Purtscher's like retinopathy - A rare ocular complication of acute pancreatitis.

INTRODUCTION AND IMPORTANCE: Purtscher retinopathy is the rare form of occlusive microvasculopathy, characterized by multiple retinal white areas around the optic nerve head and fovea with paravascular clearing and may be related to intraretinal hemorrhages. Acute Pancreatitis (AP) is one of the most common gastrointestinal reasons for hospital admissions globally. The complications of Acute Pancreatitis may include Purtscher's-like retinopathy, which has a low incidence rate of less than 0.24 instances per million cases. This case report highlights the value of thorough medical history taking and examination, and it apprises the consideration of ophthalmological manifestation in patients of Acute Pancreatitis. CASE PRESENTATION: A 34-year-old female came to the emergency room due to intense abdominal pain associated with nausea and vomiting, which worsened over the last 24 h. The pain was described as continuous, sharp, and cramping-like in the upper abdomen, radiating to the back. Lab tests revealed elevated serum amylase and lipase levels, indicating pancreatitis, along with slight leukocytosis. A contrast-enhanced CT scan confirmed acute pancreatitis with mild inflammation and enlargement of the pancreas. Two days after admission, the patient experienced a sudden and painless loss of central vision in both eyes. There was no history of trauma or any other significant relevant history, other than pancreatitis. The ophthalmologist's examination found reduced visual acuity (6/60 in the right eye, 3/60 in the left eye), normal corneas, and anterior chambers. DISCUSSION: Inkeles and Walsh established the first link between acute pancreatitis and Purtscher-like retinopathy when they reported three cases of the distinctive retinal appearance in individuals with acute pancreatitis in 1975. CONCLUSION: The recovery and prognosis in cases of Purtscher-like retinopathy is variable and further research is required to ascertain the usage of corticosteroids and pentoxifylline in improving the course of a patient's with Purtscher's-like retinopathy.

A case of tension pneumoperitoneum with fecal peritonitis due to high-pressure air insufflation through the anus.

Key Clinical Message: The reckless or ridiculous usage of high pressure compressed air could lead to disastrous consequences as demonstrated in this case. Injuries from a barotrauma can vary from a simple mucosal laceration to tension pneumoperitoneum causing abdominal compartment syndrome. Decompression by a wide-bore needle can be done as depicted in our patient to provide immediate relief. Abstract: Rectal perforation most commonly occurs due to trauma, but rarely due to a high pressure compressed air passing through the anus as a part of playful joke. Owing to the belief of medico-legal issues and socio-psychological circumstances about the ano-rectal injury, initial approach to the medical facilities might be delayed, causing a delayed presentation and poor prognosis. We report an incident of a young male who presented with tension pneumoperitoneum causing abdominal compartment syndrome with fecal peritonitis due to forceful passing of high-pressure air through his anus. An initial decompression of the abdomen with a wide-bore needle was done at the emergency room. An emergency laparotomy with a primary repair of the rectal perforation by two layered sutures was done followed by a loop colostomy, 10 cm proximal to the injury. Colostomy closure was performed after 4 weeks. Post-operative recovery period was uneventful.