Multiple ileal perforations as late complications of electrical injury: A rare case report.

Introduction: Electric injury-induced intestinal perforation is one of rare and lethal complications. Direct injury and ischemic changes are the mechanism of intestinal perforation. Proper surgical and non-surgical management may increase the survival chance. Case presentation: A 21-year-old male was referred from rural hospital with history of electric burn injury two days before. On arrival, the patient started complaining bloating and abdominal x-ray revealed small intestine dilation. On fourth day post-event, the symptoms worsened and abdominal CT-scan revealed free peritoneal air. Exploratory laparotomy was performed, and two ileal perforations were found. Suturing of perforation and ileostomy were performed. Forequarter amputation of the right superior limb was performed on the seventh day post-event. On the third month, the ileostomy was closed. Conclusion: Intestinal perforation may be one of late complications of electrical injury in abdomen. Proper clinical evaluation and management helps in morbidity and mortality reduction.

Head and tail pancreatic duct stones mimicking duplex staghorn renal calculi: A rare case.

INTRODUCTION: Pancreatolithiasis is an uncommon disease and the diagnosis of pancreatic duct stones is challenging. The radiological findings of pancreatic duct stones may mimic other diseases, such as renal stones. CASE PRESENTATION: A 42-year-old male came with chief complaint of recurrent bilateral flank pain accompanied by fever which worsen 7 days before admission. The patient was diagnosed as gastritis and received analgesics in several hospitals. Ultrasonography and IVP examinations showed stones in both kidneys. CT-scan was not performed due to limitation in the hospital. Patient was diagnosed bilateral staghorn nephrolithiasis. The patient underwent bilateral bivalve nephrotomy for staghorn renal stone performed by urologist, but intraoperatively, no stones were found. The patient was then consulted intraoperatively to the digestive surgeon and get immediate median laparotomy. Intraoperatively, stones were palpated in the head and tail of the pancreas. The stones were evacuated. The symptoms were relieved, neither recurrence, nor pain, nor postoperative leakage was found. Patient was discharged uneventfully 4 days after the procedure and had no complaints in further follow-ups. DISCUSSION: The symptoms of pancreatolithiasis may overlap with nephrolithiasis and gastritis. The presented case was unique because from the history taking, clinical symptoms, USG, and IVP findings supported the diagnosis of nephrolithiasis, but intraoperative findings reveal pancreatic duct stones. CONCLUSION: For patient diagnosed with renal calculi based on sonography and IVP findings, differential diagnosis of pancreatic stone should be considered especially if no underlying cause is detected. In such circumstances relying on IVP and sonographic findings alone can be misleading.