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Introduction and importance: While incidents are rare elsewhere, paraquat herbicide poisoning is a serious medical issue in some parts of Asia. It can cause the failure of various organs, including the heart, kidneys, liver, adrenal glands, central nervous system, muscles, and spleen. Due to its inherent toxicity and lack of available therapies, paraquat has a very high case fatality rate. Case presentation: The authors discuss a case of a 15-year-old female with an alleged history of paraquat ingestion who presented with complaints of vomiting, abdominal pain, and loose stools. Initially, she had gastrointestinal symptoms, but she developed renal failure and respiratory symptoms and died of multiple organ failure. Clinical discussion: Acute gastrointestinal tract necrosis and multiorgan failure are the initial effects of paraquat intake, and among those who survive the immediate post-ingestion interval, the lung is the target organ for poisoning. Ingestion of large amounts of liquid concentrates results in fulminant organ failure: pulmonary edema, cardiac, renal, and hepatic failure, and convulsions. The course of treatment can range from supportive care alone to various integration of immune modulation, antioxidant therapy, hemoperfusion, and hemodialysis. Conclusion: Patients presenting to the emergency department with an alleged history of ingestion of paraquat poisoning should be admitted even if they have mild symptoms initially. There is no specific antidote available. Early renal failure, along with progressive pulmonary fibrosis, can lead to death.
RESUMO
Keloids are the result of an abnormal wound-healing process and are associated with various risk factors. The majority of diagnoses are clinical. Successful treatment of keloid is challenging due to its nonregressing and recurring nature. Case presentation: We discuss the case of a 30-year-old mongoloid male who had multiple swellings over his body for the past 10 years. More striking are the giant keloids that are present over his bilateral scapulae. Diagnosis of keloid was made clinically. Smaller sessile lesions over his shoulder and upper limbs were subjected to intralesional 5-fluorouracil and triamcinolone injections, whereas the giant bilateral scapular keloids underwent excision and split skin grafting. Clinical discussion: Keloids usually present with firm and rubbery masses that extend beyond the site of the previous wound/injury. Keloids are diagnosed and evaluated clinically. Its differentiation from the hypertrophic scar is done based on the presence of multiple lesions beyond the site of the previous wound/injury. Conclusion: Treatment of keloids is difficult due to their nonregressing and recurring nature. Hence, the main goal of treatment is to tailor the therapy to the patient's needs such that the benefits outweigh the risks.
RESUMO
Introduction and importance: Foreign body ingestion leading to luminal obstruction in both the small and large bowels is rare, especially in children. The authors present a case of a 7-year-old patient who presented with a small bowel obstruction caused by an ingested radiolucent foreign body. The previous herniotomy surgery 1 year back led to initial diagnostic confusion, highlighting the need for a broad differential diagnosis. Case presentation: A 7-year-old child with a history of herniotomy presented with symptoms of small bowel obstruction. Radiological imaging revealed a soft tissue mass mimicking a polyp or cystic lesion. During exploratory laparotomy, a cystic structure was discovered in the terminal ileum. The foreign body, identified as a fluid-filled balloon, was inaccessible to endoscopy and was gently maneuvered into the ascending colon. It was punctured and removed during on-table colonoscopy. Clinical discussion: This case underscores the challenges of diagnosing and managing luminal obstruction caused by radiolucent foreign bodies in children. The presence of previous surgery can mislead clinicians, necessitating a broad differential diagnosis. Radiological imaging played a crucial role in identifying the foreign body. Surgical intervention guided by an on-table colonoscopy allowed successful removal. Conclusion: Foreign body ingestion leading to luminal obstruction should be considered, even in cases with previous abdominal surgery. Radiological imaging aids in identification, and timely surgical intervention, guided by on-table colonoscopy, facilitates foreign body removal. Awareness of such cases is essential for optimal care in pediatric patients with luminal obstruction caused by foreign body ingestion.