to biliary stones.

AIM: This study was performed to compare the efficacy of preoperative magnetic resonance cholangiopancreatography (MRCP) and intra-operative cholangiography (IOC) methods in patients suspicious to gall stones. BACKGROUND: According to previous studies, it is recommended that common bile duct investigation should be done in order to rule out choledocholithiasis in all patients with symptomatic cholelithiasis. IOC is an invasive procedure with probable complications, it would seem that MRCP could replace the direct cholangiography. PATIENTS AND METHODS: In a diagnostic clinical trial, Fifty-nine patients with symptomatic biliary stones or cholecystitis were recruited in this study. The included patients had normal size biliary ducts in sonography but high serum alkaline phosphatase level. Preoperative MRCP and IOC were performed for the patients and the obtained results were analyzed and compared. RESULTS: The positive predictive value for IOC was 88% and for MRCP was 43%. The diagnostic accuracy of IOC and MRCP were 98% and 85% respectively, suggesting that IOC is much more diagnostically accurate. There were no significant difference in specificity and sensitivity of these two methods. CONCLUSION: According to the results, we can conclude that MRCP may not obviate the need for IOC. The suggestion for routine use of MRCP instead of IOC and as a substitution of that procedure needs further investigations on more patients.

Rare presentation of pancreatic schwannoma: a case report.

INTRODUCTION: Schwannoma is a rare tumor among pancreatic neoplasms. Schwannomas vary in size, and most of them are cystic, mimicking pancreatic cystic lesions. Generally, a definitive diagnosis is made at the time of histological analysis. The mainstay treatment is surgical resection. CASE PRESENTATION: We report an unusual presentation of pancreatic schwannoma with abdominal pain and several episodes of cholangitis in a 54-year-old Caucasian (Iranian) man. The condition was not diagnosed pre-operatively and Whipple's procedure was performed. CONCLUSION: Pancreatic schwannoma is an important clinical entity to include in the differential diagnosis of pancreatic lesions. Pre-operative diagnosis is difficult but computed tomographic findings may be helpful. The tumor may also have atypical and rare presentations, such as cholangitis and weight loss. For benign tumors, simple enucleation is usually adequate, whereas malignant tumors require standard oncological resection.